Understanding Fear, Anxiety, and Phobias

Learn to recognize when fear can be healthy—and when it can affect your quality of life

June 15, 2023

Fear is the response to a perceived threat, while anxiety involves worry about a threat that has not yet, or may never, happen.

For example, if we’re in a dark parking garage late in the evening, it’s a good thing if we have a little anxiety and/or fear. Fear encourages us to be on the lookout and remain aware. It often keeps us safe and in tune with our surroundings.

A healthy level of anxiety or fear allows us to face challenges and achieve goals. However, there are times when fear and anxiety become unhealthy: when they interfere with our ability to function.

Keep Reading To Learn

  • How fear, anxiety, and phobias differ
  • How to recognize when someone may need help
  • How to manage fear, anxiety, and phobias

Watch Now!

Dr. Nathaniel Van Kirk helps us understand the differences between fear, anxiety, and panic

Is It Fear, Anxiety, a Phobia, or All Three?


Fear is not something that happens only in our minds, it is a process that occurs in our bodies. In order to survive, human beings and other animals evolved a “fight, flight, or freeze” response to stress, leading us to either combat or flee from frightening encounters.

In fight or flight mode, our heart rate increases, we breathe faster, and our senses become heightened. Blood flows away from our heart and digestive system and into our limbs, allowing us to react to the danger at hand.

Freeze mode has a different mechanism. Our heart rate decreases instead of increases, and we become immobile. Freeze mode can have a protective function. In the natural world, it is why animals play dead when under threat. In humans, however, freezing can prevent us from defending ourselves or articulating our needs.

When our senses register a fearful or stressful situation, the amygdala, an almond-shaped structure in the center of the brain, engages the sympathetic nervous system, which cues the endocrine system to release stress hormones.

At the same time that the amygdala fires up, the cerebral cortex—the part of the brain responsible for reasoning and judgment—shuts down. This can make it challenging for us to make good decisions when we’re faced with fearful or stressful situations.


When we experience anxiety, our sympathetic nervous system responds in a similar way as it does to fear. However, with anxiety, it is engaged at a lower, but more constant, level.

Instead of preparing for an immediate threat, we are on edge for prolonged periods of time. Our muscles become tense. We become cautious, vigilant for possible threats, and we may avoid situations in an attempt to dodge danger.

Just as the right amount of fear can be healthy, a certain degree of anxiety can help us sense danger and conquer challenges. However, when we feel too much anxiety, we spend an excessive amount of time feeling distressed. Racing thoughts prevent us from concentrating, and worries about the future and the past prevent us from living in the moment.

Our anxiety can be so distressing that we might misread others’ facial expressions or misinterpret social cues. We may be so consumed by potential danger that it can feel unsafe to leave our homes.

Anxiety: What You Need To Know

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Anxiety can be so much more than stress or worry. Learn about it and how to live a happy, healthy life—even if you or a loved one has anxiety.

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People often use the terms “fear” and “phobia” interchangeably. However, the two states differ in intensity. Someone may be afraid of flying, for example, but can still manage to travel by plane when necessary.

Meanwhile, a person with aerophobia (extreme fear of flying), may never set foot on an airplane. Even driving past an airport or seeing photos of an airplane may create a fear response.

When someone has a phobia, or “specific phobia,” as it is called in the mental health field, their intense fear is limited to a specific situation or object. People living with this type of anxiety disorder may not necessarily experience fear or anxiety in other aspects of their life.

According to the American Psychiatric Association (APA), however, people with specific phobia are at increased risk of developing other anxiety disorders. They also have a higher risk of developing depressive and bipolar disorders, substance use disorders, and personality disorders.

Although someone with a phobia may realize their intense fear is irrational, for the person experiencing it, it isn’t any less real and terrifying than if a serious threat were imminent.

Phobias are the most common anxiety disorder. About 12.5% of U.S. adults experience a phobia at some point in their lives.

Some of the most common situational phobias involve the following:

  • Nyctophobia (the dark)
  • Acrophobia (heights)
  • Aquaphobia (water)

Some of the most common phobias of objects include:

  • Arachnophobia (spiders)
  • Cynophobia (dogs)
  • Hemophobia (blood)

Less common phobias, such as podophobia (fear of feet) and dextraphobia (having objects to your right), may seem unusual to some, but are very real and terrifying to the people who experience them.

Infographic - 75% of people with a phobia fear more than one situation or object. People often experience at least 3 phobias

People who experience phobias have an immediate and intense fear reaction to the situation or object that triggers them: their heart rate increases, their muscles tense, and their breathing becomes fast and shallow.

They frequently have panic attacks, which include the more severe symptoms of chest pain, shaking, and a sense of being disconnected from one’s surroundings. People with phobias experience extreme fear nearly every time they encounter the object or situation that causes their distress.

