Ask a Therapist: Fears, Phobias & Anxieties with Richard Kneip

Last Editorial Review: 10/23/2003

WebMD Live Events Transcript


Are you afraid of the dark? Does the mere thought of spiders and other insects make your skin crawl? Are you afraid of heights? Does the fear of leaving the house make you anxious? If so, join Richard Kneip, PhD, as he answers your questions on how to overcome these fears, phobias and anxieties.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome everyone! Today's guest is Richard Kneip, PhD. He will be answering your questions about fears, phobias and anxieties.

loloangel_2000: What is the difference between a fear and a phobia?

Richard Kneip, PhD: A phobia is a very strong fearful reaction to a very specific thing known as a stimulus. Some of the most common phobic stimuli are snakes, heights, and spiders but could be almost anything. People with phobias may change their lifestyles to an extreme to avoid contact with the feared stimulus. Fear, on the other hand, is the normal reaction we all experience to danger or some sort of threat. You can find more detailed information about phobias and their diagnoses and treatments at

crazilynn: How do you conquer anxiety when on a job interview?

Richard Kneip, PhD: Anxiety during a job interview is a normal and expected reaction to a stressful or unpredictable social situation, especially when we are being evaluated or trying to accomplish something that is very important to us. In fact, it has been shown that mild to moderate amounts of anxiety may actually enhance our performance. However, if anxiety becomes too severe, it may interfere with our thinking and lead to responses and behavior that is uncharacteristic. Some common suggestions are doing whatever is possible to minimize one's anxiety prior to the interview, such as staying away from caffeine containing beverages, spending time preparing for the interview by reviewing materials and information you would like to have readily available during your responses to questions. In extreme cases, there are medications that can inhibit the physiological mechanisms that produce anxiety, but these should be used only in extreme cases and only after consultation with a psychiatrist or other medical professional knowledgeable in the administration of psychotropic medications.

sara_3_2_1: What is the best way to overcome the fear of public speaking?

Richard Kneip, PhD: The fear of public speaking is very common and is treatable by using techniques developed for the treatment of phobias. The techniques, known as systematic desensitization, involve first learning to achieve a state of relaxation and then imagining a series of progressively anxiety-provoking scenarios. For instance, a therapist utilizing these techniques would first assist the patient in becoming deeply relaxed utilizing self-hypnosis or relaxation procedures, then might have the patient start by imagining themselves speaking in an auditorium with only one person in the audience. If the patient could tolerate this imagery without an increase in anxiety, then the therapist might move on to a scenario involving two persons, then four, then eight, etc. At the first sign of increased anxiety, the patient would return to the previous level, establish relaxation and then move on. Research has shown these techniques practiced over several weeks will generalize to real life experience.

dthomasc_2000: What is the most difficult fear to overcome?

Richard Kneip, PhD: While I couldn't identify a single fear that we know is the most difficult to overcome, my experience has been in clinical practice that the fears that are extremely difficult to talk about are the most difficult to treat. For instance, fear resulting from prolonged abuse at the hands of another tends to be much more difficult to discuss in therapy than say a fear of spiders. The shame and embarrassment that often accompanies the fear makes it difficult for the sufferer to share the experience with someone else. The sharing is extremely important in the recovery process. There is more information about phobias, anxieties, and their treatment at

rearwindow2000: What is generalized anxiety disorder?

Richard Kneip, PhD: Generalized anxiety disorder, unlike a phobia, is an anxious reaction to no particular stimulus or circumstances. An individual suffering from this will typically report excessive anxiety and worry about a number of events or activities such as work or school performance. They find it difficult to control the worry and usually will report feelings of restlessness or feeling on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension and sleep disturbance.

imincognitoalso: My 20-year-old daughter refuses to stay anywhere alone. In addition to this only a few select people make her feel comfortable. This is ruining her life. She is unable to keep a job or maintain any sort of relationship. Any suggestions on how I can help her get over this?

Richard Kneip, PhD: Without knowing more about her, I would be reluctant to make any specific recommendations, but what little information you have given suggests that your daughter may suffer from some form of anxiety disorder and that it is interfering with her life. I would encourage her to seek out a consultation with a psychologist or other qualified mental health practitioner who I hope could help diagnose the problem and make specific recommendations.

