The Fear of Living (1)


The Fear of Living

Christian Jonathan Haverkampf, M.D.

Fear of death is widespread, but the fear of living can often be more impairing in daily life. Many mental health symptoms derive from an anxiousness, fear or apprehension about living in line with one’s needs, values and aspirations. Not engaging with life can lead to an unfilled life and several mental health issues. Engaging with life means communicating with others and oneself effectively.

Keywords: fear of living, communication, psychotherapy

Table of Contents

Introduction. 5

Control and Perspective. 6

Communication Fears and Barriers. 6

Understanding Fear. 7

Overgeneralization. 8

Fear and cognitive abilities. 8

Learning. 9

Anxiety. 9

Social Networks. 9

Connectedness, Social Networking Sites (SNSs) and the Fear of Missing Out (FOMO) 10

Extinction. 10

Flexibility. 10

Memory. 11

Learning. 11

Empathy and Fear. 11

Stress. 11

Fear and Society. 12

You and I 12

Example: Initiating Communication with a Romantic Interest. 13

The Fear of Being Single, Scarcity and ‘Settling for Less’ 13

Proactive Behaviours in Men. 13

Fear of Rejection. 14

Early Communication. 15

Attachment. 15

The Power of Connectedness. 16

Self-Statements. 16

Technology and Communication. 17

Information about Oneself 18

Anxiety vs Behaviours. 20

Misattribution. 20

Fearing the Fear. 21

Fear of Change. 21

Reasonable vs Unreasonable Fears. 21

Neurobiology. 21

The Fear Network. 22

Serotonin. 22

Oxytocin. 23

The Amygdala. 23

Fear without the Amygdala?. 23

Fast Pathways. 24

The Microbiome. 24

Inferior Frontal Gyrus. 24

Learning. 24

Reversal 25

Neuronal coordination. 25

Memory. 26

The Thalamus. 26

Fear vs Anxiety: Information. 27

Extinction. 27

Change. 28

The Cortical Neural Network. 28

Anxiety. 29

Biological Approaches. 29

Memory. 29

C-Cycloserine. 29

MDMA. 30

Other Approaches. 30

Change. 30

Change from Within. 30

Change Without. 31

Psychological Approaches. 31

CBT: Fear of Flying. 31

Virtual Exposure. 31

Fear of Flying (FOF) 32

Systematic Desentization. 32

Expressive Therapy. 32

Cognitive Processing Therapy (CPT) 32

Thoughts and Emotions. 32

Meaningfulness. 33

Communication and Fear. 33

Patterns and Communication Structures. 34

Questions. 34

Building the Motivation to Overcome One’s Fears. 34

Information Overload. 34

Relevance. 35

Selecting Information. 35

The Right Question. 35

Values and Basic Interests. 35

Generalisation. 36

General Questions. 36

Communication to Counter Fear. 36

References. 37


Many are aware of the fear of death, but the fear of living can often be more impairing in daily life. Fear can be an adaptive emotion that helps defend against potential danger. However, the overgeneralization of fear to harmless stimuli or situations is a burden to daily life and characteristic of posttraumatic stress disorder and other anxiety disorders. (Dunsmoor & Paz, 2015)

Many mental health symptoms to derive from an anxiousness, fear or apprehension about living in line with one’s needs, values and aspirations. Life can be complicated and scary, but not engaging with it can lead to an unfilled life and various mental health issues. One of the pillars of life is the exchange of information, whether this occurs in a single cell organism or the human body. The communication between cells and within cells ensures survival. Once it ceases, death results. Communication also occurs among living organisms, including people. Engaging with life means communicating with others and oneself effectively.

The first important step is to identify what is the aim of a fear one is experiencing. In many cases, this may be life itself or just allowing oneself to be happy. Facing one’s fears means acting. They are a hindrance to interactions with oneself and the world, and overcoming them can increase happiness, satisfaction and contentment in the long run. Unhelpful fears are those that do not offer protection and interfere with life. The fear of interacting and connecting with oneself and others can be the most life impairing one.

Emotions are usually valuable signals, but internal events unrelated to the current situation can trigger fear. Emotional messages, such as fear, are at the most basic information that is assembled and communicated internally. (Haverkampf, 2018a) Foa and Kozak contended that emotions are represented by information structures in memory, and anxiety occurs when an information structure that serves as a program to escape or avoid danger is activated. (Foa & Kozak, 1986) Fear of communication, the flow of information, is probably the widest-reaching and most debilitating fear because any new information to which the brain is exposed can activate it.

The information flows leading to the emergence of fear follow the basic rules of communication, while there are certain structures in the brain which play a more pronounced role in fear. The amygdala has many efferent projections and represents a central fear system involved in both the expression and the acquisition of conditioned and unconditioned fear. (Davis, 1997) Lesions of the amygdala block innate or conditioned fear, as well as various measures of attention, and local infusions of drugs into the amygdala have anxiolytic effects in several behavioural tests.  From a biological standpoint, fear is a very important emotion. It helps you respond appropriately to threatening situations that could harm you. This response is generated by stimulation of the amygdala, followed by the hypothalamus. This is why some people with brain damage affecting their amygdala do not always respond appropriately to dangerous scenarios. When the amygdala stimulates the hypothalamus, it initiates the fight-or-flight response. The hypothalamus sends signals to the adrenal glands to produce hormones, such as adrenaline and cortisol.

Control and Perspective

Having a sense of control makes people feel more secure in life. However, the amount of influence one has is a matter of perspective. Fear and anger have opposite effects on risk perception. Whereas fearful people express pessimistic risk estimates and risk-averse choices, angry people show optimistic risk estimates and risk-seeking choices. Appraisals of certainty and control seem to moderate and (in the case of control) mediate the emotion effects. (Lerner & Keltner, 2001) This does not mean going through life taking senseless risks and being angry, but to be open to and keep an eye on the options life has to offer. Following the own path feels at least more in control and less fearful than just running around in circles.

Important in overcoming fear is to assess the level of control that a given situation requires. Often, fear is a result of an increased perceived need for control to stay ‘safe’. Feeling less in control usually happens when the internal compass of needs, values and aspirations gets lost. One can recover it by thinking of what one needs to feel happy and content. In communication-focused therapy, one way to address this is to look at the primary parameters, the needs, values and aspirations of the individual. (Haverkampf, 2018f) Quite often, patients find out that they were searching for that basic sense of security in something external, such as relationships or material goods, that were not the highest priorities on their needs and value lists. So, rather than feeling safer, they often felt less safe when acquiring them.

Communication Fears and Barriers

People build barriers when they are afraid. The problem with this is that information can reduce fears, and any restrictions on the free flow of meaningful information will make it even harder to lessen fears, leading into a vicious cycle. Connectedness with oneself and with others reduces anxiety, but it may require changing unhelpful and counterproductive communication patterns which interfere with effective communication within oneself and with others (Haverkampf, 2018b, 2019a)

Internal communication, the one we have with ourselves, and external communication, the one we have with others, are closely linked, and often reflections of each other. In the area of dating communicatioon, for example, results of one study showed that relatively shy emerging adults had more internalizing problems (e.g., anxious, depressed, low self-perceptions in multiple domains), engaged in fewer externalizing behaviours (e.g., less frequent drinking), and experienced poorer relationship quality with parents, best friends, and romantic partners than did their non-shy peers. (Nelson et al., 2008)

Understanding Fear

When faced with threat, the survival of an organism is contingent upon the selection of appropriate active or passive behavioural responses. Freezing is an evolutionarily conserved passive fear response, for example. The central amygdala (CEA) is a forebrain structure vital for the acquisition and expression of conditioned fear responses, and the role of specific neuronal sub-populations of the CEA in freezing behaviour is well-established. Fadok and colleagues showed that active and passive fear responses are mediated by distinct and mutually inhibitory CEA neurons. Cells expressing corticotropin-releasing factor mediate conditioned flight, and activation of somatostatin-positive neurons initiates passive freezing behaviour. (Fadok et al., 2017) The selection of appropriate behavioural responses to threat seems to be based on competitive interactions between inhibitory signals on each other from these cell groups.

Since our reality is built from the information in our brain, an emotion can be as real as a rock. A fear of life can perfuse everything that we associate with life, including the things that may be important or of special value to us. Taking the first step to go out there and actively participate in life, whether in work or in one’s personal life, can inspire fear. Quite often apprehensiveness with connectedness in one realm can spill into the other one, and vice versa. While fears can be quite specific, such as a fear of insects, a fear of a more colourful and enjoyable life can modify everyday behaviours and thoughts considerably.

Understanding the fear signals and the information they contain provide important insight, which  can bring about change that reduces the fear. An emotion is an ‘e-motion’ because it is supposed to move something, because it needs to bring about change. Identifying the information behind, or underlying, an emotion required identifying and reflecting on the emotion, but in communication oriented therapies, for example, it can become a useful habit. (Haverkampf, 2010c, 2017d, 2017b, 2018c) The effect of fears and anxiety, and whether they can lead to positive adjustments and changes, depends on how one reads them, how one extracts and distils the signals contained in them. Often, the fear of being fearful prevents the resolution of fear. In this situation a focus on changes in internal and external communication patterns can lead to the needed information to resolve the fear in a better way than merely confronting an emotion. The author has described many techniques in this regard elsewhere (Haverkampf, 2017a, 2018c).


