Fear Less

This is Hidden Brain, I'm Shankar Vedanta. The singer Kali Simon has suffered for most of her life from stage fright. Although she enjoys performing in front of an audience, she never knows when a surge of panic will bring her to her knees. In 1981, she set out to conquer her fear by arranging a string of concert dates at Big Concert Halls.

Midway through the tour, during the first of two shows in Pittsburgh, she felt her heart began to race. Kali Simon told the audience what was happening. Go with it, they called her. We'll be with you.

She invited some fans to join her on the stage for support. They huddled around her, rubbing her arms and legs and telling her that they loved her. She was able to finish that show. But right before the next show, with 10,000 people waiting to see her perform, she collapsed.

She canceled the rest of the tour and stopped performing in public. This week on Hidden Brain, how our fears get the better of us and how we can learn to get the better of them. Between packing, passports and racing to check in, holiday prep can be well pure chaos. But your travel money, that you can take off long before you leave.

Pop into your local post office today to sort your travel money in either cash or card instantly. And now on post will even bite back your unused cash when you return. If you haven't spent it on the ice cream service, visit your local post office today on Post Money Making Better Happen. The current edition of the post money currency card is issued by PPSU, to license by MasterCard International.

PPSU is authorized by the National Financial Bank, and is regulated by the Central Bank of Ireland for consumer protection rules. On post is authorized by the Minister for Finance, provide foreign currency cash, Fx cash by available in selected post offices for purchase selected notes only. Fear is a normal and healthy response to things that threaten to do us harm. But fear can also hold us back from doing the things we want to do.

At Wayne State University, psychiatrist and neuroscientist Arash Javanbach studies the psychology of fear, how it helps us, how it hurts us, and what we can do to harness it. Arash Javan Bakh, welcome to Hidden Brain. Thanks for having me on, Shankar. Arash, I understand that you yourself have long suffered from a particular fear involving heights.

What is your earliest memory of feeling afraid of heights? I remember actually one of my first encounters with serious fear as this experience. I was a child, I think around 10 years old, and I got up this ladder to a balcony with my mom. My mom was basically overseeing building a house, and it was going from one level to another level.

There was no stairs, so we used this ladder to go up there. It wasn't much of a height, it was like about two, three meters, but going up was much easy because I wasn't looking down. I was just looking up forward. I didn't even register, it just went up easily and then tried to calm down.

We went up there and did what we were about to do. As we calmed down, she comes down first because she wanted to be able to watch me from below, so she comes down. Then I get on the edge of the balcony, I look down and I'm terrified. It took a while for me to overcome the shaking my knees and the feeling of tearing inside my heart and of course my mom's kind and encouraging face helped me.

That was my first encounter with this fear and realizing that I'm afraid of heights. I remember when I was a small kid, there is a terror in actually getting the first leg off the ledge because you're swinging it out into the air before you can catch the first rung of the ladder and it is scary. Absolutely, yeah, you're right and that is the toughest part. The anticipation is the toughest part.

I understand that this fear did not necessarily dissipate as you became an adult. How did the state with you as you grew older, Arash? I remember if let's say we went for hiking, I would really avoid any edge that could expose me to being able to see below if the decline was not gradual. When I came to America and I bought my house, of course there were addicts here, we didn't have addicts in my house in Iran, but here I couldn't go up the ladder to go to the attic or trying to replace light bulb was a big challenge for me.

So it stayed with me. I remember probably about 10 years ago I was with a friend who was jogging in Ann Arbor and we were alongside the river and then she basically wanted to show me this little tiny island in the river where there was a tree log connecting the mainland to that tiny island, probably like 10 feet long. She just ran on it like a castle and she was on the island and again it was a reminder to me that I'm afraid of heights and the water below me was probably again 8 to 10 feet below but I needed a lot of encouragement to get to the other side. Did you have to sort of hold your arms out and walk very carefully?

How did you manage to get across the log? Embarrassing there was basically on my forelimbs. I was crawling on this log to get to the other side. So your experience on the tree trunk may have been embarrassing but ultimately it was fairly minor.

Fear can also hold people back in far more serious situations. One tragic example unfolded in partland, Florida in February 2018 when we experienced a school shooting. Can you set the scene for me and paint me a picture of what happened there? So the school shooting was happening and the sound of a gun going off was coming out and one of the security officers at the school was very slow and kind of paralyzed and responding to the threat was outside the building and ended up not taking action in a timely manner.

