The physiology of the fear response To diagnose panic disorder from other differential diagnoses and be able use exposure and habituation effectively, a thorough understanding of the physiology of the fear response is essential. Being able to explain to patients what is actually happening within the body and the function of each arousal symptom is a critical success factor for engaging patients in treatment. Often however time given to this information is limited in training due to time constraints, the condensing of curricula into shorter time frames, or a lack of physiology background and expertise that has developed over time. Worryingly, out of date, poor quality or lazy explanations of anxiety and the fear response exist in many self-help materials in circulation; even those from seemingly reputable sources and those newly published can have these problems. Many encourage safety seeking behaviours, such as distraction or do not adhere to the essential conditions. Some are also interpreted as patronising under focus group review for containing cartoons and illustrations, or being too basic in their approach. Practitioners can fall into the trap of not accurately explaining why a symptom happens, only that it occurs as a result (and let’s face it, most patients with panic disorder are acutely aware of that, but are misinterpreting their cause and consequences and unsure why their body responds in this way). Most patients have already heard of arousal and fight and flight and they know that as previous hunter gathers, this response was helpful to us then. The response however is not a legacy from that time, we still very much need it. We share the arousal response with all other vertebrates and evolution has not removed it since Palaeolithic times, because of its important function to this day. We also never stepped out of our cave and saw dinosaurs, we were not on the planet at the same time and the great majority of 7
hominis did not even live in caves, they were nomadic. It also tells the patient nothing about their symptoms in particular and what their purpose is in a way that informs treatment appropriately. We also do not have a steady stream of adrenalin in our bodies all the time as some materials reviewed state - or habituation simply wouldn’t work!, We have the ability to produce it on response to a perceived threat trigger. Our blood also does not ‘divert’ from its usual route around the body to the arms and legs, flow is prioritised there, on its normal course through vasodialation and vasoconstriction. To aid with this, we have provided a thorough overview of the physiology of the fear response in the following pages and how this then applies to panic disorder. Whilst this information is not required to be relayed to the patient in full, we would strongly argue that it is a necessary level of physiological awareness for a clinician working in a CBT way to have, to ensure that assessments, information giving, selection of suitable resources and rationales given are improved. The physiology of the fear response © Marie Chellingsworth (2020). The CBT Resource.