A fear of living is different from simply a generalised anxiety disorder because of its all-pervasiveness, affecting also one’s perspective and approach to life, often without even being aware of it. The overgeneralization of fear is maladaptive and can be observed also in conditions such as PTSD. A generalisation of fear can happen quite quickly and within few steps. Asok and colleagues examined how male and female mice generalize contextual fear at 3 weeks after conditioning. The test order of training and generalization contexts appeared to be critical determinants of the generalization and context discrimination. (This was particularly true for female mice, while tactile elements that were present during fear conditioning were more salient for male mice.) (Asok et al., 2019)

Fear and cognitive abilities

Fear of physical injury includes matters that are perceived by human beings that depend on reality testing, abstraction ability, and capacity for self-preservation. (Blackman, 2018). Treating people who are afraid of physical injury involves helping them to understand the realities of life and to acknowledge their reality perceptions of danger. In cases where the reality of the danger is miniscule or non-existent but reality testing is adequate and abstraction ability good, insight-directed work can help people understand the contributions to their fears of physical injury from various stages of development where they experienced difficulty.


It may sometimes be hard to understand why horrible man-made atrocities and natural disasters happen in the world. As a first step, we may have to accept that they do, which can be helpful in trying to prevent them. When someone has experienced trauma, often the fear of communicating with oneself and others increases. Overall, engaging with and in life becomes more difficult. One usually withdraws from the world but dissociates from oneself at the same time. The end result can be a feeling of numbness and disconnectedness from oneself and others. It also shakes the sense of security in the world and within oneself because rules that underlie the predictability and normalcy of everyday life have been shattered and broken.  Soldiers who witnessed atrocities in combat or rape victims are brought to and beyond the edge of normal human experience, perpetrated by other human beings where the basic parameters of what it means to be human seemingly no longer apply.

It is now generally believed that PTSD is due at least in part to a learning process in which formerly neutral stimuli are paired with extremely aversive events. This may be something as mundane as a spoon, if this was the last thing one used before the Tsunami hit the bar, or in a rape situation the pattern on a carpet. This is a classic example of Pavlovian fear conditioning, particularly if it happens repeatedly. Even though it may seem that the fear is focused on specific objects or situations, it is important to remember that trauma by its very definition affects the overall sense of feeling safe within the world and oneself. Reshaping communication-patterns, new meaningful information and a greater connectedness with oneself and others are all helpful in overcoming trauma (Haverkampf, 2016)


Learning by conditioning is a key ability of animals and humans for acquiring novel behaviour necessary for survival in a changing environment. Aberrant conditioning has been considered a crucial factor in the aetiology and maintenance of various types of fear. We learn throughout our entire life, which brings about change, which can cause anxiety. Once we realize how close anxiety and excitement lie together, it can help to establish a deeper feeling and connection with life. While fear can be helpful in the moment, we need to overcome int over time when we face a similar situation again. Below a sea of anxiety there is really the bright light of a love for life and connectedness with the universe.


Anxiety begets more fears. The learning of fear seems to be facilitated in patients suffering from anxiety. In a meta-study by Duits and colleagues, results demonstrated increased fear responses to conditioned safety cues in anxiety patients compared to controls during acquisition. In contrast, during extinction, patients show stronger fear responses to the safety cues and a trend toward increased differentiation between the safety and danger cues compared to controls. (Duits et al., 2015) A fear of life is thus greater when there is a background anxiety. But as mentioned above, it depends on how the feeling of anxiety is interpreted. If the feeling of anxiety is interpreted as excitement in the sense of investigating how the world works, fear in general will be lower (Haverkampf, 2017g, 2018e).

Social Networks

Our social network are the outcomes of our communication patterns and interactions with other people. Social networking sites are especially attractive for adolescents, but it has also been shown that these users can suffer from negative psychological consequences when using these sites excessively. Particularly, the fear of missing out has becomes a major problem. Since information about the outside world and the inside world is processed in the same brain in often the same centres, it is easy to understand that virtual networks can seem very real. While it is still possible to use the virtual nature of social networks to ease into dating, it may be the case that over time the virtual world becomes the new real world.

At the same time, it is important to remember that the need to communicate is a basic biological requirement of life, and that the fear of missing out is connected with this basic need. The main problem is that if meaningful sources of information cannot be identified effectively, the person may look to plug into communication networks, including social networks, merely for the sake of connecting, rather than really benefiting from it. As mentioned before, fear can be reduced by meaningful information (Haverkampf, 2018e), but that requires the skills and insight to identify sources of meaningful information.

Connectedness, Social Networking Sites (SNSs) and the Fear of Missing Out (FOMO)

In an online survey of over a thousand social media users between 16 and 18 years old, it was found that both the fear of missing out and social networking intensity mediate the link between psychopathology and negative consequences of using social networking sites via mobile devices, but by different mechanisms. Additionally, for girls, feeling depressed seemed to trigger higher SNS involvement, while for boys, anxiety triggered higher SNS involvement. (Oberst, Wegmann, Stodt, Brand, & Chamarro, 2017) In another study by Blackwell and colleagues that investigated whether extraversion, neuroticism, attachment style, and fear of missing out were predictors of social media use and addiction, 207 participants completed a brief survey measuring levels of extraversion, neuroticism, attachment styles, and FOMO. Younger age, neuroticism, and fear of missing out predicted social media use. However, only fear of missing out predicted social media addiction. Attachment anxiety and avoidance predicted social media addiction, but this relationship was no longer significant after the addition of FOMO. (Blackwell, Leaman, Tramposch, Osborne, & Liss, 2017) In a study by Elhai and colleagues, smartphone use was most correlated with anxiety, need for touch and FOMO. Problematic smartphone use was associated with FOMO, depression (inversely), anxiety, and need for touch. Frequency of use was associated with need for touch, and (inversely) with depressive symptoms. Interestingly, emotional suppression also mediated the association between problematic smartphone use and anxiety. (Elhai, Levine, Dvorak, & Hall, 2016) This is another example for the tight link between external and internal connectedness (Haverkampf, 2010a).


The goal of any therapeutic approach to fear, or to managing fear in life generally, is to manage fear. While this should not mean extinguishing all fear, as this is an important informational signal for survival, but to be able to reduce or extinguish the fear which is interfering with life in unhelpful ways. In fear extinction, the positive experience of an omitted aversive event drives the reduction of fear responses and the formation of long-term extinction memories. Dopamine emerges as key neurobiological mediator of these related processes. (Kalisch, Gerlicher, & Duvarci, 2019) Exposure therapy is a form of cognitive intervention that specifically changes the expectancy of harm. (Hofmann, 2008)

Extinction is possible even without exposure to the feared situation or location in real life. A number of studies have shown that exposure to virtual stimuli works as well. Investigators have, for example, shown that VRT was successful in reducing the fear of the public speaking. (North, North, & Coble, 2015) In other words, the information is again what is important and the way in which it is communicated.


Fear can be highly adaptive in promoting survival, yet it can also be detrimental when it persists long after a threat has passed. Flexibility of the fear response may be most advantageous during adolescence when animals are prone to explore novel, potentially threatening environments. Two opposing adolescent fear-related behaviours—diminished extinction of cued fear and suppressed expression of contextual fear—may serve this purpose, but the neural basis underlying these changes is unknown.


Memory is a store of information available for retrieval by the individual. As meaningful information can reduce fear, the ability to store it, can have a lasting effect of reducing or mitigating fear. Fear memory is formed in the hippocampus (contextual conditioning and inhibitory avoidance), in the basolateral amygdala (inhibitory avoidance), and in the lateral amygdala (conditioning to a tone).

The circuitry involves, in addition, the pre- and infralimbic ventromedial prefrontal cortex, the central amygdala subnuclei, and the dentate gyrus. Fear learning models, notably inhibitory avoidance, have also been very useful for the analysis of the biochemical mechanisms of memory consolidation as a whole. These studies have capitalized on in vitro observations on long-term potentiation and other kinds of plasticity. The effect of a very large number of drugs on fear learning has been intensively studied, often as a prelude to the investigation of effects on anxiety.


Fear memory was thoroughly investigated mostly using two classical conditioning procedures (contextual fear conditioning and fear conditioning to a tone) and one instrumental procedure (one-trial inhibitory avoidance).