BRONCO_4x4: I am agoraphobic and was wondering if you know any online support groups?

Richard Kneip, PhD: While I don't know if they have an online presence, Agoraphobics in Motion is a large organization dedicated to the support of agoraphobia sufferers and the dissemination of information about agoraphobia. Agoraphobia is a common anxiety disorder characterized by anxiety about being in places and situations from which escape might be difficult or embarrassing or in which help might not be available in the event of having an unexpected panic attack. Their fears include being outside alone, being in a crowd, and being on a bridge, traveling in a bus, train or automobile. It is often accompanied by panic-like symptoms including pounding heart, shallow breathing, sweating, and fear of dying or "going crazy." You can find more information about agoraphobia and panic disorder at

darthwood2005: Is homophobia a real phobia?

Richard Kneip, PhD: No. Usually homophobia is used to describe negative attitudes that individuals might have towards gays. While these attitudes may be based on fear on an unconscious level, they are manifested most often as hatred or contempt.

nygirltoday: What is fear of change called? How do you move ahead if you are afraid of consequences of change in life, like job, relationships, etc?

Richard Kneip, PhD: I don't know the name of the phobia that represents fear of change, although I invite you to search our list of phobias at I'm sure it is in there somewhere. Fear of change probably lies as the basis of many of the problems that bring people in for therapy. If we all were flexible and willing to accommodate ourselves to our changing life circumstances, then there would be no need for a therapist or therapy at all. Far too often, however, we become trapped in the familiar and are unwilling or unable to try out new things.

almostjena: I have a fear of IV's. What can I do to overcome this fear?

Richard Kneip, PhD: Fear to a specific object, such as an IV, is a phobia and can be effectively treated with the group of techniques known as systematic desensitization as I described earlier. You might seek out a therapist trained in the so-called behavioral techniques or do a search on the Internet under systematic desensitization.

reality_jones: Can you recommend some relaxation techniques to reduce stress?

Richard Kneip, PhD: There was a book written a number of years ago, I believe by Jacobson, known as the Relaxation Response. For many years it was widely regarded as the best methodology for inducing a state of deep relaxation. The techniques are quite simple, and actually are very much like meditation involving the gradual and progressive relaxation of individual muscles while at the same time focusing on one's own breathing. With practice, it is possible to very quickly induce a state of deep relaxation, which is similar to sleep in that the brain waves as measured by an EEG become progressively greater in amplitude and lesser in frequency. In common term, this brain wave pattern is much like deep, non-dreaming sleep.

heavenlyblueyes: Can you please tell me if there is any activities I can do at night to calm the fear that someone is breaking into my house? I will stay awake all night pretending to be asleep and get in and out of the bed to check the doors and windows. I have even gone so far as placing things in front of the doors trying to calm my anxieties but to no avail. Lack of sleep is starting to affect my performance at work. Help!

Richard Kneip, PhD: I would recommend that you speak with a mental health professional to address this problem. While you suggest that your fears are unfounded in the sense that your living quarters are secured and you have difficulty sleeping after checking of the locks, a brief course of behaviorally oriented psychotherapy may be helpful in reducing the fears. Perhaps a psychiatrist might recommend a sleeping aide initially until the fears are reduced sufficiently to allow for normal uninterrupted sleep.

darthwood2005: Is arachnophobia a hereditary gene?

Richard Kneip, PhD: As far as I am aware, there is no evidence whatsoever of a genetic link to a specific phobia. In other words, if your mother had a fear of snakes, you are probably not likely to suffer a fear of snakes yourself. However, there is fairly strong evidence of at least some genetic predisposition of anxiety disorders in general. If you grew up in a household where mother spent a lot of her day making sure there were no snakes in the house, then such a powerful learning experience might be influential in your own phobic development. You might end up in the same place but it would be the result of a relatively weak genetic component and a stronger social learning component.

Thank you for all your excellent questions and judging by the large number of questions, we will do another chat on this topic soon. You can find more information about fears, phobias and anxieties at, where you will also find discussion groups.

Moderator: Thank you Dr. Kneip. We will definitely have another chat on fears and phobias soon. Thank you for all of your guidance on the topic. We apologize if we didn't get to your question today. We hope the information you received was helpful. The WebMD chat team thanks you for spending the past hour with us. It was a pleasure hosting for you today. Have a great day.

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