Fears and Phobias

NEAL CONAN, host:

This is Talk of the Nation. I'm Neal Conan in Washington. Seven months ago, a dog mauled Jennifer Willoughby and her dog, Bailey, in a violent and bloody attack. Jennifer almost lost her finger, Bailey almost died, and then there were problems afterwards. Jennifer Willoughby has been kind enough to join us here in Studio 3A. Thanks very much for coming in.

Ms. JENNIFER WILLOUGHBY (Sufferer, Dog Phobia): Hi. Thank you for having me.

CONAN: And tell us, after this episode, what happened when you saw a dog?

Ms. WILLOUGHBY: Oh, I would start shaking uncontrollably. I would have irrational, horrible thoughts of the worst happening. I would always start crying hysterically. I would be paralyzed with terror. I could not move.

CONAN: When was the first that time that happened?

Ms. WILLOUGHBY: Immediately after the attack, anytime I saw a dog.

CONAN: But tell us what happened, leaving the hospital and going to your house, what?

Ms. WILLOUGHBY: It was the next day on my way walking to my car to work, and I saw another dog, and that's when it hit me like a tidal wave. And I was just paralyzed and I started crying. The neighbors were looking at me, you know, like what is going on? And that's when I knew, you know, it was not going to get better.

(Soundbite of laughter)

CONAN: What about your dog, Bailey?

Ms. WILLOUGHBY: He's OK. He's not - he's pretty afraid of dogs, though. He always shies away and backs away.

CONAN: Mm-hm. But were you frightened of him, too?

Ms. WILLOUGHBY: No, not at all.

CONAN: Uh-huh. And so what did you do about it?

Ms. WILLOUGHBY: Well, for months, I didn't do anything. I just figured it would get better with the time, and it actually started getting worse, to the point where I wouldn't go to the grocery store because I didn't want to walk from my car to the store in case a dog attacked me, and that's when I knew that I really, really needed to get some help.

CONAN: Big dogs, little dogs, every dog.

Ms. WILLOUGHBY: Big dogs, mostly, yeah.

CONAN: But big dogs mostly. So, you went to get some help.

Ms. WILLOUGHBY: Yeah. I actually went to the Ross Center here in D.C., and I got a therapist, and she saved my life and my sanity.

CONAN: How long did it take?

Ms. WILLOUGHBY: I'm still in therapy. I've been going for two months, and I started seeing results in the first two weeks.

CONAN: And what do you do in the therapy?

Ms. WILLOUGHBY: We started going for walks at first, and now, we have moved up to going to PetSmart, which was my biggest fear. And I'm able to walk up to dogs now, and let them sniff me and pet them. So, that's what we do.

CONAN: And of course, you need to go to PetSmart, or some pet store, to get stuff for your dog.

Ms. WILLOUGHBY: I do, I know. I have to get him food.

CONAN: And for those of us who may not have experienced something like this, is there absolutely no way for you to control your emotions under those circumstances?

Ms. WILLOUGHBY: Oh, no, there's nothing I can do. I tried to speak to myself rationally. Like, a dog is not going to pop out of thin air. A dog is not going to attack you. But it is completely - you don't listen to the rational thoughts.

CONAN: Even knowing, at some point, that you had a phobia, this fear, you couldn't calm yourself down.

Ms. WILLOUGHBY: No, absolutely not. It was horrible, and I felt like no one understood what I was going through. I feel like I was the only person going through it. I felt like I was crazy.

CONAN: Well, in an odd way...

Ms. WILLOUGHBY: I know.

(Soundbite of laughter)

CONAN: You kind of were.

Ms. WILLOUGHBY: Yeah.

CONAN: But you're all better now?

Ms. WILLOUGHBY: Yes. I would say.

CONAN: Well, thanks very much for coming in and sharing your story.

Ms. WILLOUGHBY: Thank you so much for having me.