Empathy and Fear

The relationship between empathy, a connective signal, and fear, a potentially disconnective signal, is interesting. Olsson and colleagues investigated how social (vicarious) fear learning is affected by empathic appraisals by asking participants to either enhance or decrease their empathic responses to another individual (the demonstrator), who received electric shocks paired with a predictive conditioned stimulus. A third group of participants received no appraisal instructions and responded naturally to the demonstrator. During a later test, participants who had enhanced their empathy evinced the strongest vicarious fear learning as measured by skin conductance responses to the conditioned stimulus in the absence of the demonstrator. Moreover, this effect was augmented in observers high in trait empathy. Their results suggest that a demonstrator’s expression can serve as a “social” unconditioned stimulus (US), similar to a personally experienced US in Pavlovian fear conditioning, and that learning from a social US depends on both empathic appraisals and the observers’ stable traits. (Olsson et al., 2016)


Stress has a critical role in the development and expression of many psychiatric disorders and is a defining feature of posttraumatic stress disorder (PTSD). Stress also limits the efficacy of behavioural therapies aimed at limiting pathological fear, such as exposure therapy. Here we examine emerging evidence that stress impairs recovery from trauma by impairing fear extinction, a form of learning thought to underlie the suppression of trauma-related fear memories. We describe the major structural and functional abnormalities in brain regions that are particularly vulnerable to stress, including the amygdala, prefrontal cortex, and hippocampus, which may underlie stress-induced impairments in extinction. We also discuss some of the stress-induced neurochemical and molecular alterations in these brain regions that are associated with extinction deficits, and the potential for targeting these changes to prevent or reverse impaired extinction. A better understanding of the neurobiological basis of stress effects on extinction promises to yield novel approaches to improving therapeutic outcomes for PTSD and other anxiety and trauma-related disorders. (Maren & Holmes, 2016)

Fear and Society

Society is built on communication links, which are not entirely flexible. Since fear and anxiety are both lower the more meaningful information there is, their level depends on how messages are formed and can be transmitted within a community. More rapid and efficient communication networks can make more meaningful information from more sources more easily and quickly available, but their effectiveness in the end depends on how information streams are selected and the individual’s ability to choose information sources most efficiently and beneficially. Messages of fear can reduce openness and put a narrower focus on the sources and the content of these messages. Tannenbaum and colleagues have studied fear appeals in a comprehensive meta-analysis investigating their effectiveness for influencing attitudes, intentions, and behaviours. Results showed that fear appeals were effective at positively influencing attitude, intentions, and behaviours, that there were very few circumstances under which they were not effective, and that there were no identified circumstances under which they backfired and lead to undesirable outcomes. (Tannenbaum et al., 2015) Group messages can even give rise to irrational or illogical fears, which then have the potential to become entrenched. Research results imply that there is a fear of the feminine in men, which prevents them from infringing on prescribed gender boundaries. This may also take the form of the use of psychological defences to distance from thoughts and behaviours perceived as not masculine. (Kierski & Blazina, 2009)

You and I

Shyness is a form of social anxiety that has been characterized as anxious preoccupation with the self in the presence of others. Some researchers argue that a necessary precondition for experiencing the state emotion of shyness is public self-consciousness—that is, awareness of the self as a social object. Although the importance of self-processes in the experience of shyness has been generally recognized, the role of the self has not been fully explicated in this regard. This chapter reviews previous researches on shyness as well as some recent data with particular emphasis on the discrepancy between self and other perception of social behaviour. An overview of the concept of shyness is presented and its emergence in the psychological literature as a descriptive and theoretical construct is discussed. The research is analysed which focuses on shyness including the rate of its occurrence, internal, and behavioural correlates. The data linking dispositional shyness to limited and problematic social networks is also reviewed in the chapter. (Jones & Briggs, 1984)

Perspective is important, because one cannot read another person’s thoughts. One often decodes information from oneself and from other’s differently, which depends on the assumptions one makes about how another person processes information (Haverkampf, 2018a).  In one study, participants who indicated that they were more likely than a potential partner to be inhibited from making an initiative by a fear of rejection, attributed a potential partner’s inaction to a lack of interest in developing a relationship with them. Individuals spontaneously perceive a potential partner’s inaction as reflective of disinterest more so than they perceive their own inaction in these terms. Participants’ divergent perceptions of their own vs their potential partner’s underlying feelings stemmed from the biased interpretation of inaction. (Vorauer & Ratner, 1996)

Example: Initiating Communication with a Romantic Interest

Making romantic connections is a very basic, yet powerful need. Evolutionary requirements for the survival of the species come into play, which may explain why the mating process involves communication nuances on so many levels. It is biologically serious business, and fears in this domain can impact significantly on the quality of the life of the individual. On the other hand, there is hardly any domain of communication which has as much to do with how one communicates with oneself, self-image, confidence, self-esteem, and one’s place in the world overall. Mating communication thus serves as a good example to investigate the fear of living in general.

The Fear of Being Single, Scarcity and ‘Settling for Less’

Spielmann and colleagues in a cross-sectional study found that those with stronger fear of being single reported greater longing for their ex‐partners. The fear of being single seemed to increase after a breakup, regardless of who initiated the breakup. Longing for an ex‐partner and attempts to renew the relationship were greater on days with stronger fear of being single. The fear of being single increased longing and renewal attempts over time, but longing and renewal attempts did not influence fear of being single. (Spielmann, MacDonald, Joel, & Impett, 2016)

In another study by the same authors, the fear of being single predicted (Spielmann et al., 2013)

  • settling for less in ongoing relationships

interest in less responsive and less attractive dating targets being less selective in expressing romantic interest but did not predict the other’s romantic interest.

Proactive Behaviours in Men

In a study by Kraeger and colleagues on American online dating data, the authors found that men and women tend to send messages to the most socially desirable alters in the dating market regardless of their own desirability levels. They also found that male initiators connect with more desirable partners than men who wait to be contacted, but female initiators connect with equally desirable partners as women who wait to be contacted. Female‐initiated contacts are also more than twice as likely as male‐initiated contacts to result in a connection, but women send four times fewer messages than men. (Kreager, Cavanagh, Yen, & Yu, 2014)

Fear of Rejection

Fisman and colleagues studied dating behavior using data from a Speed Dating experiment where we generate random matching of subjects and create random variation in the number of potential partners. Our design allows us to directly observe individual decisions rather than just final matches. Women put greater weight on the intelligence and the race of partner, while men respond more to physical attractiveness. Moreover, men do not value women’s intelligence or ambition when it exceeds their own. Also, we find that women exhibit a preference for men who grew up in affluent neighborhoods. Finally, male selectivity is invariant to group size, while female selectivity is strongly increasing in group size. (Fisman, Iyengar, Kamenica, & Simonson, 2006)

Using technology to eliminate a fear of rejection offers a powerful incentive for a powerful emotion. One invention, for example, uses the knowledge one has with certain people or companies of interest, and discloses a member’s intention to advance relation to the other only when the other also wants to advance it, and only when certain criteria or expectations predefined by the members are met. (“US20090006120A1 – Social and/or Business Relations Icebreaker: the use of communication hardware and/or software to safely communicate desires to further advance relations without the fear of being rejected and/or unnecessarily revealing information and/or intentions. – Google Patents,” n.d.)

It is also important to consider that rejection may have an important role to play. In a study using online dating data, couple similarities were more likely to result from relationship termination, i.e. nonreciprocity, than initial homophilous preferences. (Kreager et al., 2014)

Online dating sites try to lower the fear of rejection by collecting and comparing data to lessen the risk of rejection. In one case, the computer program takes advantage of existing contact lists such as those on social networking sites, instant messaging programs, or cell phones. It allows the user to characterize each contact on the basis of the user’s level of interest in that contact as a date. The program keeps these rankings secret until two users indicate an interest in each other that surpasses a certain threshold. The users are then notified of the mutual interest. (“US9934297B2 – Method of facilitating contact between mutually interested people – Google Patents,” n.d.) This may help lesten the risk of rejection, but by not exposing individuals to rejection, it may actually worsen it when it happens. On the other hand, computer-assisted matchmaking makes it possible to screen more information in a smaller amount of time. So, thereby it may enhance the engagement with the romantic aspect of life, even though it may lower the risk of rejection.

Perceiving Reality

Fears can distort how we perceive reality. They change how information is decoded and translated into meaning or how one perceives the communication process. Work on communication patterns in interpersonal and internal contexts in CFT can reverse this distortion (Haverkampf, 2017a). Vorauer and colleagues demonstrated in their studies that fears of rejection prompt individuals to exhibit a signal amplification bias, whereby they perceive that their overtures communicate more romantic interest to potential partners than is actually the case. The link between rejection anxieties and the bias was evident regardless of whether feats of rejection were assessed in terms of chronic attachment anxiety or were induced by reflection on a previous rejection experience. Mediation analyses suggested that the bias stems in part from an expected-augmenting process, whereby persons with strong fears of rejection incorrectly assume that the recipient of their overtures will take their inhibitions into account when interpreting their behavior. Implications for understanding the link between attachment anxiety and loneliness and for designing social skills interventions are discussed. (Vorauer, Cameron, Holmes, & Pearce, 2003)

Human emotions serve adaptive functions. A study by Teich and colleagues proposed that mating anxiety helps solve the adaptive problem of the costliness of being rejected by a potential mate. To accomplish this, the mating anxiety mechanism was hypothesized to estimate the likelihood of rejection by a potential mate by calculating the discrepancy between their respective levels of desirability (Mate Value Discrepancy) in terms of social attractiveness and social / financial resources. Hierarchical Linear Modeling was used to test the predictions about mate value discrepancy (MVD) and likelihood of rejection (LR) on Anxiety. MVD had a highly significant effect on Anxiety and on LR. LR had a significant effect on Anxiety as predicted, but did not mediate the effect of MVD on Anxiety. A gender differences in anxiety were found in the effect of profile status/resources on anxiety, but not for other profile or participant characteristics as expected. men having greater anxiety than women. (Telch et al., n.d.)

