Fear, anxiety, panic

An important issue to clarify is the frequent confusion between fear and anxiety, or even the inversion of the psychophysiological process that links the perception of a threatening stimulus to the body's physiological activation response to that sensation. Fear is a perception that triggers physiological responses , the most immediate of which is an increase in heart rate, breathing rate, and the electrogalvanic reflex, which activates the body, within milliseconds, to either fight or flight.

When the set of these reactions it is kept for a longer time of the immediate response to the stimulus, is defined anxiety. Therefore anxiety is not a pathological reaction, but the natural activation response
of the subject to a feeling of threat. It becomes pathological only when it exceeds the threshold of functionality,
leading the organism to a real psychophysiological tilt: panic.

Sometimes, in people who have repeatedly experienced panic attacks, a healthy activation of anxiety is experienced with fear because it is interpreted as a prelude to a psychophysiological escalation that leads to a panic attack . In other cases, anxiety may be constantly elevated due to various types of stressors.

The individual experiences a constant sense of threat, fearing that the condition could explode into panic at any moment. Fear and anxiety therefore influence each other in a circular fashion; one is the effect of the other, but the effect can in turn become the cause. What makes the difference, however, is that if you learn to manage fear, you also control anxiety, while if you try to reduce only anxiety, you don't eliminate the fear. As noted neuroscientist Antonio Damasio writes, if a person suffering from pathological fear is sedated in their anxiety reactions, the physiological activation is blocked but the perception of fear is not eliminated . It's like putting someone in a cast and then exposing them to threatening stimuli; they won't be able to react, but they will experience fear (furthermore, pharmacological sedation with anxiolytics often leads, after a few months, to paradoxical effects, fueling anxiety rather than reducing it).

We can also learn a relaxation technique: this, provided that it can be applied to an attack of fear, controls my reaction, but does not change my perception. The research work in the clinical field on the treatment of phobic disorders and panic attacks has contributed to the development of strategic brief therapy protocols applied to tens of thousands of cases in every part of the world with decidedly high successes: in
over 96% of cases reached the total extinction of the disorder within a few months. This demonstrates how the effective overcoming of the disabling fear and anxiety beyond a certain threshold requires a change in the perceptions of the subject regarding what is experienced as frightening, producing a realignment of the physiological parameters of activation of the organism within the functional thresholds.

This condition, or the transformation of what is frightening into something manageable, restores the person's sense of control of himself and of the circumstance he fears. Furthermore, the anxiety mechanism is kept within a threshold so that a useful and healthy adaptive activation to the circumstance remains.

George Nardone
(co-founder and director of the Strategic Therapy Center)
based on the book Fear of decisions (2014)