Ryan Sharma, PsyD, ABPP


By embracing the inescapable, I lost my fear of it.  I'll tell you a secret about fear: it's an absolutist.  With fear, it's all or nothing.  Either, like any bullying tyrant, it rules your life with a stupid blinding omnipotence, or else you overthrow it, and its power vanishes in a puff of smoke.  And another secret: the revolution against fear, the engendering of that tawdry despot's fall, has more or less  nothing to do with 'courage'.  It is driven by something much more straghtforward: the simple need to get on with your life.  I stopped being afraid because, if my time on earth was limited, I didn't have seconds to spare for funk.  Lord Khusro's inunction echoed Vasco Miranda's motto, another version of which I found, years later, in a story by J. Conrad.  I must live until I die.


-Salman Rushdie

The Moor's Last Sigh





The above quote, I believe, is direct if oversimplified.


Fear is easy to quantify if we think in terms of what it takes away from us.  Fear takes regular "payments" in order to stay at bay, and we often oblige fear with these payments when we feel as though there is no other option.  A person who feels afraid of embarrassment in social situations may hand fear their party invitation in exchange for a lonely but safe night at home.  A person struggling with panic attacks may hand fear their work shift in exchange for some temporary relief from racing heart and breathlessness.  A person who is afraid of failing may give fear their college acceptance letter in exchange for some diminished expectations.


The problem with these payments is that they cost you.  They cost you what is important and meaningful.  Unless it's the case that you don't really care about friends, work, and school, then fear is necessarily subtracting value from you life.  "The simple need to get on with your life" refers to exactly that:  YOUR LIFE, not the one that fear says you can have.


Anxiety is Natural and Ubiquitous


Everyone at one time or another has experienced intense anxiety.  In fact, 1 in 5 people will have an anxiety disorder at some point in their life.  Our bodies are actually programmed for these physical reactions because they were designed to keep us safe back in the days when we lived among the dangers of the wilderness.  Sometimes we experience these bodily reactions in situations that are not really dangerous, for example, when we are in social situations or speaking publicly in front of other people.  That is, while we may fear being embarrassed or rejected, our bodies may interpret this fear as an actual threat and turn on the body’s defense systems (you may know this as the “fight or flight” system, or the sympathetic nervous response).  So not only are you nervous about being around other people, your heart is racing, your mouth is going dry, and you can’t concentrate, making your task even harder.


Many things happen in our bodies when the fight or flight response is triggered, all of which were designed to make our survival more likely when we saw that bear in the woods.  For example, our heart rates rise to increase blood flow and oxygen to our muscles, and our breathing becomes short and shallow to meet this demand for more oxygen.  We also sweat so that our bodies don’t overheat and our pupils dilate so that they can take in more light and improve our visual perception.  Another unpleasant response is that the body diverts energy from our digestive system, halting any current digestion and looking to expel any on-board waste such as urine or feces.


While all of these reactions make changes in our bodies, they also cause us to experience certain things.  For example, rapid and shallow breathing may cause us to feel dizzy, faint, or like we are choking.  Similarly, as the blood travels to our major muscles (the ones that will most help us either fight back or flee the situation), we may experience tingling or numbness in our hands, fingers, or feet.  (This may likely be where the expression “getting cold feet” comes from.)  As our digestion stops, we may feel nauseous or like we have to throw up.  The rapid heart rate can often be painful, and some people think that they are having a heart attack.  This may also cause us to tremble or shake (think about the rush of adrenaline your brain has just given you), feel flush, or have an “out-of-body” experience.  A very common experience is that people think that they are going crazy or are about to die, and this can be truly terrifying.


Generalized anxiety, the kind that persists for long periods of time, can be quite taxing and can use up a lot of energy that would be better spent on things we enjoy.  This anxiety can cause us to feel on edge and constantly tense.  We may also have a lot of tension and tightness in our muscles, particularly those in our shoulders, neck, and face.  It is not unusual for people to be irritable because of this constant tension or have difficulties sleeping and concentrating.


In all of these cases, anxiety and fear often keep us stuck in patterns that are not productive.  They are often seen as "unwanted visitors" to our daily consciousness, perpetuating fears and doubts that discourage us from moving towards our values or doing things that we want to be doing.  Those who have struggled with these problems know full well how much fear can keep them imprisoned.


The Treatment I Practice


I practice a branch of psychotherapy that is rooted in behavioral theory and philosophy and incorporates cognitive-behavioral techniques and interventions (CBT).  As such, the treatments that I may recommend for particular problems are strongly supported by scientific studies, showing good evidence for effectiveness and success in the majority of cases.  In particular, I specialize in exposure and response prevention, which is the therapy showing the most success for many different types of anxiety problems such as generalized anxiety, panic attacks, phobias (including social phobia), and obsessive-compulsive disorder.  In fact, exposure and response prevention is recognized by both the medical and psychological communities as the first-line treatment for obsessive-compulsive disorder.  I also practice acceptance and commitment therapy as well as behavioral activation for individuals struggling with depressive symptoms.


The basic assumption in behavioral philosophy is that we can change how we think and feel by changing what we do.  Often times, people think that they must first believe that they can do something in order to do it, or feel safe before they can do it.  This natural belief often traps people because, in actuality, we have limited control over our minds and our feelings.  To give you an example, try spending the next thirty seconds not thinking about a pink elephant.


Instead, behavioral therapy works to help people realize that they can do whatever they want in spite of what their minds or their feelings are telling them.  For example, a person struggling with intense fear in social situations may have thoughts like “you are going to make a fool of yourself” or “you will never make any friends.”  People in this kind of situation will often want to wait until they feel safe or wait until they believe that they can socialize successfully before trying it.  Behavioral therapy helps people confront their fears directly and learn from their experiences, not their beliefs.  After all, when your mind tells you that you can’t do something, it is really guessing about what the outcome will be before it actually happens.  This may cause you to avoid doing something that you really want to do.  Behavioral therapy helps you realize that you can go to social events even if you are feeling scared or doubtful.  You don’t have to be ruled by your fears.  In my opinion, this is the real definition of freedom.


And, of course, what usually ends up happening is that while it may be scary facing our fears the first few times, it gets less and less scary each successive time.  It is very similar to how we overcome many other things for the first time: we may stumble in the beginning, but practice makes perfect and we find out that it isn’t really as scary as we once thought it was.  You don't have to do this alone; I am willing to take this journey with you.




Anxiety Disorders Association of America.  This organization has a lot of great information about different types of anxiety disorders, treatments that are effective, and resources for the public.


Psychological Treatments.  The Society of Clinical Psychology is a division of the American Psychological Association.  They have created this website for the general public, students, and professionals to document the types of psychological treatment that have been scientifically shown to be effective for many different disorders.  This is a great resource for the public.


Association for Behavioral and Cognitive Therapies.  Also a great site with a lot of helpful information.  This site will explain more about behavioral and cognitive-behavioral approaches to therapy as well as the current state of scientific psychology.