He was armed but he took shelter in an alcove outside the building and waited for help to arrive even as the shooting was taking place inside the building so he didn't go in and confront the shooter. And of course I was not in the head of this person but I could just imagine if I go in what's going to happen to me, what's going to happen to the kids, will I buy a mistake, shoot someone else, do I know what I should be doing, will I be judging, criticized afterwards and of course all the bodily reactions which are there at the side of the terror. And it goes back to the biology and psychology of fear. This is a very, very strong force and energy within us.

It's one of our deepest and most primitive emotions which functions at many different levels from very basic primitive animal fear brain which is okay now gunshot, loud noise, and danger to the highest level of human processing and there's a lot of thoughts, plus the biology at play at the moment. So Arash, you're a psychiatrist specializing in the treatment of stress, trauma and anxiety which means that you help people who are afflicted with very severe anxieties and fears. Some of your patients have seen their lives become very constricted as a result of their fears. For one patient I understand his descent into fear began when he got laid off from his job.

Can you tell me his story? Yeah so right after college this bright kid immediately gets a job, enjoys a job, he has a circle of friends mostly work related, they hang out together. And then he's laid off. So then he searches for work a little bit and he finds a job that he can do from home and remotely.

And gradually he starts losing some of his social skills. He loses the circle of friends, he doesn't have other people outside. And then he loses his job also and starts a full period of self-doubt. And then panic attacks start.

And panic the way it works is just totally out of a blue, there is a full storm of fear, the most extreme form of fear someone can experience in their mind and in their body, heart pounding, breathing is difficult. So it's very terrifying to people especially if they don't know what's happening and this happened to coincide with driving. So then his brain associate at driving with danger, slow down on driving and at some point stops driving. Then he started to have panic attacks in social situations, started avoiding going to places, first places which were more crowded and then more and more basically generalized situations even like a grocery store.

And let's say another time had a panic attack while showering and now brain associate at shower being in the shower with a panic attack so it started basically increasing intervals of his showers and then now hygiene is not great so that was another layer of lowering self-esteem and not going out. And by the time I met this person in his mid-40s, his basically housebound, his functional spending all his day on the couch. Sometimes our fears can feel bigger and stronger than we are. They hold us back from doing what we want to do, what we know we ought to do.

When we come back, how understanding the psychology of fear can teach us when to listen to it and how to control it. You're listening to Hidden Brain, I'm Shankar Vedanta. Between packing, passports and racing to check in, holiday prep can be well pure chaos. But your travel money, that you can take off long before you leave.

Pop into your local post office today to sort your travel money in either cash or card instantly and now on post will even buy back your own use cash when you return. If you haven't spent it on an ice cream service, visit your local post office today on Post Money, making better happen. Transatic digital supply on Post Money currency currency by PPSU, PPSU, licensed by Master Card International, PPSU, authorized by the National Financial Bank, and is regulated by the Central Bank of Ireland for Consumer Protection Rules, on post is authorized by the Minister of Finance, provide foreign currency cash, FX cash, buy back available in selected post offices for purchase selected notes only. This is Hidden Brain, I'm Shankar Vedanta.

If you peer down the long corridors of evolution, you will see that there are many aspects of the brain that have changed over time. But researchers find that the neural pathways that govern fear are highly preserved across species. You can find them in rodents, antelopes and in humans. There is a simple reason for this.

Creatures who lack the capacity for fear did reckless things and were quickly removed from the gene pool. The survivors were the ones who had a healthy capacity for fear and they passed their genes to us. But what this means is that we all have fear circuits in our brains that were sculpted in the Stone Age. What worked for our ancestors may not always work for us.

Psychiatrist Arash Javanbagh has studied what fear does to us. He believes that understanding the mechanisms of fear can help us form a wiser relationship with this ancient emotion. Arash, I understand that a number of years ago you were sitting in your parked car when something very dramatic happened to you. Tell me what happened.

So this happened early medical school. We were near the University Hospital with a few of my classmates. We were getting ready to go to funeral of one of our classmates' mother. And all of a sudden this motorcycle riding very fast just plows through the driver's side door.

Wow. And I'm so happy nobody was injured, luckily and miraculously, but basically the two doors on the left were just totally damaged. What I remember was it's as if I'm seeing a slow motion movie. And right now, 20-some years later, you and I were talking, I see the image right in front of me.

And I see how slowly that bike is coming towards me, basically slow motion with full attention. And then I saw, even I remember the guy's face as the bike was getting closer and then hit the door on my side. So you clearly had a chance to look up and see him coming toward you. I'm assuming you didn't have enough time at this point to actually get out of the way or start the car or move the car.