Early Communication

This study examined the relationship between perceived dysfunctional family-of-origin rules and intimacy in single young adult dating relationships. A sample of 754 single, Caucasian-American young adults completed measures of perceived dysfunctional family-of-origin rules and emotional, intellectual, and sexual intimacy in dating relationships. When controlling for the effects of gender and age, results showed that perceived dysfunctional family-of-origin rules had a negative impact on the perceived expression and experience of these three kinds of intimacy in dating relationships. Implications for relationship therapy are discussed. (Larson, Peterson, Heath, & Birch, 2000)


Attachment anxiety predicts dating outcomes that goes beyond other factors, including attractiveness. In a study by McClure and colleagues, anxious participants at speed-dating were motivated by loneliness. They were unpopular and unselective; they missed fewer opportunities but made more failed attempts. Anxious men made fewer matches than non-anxious men, whereas anxious women were buffered by having a response bias toward saying “yes” to potential partners. (McClure, Lydon, Baccus, & Baldwin, 2010)

Electronic intrusion (EI) is the use of social media to intrude into the privacy of a dating partner, monitor a partner’s whereabouts and activities, and pressure a partner for constant contact. A survey study of 703 high school girls and boys by Reed and colleagues found that higher levels of attachment anxiety were associated with more frequent perpetration of EI for both girls and boys. Therefore, especially for anxiously attached teens, social media may create a “cycle of anxiety” in which social media serve as both a trigger for relationship anxiety and a tool for partner surveillance in an attempt to alleviate anxiety. (Reed, Tolman, Ward, & Safyer, 2016)

This prospective study (N = 90) investigated the early formation of romantic relationships within an attachment‐theoretical framework. Specifically, it tested whether general attachment to romantic partners was predictive of single individuals’ progressing from not dating to dating and from not dating or casual dating to a committed and exclusive relationship when simultaneously considering desire for starting a committed relationship, prior dating involvement, and self‐perceived physical attractiveness. Attachment avoidance, but not anxiety, was predictive of not entering into committed dating relationships even with rival predictors included. The transition from not dating to casual or committed dating was mainly predicted by prior dating success with some support for a potential additional role of the desire to form a committed relationship. (Schindler, Fagundes, & Murdock, 2010)

The Power of Connectedness

The effect of communication connectedness goes beyond any immediate direct effects. La Greca and colleagues found in their study found that adolescents with fewer other-sex friends and those with less positive and more negative interactions with their best friends reported high levels of dating anxiety. They concluded that adolescents’ social relationships have the potential to support or interfere with the development of successful romantic relationships. (La Greca & Mackey, 2007) In a study by Himadi and colleagues, low-daters showed greatermdifficulties in same-sex friendship interactions and were less well-adjusted on the Eysenck Personality Inventory (EPI) than more relaxed frequent daters. However, these differences were not observed in women. (Himadi, Arkowitz, Hinton, & Perl, 1980)


Results in a study by Glass and colleagues indicated that participants trained in cognitive self-statement modification showed significantly better performance in role-play situations for which they were not trained, made significantly more phone calls, and made a significantly better impression on the women than subjects in other groups. These effects were generally maintained at follow-up, and the cognitive self-statement groups’ performance on the role-play measures improved from posttreatment to follow-up. (Glass, Gottman, & Shmurak, 1976) Women with breast cancer or a genetic susceptibility to developing this disease report a myriad of dating concerns. In a study by Shaw and colleagues, six areas of concern were identified: Feeling unattractive due to treatment side effects; perceiving limited dating partners available; determining how, when and what to disclose; fear of cancer recurrence and reduced life expectancy; apprehension about entering into a new sexual relationship; and dating urgency and not wanting to ‘waste time’ on partners without long-term potential. (Shaw, Sherman, & Fitness, 2015)

Technology and Communication

Anxiety associated with dating appears to occur for a variety of reasons, such as (a) the desire to establish heterosocial relationships; (b) the social importance and status associated with dating; (c) the fact that dating is a social skill that emerges relatively late in development (Hansen, Christopher, & Nangle, 1992)

Technology can help overcome inhibitions, particularly in men. A survey of the users of an online computer-mediated matchmaking service by Scharlott and Christ found that (Scharlott & Christ, 1995)

  • Men generally contacted women more than vice versa, but a substantial minority of the women contacted a great number of men.
  • Users who scored higher on a shyness scale were much more likely than less shy users to say they were using the system to find romance or sex
  • Women who rated their own appearance as average were less likely to be contacted by men than those who rated their appearance as above average
  • There was no significant difference between appearance groups concerning the likelihood of starting a romantic or sexual relationship.
  • Intrinsic aspects of the computer-mediated matchmaking system helped some users overcome relationship-initiation barriers rooted in sex role, shyness, and appearance inhibitions.

In a study by Gatter and Hodkinson, no differences were found in motivations, suggesting that people may use both Online Dating Agencies and Tinder for similar reasons. There were no differences in self-esteem or sociability between the groups. Users of both Tinder and Online Dating Agencies did not appear to differ from the general population. (Gatter & Hodkinson, 2016) However, in a study by Zlot and colleagues, users of Internet-dating applications showed higher scores on a sex addiction scale. (Zlot, Goldstein, Cohen, & Weinstein, 2018)

“People-nearby applications” (PNAs) are a form of ubiquitous computing that connect users based on their physical location data. One example is Grindr, a popular PNA that facilitates connections among gay and bisexual men. A factor analysis by Van De Wiele and Tong revealed six uses and gratifications: social inclusion, sex, friendship, entertainment, romantic relationships, and location-based search. (Van De Wiele & Tong, 2014)

Dinh and colleagues examined the mate preferences and communication patterns of male and female users of the online dating site eHarmony over the past decade to identify how attitudes and behaviors have changed over the past decade. (Dinh, Gildersleve, & Yasseri, 2018) Some of the findings were that

  • women are more selective and restrict their potential mating pool more than men do
  • smoking level, ethnicity, and drinking level were the most important match criteria for both men and women overall
  • income was the second least important criterion to women, religion being the least
  • women on average do consider income in a potential match more important than men do, but the importance of this trait has decreased significantly over time
  • women are still more restrictive overall in their preference for age than men are
  • In larger group sizes, male selectivity is unchanged (about one in two), while females become significantly more selective, choosing a little more than a third of their partners
  • physical attractiveness does not have a linear relationship with communication rate; communication rates may also be determined by expectations about who will respond
  • women’s communication rates seem to me more dependent on their looks than for men
  • an indication, at least, that individuals have an awareness, if weak, of their own desirability
  • correlations between attractiveness and selectivity
  • being younger and athletic and having more photos increases likelihood of receiving messages in online dating, as does being romantic and altruistic.

However, apart from some very general pointers, much may also depend on the dating platform. As people’s motives for joining a virtual mating space may be different, so will also be the chances of finding what one is looking for. Some sites are also making the sending of certain signals that one is interested more costly or restrict their number. This could help to create a more even playing field and reduce the problem that sending messages to a large number of people is a strategy for several men. In the case of Bumble, for example, only women can make the first move by sending the first message. This may solve some problems, but also turn away those who want the man to take the first step, whether male or female, and preselect a certain profile.

Information about Oneself

The experience of the self is equivalent to the experience of information flows within oneself and with the outside world (Haverkampf, 2012, 2017f). Feeling alive means perceiving more information flows. Information about the self is information about these information flows, which are unique to the individual but happen within the information flows in the world shared with others.

Social anxiety is linked to the communication of information about the self. Social anxiety appears to arise from people’s concerns about the impressions others are forming of them. Social anxiety occurs when people are motivated to create a desired impression on audiences but doubt they will do so (Schlenker & Leary, 1985). High social anxiety, in turn, is associated with qualitative and quantitative changes in how people communicate (Schlenker & Leary, 1985).

Attempting to create the desired impression, but low expectations of achieving this, produces negative affect, physical or psychological withdrawal from the situation, and self-preoccupation with one’s limitations. The heightened social anxiety impedes optimally effective self-monitoring and control. A protective self-presentational style, in which the focus is on avoiding blatant failures rather than achieving significant successes, is engaged. The result can include (Schlenker & Leary, 1985):

  • less interactions with others,
  • the avoidance of topics that might reveal one’s ignorance (e.g. factual matters),
  • minimal disclosure of information about the self,
  • cautious self-descriptions that are less positive and less likely to assert unique qualities that draw attention to the self, and
  • a passive yet pleasant interaction style that avoids disagreement (e.g. reflective listening, agreeing with others, smiling).

The consequence is a vicious cycle in which less engagement with life leads to even greater isolation. Once one begins to focus and connect with oneself, this cycle can be broken. Practically, this can be achieved by working on the communication patterns one uses with oneself and others. The authors has described several techniques and the theoretical underpinnings elsewhere (Haverkampf, 2017a, 2018d). Improved communication patterns support a more active participation in life and foster the feeling of greater self-efficacy, self-actualization, more fulfilment, satisfaction and a greater quality of life in general (Haverkampf, 2017e).


Usually, one uses the information one has about oneself to conjecture how one appears to others. Projection is when we use our own thoughts to estimate what others are thinking, when we see others as copies of ourselves without realising it. The problem is that when we are critical of ourselves we will think others are critical of us or when we feel incompetent we think that others see us as incompetent. If we constantly feel a need to evaluate or control ourselves, we feel that others are constantly evaluating us as well, even in areas that may not be visible to another. It has been argued from a self-presentational view that the fear of being socially evaluated is pivotal to dispositional shyness.  In a study by Asendorpf, compared with the group lower in shyness, the shy subjects (Asendorpf, 1987)

  • recalled more fear of social evaluation (including fear of positive evaluation) but did not more often report other kinds of fear,
  • had more negatively biased thoughts about the impression made on their partner but not more impression-related thoughts in general, and
  • showed more negatively biased reactions to the positive feedback of their partner.