CONAN: Jennifer Willoughby with us here in Studio 3A. Almost everybody has things that make them afraid or nervous, but when those things can get in to the way of your daily life, they might be phobias. So, do you have something that makes you nervous, maybe even a phobia? Has it gotten so bad that you sought treatment for it? Tell us your story, 800-989-8255. Email us, talk@npr.org. You can join the conversation on our blog as well. That's at npr.org/blogofthenation. Also with us here in Studio 3A is Michael Kozak, a clinical psychologist at the National Institute of Mental Health. And Michael, thanks very much for joining us today.

Dr. MICHAEL KOZAK (Branch Chief, Adult Psychopath and Psychosocial Intervention Research Branch, National Institute of Mental Health): Thank you.

CONAN: And I was just going back to Jennifer's story, that part where you think it'll get better with time. Is that common?

Dr. KOZAK: It is common, and people do sometimes get better with time. They do spontaneously recover from bad experiences, but some folks do not. We don't really know how to predict exactly who will get better spontaneously and who won't, but when someone doesn't get better spontaneously, then it's very useful to try to get some help with it.

CONAN: And that part that she also said, nobody understands what I'm going through, I'm the only person in the world.

Dr. KOZAK: Well, people do commonly feel that way, even though there are other folks that do have phobias. But part of the reason that they feel way is because many, many people don't understand, and they have not had that kind of experience, and they're not aware of the distress and the thoughts that are going on in association with the feared situation.

CONAN: It could be easy to make fun of.

Dr. KOZAK: Yes, if you're not very charitable.

CONAN: Yeah. How common is it, and when does a fear become a phobia?

Dr. KOZAK: Phobias are common in the population. There are many different types of phobias. What Jennifer was describing might be called a specific phobia, because it's very focused on particular kind of situation, in her case, big dogs, big, unknown dogs. Specific phobias have been estimated to be about four-percent prevalence on a 12-month basis in the U.S. population. But there are a lot of other phobias as well. For example, social phobia, which is considered different than a specific phobia, has to do with social situations in a personal performance, public speaking, that sort of thing. That's estimated as being maybe about eight percent on an annual prevalence basis. So...

CONAN: Eight percent of the United States population, that's a lot of people.

Dr. KOZAK: That's correct, yes.

CONAN: Yes, and they're, I guess, the ones that we hear about a lot, in terms of claustrophobia and agoraphobia, fear of being in open spaces.

Dr. KOZAK: That's - agoraphobia is not considered a specific phobia, because it's kind of general to a lot of different situations, as you said, open spaces. And it's very often associated with panic disorder. And so, people with agoraphobia will develop a very strong sense that something terrible is going to happen, and they can't put their finger on exactly any particular threat, and so they will often avoid going outside into open spaces, public places, because it seems more likely for them that that feeling will occur in that situation.

CONAN: And they could feel safer in the house or the apartment or whatever it is, yeah.

Dr. KOZAK: That's right.

CONAN: Let's see if we can get some callers in on the conversation, 800-989-8255. Email is talk@npr.org. What is it that you're afraid of? And how do you cope with it? And well, does anybody else understand? Let's see if we can get Sadie on the phone. And Sadie's calling us from Lansing in Michigan.

SADIE (Caller): I wanted to explain how I was so afraid of spiders that it terrifies me.

CONAN: And when did you first notice it?

SADIE: I'm not positive. I just know when I was younger, when I was - I lived in Lebanon, and my aunt used to be afraid of dead bugs and all kinds of bugs. Even, like, on the floor, she would scream and couldn't walk in the room.

CONAN: So do you...

SADIE: And I didn't know how to - I just think it's probably from that.

CONAN: And so, then throughout your life, you've been afraid of spiders.

SADIE: Oh, yes, so incredibly petrified. I can't even - I don't even know how to even explain it. It's so terrifying. I don't even know how to - I just, like, freeze.

CONAN: And does your heart rate, does it pick up? Do you start sweating, that sort of thing?