What you're describing happening in slow motion, of course, probably happened in a couple of seconds or even a fraction of a second. Absolutely. I couldn't do anything. The car wasn't even on.

And I just saw a scared face and then boom. That was all I saw, but in a very slow motion and being aware of all the even colors of what's going on around. What time of the day was basically my brain registered all the context and accused that wordler. So why does this happen to Rush?

When we have these very dramatic things happen to us, I think many of us have these moments that almost feel cinematic where everything seems to slow down and we can see things in great clarity, but there's nothing that we can do about it. Why do you think this is happening? What is happening inside our brains? So fear has a very long story with us and we have to understand the context within which it evolved.

And the context within which fear evolved was a context of physical threats. We have to worry about a predator, another human attacking us or a falling rock or natural disaster. So the system is designed to react very fast to the dangers that are around us. And when the system is activated, the brain region is involved in fear processing including amygdala and the synthetic nervous system.

Basically, it was not that the environment slowed down. I sped up. So my processing speeds up, my attention becomes hyper focused and the memory becomes stronger. So we register such experiences even more crisp and more strongly and that by itself has an evolutionary purpose because if something is dangerous, if something is a threat, I should register and learn it so well that the next time if this is about to happen, let's say instead of the motorcycle approaching me very fast, it was a grizzly bird.

And I was attacked by a bear as a tribal human 50,000 years ago, it would be very dumb for me for the second time to go try to pet the next grizzly bird that I met. So it registers in my brain so well that this is dangerous, you've got to be careful and also learn whatever skill you need to avoid it the next time. Alright, when you describe the motorcycle approach in slow motion, it sounded like you were frozen in place, you couldn't do anything but watch the crash unfold. Why does the sensor paralysis sometimes strike us where we feel very afraid?

And that's another amazing aspect of fear. So we have the fight response, flight response and the freeze response. Freeze response has been seen mostly in animals which are praised, for example a rapid spots a hawk and the rapid freezes because it doesn't want to be seen. So basically the brain paralyzes the system so the motion is minimal.

For humans, we are more of the predatory animal and that's why freeze response is less often observed. But when there is no other option, you try to basically minimize the risk, and minimize the resources and minimize the chances of more harm by freezing. And we see this reaction in a lot of horrible situations where humans are stuck like rape and assault and torture that they cannot do anything else. So the best option is to not do anything to at least, let's say going back to the evolutionary context, reduce the amount of bleeding.

So you've given me some very dramatic examples where freezing happens. A predator is attacking its prey or a human being is being attacked by another person in very dramatic situations. Can freezing also happen in less dramatic situations, situations involving psychological peril? Absolutely.

We talked about how this system has evolved to react to very physical situations of danger. But what you are coming to now is that in the modern life, the majority of the threats that we are perceiving are so abstract. A few years ago we were talking about this virus which is spreading from China to Europe and gradually coming to America, it's a virus. We don't even see it.

We just hear the news and we have to make decisions based on that. The system gets confused a lot of times but also there are situations that you pause to be able to process more. You pause because you cannot do anything else. Or it's a better self-preservation to not make a move when you do not know what is the move to make.

In your work with many veterans, first responders and refugees, you say that sometimes what happens is that not only are we afraid of the thing that originally caused our fear, we start to generalize across similar things that might also be a trigger for our fear. And you say that many of these first responders and veterans often have frightening experiences when it comes to one holiday in the United States. What is that holiday rush? Fourth of July.

So this generalization of fear is again an evolutionary advantage. As you said, a grizzly bear attacks me on one of my tri-mates. Now I avoid not only grizzly bears but also black bears. Or a wolf attacks me.

Now I avoid all different kinds of wolves. And for people who have been in war or near explosions or gun violence or shootings, the loud noise is associated with something horrific and dangerous. And now any unpredictable loud noise can create the same response in the brain over generalizes the fear response to any loud noise, whether it's a slamming door or the fireworks. And that's why a lot of veterans and survivors of gun violence, they are terrified of Fourth of July and they try to where headphones go to the basement because they logically know they are safe.

This is not the war environment, this is not the shooting context. The problem is that we are talking about the illogical part of the brain which basically learns fear through association. And I've had even veterans that during Fourth of July when the firework goes off, you just drop on the floor. One of the things that you mentioned about the patient you had who was very successful coming out of college but gradually started to withdraw into himself is that fear tends to cause us to avoid the things that made us fearful.

