On a trip to Argentina that I took in September 2022, I had the opportunity to visit one of the most beautiful bookstores in the world: El Ateneo Grand Splendid. There, in one of its display cases, I was able to see the book I will talk about in this article: Fear of Fear: anxiety, panic, and agoraphobia by authors Marchand, Letarte, and Seidah (2019).

What is the conceptual difference?

First of all, it is worth dedicating efforts to ask the following question: what is the conceptual difference between fear, anxiety, phobias, panic attacks, panic disorder, and agoraphobia?

  • ✅ Fear: is an emotion that functionally serves a protective role. Since ancient times, fear has helped humans fulfill a survival function. Similarly, it is worth noting that each person decides how to feel fear. What is the reason? Some people choose to experience fear from a perspective of pleasure. For example, there are people who engage in extreme sports, watch horror movies, or experience high speeds in a car. On the other hand, there is another segment of the population that may start to feel terrified in the face of fear, a situation that could trigger the fear of fear. I hope to delve deeper into this later.
  • ✅ Anxiety: consists of an emotional reaction usually triggered by apprehension of painful events. Unlike fear, in anxiety, the threat or danger tends to be less concrete, as the individual may perceive it as more distant and future. It is good to clarify that anxiety serves as an alarm function that helps sharpen the senses and prepare the body for action. For this reason, it can be concluded that there is normal anxiety and pathological anxiety. Apart from phobias (which are considered a type of pathological anxiety), there are other problems caused by excessive anxiety, such as separation anxiety or generalized anxiety.
  • ✅ Phobias: are a type of dysfunctional fear, as the emotional reaction is disproportionate to the situation that triggered it. For this reason, it can be concluded that a phobia is an irrational fear of a stimulus that is not dangerous in itself. Such is the intense fear reaction that it causes a deterioration in the person's functioning, affecting various spheres of their life: family, work, social, educational, and personal.
  • ✅ Panic attack: It is worth noting that before considering the presence of a panic attack, it is important to rule out the presence of physical problems, which is why cardiac, respiratory, neurological, or endocrine checks are of utmost importance. According to the DSM-V (2014), there are various criteria that must be met when referring to a panic attack: palpitations, pounding heart, sweating, trembling or muscle contractions, feeling of choking, chest pain or discomfort, nausea or abdominal discomfort, chills, hot flashes, fear of losing control, or fear of dying. It is important to clarify that a panic attack can occur in a state of calm (i.e., in the absence of disorders), or it can occur in the presence of other disorders (anxiety, phobias, depression, etc.).
  • ✅ Panic disorder: panic disorder is discussed when there are several recurrent and unexpected panic attacks. The term recurrent refers to the necessity of having more than one panic attack, and the term unexpected refers to the absence of a clearly defined trigger, which is why attacks can occur at any moment and suddenly. The above allows us to conclude that an isolated panic attack is not a sufficient indicator to diagnose panic disorder.
  • ✅ Agoraphobia: unlike phobias, where fear or threat is perceived towards an external object, in agoraphobia, the person experiences fear or anxiety caused by real or anticipated exposure to various situations, leading to a desire to escape or avoid different situations. An example of this could be feeling the need to escape or avoid specific means of transportation, such as an airplane.
  • ✅ Agoraphobia/panic disorder: sometimes, both mental health conditions can occur simultaneously. The main characteristic is that, in these cases, the fear or anxiety is not external to the individual (as occurs in phobias), but rather the fear or anxiety is within the person themselves. For this reason, the person fears their own sensations, whether due to fear of worsening and experiencing dramatic situations or fear of losing control.

🤔 Part of the reasons why a panic disorder/agoraphobia arises is due to the interpretations that people give to the perceived sensations, which is why some people attribute the symptoms to fear of having a heart attack, fear of choking, fear of fainting, fear of losing control, or fear of dying. It is important to mention that these are distorted interpretations of reality, which is why one aspect that is often worked on at the mental health level is the modification of internal discourse, so that the person can be more aware of seeking and selecting realistic and constructive thought mechanisms that promote well-being.

✋🏻 Another key point to work on therapeutically is the acceptance of sensations. A good ally for working on acceptance is Acceptance and Commitment Therapy (ACT), which asserts that establishing control over thoughts, feelings, and emotions is part of the problem and not the solution, as this control can increase the frequency of thoughts, which is why the goal is for the patient to be able to progress in any problem they are facing in the direction of their own values (García-Higuera, 2006). Psychoeducation is an important part of treatment, as by identifying and acquiring relaxation strategies, the patient will progressively be able to take control of their panic. Likewise, gradual, prolonged, and repeated exposure (always conducted safely and guided by a mental health specialist) will allow you to face the situations that you fear. Obviously, at the beginning of the exposures, a situation that evokes a mild fear reaction is selected, so that the person can tolerate the anxiety without panicking. The idea is that as the person tolerates stimuli, they can gradually increase the complexity of their exposures.

📚 I recommend acquiring the book Fear of Fear: anxiety, panic, and agoraphobia by authors Marchand, Letarte, and Seidah (2019), as it provides countless self-help strategies. Remember that self-help books are a complement, but they in no way replace the guidance and advice of a mental health professional.

References

  • ✅ Higuera, J. A. G.: (2006). Acceptance and Commitment Therapy (ACT) as a development of cognitive behavioral therapy. Edupsykhé. Journal of Psychology and Education, 5(2).
  • ✅ Marchand, A., Letarte, A., & Seidah, A.: (2019). Fear of Fear: Anxiety, Panic, and Agoraphobia. Mexico City, Mexico: Oceano.