SADIE? I don't know about that. I just know that - I don't even know - I just freeze and I want to get it. I know I can't kill him very well myself, but I have my niece who lives with us and she's not afraid, so that's a good thing.

(Soundbite of laughter)

CONAN: That's a good thing. Have you gotten help for it?

SADIE: No, I have not. But my husband and I, we have these conventions where we attend for the Quixtar that we're part of, and this guy, he actually helps people overcome the fear. He told me I needed to just think happy thoughts, and he was explaining to us during our weekend seminars. It has helped a little bit, to where I can actually kill tiny ones.

CONAN: Happy thoughts, Michael Kozak, is that going to help?

Dr. KOZAK: Ordinarily, the kind of treatment that has been found to be most helpful involves confronting the situation that you're afraid of, providing, of course, that it's not dangerous. And part of the notion of a phobia is that the fear is mismatched to the actual threat of the situation. So, for example, in the case of spiders, most spiders are not particularly dangerous. There are few exceptions, but in general, they're not. And so, the treatment that has been studied very extensively and found helpful involves doing some exercises, confronting the situation that bothers you.

So, if I were working with somebody, I would probably focus on that kind of approach, actually, similar to what Jennifer described, where she would actually enter situations where there were non-dangerous dogs, and get used to them. If she stayed there for - without withdrawing, her distress would spontaneously decline, providing she didn't avoid and run away.

And I would say, for the same thing, I would probably do with spiders. In fact, I've worked with folks who had spider fears, and generally, you would start with something easier, maybe some insects that are dead, or some spiders that are dead, and then gradually work to live ones and maybe larger ones, until the person is able to confront what you would think would be the worst harmless spider that they would encounter without distress.

CONAN: Sadie, is that approach something that you might want to try?

SADIE: Oh, I definitely will try. When he told me that, I got scared even thinking about doing that. I'm afraid if I kind of do overcome it a little, I'm afraid if I see one and then I freak out because I'm really, you know, like, it'll come back.

CONAN: Well, get maybe a professional who can help you with that.

SADIE: Yeah. But I'm going to try that. Thank you very much.

CONAN: OK.

SADIE: I really need to. My husband knows that I need to, too, and thank you very, very much.

CONAN: Good luck, Sadie.

SADIE: Thank you.

CONAN: Bye-bye. One other thing, she said the origin may have been, you know, she saw another adult - as a child, she saw an adult who was afraid of spiders. Can it be communicated like that?

Dr. KOZAK: Sure. The - many people who have phobias cannot recall a particular incident that prompted the fear, but they - fears can be communicated vicariously. There's actually evidence with studies of chimps, for example, where if the one chimp is afraid of something and the other one observes it, well, then, when you present that item to the chimp that was a witness...

CONAN: The second chimp, yeah.

Dr. KOZAK: They are afraid. So, that's an example of fear being communicated vicariously. I wouldn't suspect that just because you saw someone be afraid of something that you would automatically develop a phobia.

CONAN: But you might.

Dr. KOZAK: But we do profit from observing what other people do, and if you see someone withdrawing or acting as if something is dangerous, will you get that information and take that in? So, it makes sense that you could develop a fear that way.

(Soundbite of laughter)

CONAN: Michael Kozak, stay with us, if you will. More on fears and phobias in just a couple of minutes, just one minute, in fact. Do you live with a phobia? Tell us your story. Our number here in Washington, 800-989-8255. Email us, talk@npr.org. I'm Neal Conan. It's the Talk of the Nation from NPR News.

(Soundbite of music)

CONAN: This is Talk of the Nation. I'm Neal Conan in Washington. Later in the program, we'll preview a new documentary about Helen Thomas' questions to the last nine presidents. Right now, fear and phobias. Most of us live with some amount of fear. It's when it starts to affect the way you live that doctors might call it a phobia. An article in Sunday's Washington Post talked about how to understand your phobias and offered us several tips for living with them. We have a link to that article on our blog at npr.org/blogofthenation.