Can you tell me the story of one of your patients who was robbed at a gas station and the effect this later on had on the patient's life? Yeah, so when something dangerous happens, these highly dangerous painful situations are very strongly registered. So for this person when the robbing happened, they were in the gas station, they were just about to get in their car, somebody comes pointing to gun at them and then takes their money, this was very terrifying. And now this brain wants to prevent this from happening again, right?

The same story as the grizzly bear. I don't want to be attacked by a grizzly bear again and lose another limb to them. So now the brain tries to collect not only data about the bear but also about the context in what context did this happen? That corner of the woods, the bears there, I shouldn't go there anymore.

Same applies here. It was a gas station, it was at this time of the day. So the association becomes the gas station for this person, avoiding gas stations, finding the very difficult going there. And it's automatic.

Logically they know that the guy with the gun is not at this gas station, now they may even be cops nearby but they find it difficult gradually, they can't expand to convenience stores. Or that time of the day, for a lot of people, it's the time of the day or the time of the year that this happened, that the anxiety increases because amazingly the context is not just the physical context but also social context but also temporal context. From an evolutionary perspective, let's say you encounter a bear in one neck of the woods. You now give that area a wide berth.

The more often you avoid that area, the better off you're going to be. But that same adaptation in the modern context can mean that people quickly cut themselves off from everyday sources of meaning and connection. So if we avoid a grizzly bear in the woods, every time we avoid it's a benefit. The challenge is a lot of these fears that we have learned are context dependent, allowed noise just in the war zone or in the shooting environment is dangerous.

On the 4th of July it's a fun experience. The problem is that sometimes the thing that we are avoiding, for instance now in this example, new other gas stations, it's not dangerous. But the way it works is that I see it, I freak out because the brain says this is dangerous, you shouldn't go there. You don't go there, nothing bad happens.

The brain says you see, you avoid it, nothing bad happens, so you should keep avoiding. So now it will become harder and harder and harder and it keeps expanding and generalizing and consolidating the field and become stronger. I've seen it in other examples of patients how a plague it expands through their life and generalizes to other modern and modern conditions. I understand for one of your patients, even a cheerful bus and restaurant has become a place of danger.

Tell me what the world looks like for this person. So I see this actually a lot in first responders. I work a lot with cops and firefighters and emergency personnel and I didn't know how tough their lives are until I started working with them. There's a ton of stress, there's a lot of unpredictable dangers happening in their lives.

And if you're a police officer, you go to deal with the shooting that has happened or there's been domestic violence abuse, you go to where there's been car crash after people out of burning cars. And the difference they have, let's say with veterans is that the veteran goes to war zone and then they come back to the safe civilian environment. For first responders, the same environment where they live is the same environment they are exposed to the worst of what humans do to each other and to themselves. So their brain automatically goes to the state of fight and flight constantly screening for danger.

And they could have arrested or done a CPR on someone in the same restaurant now they want to go through their family. So when they go to the place, a lot of them, they're at the time that there are many people that are in the same place. And if they go, they'll sit somewhere with the back to the wall where they can watch everything and watch the exits and so it basically becomes an automatic safety behavior. Fear works by distorting the thing that is fearful, by magnifying it.

Again, this worked well in a context where survival was a challenge and avoiding threats was a far more important priority than seeking out opportunities. But many of our fears today are not connected with matters of survival. Messing up a speech, burning a casserole or being rejected by a date are not in the same league as being confronted by a hungry tiger. Can we treat trivial dangers the same as life threatening dangers?

This can skew everything in our lives. So a lot of times fear as you said distorts our attention. So when I'm scared, let me just bring an example. I go to a class that I'm teaching and I already am terrified that I may not be a good speaker, I may not be a good professor or I already have some fear of public speaking and I have actually had this in a lot of my patients.

So I go into this class and I already feel less confident. My heart is pounding, my breathing is difficult, I might be a little bit sweaty, my attention is a little bit distracted and distorted. And then the amazing thing about it is that my brain is in fight and flight mode and threat detection. So my attention is focused on any signal in Q from the environment.

That might suggest that things are not going well. Let's say for one of my students is on their phone, I will think that they are texting another student about how bad of a teacher I am. If another one is on the computer, even though if they're taking notes from my speech, I may think that they're bored. If someone is sitting with their arms crossed, I think they are now guarded.

So that makes me become less confident in myself and my reaction to them may become awkward. And they start thinking what's wrong with this guy, why is he acting awkwardly? And gradually, this basically creates a self-fulfilling prophecy cycle. Because we already set the expectation that this world and this environment is dangerous.

