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When was the last time you felt anxious or afraid? For me, it’s pretty common. I used to dread speaking in front of a crowd. I’m still afraid of heights. And many mornings I wake with an uneasy feeling that something might go wrong, even when nothing is.

My daughters say I don’t have particularly good boundaries, and they’re probably right. But I suspect some of you will recognize yourselves in what follows.

The cold-water swim

I’ve done Ironman triathlons and other endurance events for decades. In the first minutes of nearly every race swim, I’ve had panic-like episodes. Usually the fear passes in a minute or two and I keep going.

At a recent swimrun race, it didn’t. The water was very cold, the fear was very big, and for far longer than usual I couldn’t make myself put my face back in the water.

Almost as upsetting as the panic was how I judged myself. Here I was, a veteran Ironman athlete, unable to control my own fear, and other people could see it. I was suffering twice: once from the fear, and again from the shame of being afraid.

Afterward I told a friend who knew about my earlier episodes. Instead of sympathy, he said he admired me for continuing to race, knowing the panic might return again and again. I had seen failure. He saw courage. And courage isn’t the absence of fear. It’s choosing to act despite it.

The iceberg below the surface

I later told four other friends, all men. Every one had a fear of his own: heights, butterflies in the stomach, a vague dread he rarely mentioned. Men aren’t often comfortable sharing vulnerability, but once I went first, each of them did too.

Five friends aren’t a scientific sample, but the data agree. An analysis of the 2019 U.S. National Health and Wellness Survey found that 44% of adults reported anxiety symptoms and 18.1% had a diagnosed anxiety disorder, and those symptoms were tied to worse quality of life. Women report anxiety disorders more often than men, but a systematic review of anxiety in men suggests many men are reluctant to acknowledge it or seek help. The dramatic phobias and panic attacks we hear about may be only the visible tip.

Fear is a response to an immediate threat, like a growling dog charging toward you. Anxiety is the anticipation of one, like walking that same street the next day, worried the dog will be back. Fear protects us, but the response often outsizes the danger. Cold water triggers involuntary gasping and rapid breathing, and those normal sensations probably amplified my panic. Then anticipation takes over. I’m already anxious about becoming anxious on my next swim, and about an upcoming hot air balloon ride.

And then there’s shame. My hypothesis: if my anxiety in the water is a six out of ten, adding the thought “I’m weak” doesn’t change the six, but it increases my total suffering. A meta-analysis of shame, guilt, and anxiety found a moderate association between shame and anxiety symptoms. That shows they travel together, not that shame causes the extra distress. But a systematic review of mental-health stigma found that stigma discourages help-seeking, which may be why so much of the iceberg stays submerged.

Serenity, courage, and wisdom

As I thought about what to do, I kept returning to the Serenity Prayer: “God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.” Religious or not, it’s a useful framework for fear.

Courage first, because some fears are very treatable. Exposure-based cognitive behavioral therapy isn’t white-knuckling through terror. It’s a structured way of gradually and safely facing feared situations and learning that anxiety doesn’t mean danger. A meta-analysis of 33 randomized trials for specific phobias found large benefits compared with no treatment. Closer to home, a randomized trial of automated virtual reality therapy in 100 adults with fear of heights produced large improvements, often in people who had lived with the fear for decades.

I’ve also started eye movement desensitization and reprocessing (EMDR) for my fear of heights. The evidence is strong for PTSD but only preliminary for phobias and other conditions. After just a few sessions, my fear seems noticeably smaller. Stay tuned for my balloon report.

Serenity is for anxiety without a single target, like my morning apprehension. The goal shifts from eliminating the feeling to reducing how much it runs my life. Acceptance and Commitment Therapy helps us notice anxious thoughts without obeying them. A meta-analysis of 23 randomized trials of acceptance- and mindfulness-based approaches in 1,815 adults with anxiety disorders found short-term symptom reductions, though long-term benefits remain uncertain. In a randomized trial in JAMA Psychiatry, an eight-week mindfulness-based stress reduction program did about as well as the antidepressant escitalopram in 276 adults with anxiety disorders. Breathwork shows modest benefits for stress and anxiety, though study quality warrants caution.

Even the shame itself may be workable. A systematic review of 37 shame-reduction studies found that 32 reported reductions, though only nine showed the benefit lasting. My friend didn’t cure my fear of swimming. He changed what it meant to me.

One caveat from my own life. My morning coffee seems to ease my vague apprehension, yet a meta-analysis on caffeine finds it generally increases anxiety, especially at higher doses. This is exactly where an N-of-1 experiment earns its keep: the average result may not be your result. And if these approaches aren’t enough, medications are a reasonable option to discuss with your doctor.

Into the sunlight

Wisdom is knowing which fears we can treat and which we may need to live with more gracefully. Most of us don’t need to become fearless. We just need fear to stop making our decisions, so we don’t skip the family wedding because of the flight.

Fear and anxiety are far more common than most of us admit. Many are treatable, and even the stubborn ones can lose their grip. Perhaps the simplest first step is the one I was so reluctant to take: saying out loud that we’re afraid.

Because living long and well isn’t just about adding years to our lives. It’s also about finding more joy in the years we have.

Live long and well.