The level of fear someone with a phobia experiences can depend on different factors:

  • How long they are exposed to a situation (e.g., a short flight versus a long flight)
  • How much of an object they encounter (e.g., several spiders versus one spider)
  • How intense the situation is (e.g., heavy traffic versus light traffic)

When it comes to phobias, the presence of other people can play a role, for better or for worse. For example, if you’re afraid of driving on highways, it may be comforting to have a friend in the passenger seat. A friend could keep you company, point out road hazards, and help you with directions.

On the other hand, their presence could add pressure if you worry they’ll judge your driving skills or that you’ll be responsible for harming them in a traffic accident.

The Role of Avoidance in Phobias

As with other anxiety conditions, many people who experience phobias go out of their way to avoid the source of their fear. While this may provide relief in the short term, it only increases fear and anxiety overall. The more we avoid the source of our fears, the more stimulating it becomes.

Phobias can disrupt and limit the lives of those who experience them. For example, someone with a fear of flying may prolong their travels by several days by taking a train for a long-distance trip. Someone with a fear of the ocean might uproot their life to move more inland from their home on the coast.

In addition to specific phobia, other phobia conditions include:

  • Social phobia/social anxiety disorder is an extreme fear of social situations. The fear is rooted in thoughts of embarrassing oneself or being judged by others. Fear of public speaking is one form of social phobia.
  • Agoraphobia is an extreme fear of situations, including using public transportation or being outside of their homes. The fear is rooted in a person’s belief they will be unable to escape or find help when panicking.

Not everyone who has a phobia will react to the source of their fear with avoidance. Some people may have extreme difficulty facing a feared situation or object, but do not avoid the issue altogether. These individuals may still have a strong reaction, like a panic attack or uncontrollable crying.

People in these instances would likely find significant benefits from treatment in the same ways as those who avoid their fears.

Panic and Anxiety: Do You Know the Difference?

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While a little bit of anxiety is healthy, too much worry or panic may be a reason to seek help from a health care professional. Discover how to tell the difference between panic and anxiety and learn relevant treatment options.

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Who Develops Phobias?

Anyone can develop a phobia, but some people are at greater risk. Genetics play a role, but you may also develop a phobia if you experienced, witnessed, or have been exposed to something potentially traumatic. For example, if you were trapped in your basement for several hours during a hurricane, you may develop an intense fear of storms.

Women are twice as likely as men to have a phobia. However, certain phobias, such as those involving injection and the sight of blood, are experienced equally by women and men.

Fear, anxiety, and phobia can all be part of the same experience.

For example, if someone struggles with anxiety but has a specific phobia of heights, they may worry about many different concerns on a daily basis.

However, if they know they will go hiking in two weeks in unfamiliar terrain, their anxiety will likely increase during that time as they focus on possibly encountering their specific phobia. Their anxiety will escalate into fear if they encounter their phobia by cresting a high hill.

When Fear & Anxiety Become Unhealthy – Signs & Symptoms

People who struggle with anxiety, fear, and phobias often wish to eliminate or avoid the experience of any fear and uncertainty. This desire is impossible, though, since fear and uncertainty exist in life. They serve a purpose when they occur in small, manageable, and meaningful doses.

For many people, uncertainty is something that is not readily acknowledged. We accept that our decaf coffee is, in fact, decaf, although we have no certainty of it. We accept that we will arrive at our destination safely, although we have no way of being sure that will be the case.

Uncertainty is something we all accept in many things we do, although we may not even recognize it. For people who struggle with anxiety, however, accepting uncertainty is much more challenging. It is something that does not come as easily and is coupled with feelings of distress, avoidance, and overall disturbance.

Signs that fear, anxiety, or phobias are affecting your well-being:

  • You avoid social situations, travel, and other activities even when you would like to engage in them
  • You spend an excessive amount of time worrying—to the point where you lose sleep or can’t pay attention to what is happening around you
  • You give up or never take on activities that are essential to your quality of life (e.g., stopping driving or never learning to drive)
  • You find it increasingly difficult to leave home or to do anything outside of a strict routine
  • You avoid certain situations, objects, or animals even though you are aware your fear of them is exaggerated
  • You experience physical symptoms, such as headaches, trembling, and muscle tension

In this episode of McLean’s podcast Mindful Things, hear about how we can ease kids’ anxiety about school

Ways To Address Unhealthy Fears

While our sympathetic nervous system engages in “fight or flight” when we feel frightened, our parasympathetic nervous system allows us to “rest and digest” by slowing the body down.

We are at our healthiest when we achieve a balance, known as “homeostasis,” between the two systems. If we feel frightened or anxious, we can engage our parasympathetic nervous system to achieve a calmer state.

Coping With Fears and Anxiety

If our fears and anxieties are creating discomfort, it can be helpful to face them. Once we face a fear and get to the other side of it, our distress is gradually lessened.

The more we engage in the fearful activity, the less frightening it becomes. When we overcome fears, we can feel a sense of mastery that allows us to take on new challenges.

