Motivation and emotion/Book/2022/Fear

Overview
"'Imagine that you are walking along a forest track, dense undergrowth on either side, a thick silence emphasising the sound of your own footfalls. Suddenly, no more than thirty metres in front of you, a large gold and black striped cat emerges from the forest to halt on the path ahead. It is a tiger. It stands looking intently towards you, its tail swaying slowly from side to side. You freeze in mid-step. You experience the physical symptoms of fear: your heartbeat accelerates; your breathing turns shallow; your mouth goes dry. Perhaps you break out in a cold sweat. Then, after that frozen moment of shock, you turn and take flight backdown the path from whence you came. Or do you?' (Tudor, 2008, p. 239-240)"

Fear is our automatic response in presence of a perceived threat or danger. The function of fear is to help us protect ourselves through fighting, fleeing, or freezing. Fear can offer both advantages and disadvantages in everyday life. Understanding the causation of fear can lead to courses of action that helps to manage fear.

This chapter defines fear and discusses fear-related psychological states, the causes of fear (from a physiological, social, and psychological perspective), and fear management (through self-help and professional help).

Focus questions:


 * What is fear?
 * What causes fear?
 * How can fear be managed?

What is fear?


Fear is one of the core emotions that occurs, in humans and many other animals, when we perceive a situation as dangerous or threatening to our physical and/or mental well-being (Reeve, 2018). Often, fear is displayed through the facial expression of eyebrows raised and pulled together, raised upper eyelids, tensed lower eyelids, jaw dropped open, and lips stretched horizontally backwards (see Figure 1). Since fear arises as the result of how we judge our surroundings, one can have a fear of anything.

According to ethologists, fear is a motivational condition triggered by particular stimuli that cause a person to defend themselves (fight) or flee (flight) (Steimer, 2002). This makes fear a powerful motivator that we can rely on to tell us when to face the situation and when to move away from it (Andreasen, 2016). For example, when we see a spider on the floor as a threat we may choose to fight by stepping on it, or we may choose flight by leaving the room. In addition to this, freezing in a threat-related situation is also found to be a universal fear response (Roelofs, 2017). For example, you may notice a snake on the ground and freeze (standing still, holding your breath) because you do not want the snake to be aware of your presence, or you may need more time to decide what to do next.

Fear-related psychological states
People often get confused or mistaken between fear and anxiety when it comes to emotions. However, fear and anxiety are separate emotions and that they are not interchangeable constructs, in which one can experience fear without anxiety and vice versa (Perkins et al., 2007). Anxiety often occurs as a generalised response to unknown threats or internal conflicts.

Case study

William has been invited to a party by his classmates. However, he is told that people from other classes may be there as well. William worries that he may be judged by people he does not know, which makes him very anxious. When the party day comes, he chooses an avoidance solution by staying home. This is an example of anxiety.

When a person has an unrealistic sense of danger and irrational fearful thoughts, this can lead to anxiety disorders. The most common types of anxiety disorders are generalised anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and phobia.

What causes fear?
The James-Lange theory of emotion suggests that fear may occur as a result of our physical reactions to events. For example, your heart rate may increase at the sight of a lion creating feelings of fear. While this theory provides useful insights, it has also been criticised due to its use of correlational, not causal research (Northoff, 2008).

Questions to consider:
 * Why do we fear?
 * What are the benefits and costs of fear?

Physiological perspective
What happens in the brain when we feel fear? When we identify something as a threat or danger, this sensory information enters the thalamus and projects via two pathways – the high road and the low road – to the lateral nucleus of the amygdala (Carr, 2015).


 * The high road is an indirect pathway to the amygdala via the somatosensory cortex and hippocampus. This pathway is known as important for learned fear and fear resulting from observing others. For example, you may see a person getting swooped by magpies and learn to be scared when you see a magpie flying over your head, which may cause you to walk faster or to cover your head in the presence of magpies.


 * The low road is a direct pathway going straight from the thalamus to the lateral amygdala to produce an immediate fear response. An example of this is when you get swooped by a magpie while walking and it may cause you to scream or run away.

The lateral nucleus then stimulates the central nucleus of the amygdala, which then transmits information to several other brain regions, including the periaqueductal gray, the lateral hypothalamus, and the bed nucleus of the stria terminalis. The periaqueductal gray is responsible for sympathetic responses, such as defensive and aversive behaviours, to eliminate pain (Kim, 2013). The lateral hypothalamus also activates the sympathetic nervous system by sending signals to the adrenal glands through the autonomic nerves (Owens-French et al., 2022). And the bed nucleus of the stria terminalis orchestrates hormone responses (emotional and behavioural) to stress (Crestani et al., 2013).

Furthermore, the hippocampus and the prefrontal cortex can help us to understand whether our fear response is justified or overreacted. For example, your amygdala’s activity may be activated while watching a horror movie (jumping and screaming), then if the hippocampus and the prefrontal cortex decide that you exaggerated your fear, it can dampen your stress response (see Table 1).

Table 1.

Brain Regions Associated with Fear and its Functions.