If you have a phobia, has it gotten so bad that you've sought a treatment for it? Tell us your story, 800-989-8255. Email, talk@npr.org. And you can also join the conversation on our blog at npr.org/blogofthenation. Our guest is Michael Kozak, a clinical psychologist at the National Institute of Mental Health. And I just wanted to follow up on what we were talking about just before the break. Is - we learn that if somebody else is afraid of something, we should be afraid of it, too. Is this an evolutionary response? I mean, is this how we learn to - well, you know, we don't have to put our hand in the fire, we know it's hot, if somebody is afraid of it?

Dr. KOZAK: There's some evidence that there might be some evolutionary advantage to developing certain fears. For example, it's been observed that certain themes come up with phobias. You notice that there are people reporting spider phobias and snake phobias, small animals. On the other hand, you don't see a lot of folks who come in with phobias of, let's say, electrical outlets.

CONAN: Right.

Dr. KOZAK: Even though...

CONAN: They're much more dangerous.

Dr. KOZAK: Even though they are very common, contemporarily, and people often have had experiences of getting a shock, and yet, they haven't developed phobias the same way that you seem to see them with spiders and snakes. So, people have actually studied this and have done some conditioning experiments, and have found that it is easier to condition fears to certain sets of stimuli, like snakes and spiders, that have some significance in the way of threat, if you were trying to survive in a different environment than we are in now.

CONAN: So, that might be hardwired somehow?

Dr. KOZAK: So, there's probably some preparation. Actually, the term that's used is prepared learning. So, it's you are more prepared to learn a connection between A and B, if it's a snake or something like that and a punishment, or an aversive situation, than other situations. So, that's called prepared learning.

CONAN: Let's see if we can get another caller on the line. This is Erin, Erin with us from Portland, Oregon.

ERIN (Caller): Hi, how are you doing? Hey, Neal.

CONAN: Hi, Erin. How are you doing?

ERIN: Good, good. I'm calling in because I have a very intense snake phobia, and I do know exactly when I started this phobia, actually. This was when I was about four and a half, almost five years old, and I can literally remember every second leading up to it. I was given an adult dosage of nasal decongestant. It was a - high with pseudoephedrine in it, and I went to sleep that night, and I ended up kind of waking up to a sleepwalking state and into full-blown hallucinations.

So, my story basically starts from there with snakes, because what I woke up to was what I believed a cobra or a python or something coming across my back. And from then on, it was pure terror and screaming, and I happened to be staying at my aunt and uncle's house for the weekend because it was Mother's Day weekend and my mom wanted some time off. So, I ended up going and hallucinated for, I believe, from what my mother says, a couple of days. I just know - all I know is that my veins, water, wrinkles in sheets, they were all snakes. And to this day, I can't come across a live snake without complete terror.

It worked out very well for - to have - I live in a Caribbean island for the last couple of years, and there were no snakes because there were mongoose everywhere. So, I was able to get from snakes, and I - snakes is one of those things where you don't usually come across them. So, I have not sought any kind of behavior modification. I have no desire to become friends with snakes. If it was something with spiders, which I guess part of the case study that I was involved in after this episode - other children had crabs and spiders, is what they hallucinated, and mine was snakes. So, luckily with snakes, I'm able to avoid them. They want to stay as far away from me as usually I want to stay as far away from them.

CONAN: Yeah, yeah.

ERIN: So - but a couple of weeks before my wedding, which was an outdoor wedding, I came across a live snake and came flying into the house screaming, bawling, and looking at my husband-to-be with pure terror, and he thought our dog had been hit by a car. So, it's a hard response. It's hard to control. It's - I really feel out of control if I even come across a snake that's on a cover of a book.

CONAN: And I assume he's now your husband. Does he understand this?

ERIN: He completely understands.

CONAN: Yeah.

ERIN: And of course, he's an any animal lover. So, you know, when we go to the zoo and there's the reptile house and our niece wants to go into it...

CONAN: He takes her in.