And these other people, and we see this actually example I brought up a lot of times in people with social anxiety, for example. They go out thinking everyone out there is trying to judge them. And anytime they see any sign that other people appreciate them, the brain basically screens this out as noise. But any sign that can be interpreted even neutral signs as there's something dangerous when some people are judging me or they don't like me or I did something dumb and they didn't like it, that will affect basically my perception of other people and my perception of myself and my own behavior.

When we come back, strategies for overcoming unwarranted fears that can allow us to move to our goals and activities that are important to us. You're listening to Hidden Brain, I'm Shankar Vedanta. This is Hidden Brain, I'm Shankar Vedanta. I told you earlier about how the singer Carly Simon suffered a very dramatic experience of stage fright while performing live in 1981.

Her fear kept her from singing in front of an audience for many years afterwards. In 1987 however, she ventured on stage again. In a carefully planned event, she performed before a small, local crowd in the seaside community that had been her home for many years. The concert was a triumph.

Psychiatrist Ora Shjabenbach has helped many people keep fear from destroying their lives. He's the author of a Fraid, understanding the purpose of fear and harnessing the power of anxiety. Ora Shjab said that the path to becoming brave is not to eliminate fear but to work with it. What do you mean by this idea?

So, bravery and courage are defined in situations which are difficult and challenging for the person but the person is able to overcome that primitive animal reaction and take their eye into action. Sometimes it's basically a self-sacrifice which could be logical. The case I remember is there was a firefighter who was stuck with his partner with his colleagues inside the building. And this person decides that the other two should go first and push his them out and help them out of the building and he dies.

So this is a brave action but then there are a lot of actions that might sound brave from outside but could just be an impulsive action, right? I mean it's interesting that I think we use the words courage and fearlessness synonymously but in some ways courage is not merely the absence of fear is it? No it's not. Actually to be fearless basically one needs to not have a make though, basically brain damage leads to an ability to experience fear.

Otherwise all of us normal humans do experience fear the same way we experience pain. Well of course there are things that help us be stronger, be more prepared. So accurate threat perception, right? I see a snake, I freak out.

Someone as well as a zoologist sees that snake and they're like well we are in Michigan, Michigan, the prevalence of poison venomous snakes is very low and then of course I'm looking at this snake and I know this snake is not venomous. So they look very brave to me but what is happening here is that they just have knowledge or someone has training, someone has a sense of control or a sense of purpose. So there's so many different aspects that come into a brave action. Can we just spend a moment on this idea that you just brought up which is one major way of cultivating bravery and courage to shore up our feelings of safety is to have a sense of control over what's happening and in some ways maybe a sense of control is what allowed Carly Simon to return to the stage on that day in 1987.

Can you just talk about this idea that in some ways what fear steals from us is our sense of control over what is happening and we regain a sense of control in some ways we get a sense of control over the fear itself. This is one of the most important aspects of dealing with fear. In normal usual scary situations yes that is a sense of control that allows me to feel I can do something about it. Let's say when the pandemic started we didn't know anything about how we can protect ourselves.

Then some came and said okay there's a mask here, there's a vaccine here that reduces the chance of getting sick and we started feeling a lot more confident because now we had some control we could do things that could help us protect ourselves against adventure and the one way of gaining this sense of control is gaining the knowledge to prepare, educate, learn ways we can deal with the situations we are afraid of. Learning that's more than simply provide us with knowledge. When we are learning our mindset changes, our emotional storms quiet down. How much brought this insight to bear has he helped one patient deal with a fear of sharks?

So this person loved the swimming and surfing and they would love to go to California and go on the beach and do surfing and swimming but they were so terrified of sharks and interestingly this fear started when they were younger and they watched the movie Jaws. Of course these fears are not logical. The person even comes to my absence and says I know it's stupid but I'm afraid of this or that to which answer it's not stupid it's illogical. We have a logical way of processing and we have the illogical way associated with it.

So how about we start learning about sharks? How about we learn about which ones are dangerous? Because not all sharks are dangerous to humans. Which ones are dangerous?

Which ones are not? Where are those dangerous sharks? What are the chances and the beach here that I go? There are more and less of them.

So not only learning about that environment allows him to be more comfortable. Okay, the kind of shark that is dangerous is never spotted on this beach so I can probably go here. But also it became a kind of a curious interest which helped him every time engage and incorporate basically a cognitive brain to and every time we bring the cognitive logic of brain whether it's through paying attention to things around us or doing something mindful or learning something or even labeling the emotions, the intensity of the emotions declines. So sometimes learning more about the thing that we fear can quell our feelings of panic.