While this process of fear can be complicated and confusing, it can be simply interpreted as these following seven steps:


 * 1) Fear recognised;
 * 2) Amygdala triggered;
 * 3) Nervous system alerted;
 * 4) Stress hormones released (e.g., cortisol and adrenaline);
 * 5) Bodily changes (e.g., heart rate, blood pressure, blood flow);
 * 6) Muscles prepared; then
 * 7) Action taken (fight, flight, or freeze).



When you get stressed or scared suddenly, your body then quickly release adrenaline (also known as an adrenaline rush – AR). James (2012) finds that while AR can make people feel nervous and anxious, it can also induce euphoric excitement in anticipation for some events. This is why some people deliberately seek out and participate in extreme activities, such as skydiving or bungee jumping, to satisfy their adrenaline needs.



Patient S.M. is an American woman with rare bilateral lesions of the amygdala that prevent her from feeling fear. This is a genetic condition caused by Urbach-Wiethe disease. She has not experienced fear since she was a child, even when held at knifepoint. However, S.M.’s fear response is shown when she is deprived of oxygen by using a mask to inhale carbon dioxide, creating a momentary feeling of suffocation. This shows that while the amygdala plays an important role in generating fear, there are also other brain regions that can produce the feeling of fear.

Research by Feinstein et al. (2011)

Social perspective
Can you learn to be scared of something just by watching how others react to it? The short answer is yes. While fear is an automatic response, our perception of potential threats can be influenced, such as be watching someone else getting swooped by a magpie. This is explained through the social learning theory, proposed by Albert Bandura in 1977. Fear that is attained indirectly is also found to be just as powerful as a fear that is originated from direct experiences (Olsson et al., 2007). Fear through observational learning, however, is not always bad. Learned fear is beneficial because it helps us to avoid potential dangers in the environment by watching others, without having to have a personal exposure to it (Olsson et al., 2007).

Example

Why are some people afraid of sharks even when they have never had any close encounters with sharks? This is because we often see people getting attacked or eaten by sharks through the news media, documentaries, or movies (Le Busque et al., 2021).

However, since fear can be successfully induced through social influence, it can also be manipulated to achieve political objectives. This concept is known as a culture of fear. The idea behind a culture of fear is that, by using emotional bias, people may foment fear in the public to further their own political or workplace goals. It is important to acknowledge and not underestimate the power of the media and its influence on our beliefs.



It is believed that the lack of security (health, economic, and social) during the first wave of the pandemic is fostered and spread by the media, which establishes a culture of fear, rather than caused by a personal experience (a real threat). Gruchola and Stawek-Czochra (2021) also find that the fear of the pandemic and its impacts has become a more widespread problem than the pandemic itself.

Questions to consider:

Do you live in a culture of fear?

Behavioural perspective
Fear is a behaviour that can also be learned via conditioning. Fear conditioning can be achieved through classical conditioning. This is a learning process, discovered by Ivan Pavlov, focusing on pairing an unconditioned stimulus (US) with a neutral stimulus (NS) repeatedly. Then eventually, the neutral stimulus becomes the conditioned stimulus (CS), which elicits a conditioned response (see Figure 2). However, over time, the learned behaviour can occur less and lead to extinction if the CS is no longer paired with the US.

 Little Albert was a 9-month-old participant in an experiment conducted by psychologist John B. Watson and his graduate student Rosalie Rayner. Watson and Rayner paired a white rat (NS) with a loud bang (US) whenever Albert touched the rat. The NS then became CS, resulting in Little Albert crying and showing fear whenever he saw a white rat. Albert also showed fear of objects which shared similar characteristics with the rat (dog, fur coat, cotton wool, and Santa Claus mask). This is referred to as the process of generalisation (Harris et al., 1979).



Operant conditioning, or instrumental conditioning, is first described by B.F. Skinner as a learning process where behaviours can be strengthened or weakened using reinforcement or punishment (see Figure 3). Operant conditioning is seen as relevant for the development of extreme fear, leading to anxiety disorders or phobias. This is because when we choose to flee away from a situation that we find as dangerous, it can reduce our stress level. And as a result, we may do this more and more often to avoid the negative feelings. Operant conditioning explains this as our avoidance behaviour (flight response) is strengthened to remove the unpleasant consequence (being fearful). Anxiety disorders and phobias are therefore negatively reinforced (Reichenberger et al., 2017).

How can fear be managed?
Have you ever stood on a diving board, wishing that you can just get rid of the fear and jump in? While fear offers us the positive side of protection, it also has the negative side of stopping us from doing the things we want.

Mindfulness


Mindfulness exercise is effective in reducing fear and the stress related to this emotion. Kummar (2017) finds that meditation-based mindfulness exercises can desensitise, and consequently, lead to the distinction of fearful thoughts, aversive memories, and emotional states. This is because meditation offers a direct exposure to one’s unhelpful thoughts, emotions, or memories, simultaneously with the nonjudgmental observation of it (see Figure 4).

In another study, Hooper et al. (2011) finds that mindfulness is a successful strategy in managing the fear of spiders, compared to thought suppression. Mindfulness-based stress reduction (MBSR) program has also been found to be effective in helping university students with facing the fear of failure (Hjeltnes et al., 2015).