ERIN: He's the one who takes her.

CONAN: OK.

ERIN: Yeah, I have never been in a reptile house and cannot, but my biggest fear in my future life is when we do go to have children, all I can imagine is having a little boy and to have him come running up with a gardener snake on his hand or something, and me just, you know, swatting him away just to try and get away.

CONAN: Yeah.

ERIN: So, if any behavioral modification would be necessary, it would be around that time.

CONAN: OK, well, that idea of hallucinations, is that unusual?

Dr. KOZAK: I've never encountered it before as a precipitant for developing fear, but people could have all kinds of experiences that might precipitate it, and as I said, many people cannot remember any particular event that precipitated it. So, it's not clear, you know, what had happened to them.

CONAN: Yeah, Erin clearly remembers every detail.

(Soundbite of laughter)

ERIN: Oh, every minute.

CONAN: OK. Erin, thanks very much for the call. Good luck.

ERIN: Thank you. All right. Have a good day, guys.

CONAN: Bye-bye. Let's see if we can go now to Lynn, and Lynn's with us from Edwardsville in Illinois.

LYNN (Caller): Yes. My daughter, about two years ago, was at summer camp, and they had program on the Heimlich maneuver, and from that, she developed a fear of eating. Of course, at the time, my husband and I didn't know it. Getting her to eat was very difficult, and then she'd lost quite a bit of weight. I became alarmed. I took her to the pediatrician. The pediatrician pulled me into another room and said, I don't care what you do. You've got to get her to eat. This could become very, very serious. So, I took her to a therapist, and I still really didn't understand that she had a phobia. The therapist diagnosed with a phobia and said it was the first time she'd seen a phobia of eating.

CONAN: Or fear of choking, I guess was the...

LYNN: Yes, she was afraid to choke. And it was a terrifying experience for her father and I to watch our daughter unable to eat.

CONAN: Yeah.

LYNN: And to - basically, we had to force her to eat, because, well, for obviously two reasons, one, for sheer survival, and two, to get over the phobia.

CONAN: And did she get over it?

LYNN: She did. We do have to do a lot of relaxation at certain times. But for the most part, she has gotten over it.

CONAN: I never it's obviously not a - like an eating disorder. It's something completely different, Michael Kozak.

Dr. KOZAK: Well, at least, topographically, it's an eating disorder.

CONAN: Yeah.

Dr. KOZAK: Because the surface form is an avoidance of eating. But typically, in eating disorders, there's a concern with weight or a concern with appearance and thinness. Not having interviewed your daughter, I'm not sure about what the sources are, but it sounds like it's more oriented to choking.

LYNN: Yeah.

Dr. KOZAK: And that sounds like more of a fear that might be approached by gradual exposure to foods. So, for example, there's a person that I worked with who had a fear of choking, and it was manifested particularly with chunks of food. So, she was eating only liquids, because she didn't have the problem with the swallowing the liquid. So, it was really the swallowing that was of most concern for her.

So, we started with small chunks and worked up, and also tried to find some items that could stay in her throat and give her the sensations that she didn't like but that were not dangerous, because you - it's tricky. You can't put things in a person's throat that will actually injure them. So, one thing that we used was some dry peanut butter, which tends to get in the - towards...

CONAN: Sticks to, yeah.

Dr. KOZAK: The back of your tongue, and normally, you want to have something to drink with it to chase it down. But in this case, it actually served very well, because it produced that sensation that she was very distressed about. And she was able to get used to it and realized that just because she had the sensation didn't mean she was going to choke. And that helped her to work into bigger chunks of food. And by the end of the set of exercises, I don't know, it probably took a few, three, four months of weekly exercises, she was able to eat pieces of steak and other chunks of food.

CONAN: Lynn, good luck with this.

LYNN: Thank you, and that's excellent advice. I appreciate it.

