Fear Factors

This spider can't crawl off the page ... so why are you scared? (Istock)

"There are a lot of different pathways, but we think a certain person likely has certain vulnerabilities," Teachman says. Those vulnerabilities might be genetic or biological, but they might also be linked to our worldview. "If you see the world as a dangerous place or yourself as vulnerable, then you're likely to let something develop into a full-blown fear," she says. "You're going to interpret things differently than other people would."

That doesn't mean you're crazy or even weird if you have a phobia, Ross says. "You're not weak. There's nothing wrong with you. It just means you probably have an anxiety disorder." To deal with that, many people can take a do-it-yourself approach using a self-help book. Others will need to turn to a professional. Either way, if your fear is affecting your day-to-day life, "it's time to get help," Ross says.

Getting Beyond 'Help!'

If you're deathly afraid of something, the good news is that phobias are highly treatable and treatment is usually relatively quick, effective and lasting (and, better still, many insurance carriers cover treatment). "Generally all people need is eight to 12 sessions to get all the tools and techniques to overcome it," Ross says.

For a phobia such as the fear of spiders (arachnophobia), most people can even see significant benefit from a single three-hour session, Teachman says. And though it might take longer if you've had a phobia for many years, it's never too late to seek treatment. "I've treated a woman who was housebound for 30 years, and within five weeks I had her out and about," Ross says.

For most sufferers, help comes in the form of cognitive-behavioral therapy, which involves examining the thoughts behind the feelings and working to change the behaviors that stem from those thoughts. The therapy often includes learning relaxation techniques. It's sometimes done in conjunction with medication (anti-anxiety drugs or anti-depressants work well for chronic anxiety), but for most phobias, medication isn't a good long-term solution, Ross says.

Instead, therapy usually begins with the cognitive piece of the puzzle, which focuses on examining the messages you send yourself -- "I can't do it, I'm going to pass out, I'm going to die," Ross says -- and then working to change them. Practically, that means that instead of feeling your heart race and thinking, "I'm going to have a heart attack," you replace it with, "My heart is pounding because I'm anxious," and accepting and coping with the feeling, Ross says. She often suggests that patients imagine their fear as a wave. "If you fight it, you end up drinking it," she says. "I use the concept of just floating over it."

That thinking will come in handy during exposure therapy, the behavioral part of cognitive-behavioral therapy that involves gradually exposing yourself to the thing you fear. Doing so helps you realize that the situation, person or thing will not hurt you and, more important, that you can cope with facing your fear. It's a leap of faith, Ross admits, but patients who make the leap do see results.

The key to exposure therapy is the word "gradual." If you're afraid of crowded spaces, don't start by planning an all-day spending spree at the mall on a Saturday afternoon. Instead, pick a time and place that feels manageable, and work your way up. "Hang out in the mall parking lot for a while," Teachman says. "Then, when you're ready, just go into one store and hang out there for a while." Finally, work your way up to a multi-store visit and then a visit during the shopping rush.

As you go, concentrate on increasing your exposure, even if it's only in small increments, Ross says. "If you can't take one step closer, just put a toe closer," says Ross, who had one patient who was so afraid of elevators that she couldn't press the call button. "We started with me touching it and her holding my hand," she says. Eventually the woman graduated to pushing the button alone and, later, to riding the elevator by herself.

During exposure therapy, Ross also has patients label their anxiety level, from zero (no anxiety) to 10 (complete panic). When they hit five, "they're probably thinking catastrophic thoughts," says Ross, who then reminds them to stop.

Although it might be tempting to bow out as your anxiety rises, it's important to push yourself past that I-can't-do-it moment. "The goal is to stay in the situation long enough to see that the feelings will pass," Ross says. "You never want to leave a situation when your anxiety is above a five." Leaving reinforces your fear. But if you do yield to the urge to step back, don't beat yourself up. "Just be sure to go back into the situation as soon as possible," she says.

With enough exposure, most people ultimately realize that the worst case isn't going to happen. "The scale doesn't go to 11," Ross says. "Once you reach a panic attack, it doesn't get worse. And it doesn't go on forever. It's a huge relief for most people to discover that."

Virtual Exposure

Facing your fears, of course, is more practical in some cases than in others. If you're terrified of flying, gradually exposing yourself to an airplane might be helpful, but it's also a logistical nightmare (unless you happen to have your own airplane, in which case, you're probably more afraid of the soaring cost of fuel).

Enter virtual reality, which increasingly is being employed to handle the exposure-therapy piece of the puzzle, says Brenda Wiederhold, a clinical psychologist and director of the Virtual Reality Medical Center, which has three virtual reality centers on the West Coast.

Instead of stepping onto an airplane, a patient can strap on a headset and go through a simulated flight, with a 360-degree view that appears as the head turns. To enhance the experience, there are props: a steering wheel and gas and brake pedals if you're driving, and airliner seats if you're flying.

Unlike in the real world, Wiederhold says, "in the virtual world we can control the stimuli." That means there's no chance of a freak driving accident, a delayed flight or a fire alarm going off in a crowded mall.

There are some whiz-bang benefits, too. Patients can see a readout of their physiological response: their heart rate going up as they "drive" into a tunnel and then decreasing with more exposure, for example. "It improves their confidence and self-efficacy," Wiederhold says.

Compared with traditional cognitive-behavioral therapy, virtual reality is about as effective. In Wiederhold's studies, virtual reality had a 95 percent success rate after six sessions. The catch: There are only about 10 virtual reality centers in the United States, making access an issue.

But even if there isn't a center near you, you probably can find good old-fashioned exposure therapy, Wiederhold says. Your doctor can refer you to a professional (and see the box at left for other ways to find help). Wiederhold's advice: Whether it's virtual or traditional cognitive-behavioral therapy, find somewhere reputable to get help. "Life is short," she says. "Don't wait."