Fear of Fear Itself

The consequence is structural. A person who fears dogs can leave the park. A person who fears the sensation of fear is carrying the trigger, and any anxious response becomes a conditioned stimulus generating further anxiety, which is a self-sustaining loop rather than a reaction.

What it does to the other fears

Phobophobia is described as a bridge, sitting between the anxiety or panic a person experiences and whatever phobia they have, and intensifying the second by way of the first. It is not necessarily produced by another phobia and it is named as an important factor in maintaining them.

The mechanism is anticipatory. The fear arrives before the feared thing does, attached to the somatic sensations that precede it, so a person avoids the phobia in order to avoid the fear of it, where Counterphobia is the opposite response to the same problem. Agoraphobia is the presentation named most often, along with an extreme fear of panicking.

One belief that comes with it is worth stating on its own, because it is specific and false: patients may become convinced that their continuing anxiety symptoms will eventually culminate in a much more severe mental disorder, schizophrenia being the example given.

Which order the conditions arrive in

Generalised anxiety disorder always comes before phobophobia in the account given. The sequence is anxiety arising for no accountable reason, then panic developing from it, then phobophobia developing as a consequence of both and sharing symptoms with each.

The symptoms are the panic ones:

• dizziness and faintness
• pounding heart and excess perspiration
• slight paraesthesia and tension
• hyperventilation
• avoidance The article treats catastrophising and overgeneralisation as central to perpetuating it.

The instruction for clinicians is unambiguous: where a patient has developed phobophobia, the condition is to be diagnosed and treated as part of anxiety disorders rather than as a phobia in its own right.

Why the treatment produces the symptoms

Exposure for a fear with no external object has to be interoceptive, and the two approaches described are unusual enough to set out.

Paradoxical intention exposes the person directly to the stimulus they avoid, bringing on the sensations they fear alongside the phobia itself, so that the encounter takes place with no danger present.

The second method produces the symptoms artificially. Chemical agents including caffeine, a carbon dioxide and oxygen mixture, and adrenaline are used to trigger hyperventilation, pounding heart, blurred vision and paraesthesia. The material describes what follows in order: panic attacks occur at first, and eventually, on the evidence of a study by Griez and Van den Hout, the patient shows no fear of the somatic sensations, then none of panic attacks, and finally none of the feared phobia.

Deliberately inducing a panic attack in a person whose entire condition is a fear of panic attacks is the most counterintuitive procedure in this catalogue, and it follows exactly from the diagnosis: the object of the fear is a sensation, so the sensation is what has to be met.

Cognitive modification runs alongside it, correcting catastrophic beliefs and the expectation of imminent disaster. Some clinicians consider it the most helpful component, particularly combined with interoceptive exposure, where the point is to demonstrate that the symptoms do not signify danger or loss of control.

What the source itself reads like

The article this entry is drawn from is repetitive and in places circular, restating the same relationship between anxiety, panic and phobophobia several times in different words. That is recorded here because it is visible to anyone who reads it, and because a subject that is difficult to write about clearly is worth flagging as such rather than smoothed over.

The 2008 printed encyclopedia handles it differently, defining fear of fears in three words and cross-referencing its own entry on fear. No prevalence figure exists in either.