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I can pinpoint the exact moment when my dislike of flying became a full-fledged phobia. Five years ago, I was returning from a business trip on a perfectly clear day when we suddenly hit turbulence so severe that even the flight attendant seated next to me clutched her chest. It was the most terrifying moment of my life, and I felt certain I was going to die. Once my heart started beating again, I vowed I would never, ever set foot on a plane again.
My phobia -- and how it developed -- is hardly unique. Phobias affect as many as 12 percent of all Americans and are the most common anxiety disorder in women. They're characterized by symptoms such as a pounding heart, nausea, sweating, shaking, shortness of breath, and dizziness. Though phobias often stem from a bad personal experience, particularly in early childhood, there may also be a genetic link, according to Brian Doyle, MD, a clinical professor of psychiatry and family medicine at Georgetown University Medical School in Washington, D.C.
"Some people are just predisposed to anxiety, which makes them more susceptible to developing a phobia," he explains.
If an irrational fear is holding you back or preventing you from enjoying your life to the fullest, it's time to take action. About 20 percent of phobias resolve on their own. For the rest of them, there are things you can do to minimize their hold on you. Here, experts explain what's behind the five most common phobias and how to put your fears to rest -- or at least diminish their intensity. As a bonus, we asked pros such as a flight attendant and a speech coach for practical ways to manage panic in the moment.
What's behind it: Yes, you're worrying about forgetting your speech, being boring, and looking foolish. But what also has you on edge is a need to be liked, says Harold Steinitz, PhD, codirector of the Anxiety and Stress Disorders Institute of Maryland in Towson.
"Since there's no one-on-one feedback when you speak to a crowd, you have no way of knowing what anyone's thinking. Part of overcoming your fear is accepting this uncertainty."
But consider this reassuring fact: Researchers who have studied what's on the audience's mind during speeches have found that people want you to succeed. "When you're comfortable, they're comfortable," says Steinitz. "Rest assured that no one is picking out your flaws." If you slip up, move on quickly: The crowd will notice only if you overreact, says Steinitz.
Pro tip: Till K. Kahrs, consultant on public speaking to top CEOs and cofounder of thetrainer4u.com
In his former career as a country singer, Kahrs regularly performed in front of 25,000 fans. Nonetheless, he still sometimes gets anxious in front of a crowd. "The secret is to manage and focus your nervous energy," he explains.
His suggestions: As you speak, look at one person at a time; then, every sentence or thought, pause and shift your gaze to someone else. "Most people make the mistake of letting their eyes roam constantly around the room, but this builds tension because the brain can become overstimulated," says Kahrs. If you're still nervous, try using hand gestures as you speak; they can release tension and make you appear to be a more dynamic presenter.
What's behind it: Many people aren't necessarily worried about being bitten; they're having an intense disgust reaction. "We also may be predisposed to be on alert because these animals can be dangerous," explains Martin M. Antony, PhD, coauthor of Overcoming Animal and Insect Phobias.
In most parts of the country you can manage this phobia simply by staying out of the reptile house at the zoo. But for those who live in an area heavily populated by snakes and spiders, such as the Southwest, exposure-based treatments are often the best way to cope, says Antony. "You start by looking at images of the animal and then work your way up to handling it -- for example, holding a garter snake at a local nature reserve or a natural history museum." Once you can hold or just be near a snake or spider without a bad reaction, you should be able to manage fear if you encounter the creature in an uncontrolled setting.
Pro tip: David Catlin, director of field support for the National Audubon Society in Springfield, Missouri
If you discover a snake in your lawn or under your house, don't panic and try to decapitate it or get rid of it yourself. "Most bites occur when people try to mess with a snake, so call a professional to remove a venomous one," advises Catlin. Avoid surprise encounters by keeping your lawn mowed and clear of places where snakes might hide, such as woodpiles. Fortunately, spiders want nothing to do with humans and stay hidden in dark places, such as underneath furniture and radiators. Use a vacuum attachment to clean hard-to-reach spots where adults and eggs might be tucked away.
What's behind it: Like fear of snakes and spiders, being scared of heights is largely primitive. After all, one of your brain's jobs is to keep you away from dangerous situations, and heights are a legitimate threat, explains Sheryl R. Jackson, PhD, a clinical psychologist and associate professor at the University of Alabama at Birmingham. Even people who go bungee jumping are afraid. They've just channeled their fear into excitement, she explains.
If you become stuck on a bridge or have to go into a high-rise office building, try reasoning out the situation, suggests Jackson. "Ask yourself, what's the likelihood that the bridge or building will collapse? Think about how many millions of people have stood in your spot and been just fine." Avoid looking at your feet, which can make you feel woozy. Jackson also suggests getting something cold to drink, which shifts your focus and helps you calm down.
Pro tip: Tiki Mashy, a hang gliding instructor and co-owner of Cowboy Up Hang Gliding in Jackson Hole, Wyoming
This champion hang glider has a healthy fear of heights, even though she's soared as high as 16,000 feet. To cope, Mashy keeps low to the ground when she has to peer over the edge of a precipice. "I crouch down and look only as long as I need to. When you're down low, it helps you feel grounded, even if you're on the edge of a huge drop-off."
What's behind it: Some claustrophobics have been traumatized by a past experience, such as being locked in a closet or elevator; but for many, there is no trigger event, says Dr. Doyle. "Often, the person once had a panic attack in an enclosed space and felt she couldn't escape, then grew more afraid of having another attack than of the small space itself."
Using desensitization techniques is also one of the best ways to overcome claustrophobia, says Dr. Doyle. "Start with imagining the least scary scenario. Visualize sitting in a small room with the door closed, for example, then work up to the most frightening situation, like riding in a crowded elevator." Claustrophobics can benefit from anxiety-reducing techniques like meditation as well. "This helps you go into 'relax mode' once symptoms begin," says Dr. Doyle.
Pro tip: Kenneth Kamler, MD, author of Surviving the Extremes, and a hand surgeon and medical expert on mountain climbing and scuba expeditions
As a medical expert on dangerous expeditions, Dr. Kamler has hunkered down in tiny tents while scaling Mount Everest and gone scuba diving in narrow lava tubes. "If I feel anxious in a tight space, I imagine leaving my body," he says. This trick provides objectivity and focus; you can then ask yourself, "Do I really have a reason to panic?" and "If I need to get out of this situation, what's my best approach?"
What's behind it: There are many types of fearful fliers. Some are scared of crashes, while others have developed anxiety over terrorist hijackings post-9/11. Control issues also play a role, says Steinitz. "In a plane, you have to trust that the pilots know what they're doing." When flying, unlike driving, you can't get out whenever you want, which sets up a vicious cycle: Some fliers feel claustrophobic and fear they'll have an anxiety attack. Underlying these anxieties are troubles with risk assessment, explains Steinitz. "Anxious people confuse the possibility of an event with the probability of an event," he says. "Yes, the plane could be hijacked or crash, but it's extremely improbable." Though accidents are few, they get a lot of media coverage, exaggerating fears. "There are risks in everyday life. Ask yourself why you're investing so much energy in one that's so unlikely," he suggests.
Pro tip: James Wysong, flight attendant and author of The Plane Truth: Shift Happens at 35,000 Feet
To feel calm and in control, suggests Wysong, ask at the gate for a seat in front of the wings, where turbulence feels milder. "If you do hit a bump, sway with the motion instead of stiffening up, which makes it seem more intense," he says. And repeat to yourself: Those ups and downs don't mean that anything is wrong. Wysong's tried-and-true tip: "Watch the in-flight movie. You'll be on the ground again before you know it."
Originally published in FITNESS magazine, July 2006.