But sometimes the fear itself is unreasonable and needs to be reevaluated. Like for example when we're talking about public speaking instead of sharks. Talk about this idea that sometimes our response to fear needs to be to reevaluate the fear itself. Yeah, and this happens a lot in anxious people with more abstract forms of fear experiences.

For instance, how scary is failing an exam or not grading well on an exam or failing job evaluation or failing an interview I'm doing? For a lot of people who are anxious. You ask them which part was the most scary? They say the anticipation.

So a lot of times I say look back in the past and see the past on average what percent you overshoot the danger. And then I say cognitively try to bring it down. That's one way. Basically knowing myself and knowing how scared I usually am compared to the reality.

Let's look at the statistics and utilizing all of these cognitive resources and tools allows us basically control and leash that animal fear response. Arash, psychologists have a name for this kind of reevaluation. They call it cognitive reappraisal. I understand that you were once prompted to engage in cognitive reappraisal by your boxing coach.

So boxing started in my life and a friend of mine probably about 10 years ago dragged me to this fitness box in June. I first thought it's such a stupid thing just standing there and hit a bag. But I just fell in love. First of all, it was fitness boxing.

Just setting the bag I found at a very good discharge of a lot of tension, being focused and of course good workout. And basically I have a trainer who is a boxer himself and we have started basically sparring training but we don't hit each other hard. So after so many years, 10 years of fitness boxing, I knew all the moves and I'm not bad, I glove up and I'm standing in front of him. All of a sudden it's just like I try and travel to when I was in school standing in front of a bully.

As a kid I was never fit, I was never athletic or smaller so I was bullied a few times so I see myself right in front of this bully and I was like wow Reggie, I'm just experiencing the whole body experience that fear. And he said imagine if that child you were once was here today, how proud of you he would be. He basically made a beautiful connection, I time traveled there and he made a bridge between there and now. Yeah, it's almost like you were time traveling to your past and he was helping your past to time travel to you.

Absolutely, it's such a beautiful way of saying it and a lot of times we do this with patients in treatment that they are stuck in the past. Part of our animal brain doesn't understand time, doesn't understand the distinction between one happened there and then what happens here and here and now, right? A person with that's a post traumatic stress disorder, they have a flashback of the memory and now they have a panic attack. And one of the things we do in treatment is to put those memories in the context that's in the past.

So, what did I learn and now I'm a different person than that other person and making basically these connections. You said it very beautifully. So, when fear takes hold of us, we often get caught up in spirals of fearful thoughts and ruminations or as you say that grounding ourselves in our bodies can help in moments like this. What do you mean?

Interestingly, I have started over the past few days doing this ice plunge. Basically, I got one of these buckets and I sent it, I mean I was too lazy, I put it outside on the back porch in Michigan, it's already very cold. So, I don't recommend the 25 degrees but I have been able to sit in it for 30 seconds. During that time, I'm just here and now in my body.

I'm not anywhere else. And the idea is that when I do mindfulness practices with my patient, I ask them basically at the moment listen very carefully and tell me how many sounds are in your environment. Then ask them to look around and tell me how many colors they are seeing around them, all shades of color right now. There is in front of me in my office, there's a picture that I took in Alaska which has a mountain and beautiful water and trees and there's so many colors in this.

Then I ask them to feel their shoes, feel every inch of the shoe where there's more pressure or less pressure where the foot is touching the ground where the foot is not even touching the shoe. And then this bit, very tiny practice after we've done and asked them how much did you think about the past or the future? The answer is no. The reality is that we as humans are capable of reflecting on the past and planning for the future which is an amazing human capability that has made us very capable but it has also plagued our lives because majority of the times we are not here, we are in the past or in the future.

And mindfulness is a practice of bringing us to here and now because the reality is the only true moment in our lives is this very moment which most of the times is the safest moment. If you can use practicing mindfulness to bring us to the here and now and ground us in the here and a lot of times that could be our body. I use the example of this cold plunge because at that moment really I kind of think of anything else and actually that's one way fear helps us. For me with my fear of high-sified standard edge of a rock in Grand Canyon even though I'm safe I cannot at that moment think about anything else.