Findings further suggested that evaluative situations also arouse fears of having to evaluate others. (Asendorpf, 1987) The problem with a constant need for evaluation is that we cannot measure something that is still unfolding, one’s journey in life. Something that may not make sense yet could be a blessing later on. The only thing we can do is live life in alignment with the basic parameters, the needs, values and aspirations, which should spring from well-informed insight (Haverkampf, 2018f).  This approach is particularly helpful when one experiences anxiety and fears, and the author has described several techniques from a CFT perspective (Haverkampf, 2017c)

Socially anxious or shy individuals may use their anxiety symptoms as a strategy to control attributions made about their performances in social-evaluative settings. In a study by Snyder and colleagues the results supported the following for males but not for females  (Snyder, Smith, Augelli, & Ingram, 1985):

  • trait-socially anxious or shy Ss would report more symptoms of social anxiety in an evaluative setting in which anxiety or shyness could serve as an excuse for poor performance than would Ss in (a) an evaluative setting in which shyness was precluded as an excuse or (b) a nonevaluative setting
  • this self-protective pattern of symptom reporting would not occur for Ss who were not trait-socially anxious because these Ss would not commonly use such symptoms as a self-handicapping strategy

Anxiety vs Behaviours

From a communication perspective, it is important to remember that it is ultimately about meaningful information. Since information flows on the inside inform us of moods and anxiety, for example, communication patterns in the external world have also as an aim to gain or to give information. There are important conceptual distinctions between of reticence, shyness, communication apprehension, and unwillingness to communicate and other constructs. Some of these terms refer to subjective, affective responses, and comprise specific instances of the umbrella construct of social anxiety. Others refer to patterns of overt, social‐communicative behaviours. (LEARY, 1983) But all of them affect how information is being communicated and whether a message ultimately arrives as intended.

In any pursuit in life, not just dating, better ways of communicating and working with information are frequently key in being successful. Work on communication patterns in Communication-Focussed Therapy (CFT) helps to make communication with oneself and the world more effective (Haverkampf, 2010b, 2017a, 2019b)


Schachter and Singer postulated in the 1960s that physical arousal played a primary role in emotions. The arousal was hypothesized to be the same for a wide variety of emotions, so physical arousal alone could not be responsible for emotional responses. The arousal must be identified to feel a specific emotion. An experimental design based upon an explication of Schachter’s theory of emotion demonstrated that fear reduction through induced misattribution of the physiological concomitants of fear could be accomplished. A test situation was utilized in which reduced fear would be reflected by test subjects’ willingness to work on a puzzle which would gain them monetary reward while leaving unsolved a puzzle which could allow them to avoid impending electrical shock. (Ross, Rodin, & Zimbardo, 1969)

Fearing the Fear

Fear can inhibit communication, which happens to be the instrument to resolve it. The reason for this may be to conserve resources for more automatic problems of fight or flight. In today’s world, however, more complex ways of reacting to fear are required, and new sources of information to be able to do so have to be tapped. An important strategy to counter fear is thus to communicate nonetheless. An adjustment and change in communication patterns can make this easier and less fear inducing. On the inside, more effective and gentler ways of connecting with oneself are helpful. Towards the outside, adjusting communication patterns, more questioning and reflecting, and more openness can make it easier to get the information one needs, while reducing the fear and anxiety.

In the case of kidney transplantation, prolongation of life involves not only adding time to the length of life, but it also involves the matter of the quality and worthwhileness of the life that is thus prolonged (Beard, 1969).

Fear of Change

Often, people are afraid of connecting with themselves and others because they fear the changes which can be brought on by the additional information, the impact it can have on their lives. In the case of anxiety and OCD, the ability to distinguish between a mere thought and reality is often reduced, which leads to more anxiety in a world which seems more uncertain and unpredictable. Breaking down fears is thus made easier when one is able to take a step back and identify the type and source of communicated messages, while also trying to determine the meaning in them relative to oneself.

Reasonable vs Unreasonable Fears

Our mind may tell us that a fear of tall buildings is unnecessary, but our emotions tell us otherwise. Some of these fears may be linked with experiences from one’s own past, others with innate programs in our brain. Emotions have an evolutionary function to guarantee our survival by providing simple signals to induce action or stop an action. However, the brain circuits leading to fear, for example, are partly hardwired for specific information. A fear of heights on top of a tall building makes sense, because tall buildings have only been around for a fraction of human history. In earlier times, standing close to a precipice on a tall cliff or mountain was indeed a dangerous affair.


Tremendous progress has been made in basic neuroscience in recent decades. One area that has been especially successful is research on how the brain detects and responds to threats. Such studies have demonstrated comparable patterns of brain-behaviour relationships underlying threat processing across a range of mammalian species, including humans. This would seem to be an ideal body of information for advancing our understanding of disorders in which altered threat processing is a key factor, namely, fear and anxiety disorders. But research on threat processing has not led to significant improvements in clinical practice. The authors propose that in order to take advantage of this progress for clinical gain, a conceptual reframing is needed. Key to this conceptual change is recognition of a distinction between circuits underlying two classes of responses elicited by threats:

  • behavioral responses and accompanying physiological changes in the brain and body and
  • conscious feeling states reflected in self-reports of fear and anxiety.

This distinction leads to a “two systems” view of fear and anxiety. The authors argue that failure to recognize and consistently emphasize this distinction has impeded progress in understanding fear and anxiety disorders and hindered attempts to develop more effective pharmaceutical and psychological treatments. The two-system view suggests a new way forward. (LeDoux & Pine, 2016) Fear conditioning and extinction learning in animals often serve as simple models of fear acquisition and exposure therapy of anxiety disorders in humans.

The Fear Network

Fear is mediated by a brain-wide distributed network involving long-range projection pathways and local connectivity. The disinhibitory microcircuit is a common motif in the basolateral amygdala (BLA), central amygdala and the prelimbic region of the medial prefrontal cortex, and is instrumental in fear acquisition and expression. (Tovote, Fadok, & Lüthi, 2015) Stress promotes a shift from a hippocampus-dependent, ‘cognitive’ memory system to a dorsal striatum-dependent, ‘habitual’ memory system, which also plays an important part in fear-related disorders. Importantly, glucocorticoids have similar effects on memory processes in both cognitive and habitual forms of memory. (de Quervain, Schwabe, & Roozendaal, 2017) There is overlap of neuronal circuits that mediate negative and positive valence in areas such as the VTA. Understanding the interplay between these circuits is of vital importance for understanding adaptive behavioural states. (Tovote et al., 2015)


Brain serotonin system dysfunction is implicated in exaggerated fear responses triggering various anxiety-, stress-, and trauma-related disorders. Waider and colleagues investigated the impact of constitutively inactivated serotonin synthesis on context-dependent fear learning and extinction using mice, which are completely devoid of serotonin synthesis in the  brain. The mice displayed accelerated fear memory formation and increased locomotor responses to foot shock. Furthermore, recall of context-dependent fear memory was increased. The behavioural responses were associated with increased c-Fos expression in the dorsal hippocampus. The hippocampus controls contextual representation of fear-related behavioural responses and c-fos expression indicates neuronal activity. It also showed resistance to foot shock-induced impairment of hippocampal long-term potentiation. (Waider et al., 2019)


Brain areas supporting the formation romantic attachment are those rich in oxytocin (OT) receptors (Acevedo et al., 2011), underscoring the potential role of OT in romantic bonding. (Schneiderman, Zagoory-Sharon, Leckman, & Feldman, 2012)  OT is a nonapeptide hormone associated with affiliative bonding in mammals (Insel et al., 1997) that is known to mediate social behaviour, pair-bonding, and parental attachment across a variety of species (Carter, 1998). Specifically, OT has been shown to play a critical role in the regulation of pair-bond formation in monogamous mammals (Ross and Young, 2009). It has been repeatedly shown that the Mating-induced release of OT reverses social fear in mice (Grossmann, Sommer, Menon, & Neumann, 2017)

The Amygdala

Conditions such as anxiety, autism, depression, post-traumatic stress disorder, and phobias are suspected of being linked to abnormal functioning of the amygdala, owing to damage, developmental problems, or neurotransmitter imbalance. The amygdala is a key brain region that is critically involved in the processing and expression of anxiety and fear-related signals. It is an almond-shape set of neurons located deep in the brain’s medial temporal lobe and forms part of the limbic system. The amygdala has been shown to play key roles in the processing of emotions. In humans and other animals, this subcortical brain structure is linked to both fear responses and pleasure. Its size is also positively correlated with aggressive behaviour across species. In humans, it is the most sexually-dimorphic brain structure, and shrinks by more than 30% in males upon castration.

Fear without the Amygdala?