CONAN: OK. Here's an email from Jennifer in Cleveland. How would the doctor recommend you approach a family member whom you suspect of having a phobia like agoraphobia? My brother is very resistant to leaving the house, going out to dinner as a family, or otherwise participating in social situations. My parents' approach has been to try to force him to go in the hopes that this will make him more used to it. I'm not sure that's the right approach. What do you think?

Dr. KOZAK: My experience is that trying to force people to approach situations, particularly adults, it really provokes opposition rather than cooperation. And a good therapeutic technique - I mean, a good therapist acts more like a coach - where the therapist, or whoever the helper is, whoever is trying to persuade the person, forms an alliance with that person to help him understand how acting courageously in approaching these situations is an investment in a good outcome for them, and then, supports them in doing that...

CONAN: We are going to do it.

Dr. KOZAK: Well, exactly, and - or also reminding them of the contingency. The contingency is, if you do this exercise, you are likely to get what you want, which is freedom from this distress. If you don't do it, you're not likely to. And it's easy for someone outside to say, you should do this. It's not so easy to muster the courage, to approach those situations that are very distressing. So, I think, you know, usually there's some preparation that's involved before helping a person to confront things. What you often hear is just about the exposure, sort of the dramatic thing, you have to go and shake hands with the snake. But that's usually toward the end of a therapy, where all the preparation has occurred, and that person is now ready to take that step and confront the feared situation of their own accord.

CONAN: Harmony77 tweets, I have a phobia of answering the telephone. My whole family thinks I hate them. Therapy has helped me, but I still prefer not to. We're talking about the phobias and fears with Michael Kozak, a clinical psychologist at the National Institute of Mental Health. And you're listening to Talk of the Nation from NPR News. Let's go to Jane, and Jane's calling us from Ann Arbor, Michigan.

JANE (Caller): Hello?

CONAN: Hi, Jane. You're on the air.

JANE: Oh, hi. I love your show.

CONAN: Thank you.

JANE: I had a couple of questions. I have a severe phobia of flying, which I - the first question has to do with the - is this something that can develop years later, almost - with - as if it were traumatic stress disorder - that - a similar approach? My brother, when I was 16 and he was 21, died in a mountain climbing accident. And I never had any problems. I wasn't afraid of heights. I, in fact, did a little bit of climbing after that. And then, years later, when - about 10 years later, when I was pregnant with my second child, I was on an airplane and had - I mean, it was fine, and we were fine, but it was a very scary descent, and from that moment on, I was completely phobic of flying.

So, that's - is there a - is there - can there be a delayed reaction? And the second question is, whether this can be hereditary, because my daughter, who is now 25, but a couple of years ago started dealing with an anxiety disorder, which is now, thankfully, pretty much under control. But I realize it's not exactly the same thing. She, as a kid, had had very severe phobia of aliens. She couldn't watch "ET" and all those sort of things. So, those are a couple of questions that I had related to it.

Dr. KOZAK: So, maybe the first question, can a phobia develop some time...

JANE: Years later, yes.

Dr. KOZAK: After the experience? Well, it sounds like you're describing some evidence that it can, and that is in your own personal situation.

JANE: I mean, that's my analysis of where it came from.

Dr. KOZAK: And I - I know of a situation that illustrates the emergence of a severe fear after a situation, somewhat after a situation has occurred, often with the addition of a little piece of information that wasn't available then. There is a person who was assaulted - basically mugged and sexually assaulted - and afterwards, did not develop any symptoms of fear or PTSD. But it was later found out that the person who had assaulted her had killed a number of his victims. And when this victim found out that other victims have been murdered, she developed severe phobia.

So, she didn't develop the phobia right after the time of the assault. It was only after that other piece of information was presented to her. So, just that piece of information, that it was a much more severe threat that she had realized, was enough to change her experience kind of retroactively. And so, that's an example of a very strong fear that developed after the initial precipitant, but was precipitated by piece of additional information. Sometimes another insight, some other thought, can add to your experience and change it in a way that makes it worse for you.

CONAN: But the first experience was mountain climbing, and then it became a fear of flying. Are these both fears of heights?