So one of the best established clinical techniques to reduce unwarranted fear is known as exposure therapy. Can you tell me how that works Raj? So we talked earlier about how my brain associates something to danger and every time I avoid it I reconsolidate the fear and the idea and the belief that that thing is dangerous. So exposure therapy is the opposite of that that we gradually slowly introduce the feared situation to the person.

Let's say I'm afraid of dogs. So we can sit here in my office and for talk about how and why dogs are safe is not going to work. It's not going to teach the animal brain. Animal brain learns through experience.

So we gradually introduce the feared situation whether it's a dog whether it's height whether it's a public speaking whether it's being around other people. I go in I get terrified nothing bad happens. I go in I get terrified nothing bad happens gradually gradually I develop a new learning that in this environment it's this context I'm safe which is paired with a sense of control because it's not forced upon the person right we don't throw a person with a dog in the room and close the door on them. It was their own agency they took charge and did it and of course I as a social safety queue I'm there with them and they gradually this brain develops and it's just not learning along with the sense of control I could do it and we say you should keep doing it until it becomes boring or just annoying and that's it.

So you've done some work using virtual technologies to help people extinguish their fears. How does this work what do you do? I'm very excited about this technology we have created so virtual reality you wear these goggles you're in a different world but augmented reality you wear these goggles as imagine you're wearing a pair of sunglasses you see what is exactly around you and then on your desk you see a spider so we combine the real and unreal and it makes it more real and immersive so we started this for exposure therapy let's say I have people with true f spiders we put tiny spiders in the environment and gradually the spiders become bigger and more spiders more colors of spiders so we can generalize and of course it's not as easy in the beginning it's just one tiny spider in the very far corner and they're terrified what's amazing is that we have found the subjective responses and brain autonomic responses to these virtual spiders are the same as a real spider. So then we gradually advanced this to dogs and snakes and now for people with post-traumatic stress disorder they find it difficult to be around other people now I have someone in my office wearing the goggles a virtual door opens on the wall humans of different race sex, body type, behavior walk in the room starting to track with the patient and then the patient practices exposure so we have been using this technology and it works so well.

You had a patient who was extremely afraid of spiders and you brought her in to your lab and you basically had these virtual reality goggles placed on her and you started you know running these spiders around the room that she could essentially interact with and you even recorded the session of you talking her through this session I want to play you a little clip. So we can touch it. Why not? Why not?

I'm going to touch it also. I'm just going to feel a board. Ooh, I'm under it. So we can swear if I'll warm her under.

That's good that's very good see if you can hold it like longer. Because what are we doing we are trying to get a brain. That is the safe this is safe. Arash what was happening in the session there?

This is actually the part that she was trying to slide her hand under the spider. How amazing the our brains perceive this that she started to even feel it's like oh it's for warmer. It feels warmer here while she was sliding her hand under this thing. It's one thing to be okay with some virtual augmented spiders but we want this to have real life implications.

So after that we have a live tarantula. My lab is stress-strong and anxiety research clinic stark with the sea and this tarantula is Tony Stark. So they will see how close they can get after the treatment to Tony Stark and actually this patient was able to go ultimately have Tony in her hand which is a large rose hair tarantula. And interestingly we have published this clinical trial everybody we treated with this technology for if you have spiders in less than one hour one session treatment was able to touch Tony Stark or the tank containing Tony and these are people who were like standing 15 meters away from Tony before treatment.

So you see that we might all want to practice a kind of exposure therapy as we go about our daily lives. How would this work Arash? I always say the only way beyond fear is through fear. At the end of the day exposure matters.

We got it through ourselves in it. Of course we want to do it the way that we succeed. So gradually one step at a time and I recommend people go to the minimum level I can do. Let's say I'm afraid of grocery shopping because of my anxieties.

Just go to a grocery store which is smaller which you're most comfortable at the time that there may be even two people at the store. Just go there stay there that what matters most is stay with that scary situation whether it's the date whether it's the grocery store stay with that little tiny bit keep repeating repeating repeating repeating until I'm asked to that stage. Now I have a sense of autonomy I've learned my own limits and I've learned how my brain and my body is response to this. Then go to the next level then go to the next level then go to the next level and I've seen a lot of good responses from people who do this.

I understand that you once got the opportunity to unlearn a fear during a visit to the Grand Canyon. Tell me what happened to Rush. Yeah so this happened I still have every time I think about it. Many years ago I was doing my residency and I had a week of vacation I had to use in December.