The amygdala’s role appears to extend to both recognition and recall of fearful facial expressions. Bilateral amygdala damage in humans compromises the recognition of fear in facial expressions while leaving intact recognition of face identity (Adolphs et al., 1994). This impairment appears to result from an insensitivity to the intensity of fear expressed by faces. The amygdala seems to be required to link visual representations of facial expressions, on the one hand, with representations that constitute the concept of fear, on the other. Adolphs and colleagues reported of patient “S.M.” who lost her left and right amygdalae to disease. Initial testing suggested that S.M.’s most defining symptom was an inability to recognize fear in other people’s facial expressions. (R Adolphs, Tranel, Damasio, & Damasio, 1995; Barrett, 2018) Returning to the patient ten years later, Adolphs and colleagues showed that her impairment stems from an inability to make normal use of information from the eye region of faces when judging emotions, a defect they traced to a lack of spontaneous fixations on the eyes during free viewing of faces. Although the patient failed to look normally at the eye region in all facial expressions, her selective impairment in recognizing fear was explained by the investigators by the fact that the eyes are the most important feature for identifying this emotion. Her recognition of fearful faces became entirely normal when she was instructed explicitly to look at the eyes. (Ralph Adolphs et al., 2005)

Fast Pathways

A fast, subcortical and phylogenetically old pathway to the amygdala is thought to have evolved to enable rapid detection of threat, which could also explain nonconscious emotional responses. Mendez-Bertolo and colleagues recorded human intracranial electrophysiological data and found fast amygdala responses, beginning 74-ms post-stimulus onset, to fearful facial expressions, which had considerably shorter latency than fear responses that were observed in the visual cortex. They were limited to low spatial frequency components of fearful faces and were not evoked by photographs of arousing scenes. (Méndez-Bértolo et al., 2016)

The Microbiome

There are at least as many bacterial cells as human cells in the body, of which many are in the intestinal tract. They are commonly called the microbiome in their entirety. They seem to influence brain development, activity and behaviour. A growing number of preclinical and human studies have implicated the microbiome–gut–brain in regulating anxiety and stress-related responses. Hoban and colleagues demonstrated in their study that the presence of the host microbiome is crucial for the appropriate behavioural response during amygdala-dependent memory retention. (Hoban et al., 2018)

Inferior Frontal Gyrus

There appears to be a link between cerebral correlates of cognitive processing in the inferior frontal gyrus and emotional processing in the amygdalae – insulae – anterior cingulate cortex axis during symptom improvement across time in panic disorder with agoraphobia. In a randomized, controlled, multicentre clinical trial Kircher and colleagues studied medication-free patients with panic disorder with agoraphobia who were treated with 12 sessions of manualized CBT. Patients’ functional MRIs compared to those of control subjects revealed reduced activation for the conditioned response in the left inferior frontal gyrus. This activation reduction was correlated with reduction in agoraphobic symptoms. Patients compared to control subjects also demonstrated increased connectivity between the IFG and the amygdalae – insulae – anterior cingulate cortex axis across time. (Kircher et al., 2013)


The link between specific stimuli and fear responses is often learned. Input specificity is a fundamental property of long-term potentiation (LTP). (Maren, 2017) Kim and Cho showed that fear conditioning is mediated by synapse-specific LTP in the amygdala, allowing animals to discriminate stimuli that predict threat from those that do not. (Kim and Cho, 2017) In rats, brief electrical stimulation of the infralimbic cortex has been shown to reduce conditioned freezing during recall of extinction memory. This finding has been translated to humans with magnetic resonance imaging–navigated transcranial magnetic stimulation (TMS). (Raij et al., 2018)


Learning mechanisms can also explain how the link between specific stimuli and a fear response can be attenuated and eliminated. Learning-related changes of synaptic connections in the cortex seem to be at least partially reversed after unlearning. Lai and colleagues examined in their study the impact of auditory-cued fear conditioning and extinction on the remodelling of synaptic connections in the living mouse auditory cortex. They found that fear conditioning leads to cue-specific formation of new postsynaptic dendritic spines, whereas fear extinction preferentially eliminates these new spines in a cue-specific manner. (Lai, Adler, & Gan, 2018)

Neuronal coordination

Coordination dynamics provides a unifying framework for understanding the neurophysiological mechanisms underlying the integration and segregation of cortical areas in large-scale networks. A goal of coordination dynamics is to identify the key variables of coordination (defined as a functional and/or task-dependent ordering among context-sensitive interacting components) and their dynamics (rules that govern the stability and change of coordination patterns), and the nonlinear coupling among components that gives rise to them. In the context of cognitive neuroscience, the aim of coordination dynamics is to understand the functional interactions within and between different areas of the brain in relation to cognitive task performance. (Bressler & Kelso, 2016)

Precise spike timing through the coordination and synchronization of neuronal assemblies is an efficient and flexible coding mechanism for sensory and cognitive processing. In cortical and subcortical areas, the formation of cell assemblies critically depends on neuronal oscillations, which can precisely control the timing of spiking activity. Fear behaviour relies on the activation of distributed structures, among which the dorsal medial prefrontal cortex (dmPFC) is known to be critical for fear memory expression.

The results of a study by Dejean and colleagues identified a novel phase-specific coding mechanism, which dynamically regulates the development of dmPFC assemblies to control the precise timing of fear responses. Fear behaviour relies on the activation of distributed structures, among which the dmPFC is known to be critical for fear memory expression. In the dmPFC, the phasic activation of neurons to threat-predicting cues, a spike-rate coding mechanism, correlates with conditioned fear responses and supports the discrimination between aversive and neutral stimuli. However, this mechanism does not account for freezing observed outside stimuli presentations, and the contribution of a general spike-time coding mechanism for freezing in the dmPFC remains to be established. They used a combination of single-unit and local field potential recordings along with optogenetic manipulations to show that, in the dmPFC, expression of conditioned fear is causally related to the organization of neurons into functional assemblies. During fear behaviour, the development of 4 Hz oscillations coincides with the activation of assemblies nested in the ascending phase of the oscillation. The selective optogenetic inhibition of dmPFC neurons during the ascending or descending phases of this oscillation blocks and promotes conditioned fear responses, respectively. (Dejean et al., 2016)


Strong aversive memories lie at the core of several fear-related disorders. Therefore, the memory-modulating properties of glucocorticoids have become of considerable translational interest. (de Quervain et al., 2017) Evidence indicates that the effects of glucocorticoids on both the consolidation and the retrieval of memory depend on interactions with the endocannabinoid system, which may open novel therapeutic avenues. (de Quervain et al., 2017) The evidence that genetic and epigenetic variations in the glucocorticoid system are related to traumatic memory, as well as to post-traumatic stress disorder (PTSD) risk and treatment, adds to the understanding of individual risk and resilience factors for PTSD. (de Quervain et al., 2017) Collections of cells called engrams are thought to represent memories. Although there has been progress in identifying and manipulating single engrams, little is known about how multiple engrams interact to influence memory. In lateral amygdala (LA), neurons with increased excitability during training outcompete their neighbours for allocation to an engram. Rashid and colleagues examined whether competition based on neuronal excitability also governs the interaction between engrams. Mice received two distinct fear conditioning events separated by different intervals. LA neuron excitability was optogenetically manipulated and revealed a transient competitive process that integrates memories for events occurring closely in time (coallocating overlapping populations of neurons to both engrams) and separates memories for events occurring at distal times (disallocating nonoverlapping populations to each engram). (Rashid et al., 2016)

The Thalamus

The prelimbic prefrontal cortex, which is necessary for fear retrieval sends dense projections to the paraventricular nucleus of the thalamus (PVT). Do-Monte and colleagues showed that the PVT may act as a crucial thalamic node recruited into cortico-amygdalar networks for retrieval and maintenance of long-term fear memories by demonstrating that the dorsal midline thalamus of rats is required for the retrieval of auditory conditioned fear at late (days), but not early (hours) time points after learning. (Do-Monte, Quiñones-Laracuente, & Quirk, 2015)

Shift in Retrieval Circuits

Do-Monte also showed that there may be a shift in the retrieval circuits along the time axis. The PVT showed increased c-Fos expression, indicating neuronal activity, only at late time points, indicating that the PVT is gradually recruited for fear retrieval. Retrieval at late time points activated prelimbic prefrontal cortex neurons projecting to the PVT and silencing of these projections impaired retrieval at late time points. In contrast, silencing of prelimbic prefrontal cortex inputs to the basolateral amygdala impaired retrieval at early time points. Retrieval at late time points also activated PVT neurons projecting to the central nucleus of the amygdala, and silencing these projections at late time points induced a persistent attenuation of fear. (Do-Monte et al., 2015)

Fear vs Anxiety: Information

A fear of living is really a combination of both, a concrete fear of a very broad concept and an anxiety associated with uncertainty and strong emotions. It is unclear to what extent a small dose of them can push or pull us forward on our journey. But it is quite clear that they can be huge obstacles in large doses. In order to better work with them, it is first of all important to distinguish a deep respect, excitement and appreciation for the miracle of life from fear and anxiety. As a second important step, one needs to be able to distinguish between fear and anxiety, since the target of a fear is much better defined and clearer than the general uncertainty that is associated with anxiety. From a CFT perspective, however, both manifest with well defined communication patterns (Haverkampf, 2017c, 2017g)

As mentioned previously, fear and anxiety are two distinguishable phenomenological entities. The amount of information available about the threat appears to be a critical deciding factor. Fear is elicited by a defined threat, while one feels anxious when the threat is uncertain or not clearly defined. The distinction is also reflected on a neuro-morphological level. Anxiety is usually associated with activation in ventromedial prefrontal cortex and hippocampus, while fear is correlated with activation in the periaqueductal grey. At the same time, the amygdala seems associated with both.

To test this, Rigoli and colleagues used functional MRIs to record participants’ brain activity while they performed a computer-based task which required to press a button to move an artificial agent to a target position while an artificial predator chased the agent. In the fear condition the predator was visible, while in the anxiety condition the predator was invisible. Ventromedial prefrontal cortex, hippocampus, and amygdala showed increased activity when the predator was invisible compared to visible, while the opposite effect was observed in periaqueductal grey. They also observed that participants with high but not low trait-anxiety showedhippocampal activation with invisible threat at an earlier time stage during the trial. (Rigoli, Ewbank, Dalgleish, & Calder, 2016)


A single session of exposure therapy can eliminate fears of objects or situations. Encoding of fear extinction involves many of the same brain areas that are involved in fear acquisition and expression; however, different circuits within the amygdala and prefrontal cortex are involved. Indeed, fear extinction circuits may in fact inhibit fear circuits to dampen fearful responding. (Tovote et al., 2015) The extinction of fear learning involves to an extent a reversal of the flow of information in the pre- and infralimbic ventromedial prefrontal cortex, the central amygdala subnuclei, and the dentate gyrus. and is used in the therapy of posttraumatic stress disorder and fear memories in general. (Izquierdo, Furini, & Myskiw, 2016)

If applied too life itself, exposure can include anything from meditation to going on a date. We expose ourselves to life if we constantly break down barriers and widen our horizon. This can also include information inside of us. For example, someone who is reflecting on a topic or investigating a feeling is also widening the information horizon, transmitting and receiving meaningful information, and thus engaging with life. As with many other fears, exposure to communication can reduce the anxieties and fears connected with life.