JANE: Well, it was the death of my brother.

CONAN: Yes.

JANE: And it was - - but as I said, I was - the heights, everything, I was fine until 10 years later. I was in vulnerable situation, I was having a bit of a problem pregnancy, and this plane just made a basically, almost completely, vertical descent, and the pilot warned us, and it was - the fear was overwhelming. And then from then on, I just made excuses to avoid getting on planes, which I now do with the helped of a lot of medications.

(Soundbite of laughter)

CONAN: Well, we hope that you and, well, your daughter, too, can work these problems out.

JANE: But is - is there - very quickly, is there a hereditary component would you say?

Dr. KOZAK: Fear and anxiety has been known to, quote, "run in families," unquote. The extent to which that is genetic versus cultural, where, you know, part of the - part of the milieu of the family is not really clear. But you're not, certainly not, the first person to have observed that some family seem to have - be more anxious than others, and it might be - there's - it wouldn't be surprising if there is a hereditary component.

(Soundbite of music)

JANE: Well, thank you.

CONAN: Jane, thank you.

JANE: Yes, bye-bye.

CONAN: We're going to take a couple of more calls about phobias when we come back. And we're also going to be talking about a new film about the long-time dean of the White House press corps, Helen Thomas. So, stay with us. I'm Neal Conan. You're listening to Talk of the Nation from NPR News.

(Soundbite of music)

CONAN: Right now, we're continuing our conversation about fears and phobias. Our guest is Michael Kozak, a clinical psychologist with the National Institute of Mental Health. And if you'd like to join us, 800-989-8255. Email us, talk@npr.org. And let's go to Jennifer. Jennifer's calling us from Sacramento in California.

JENNIFER (Caller): Hi.

CONAN: Hi.

JENNIFER: I'm calling because four years ago, I was hit by a big rig on the freeway going about 50, 60 miles an hour.

CONAN: A semi - tractor trailer?

JENNIFER: Yes. And since then - it's been four years - I get - I don't know if it's mini-anxiety attacks or what it is - but sometimes I just kind of get stuck behind a big rig and I can't - my - the fear is so bad that I can't pass it. So, I get stuck going, like, 55 miles an hour on a freeway in a 70-mile-an-hour zone because I'm so scared. Sometimes, I'm able to pass, but it's very scary for me. And I just live with this fear when I'm driving that I'm going to get hit by a big rig. And I don't know - it's been four years. I don't know if it's just going to kind of go away eventually, or if I should try to get help. I try to talk myself out of it, like, it's OK, he's not going to hit me, but - and sometimes it works, sometimes it doesn't.

CONAN: Hm, interesting. We got an email from Kitty in Rochester, New York. I am petrified of driving on expressways or thruways. Regular streets and roads are usually fine for me, but I can't even think about merging onto a turnpike without feeling weak in the knees. It came on gradually. No major trauma started it. In fact, I was courier for a medical lab for five years driving all the area expressways. Now on long trips, my poor husband has to drive the whole way and listen to me panic. He's a saint, poor guy. How can I get over this? I'm afraid if I get on the expressway, I'll have an accident and kill myself or someone else. A lot of driving anxieties.

Dr. KOZAK: That seems to be an exception to the situation we were talking about earlier with evolutionary fears, where - we said that we don't seem to see fears of electrical outlets. There are a lot of reported fears of automobile accidents and driving. Of course, some of the situations have clear precipitants that you might consider, like, traumas, where...

CONAN: Like Jennifer, yeah

Dr. KOZAK: Exactly, where there's a very clear and very severe situation that conditions the fear. In response to her question about, will it go away? Can I talk myself out of it? It sounds to me, if I understand correctly, that it has persisted for quite - for several years. And it - you know, it might be a good idea to think about trying to see someone with expertise in helping you reduced the fear, if it is - if it's causing you a lot of distress and maybe provoking you to avoid -one - one thing that can also be a little of a problem is that the distress that occurs in the situation can actually interfere with your functioning.