One of my friends who was very adventurous tells me that hey go to Grand Canyon there's this mule right down the bottom of the canyon it's beautiful. And I was so naive I didn't think for a second that I'm afraid of heights. So I signed up for this thing I go there 6 a.m. in the morning in December very cold everybody's wearing several layers sitting on this huge mules and that was the first time I saw what Grand Canyon is you look down and you see the bottom.

It was terrifying and we were told listen if you're afraid you can leave now but you have to leave now when we start removing you cannot back off. And I'm like thinking should I start should I not she's looking around seeing all these kids and older people are very comfortable having fun I was embarrassed I'm like okay we'll do it. And these mules they tend to walk on the edge of the canyon and it was icy and slippery sometimes they slipped and when they make you and the trails are narrow and when they make you turn you just see the bottom of the canyon. Your mules head is off the canyon basically so it was very terrifying for me but knowing that what are the principles of this exposure I tried to basically do as much as I could looking at others getting so seeing other people are having fun remembering the fact they told us that they were running this business for a hundred years and nobody has been injured or died no mule has been killed.

So basically utilizing all my cognitive and not cognitive resources we went down to the canyon and the next day we come back up. And that basically not that I recommend this as a way of overcoming a few but that was it for me and I overcame my fear of heights actually a couple of weeks ago I was back in Grand Canyon I stood on the edge of that cliff of course in a safe way I felt the tingling in my knees but I could do it. And another amazing experience that came out of this besides the overcoming my fear of heights was for the next few days I realized I'm not experiencing my usual anxieties of daily life. And I started thinking about what is the source I mean one theory I came up with was that maybe we need some occasional experiences of real fear to exercise the fear system in a normal way the same way we exercise our bodies to be healthy because our lives are so sedentary these days.

The other thing I realized was that when we experienced such real fears because at that moment I'm standing on the edge of that cliff on that mule what is my fear my fear is if I fall I'm dead. So now I'm facing a real fear now in compared to this fear how much does it matter the things that are going on at work or the paper that got rejected or disagreement that I have with this other person basically these kind of fears put other anxieties in context. Yeah because the other fear started look trivial at this point compared to actually plunging to your death 2000 feet in the Grand Canyon. Absolutely and that's why a lot of people I mean we did talk a lot about the trauma in let's say first responders police firefighters veterans but the other side of it is that people who have seen the real danger situations who have experienced what really matters.

A lot of them have grown to the point that they find other anxieties that bother the rest of us meaningless. We've talked about different ways to get our fears under control but it's also possible for us to change in some ways what's on the other side of the equation when we're afraid of something instead of reducing our fear we can increase how much we care about the thing that our fears are holding us back from. In some cases that bigger thing might be a sense of duty or patriotism so when Western countries offer to airlift Ukrainian President Wollordemer Zelensky to safety after Russia invaded Ukraine in February 2022 he said I need ammunition not a ride. Can you talk about this idea, Arash that the things we care about deeply can be a bulwark against our fears.

And that's one amazing thing about us humans that we are capable of overcoming a lot of terrifying situations that we even did not know we were capable of. What I found in my career is that the meaning we create for our experiences transcends a lot of our fears and can help us basically protect us against fear. So sometimes the thing that is bigger than our fear is I love for another person. When you were training as a doctor you once helped a family who had been brought into the emergency room and paid me a picture of what happened to Russia.

So I was in the emergency room and there was a car accident. There is a mom on a stretcher with a very pale face and there's a dad and a couple of kids probably five, six years old. And I remember this woman's son was next to the stretcher terrified crying worried about his mom. And mom was basically so calmly such a soothing way saying it's okay I'm all right nothing bad has happened it's okay.

And then we unwrap her arm which was wrapped in a sheet or towel I don't exactly remember and I saw the worst injury crush bones on her arm. And I was just amazed by this is crushing pain and she knows she has a high chance of losing this arm but for her the priority is to make sure her child is okay and not terrified and not hurting. And this was one of the most amazing examples of selflessness and bravery I've seen. Marash Javanbach is the director of the Stress, Trauma and Anxiety Research Clinic at Wayne State University School of Medicine.

He's the author of Afraid, Understanding the Purpose of Fear and Harnessing the Power of Anxiety. Arash thank you for joining me today on Hidden Brain. Thanks for having me on Shankar. Do you have questions for Arash Javanbach?

What kind of fears have you faced in your own life? If you'd be willing to share a personal story and the strategies you've used to combat your fears with a hidden brain audience please record a voice memo on your phone and send it to us at ideas at hiddenbrain.org. 60 seconds is plenty. That email address again is ideas at hiddenbrain.org.

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