"follow this link to test out the MBSR program, this is a free version."



Give yourself a moment to find a comfortable position, whether sitting up or lying down. Pay attention to how your body is feeling at this moment. Feel the contact with what is supporting your body right now (can be your bed, couch, or the ground). You may have thoughts running through your head, and that is okay. Now, focus on your breathing as it goes in and out and in and out of your body. Continue doing this for as long as you want. When you are finished, give yourself some gratitude. Well done!

Questions to consider:

Do you find it easier to meditate with or without noise?

How often do you meditate?

Self-control instruction
Self-control instruction can be a useful home-based practice in reducing fear. Graziano et al. (1979) conducted an experiment where children from the age of 8 to 12 with night-time fears were given self-control exercises to practice every night before bed. The exercises consisted of muscle relaxation, a pleasant scene imagination, and recitation of “brave” self-statements. Children were praised and given “bravery tokens” by their parents every time they had done the exercises. After five weeks, the problem of night-time fears was solved for all families. This stayed consistent over the three-month, six-month, and one-year follow-ups. However, exercising self-control is not always easy (Duckworth et al., 2016). Sometimes, our fearful thoughts can strengthen our impulses to react in a fearful way. Muraven (2010) suggests that we can improve our self-control performance by practicing small steps towards the self-control goal.

Case study

Jenny finds it overwhelming and difficult to follow all three steps of the self-control instruction when she is experiencing night time fears. So, she starts with just remembering to relax her muscles. Then, when she is more familiar with it, she then remembers to relax her muscles and imagine a happy scene. Finally, she adds in the self-statement of "I am brave" after relaxing her body and picturing something positive.

Test yourself! {What type of associative learning was used in this statement: "Children were praised and given “bravery tokens” by their parents every time they had done the exercises"? + Instrumental conditioning - Classical conditioning - None of the above
 * type=""}

Within clinical settings
Several treatments can be used, with the help of professionals, to help manage fear when it becomes dysfunctional and affects everyday life.

Exposure therapy
Exposure therapy is a form of cognitive behavioural therapy developed to help people to confront their fears (Emmelkamp et al., 2002). During exposure therapy, the therapist will create a safe environment for the client to be exposed to the things that they fear. This can be done in real life (in vivo exposure), in one’s imagination of the objects or places (imaginal exposure), or with virtual reality technology (VR exposure). VR exposure has been found to be just as effective as in vivo exposure, with some advantages regarding cost-effectiveness and the convenience of locations. The course of treatment often ranges from a few weeks to a few months, depending on the individuals and their psychological distress level. Exposure therapy is proven to be effective in treating many types of fear, including fear of flying and fear of driving.

Test yourself! {What benefits can exposure therapy offer? - Help one to find a meaningful life and a purpose - Help one to reduce negative thoughts and increase positive thoughts + Help one to diminish unwanted symptoms of fearful stimuli
 * type=""}

Eye movement desensitisation and reprocessing
Eye movement desensitisation and reprocessing (EMDR) is a form of psychotherapy, often used to treat the symptoms and emotional distress of traumatic memories (Rousseau et al., 2019). During EMDR, a therapist will help you to connect your amygdala (where you feel afraid) with your prefrontal cortex (where you can develop logical thinking). The process requires you to keep the traumatic event in mind while tracking the therapist’s fingers (see Figure 5). This allows you to focus on the memories that contributes to fear while relaxing your sympathetic nervous system. EMDR has been found to be effective in treating specific phobia and PTSD. While EMDR is not more effective than exposure therapy, it is considered a useful alternative where exposure strategies are not possible.



The capacity to extinguish a conditioned fear is impaired in PTSD patients. However, this impairment may be reversed with EMDR treatment. Rousseau et al. (2019) found that EMDR therapy significantly improves the restoration of fear extinction learning for PTSD patients. EMDR restores the fear conditioning ability by relying on the fear circuitry of the amygdala and the hippocampus, as well as other cortical brain structures.

Conclusion
This chapter explains what fear is, what causes it, and how to manage it. Fear is a basic emotion that occurs when we are presented with an imminent threat. Once the brain recognises a fearful information input, it then activates the amygdala to prepare our limbic system for a stress response. Moreover, the concept of fear can be distinct from anxiety, where anxiety is often triggered by an unknown threat or a variety of stimuli. Through observational learning tasks, we can learn to fear certain things without having to be exposed to them. Fear can be healthy as it serves to protect and prevent human from danger. However, extreme fear can be crippling and lead to anxiety disorders and other psychological problems. It is important for fear to be recognised and properly regulated to prevent it from interfering with our daily life and stopping us from doing the things we want. Fear can be managed with self-help and/or professional help. Some of the treatments are mindfulness exercise, self-control instruction, exposure therapy, and EMDR therapy. The effectiveness of the treatments can vary across individuals depending on their psychological distress level.

Take home message: Fear is a fundamental emotion that offers advantages and disadvantages. If irrational fear is left unattended, it can cause mental health problems. Treatment is required when fear becomes intense and interferes with everyday life.