Exposure to various forms of communication, as long as they are not intrinsically harmful, can reduce the fears and anxieties associated with them. This also enlarges the activity radius and mental horizon an individual experiences in life. There are specific brain regios that seem to play an elevated role in fear and the effect of exposure in general. Hauner and colleagues studied changes in brain activity as a result of one successful two hour exposure treatment. Before treatment, fear eliciting images excited activity in a network of brain regions, including amygdala, insula, and cingulate cortex, relative to neutral images. Successful therapy dampened responsiveness in this fear-sensitive network while concomitantly heightening prefrontal involvement, which persisted even six months later, but without prefrontal engagement. Additionally, individual differences in the magnitude of visual cortex activations recorded shortly after therapy predicted therapeutic outcomes six months later. (Hauner, Mineka, Voss, & Paller, 2012)


Throughout development, an important process is to arrive at a point where the amount of fear signalled in daily life is at the correct measure where it sustains survival without interfering too much in life. Flexibility of the fear response may be most advantageous during adolescence when living beings in general are prone to explore novel, potentially threatening environments.

Two opposing adolescent fear-related behaviours—diminished extinction of cued fear and suppressed expression of contextual fear—may serve this purpose. Using microprisms to image prefrontal cortical spine maturation across development in mice, Pattwell and colleagues identified a dynamic blasolateral amygdala – hippocampus – medial prefrontal cortex circuit reorganization associated with behavioural shifts. (Pattwell et al., 2016) The same circuit also seems to play a role in social defeat and some of its consequences. (Qi et al., 2018)

The Cortical Neural Network

Emotional states of consciousness, or what are typically called emotional feelings, are traditionally viewed as being innately programmed in subcortical areas of the brain and are often treated as different from cognitive states of consciousness, such as those related to the perception of external stimuli. Ledoux and Brown argued that conscious experiences, regardless of their content, arise from one system in the brain. In this view, what differs in emotional and non-emotional states are the kinds of inputs that are processed by a general cortical network of cognition, a network essential for conscious experiences. Although subcortical circuits are not directly responsible for conscious feelings, they provide nonconscious inputs that coalesce with other kinds of neural signals in the cognitive assembly of conscious emotional experiences. (LeDoux & Brown, 2017) When subjective state words are used to describe behaviours, or brain circuits that control them nonconsciously, the behaviours and circuits take on properties of the subjective state. Subjective state words should be limited to the description of inner experiences, and avoided when referring to circuits underlying nonsubjectively controlled behaviors. (LeDoux, 2017)


Anxiety is an emotion characterized by an unpleasant state of inner turmoil. It is the subjectively unpleasant feelings of dread over anticipated events, such as the feeling of imminent death.  Anxiety is, as mentioned, not the same as fear, which is a response to a real or perceived immediate threat, whereas anxiety involves the expectation of future threat. Anxiety is a feeling of uneasiness and worry, usually generalized and unfocused as an overreaction to a situation that is only subjectively seen as menacing.

As with fear and fear extinction, a brain-wide neuronal network underlies anxiety, with identified local microcircuits within the bed nucleus of the stria terminalis, the lateral septum, the ventral tegmental area (VTA) and the basolateral amygdala. Importantly, there is potential overlap between fear and anxiety circuits. (Tovote et al., 2015)

Biological Approaches

While psychotherapy should be the first line of treatment when it comes to unhelpful fears, there are biological tools that may be of use in more extreme cases of fear. Psychotherapy and medication both work on the information receiving and processing system in the brain.


Glucocorticoids affect distinct memory processes that can synergistically contribute to a reduction of fear-related symptoms, for example, by both reducing aversive-memory retrieval and enhancing the consolidation of fear-extinction memory (de Quervain et al., 2017). Clinical trials have provided the first evidence that glucocorticoid-based pharmacotherapies aimed at attenuating aversive memories might be helpful in the treatment of fear-related disorders. In particular, the strategy to enhance extinction processes by combining exposure-based psychotherapy with timed glucocorticoid administration seems to be a promising approach to treat fear-related disorders. (de Quervain et al., 2017)


D-cycloserine is a molecule that binds to the NMDA receptor and improves its efficiency. Because D-cycloserine facilitates extinction in rats, Davis and colleagues investigated whether D-cycloserine might facilitate the loss of fear in human patients. It indeed seemed to help reduce fear of heights substantially after seven or eight sessions. (Davis, 2010) The ability of D-cycloserine to improve psychotherapy been replicated in other studies in obsessive- compulsive disorder, social phobia, and panic disorder.


MDMA used as an adjunct during psychotherapy sessions has demonstrated effectiveness and acceptable safety in reducing PTSD symptoms in Phase 2 trials, with durable remission of PTSD diagnosis in more than two thirds of participants. MDMA enhances release of monoamines (serotonin, norepinephrine, dopamine), hormones (oxytocin, cortisol), and other downstream signalling molecules (BDNF) to dynamically modulate emotional memory circuits. By reducing activation in the amygdala and insula, and increasing connectivity between the amygdala and hippocampus, MDMA may allow for reprocessing of traumatic memories and emotional engagement with therapeutic processes. (Feduccia & Mithoefer, 2018)

Other Approaches

Transcranial magnetic stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression, for example. During a repetitive TMS session, an electromagnetic coil is placed against the scalp near the forehead, which is thought to activate regions of the brain that have decreased activity in depression. Liston showed that transcranial magnetic stimulation targeting a human homolog of a rodent fear regulation circuit enhanced extinction learning in healthy human subjects. (Liston, 2018)


The brain processes information, and fortunately we can consciously select information and teach our brain new ways of dealing with information. But this requires taking a close look at our basic values and fundamental interests, which ultimately drive any change. If you feel that something is important to you, you are more likely to spend energy on figuring out a way to effect a change. Knowing why doing something is valuable and important to oneself is an important force in doing something even if one is fearful (as long as there is no real threat of harm from the activity).

Change from Within

In many cases, however, feeling pressure to go through with a feared activity can be counterproductive. As the need to take the elevator, for example, increases, the fear increases as well. The problem is that the activity is seen as a ‘need’ dictated by the outside world. Overcoming a fear should come from an internal need, the fulfilment of a basic value or fundamental interest.

Greater insight into the own needs, values and aspirations can thus be very helpful in confronting the own fears. This explorative process in itself can already be helpful in confronting the fears. It is facilitated through a better internal communication (Haverkampf, 2010c), a better emotional and cognitive communication, which can be trained in a communication-oriented therapy. (Haverkampf, 2010b, 2017a) An easier access to this emotional information can also provide more stability and trust in oneself, which helps whenever fears, whether internal or external, need to be confronted.

Change Without

Changing communication patterns within leads to changes in communication patterns without. This is how better boundaries can be drawn to the outside world, which also makes the world appear safer and more secure. The ability to stand up for one’s needs, values and aspirations and to say ‘No’ as well as ‘Yes’ requires a good connection on the inside, which then makes it possible to work on one’s communication patterns with the world. Better and more effective external communication patterns can make it easier to deal with everyday problems and other people who may hold different opinions.

Good external communication patterns are those which facilitate understanding on both sides, and understanding can reduce fears and anxiety, as thus feeling understood. Meaningful communication can reduce fears and anxiety because it can bring about changes in the communication partners and adjustments in as situation which benefit everyone. However, it can only accomplish this if the internal communication is also working on both sides.

Psychological Approaches

CBT: Fear of Flying

The Fear of flying (FOF) can be a serious problem for individuals who develop this condition and for military and civilian organizations that operate aircraft. People with fear of flying experience intense, persistent fear or anxiety when they consider flying, as well as during flying. They will avoid flying if they can, and the fear, anxiety, and avoidance cause significant distress and impair their ability to function. Take-off, bad weather, and turbulence appear to be the most anxiety provoking aspects of flying. The most extreme manifestations can include panic attacks or vomiting at the mere sight or mention of an aircraft or air travel. Around 60% of people with fear of flying report having some other anxiety disorder.

Krijn and colleagues compared the effectiveness of bibliotherapy (BIB) without therapist contact, individualized virtual reality exposure therapy (VRE) and CBT. Treatment with VRE or CBT was more effective than BIB. Both VRE and CBT showed a decline in FOF on the two main outcome measures. There was no statistically significant difference between those two therapies. However, effect sizes were lower for VRE (small to moderate) than for CBT (moderate). CBT followed by group cognitive-behavioural training showed the largest decrease in subjective anxiety. (Krijn et al., n.d.)