Here are some ways to help manage fears and anxiety.


Exercise releases endorphins and other feel-good chemicals into your brain, reduces muscle tension through movement, and can distract you from distressing thoughts.

Social Connection

When we connect with friends, we can be distracted from our worries and fears, receive feedback on whether our concerns are reasonable, and receive moral support.


Mindfulness involves being present by having moment-to-moment awareness. Being mindful helps us pause to recognize the thoughts we’re having and how they are contributing to our emotions.

In the case of anxiety and phobia, when we practice mindfulness, we can better assess whether our fears are well-founded or irrational.

Progressive Muscle Relaxation

Progressive muscle relaxation involves a deliberate tensing and releasing of specific muscle groups, which relaxes the body and mind. People who practice progressive muscle relaxation become better at identifying and addressing tension in their bodies.

Breathing Exercises

When we experience anxiety and stress, our breathing becomes fast and shallow, perpetuating our distress. Deep breathing, however, automatically engages the parasympathetic nervous system, helping us calm down.

If these methods are not able to fully help support a healthy level of fear and anxiety, it’s time to reach out to a health care professional for further guidance. Because phobias cause significant distress, it is especially important to consider professional help when addressing them.

Become Friends With Your Anxiety

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In this webinar, Dr. Lisa Coyne unearths the positives about feeling anxious, shares ways to befriend our fears, and answers audience questions about shifting our attitudes about anxiety toward acceptance.

Two women walking with their bikes in a park

Best Treatments for Anxiety and Phobias

Anxiety and phobias are well researched and highly treatable.

Cognitive Behavior Therapy

Cognitive behavior therapy (CBT) is the most effective behavioral intervention for anxiety, phobias, and related disorders. With CBT, therapists help patients explore the relationship between thoughts, emotions, and behavior.

With this treatment, people can identify and manage thoughts of exaggerated threat that are part of anxiety. For example, therapists may challenge patients’ thoughts by asking for evidence to support the thoughts.

Together, the provider and patient may explore alternative explanations for the source of a patient’s fear and develop healthy coping mechanisms to manage symptoms.

Aspects of cognitive behavioral treatment can include skills for developing supportive relationships, incorporating relaxation and mindfulness techniques, and exploring ways patients can face fears.

Exposure Therapy

Exposure and response prevention (ERP) therapy is a form of CBT that is effective for phobias, panic disorder, and other anxiety disorders.

Since avoidance is a key feature of anxiety conditions, exposure therapy helps patients confront their fears by bringing patients into contact with the feared object or situation in a safe environment.

For example, under the guidance of a clinician, someone with an intense fear of dogs may progress from looking at a photo of a dog, to being in the same room as a dog, to petting a dog.

Before working on an actual exposure, therapists interview patients about what they are most afraid of and their internal experiences of the fear. This helps clinicians challenge the patient’s belief system through the exposure process.

Exposures initially start with a small dose of the feared situation or object. For example, if a person fears dogs, they may start by looking at a picture of a dog. Over time, patients increase the difficulty of the exposure (for example, being in the same room as a dog).

Many people find that the anxiety created by their exposures becomes less pronounced and less bothersome over time.

It takes courage for patients to face their fears directly. However, once they confront the source of their phobia, they can develop a new belief system around their fears.

After patients leave treatment, they can repeat the exposures on their own, locking in new beliefs and behaviors.

Whether your experiences of fear, anxiety, or phobias can be managed with lifestyle changes or you need help from a mental health professional, you can learn to address your symptoms and live a productive, successful life.

The experience of anxiety is universal, and anxiety disorders are an extremely common mental health condition. You are not alone. Help and hope are always available.

McLean Hospital offers world-class mental health services to help children and adults living with mood disorders, such as anxiety.

Let us help you find the care that’s right for you or your loved one. Call us today at 617.855.3141 to discuss treatment options.


American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Want More Information?

Looking for even more information about anxiety, fears, and phobias? You may find these resources helpful.

Interesting Articles and Videos and More

Learn more about anxiety and what you can do if you or a loved one is displaying signs of anxiety or related disorders.

Helpful Links

These organizations may also have useful information:

Anxiety and Depression Association of America
An organization dedicated to increasing awareness and improving the diagnosis and treatment of anxiety disorders in children and adults.

The Child Anxiety Network
This organization aims to provide thorough, user-friendly information about child anxiety. They also offer direction for those who are not sure where to turn when they think their child or a child they know may need professional help to cope with anxiety.

Books About Anxiety, Fear, and Phobias

Book Find Your Fierce

Find Your Fierce
by Jacqueline Sperling, PhD
(Magination Press/American Psychological Association, 2021)

Book cover - Anxiety and Panic Attacks

Anxiety and Panic Attacks: Your Questions Answered
by Daniel Zwillenberg
(Greenwood, 2018)