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  • Writer's pictureKari Gregory

The "Fear of Fear": Understanding Anxiety Sensitivity

We all experience anxiety from time to time. It's a natural, even helpful response to stressful situations. For most people we experience anxiety as a response to situations, objects or issues; for instance public speaking, large dogs or climate change.  But for some people, the physical sensations of anxiety trigger a whole new level of fear: the fear of the fear itself. This is anxiety sensitivity, and it can significantly impact your mental and physical well-being.

What is Anxiety Sensitivity?

Think of anxiety sensitivity as a kind of faulty internal alarm system. When your body experiences normal anxiety symptoms like racing heart, muscle tension, or dizziness, instead of recognizing them as normal and harmless, your alarm goes off. You misinterpret these sensations as dangerous, triggering even more anxiety and potentially leading to panic attacks.

Why is it a problem?

Anxiety sensitivity plays a major role in the development and maintenance of anxiety disorders, especially panic disorder. The fear of these physical sensations can create a vicious cycle: you experience anxiety, misinterpret the physical sensations as dangerous, and your anxiety intensifies as you try to avoid these sensations. This cycle can be debilitating and interfere with your daily life.

Signs you might have high anxiety sensitivity:

Consider the following questions:

  • Is it important to you not to appear nervous?

  • Does it scare you when you feel “shaky”, faint or nauseous?

  • Do you feel embarrassed around people when your stomach growls?

  • Does it scare you when your heart beats rapidly?

  • Does it scare you when you are unable to keep your mind on a task?

  • Do you constantly worry about your physical health?

  • Do you misinterpret physical sensations like a racing heart or shortness of breath as signs of a serious illness?

  • Do you avoid situations you think might trigger anxiety symptoms?

  • Do you have a history of panic attacks?

If you said yes to all or many of the above questions, you may be high in anxiety sensitivity.

What can you do about it?

The good news is that targeting anxiety sensitivity directly in therapy has been proven to produce positive results for clients with panic disorder, phobias, social anxiety disorder, PTSD and OCD.  High anxiety sensitivity is targeted via a variety of interventions.  These include:

Psychoeducation:  This may involve providing the client with information about the physiology of anxiety, how the sympathetic nervous system (fight-flight-freeze) works, and the meaning of the various bodily sensations.

Cognitive Restructuring:  With anxiety sensitivity, the client has distorted beliefs and predictions about their internal experience.  The focus of these distortions tend to surround three categories: physical concerns (heart attack), cognitive concerns (going crazy), social concerns (judgment from others).  For instance, a client’s distorted thought (“everyone can see that I am nervous, they are all going to hate my presentation.  I’m so nervous I am likely to faint mid-sentence”) could be reframed by understanding that the physiology of anxiety is opposite to fainting, that most people are not hostile to public speakers, and it’s unlikely everyone can tell.

Emotional Acceptance:  It can seem paradoxical, but being opening and accepting rather than resistant to difficult emotional experiences has been shown to be effective in reducing anxiety and anxiety sensitivity.  Clients are taught to observe their emotional reactions and internal sensations with mindful curiosity in place of attempting to control or fight them.

Interoceptive Exposure:  This involves exposing the client to their own bodily sensations purposefully and creates new learning rather than fear and avoidance.  Interoceptive exposures are practiced in session with the therapist.  Common exercises include breathing through a straw, spinning in an office chair, hyperventilating intentionally, or looking intently into a mirror.  Once the fight-or-flight response is provoked, the client is instructed to allow themselves to experience while not doing any safety behaviors.  Eventually the client learns that the sensations are manageable, harmless and go away on their own. No need to cause alarm.


You're not alone in this. Millions of people struggle with anxiety sensitivity. By understanding this condition and taking steps to manage it, you can break free from the fear of fear and live a fulfilling life.

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