Virtual Exposure

Virtual Reality (VR) is a technological interface that allows users to experience computer-generated environments within a controlled setting. This technology has been increasingly used in the context of mental health treatment and within clinical research.  VR aims to parallel reality and create a world that is both immersive and interactive. Users fully experience VR when they believe that the paradigm accurately simulates the real-world experience that it attempts to recreate. The sense of presence, or “being there” in VR, is facilitated through the use of technology such as head-mounted displays, gesture-sensing gloves, synthesized sounds, and vibrotactile platforms, which allow for the stimulation of multiple senses and active exploration of the virtual environment. Furthermore, some VR paradigms are programmed to react to the actions of the user. This dynamic interaction enables the participant to engage with the VR environment in a more naturalistic and intuitive way. VR’s precise control of sensory cues, particularly for auditory, tactile, and olfactory systems, increases the sense of realism and memory of the virtual environment. (Maples-Keller, Bunnell, Kim, & Rothbaum, 2017)

Fear of Flying (FOF)

In a study by Rothbaum and colleagues, patients with FOF (N = 49) were randomly assigned to virtual reality exposure therapy, standard exposure therapy, or a wait-list control. Treatment consisted of 8 sessions over 6 weeks, with 4 sessions of anxiety management training followed by either exposure to a virtual airplane or exposure to an actual airplane at the airport. The results indicated that virtual reality exposure and standard exposure were both superior to the control group, with no differences between the two approaches. The gains observed in treatment were maintained at a 6-month follow up. (Rothbaum, Hodges, Smith, Lee, & Price, 2000)

Systematic Desentization

Systematic desensitization has become one of the most effective new therapeutic methods. There are clinical series and laboratory experiments demonstrating its success in alleviating fear and anxiety. Both stimulus and response control elements may contribute to the success of desensitization and similar fear modification treatments. (Lang, 2017)

Expressive Therapy

Fagen reported cases and analyses of terminal-cancer pediatric patients that display a variety of music therapy techniques to show how “grief work” is part of a larger therapeutic process. Fagan concluded that the creative life of the child must not be dismissed as secondary in times of illness, that it must share equal importance with other intellectual and physical needs. (Fagen, 1982)

Cognitive Processing Therapy (CPT)

Cognitive processing therapy (CPT) is based on an information processing theory of PTSD and includes education, exposure, and cognitive components. Its effectiveness was shown in smaller sample sizes. (Resick & Schnicke, 1992)

Thoughts and Emotions

The thoughts and emotions we perceive arise in an interconnected system of areas with nerve cells (neurons). Both are types of information, which can lead to change in the individual, whether resulting in changes in state, behaviours or thinking, if the messages are meaningful, that is if they lead to new meaningful information within the context of existing information, whether in memory or anywhere else in the nervous system.

Thoughts and emotions are thus messages representing sets of information being shuttled between different locations in the brain. The sense of this movement of information gives rise to the sense of self, which is not just a metacognitive ability, but the actual awareness of all those information flows. The greatest fear may be the fear that these information flows stop suddenly, which would resemble the death of the self. However, since the information flows continue throughout life, it is a fear of losing the awareness of them.

The emotions in conjunction with the ability to reflect about them help to identify the thoughts, actions, behaviours and situations which make a person feel better. Especially when confronting fears, whether on the inside or on the outside, this information can be helpful. Emotions are not as accessible to rationality because we are not conscious of the large amount of information that goes into them, a process that happens largely in our subconscious, but thinking about situations in the past and connecting emotionally can help to make it easier to identify them.


It is only worth facing one’s fears where an action makes sense in the context of one’s values and aspirations. This means using one’s thoughts and feelings to find those things which make one happy and are enjoyable, as well as being in sync with one’s values. This is a first important step in breaking down fears and developing the motivation and initiative to overcome them.

Meaningfulness is a practical concept. If something is meaningful, it can bring about a change in an individual. For example, if something triggers a feeling in a person, it is meaningful, particularly if it changes the affective state of the person. Whether something triggers a new though, a sadness, anger or happiness, it is meaningful. How a message fits into and corresponds with the information already in the nervous system, and other parts of the body, determines whether it is meaningful. If information about a situation, for example, corresponds with a past situation in memory, which is associated with other information and a feeling of sadness, both these thoughts and the sadness can be triggered. But something more happens, than the retrieval of information. The information about the new situation and the existing information have to be reconciled, which is essentially a creative act, leading to new information. There could, for example, be a new insight into oneself or the world, cognitively, emotionally or otherwise. Meaningfulness thus leads to innovation, which is of particular importance when it comes to facing fears, within and without. Anxiety in itself is not an emotion, but underlying it are usually emotions which need to be addressed to resolve the anxiety or panic attacks.

Communication and Fear

How we communicate with others has an influence of the fears we are experiencing. Meaningful helpful communication can reduce fears, if delivered with empathy and understanding, while negative communication or a lack of communication can increase fears. When we face those fears, communicating with someone else or others can be helpful in overcoming the fears.

Patterns and Communication Structures

Whether something is a fear or not depends on how one communicates with oneself and others. It is usually helpful to recognize the emotion of fear, but to see in it the question which it is. When one encounters a tiger in the wild, the fear really presses the question on one, what to do, whether to freeze or run away. Once the question has been answered, fear may also provide the increase in energy to initiate the action, such as running away. In other words, the purpose of the emotion is to get a new communication process going which often involves the non-emotional mind in the form of asking a question.


Many people who experience fears and anxieties have picked up on the need for answers, but they skip the crucial step of asking the right question. However, without an awareness of the question looking for an answer is futile, which usually increases the sense of helplessness and hopelessness. An employee who experiences anxiety and the workplace and begins to dread everything about it, and as a consequence is heading straight into a burnout, cannot change anything until the question is asked what needs to be changed. In essence, the fear or possible change and the uncertainty which comes with it lets him or her experience anxiety fears, anxiety or even emotional numbness and disconnect, which would end in the moment the question about change is asked. The mind would immediately focus on constructing a new future rather than on the helplessness and hopelessness of the situation.

Questions are so powerful because they change the communication patterns one has with oneself and with others. While they are a communication entity in themselves with message and meaning, the information they contain leads to a change in the information flows in oneself or in others, as long as they possess meaning to the recipient.

Building the Motivation to Overcome One’s Fears

Reconnecting with ourselves should allow us to identify our value and aspirations which can be very effective in building the motivation to overcome fears and even to reduce them. Doing something we feel strongly about might not reduce the nervousness we feel, but it can lower the amount of fear or even transform it into excitement. It is easier to overcome one’s fears if one knows why this is beneficial to oneself and others.

Information Overload

In the complex world we live in our brains can get overloaded with information, a situation that in itself can cause fears. So, an important first step is to untangle the web of complexity by picking out the information that is important to us. Being selective requires knowing what one wants and what one is looking for. This is why getting in touch with one’s values can be so important. They tell us what is important to us and what we should be looking for. Openness is important to find new interests, make better decisions, formulate new plans and aspire to even greater things, but if we do things that are not in sync with our core sense of ourselves as person and our basic values[1], there will be little happiness in these activities.


Humans often spend too much resources on information that is not relevant to them or where they cannot change anything. If you cannot change an issue, there is not much sense in wasting mental or physical resources on it. In such a situation, it is more important to deal with your emotions, be they fears, sadness or anger. One way is to find a way to communicate them in a meaningful way. Communicating an emotion helps to resolve it. This could be in the form of talking about it, writing about it, or even making a movie about it.

Selecting Information

The way we select, process and manage information is important in alleviating fears. You may be anxious of something or of a situation, but maybe one reason is that you do not have enough information about it. We live in a world where information is very readily available, so informing oneself is often not that difficult. And if you do not find answers to a question you have, consider if you are asking the right question, one that is helpful to you.

The Right Question

Often, we ask questions that do not really provide us direction or useful answers, so we get lost in ruminations and endless spirals of meaningless thought cascades. Try to split up a question and see if you might not get at least partial answers to the component that is relevant, while leaving the irrelevant part unanswered.

Values and Basic Interests

Any information is helpful if it helps one live according to one’s values and basic interests. Life is going along a path. You cannot know the entire path until you have lived your life, but your values provide a good compass and they help dispel fear whenever it pops up along the way.


Quite often fears generalize in what is called a ‘generalised anxiety’. This can lead to a general fear of life itself. Here it is important to determine which emotions and specific fears are underlying the generalised anxiety.

You may identify something that triggered the anxiety, but the reasons for it can go back a long time. Dealing with some of the underlying issues may require identifying your values and interests. You want to cut down on thoughts and fears that are irrelevant to you and focus constructively on the issue that are relevant to you by finding helpful information.

General Questions

Generalised anxiety occurs often when people feel they have to fix something or find answers or make decisions, when they do not know where to look for them, or even where to start. Take a step back, see the situations for what it is with its relevant and irrelevant components, and measure your options against what you truly need and want. Much in life is noise and irrelevant to one’s path.

Communication to Counter Fear

It helps to be in contact with someone else to make the fears manageable. Facing fears with another may make it easier to deal with your fears and anxieties because you know you do not have to face them alone. When you talk to your neighbour on an airplane, for example, you might not even notice the take-off, and the brief interaction with the stranger reduces the emotional pressure on the inside.

Dr Jonathan Haverkampf, M.D. (Vienna) MLA (Harvard) LL.M. (ULaw) trained in medicine, psychiatry and psychotherapy and works in private practice for psychotherapy, counselling and psychiatric medication in Dublin, Ireland. He is the author of several books and over two hundred articles.

Jonathan can be reached by email at jo****************@gm***.com or via the websites and


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[1] One’s sense of self, one’s personality and one’s values usually change little over one’s life span, except for exposure to extreme, and especially traumatic, experiences.

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