I might give you an example. Suppose the person is afraid of bees, and they're driving, and there's a bee in the car. Well, the bee is less dangerous than if they get all distracted and don't pay attention to the traffic. And they can actually - their distress and distraction from there that's part of their fear can be interfering with their practical functioning. So, I don't know if that occurs with you, with your driving, but it might be worthwhile to think about trying to get some help, so you don't have to put up with this for four more years, waiting or hoping that it might spontaneously decline.

JENNIFER: Yeah, I'm thinking, that's true, because it has - it's been quite some time. And I don't really get distracted. I get - like my hands clinch up, and my heart just start pounding, and I just - I'm so fearing that, you know, I'm going to get hit again.

Dr. KOZAK: There is a clearing house for information about anxiety. It's the Anxiety Disorders Association of America. So, if you're trying to find information about anxiety disorders and potential referrals for people with expertise in working with them, that might be a good place to start looking.

CONAN: Do they have a website?

Dr. KOZAK: Yes, they do.

CONAN: We'll get the information from you at the end of the show and put it up on our website, so Jennifer or anybody else who is interested can go to npr.org/talk and find the information there.

JENNIFER: Thank you so much.

CONAN: OK, Jennifer. Thanks very much.

JENNIFER: OK.

CONAN: And this is, I guess, a not unconnected email from Tina in Appleton, Wisconsin. I'm afraid to cross bridges. Sometimes it's worse than other times. God forbid, I get stopped in traffic on a bridge. Sometimes the anxiety gets so bad I have to take a different route. Nothing bad has ever happened to me on a bridge, and it's not the height. I'm equally afraid on low bridges and high bridges.

Dr. KOZAK: Bridges are another variant of fear of driving, and...

CONAN: And fear of heights, I guess.

Dr. KOZAK: And I've been - I have walked across bridges with folks, with high bridges, and driven across them repeatedly. And you know, there was an incident in the area recently of a tractor trailer going off a bridge around Annapolis.

CONAN: The Bay Bridge across the Chesapeake Bay, yeah.

Dr. KOZAK: Exactly. So, that - it wouldn't be surprising if some folks might develop vicarious fears about that, even though they didn't have the bad experience themself (ph). They might not have seen it or been in the traffic backup. Just knowing about that possibility, that salience in the recent news reports, could either provoke fear or exacerbate fears that - of driving and bridges that are already there.

CONAN: And that bridge, with which I'm very familiar, has a sign in front of it as saying, if you're nervous, call this number and we can have somebody else drive you over. Do those signs in themselves might trigger anxiety, you would think?

Dr. KOZAK: I don't know about that. I mean, I think the contribution of that service is that it can avoid someone who gets dysfunctional stopping in the middle of the bridge and holding up traffic, causing a safety risk, or just the distress that they have. So, I don't know that an opportunity to avoid would necessarily be sufficient to provoke a phobia. I don't know about that.

CONAN: Before we let you go, has there ever been anything that you've been afraid of?

Dr. KOZAK: Ah, I think speaking was something that I used to avoid and be anxious about, before I had a lot of experiences having to speak in public, to large groups, teaching classes, doing media presentations, et cetera. And I think that's actually a very common fear for people. In laboratory experiments where people study fear, that's one that they can use, a situation that they can use, to provoke fear in the laboratory without a lot of danger, in order to be able to study it under controlled conditions.

CONAN: Well, you should see some of the audiences as I've talked in front of.

Dr. KOZAK: It is so common...

(Soundbite of laughter)

CONAN: They can get pretty scary. Well, Michael, thanks very much for coming in. We appreciate your time.

Dr. KOZAK: And thank you for inviting me.

CONAN: Michael Kozak, a clinical psychologist at the National Institute of Mental Health. He joined us from here in Studio 3A in Washington. And coming up, "Thank you, Mr. President." Transcript provided by NPR, Copyright National Public Radio.