Distress

Main distress signs for fear can be summarized:

A) General signs:

—difficulty in breathing (uneven heaving of the chest or unusual tightness in a person whom you know normally breathes more freely).

—increasing pallor of the skin, possibly accompanied by visible breaking out in beads of sweat.

—increasing fidgetiness or agitation.

—signs of dryness in the mouth and throat—working of the jaw, frequent swallowing, licking of the lips; increasing dryness of the voice, tendency to speak in a croak or more huskily and lower than usual.

—increased blinking (may represent an attempt to restore moisture to eyeballs that are becoming dry through activation of the emergency branch of the autonomic nervous system); or conversely, increased protrusion of the eyeballs and the development of a fixed stare.

—clamping together of the knees tightly.

—shakiness or trembling (in itself not necessarily fear, since it may indicate anxious excitement or anticipation).

B) 'Freezing':

—rigid immobility of the whole body.

—rigid immobility of the eyes, which protrude and stare blankly into space.

—jaw hangs open.

—breathing apparently suspended (only slight movement around the area of the waist).

—inability to speak, 'struck dumb'.

C) Panic:

—frantic rolling of the eyes with desperate or piteous expression.

—mouth open with corners turned down as in the grief expression, but with a tendency for the neck muscles to be contracted and stand out in cords (this represents a suppressed scream).

—agitated rushing about, bumping into things, repeating actions compulsively and irrationally (e.g. getting a tissue, wiping nose, throwing tissue away, then repeating the whole sequence; or lighting a cigarette then stubbing it out, i.e. agitation without contact).

—extreme shakiness and shuddering of the body.

—constant repetition of a word or phrase.

—splaying wide of the fingers and/or compulsive jerking of the hands.

—self-destructive behavior, such as banging into walls (this seems to represent a blind flight away).

—desperate and convulsive clinging to someone else (flight towards).

—hyperventilation (uncontrollable panting); see section EMERGENCY.

Provocation

It is not necessary to discuss the obvious ways of frightening a person, such as bullying, threatening violence, or pushing them into danger. Some more subtle ways may be worth mentioning.

Destructive threats may provoke anger as well as fear, or even rational withdrawal. The kind of threat that seems most likely to provoke fear alone is the threat of withdrawal of support that is normally given. If a person has been relying on you for some kind of support, and you are now withdrawing it, never underestimate the fear this may provoke. Support in the literal sense of keeping another organism from falling is the most basic primal antidote to fear, since there is evidence that the most primitive fears in newborn infants and primates are those linked with 'falling anxiety'—being dropped by or losing the grip on the mother. At this primitive level, which therapeutic evidence suggests lives on in us all, support equals mother. Likewise, withdrawal of support equals withdrawal of mother. Even if the support has been metaphorical or symbolic, far removed from actual physical support (examples are financial support, support for advice seeking), its withdrawal may be met with panic, especially in a person who has difficulties being independent. An emotionally self-supporting person for whom support is a welcome help but not a perpetual necessity, does not have this difficulty. So even if you withdraw support from someone and the first reaction you receive is rage, do not underestimate the fear content.

There are also many subtle and indirect ways of threatening a person that are nevertheless extremely potent because they evoke childhood fears. An adult's looming above a child is one of the most potent triggers of fear. Even among adults, if one insists on always looming or towering above another, sitting always higher, looking intimidatingly downward, the result will be the evocation of at least a continual low grade anxiety. Watch your habits in this way; many tall people in particular feel insecure and awkward because of their height, on the one hand, but compensate by crowding in on shorter people, on the other. Or, if you set out to comfort someone by sitting on the arm of their chair and towering over them as you reassure them, do not be surprised if your reassurances are not well received.

Similarly, in comforting a person who is frightened, it does not make much sense to sweep them off their feet and smother them in your arms in a vigorous movement. No matter what trust they already have in you, your behavior is, at a biological level, threatening. There is a fine line between smothering and protection.

Finally, as is well known, panic is infectious. This seems to be true much more than of anger. Although the situation is commonplace of a crowd dispersing in panic and becoming a stampeding mob, the opposite situation of a crowd becoming whipped up into a frenzy of murderous rage, as in a lynch mob, seems to require more effort by a leader to induce. Fear, in the form of constant anxiety, seems to be nearer the surface in most people than any other emotion. In a crowd, where tension is high and contact relentless, it may only take one person's explosion into panic to trigger the whole group into flight, as in a flock of birds wheeling away with a single bird who takes off in a hurry. But even in a room with two people, increasing anxiety in one will tend to trigger the same in the other even if it is at first responded to with irritation. Think which situation makes you most quickly upset: if you are with a friend and he or she gets suddenly worked up with rage and starts sounding off about something, or if you are with another friend who suddenly becomes acutely anxious and almost hysterical about some impending event. Which would tend to come quicker, your anger in the first situation or your anxiety in the second?

Your own anxiety can provoke anxiety in others. This is not to say that your anxiety can be eliminated on the spot in the service of Emotional First Aid. Rather, if you are seriously anxious, and on the way to becoming frightened by a situation, this is no time for you to administer EFA. (The slight anxiety that is felt as part of anticipation or excitement, when your energy is mobilized for action but you have not yet begun to act, is normal and not infectious.)

Contact (1): Words

The only words that have any effect in the EFA of fear are those that draw the person into contact. Anything else in the way of reassurances about a situation will be useless if a person is frozen or in panic. As is acknowledged in the common phrase, 'my reassurances fell on deaf ears,' the main problem to deal with in fear is that the person is cut off from contact with you either by the wall of his or her frozen paralysis or by the confusion of flight and panic. This is visible as a temporary 'contact block' at the level of the eyes, which are either rigidly 'unseeing' or so mobile with panic that perception is confused. To the eyes of the frightened person you either do not exist (the only images in front of them are from their own brain) or you exist in the form of monstrous and often threateningly fragmented distortions. In view of this, whatever words you use must reduce ultimately to one word— look. It can be 'look at me,' 'look at my eyes,' 'look at what's happening,' look at this or look at that, but always look. Get the person's eyes directed outwards, get them steady, in focus, preferably on your own eyes. Since you cannot manipulate the eyes physically, words must suffice for this, but you can reinforce the words with gestures.

Reassurance is not very effective in cases of low-grade anxiety, which tends to cause the same dulling or confusion of visual perceptions as fear, although on a lesser level. According to much physiological evidence, the eyes function largely as a sort of outer layer of the brain: they are not only windows into the brain, but they reflect deep levels of brain functioning and even perform some outer level brain functions in processing information. This means that a noticeable suspension or confusion of perception through the eyes, in the form of immobility or hypermobility, is actually a reflection of what is happening in the brain. To reduce some complex physiological data to a simple rule of thumb: if you cannot make contact with a person's eyes, you will not be able to make contact with their brain. In this sense your verbal reassurances do not only fall on deaf ears, your physical gestures or expressions of support are seen with blind eyes.

Since fear has this paralyzing effect on the more sophisticated levels of brain functioning, visual processing, etc., as well as progressively even on less sophisticated functions such as keeping balance and maintaining an upright position, it is as well to realize that EFA with a frightened person must, and only can, make contact at a primitive level. For a brief moment of time, at least, the person has become something like a baby.