August 26, 2025 • 14 mins
Being healthy involves more than just your physical health. Taking care of your mental and emotional health is just as important. This includes overcoming fears, phobias and anxiety. In today’s episode, we will speak with Dr. Eric Berko, Psychologist at MetroHealth, about how to tell the difference between fears and phobias, and the treatments and techniques to face them.
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Episode Transcript
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Speaker 1 (00:01):
What's up, guys on Maddie Will's back with another episode
of Be Well with Maddie Wills, of course, brought to
you by the fine folks at Metro Health, where each
episode we talk to a different healthcare expert about a
variety of topics. Today we have my good friend, doctor
Eric burko In and first and foremost, thanks for taking
some time out of your busy schedule to talk with us.
We know you guys have really important jobs, so we
(00:23):
really appreciate your time.
Speaker 2 (00:24):
Happy to be here absolutely.
Speaker 1 (00:26):
So before we get started, and of course today's topic
is what are you afraid of? Before we dive into
those questions, give our listeners and viewers just a little
bit about your journey through Metro, what your role is
here and how you got here.
Speaker 2 (00:39):
Yeah.
Speaker 3 (00:40):
So I'm a psychologist. I've been at Metro for about
twenty years. I started because they asked me to be
the behavioral science educator and the Department of Family Medicine.
So that's a requirement for family Medicine for them to
learn about psychology, good communication skills, treatment of mental health disorders.
(01:00):
So I started doing that twenty years ago and then
we created this integrated care clinic where we do some
pretty innovative work that we are immediately available in primary
care clinics if someone's having a mental health issue, so
we work side by side with the primary care docs
to take care of our patients.
Speaker 2 (01:18):
Perfect.
Speaker 1 (01:18):
So again, in other words, you're a perfect person to
talk about today's topic for our loyal listeners and fans.
So let's just jump right into it. Okay, let's talk
about fears and phobias, which I'll admit I didn't think
there was that much of a difference before I started
researching today's episode. But aren't they the same thing? And
how can you tell the difference between the two.
Speaker 3 (01:40):
It's a really good question. I will say that I
think we've as a general society, we've almost overpathologized everything,
so we label things when there are normal, natural fears,
and it's an important, baked in part of human nature.
We need to be afraid because we need to So
(02:01):
if you and I were out in the woods tonight
and we didn't have food, we didn't have water, we
better be afraid. There's a part of our brain called
the amigdala that fires and sends this hormonal rush through
our body that we all know that feeling, that feeling
of fear, like if someone cuts you off in traffic
and your heart's pounding and your palms are sweating. That's
(02:23):
a normal natural reaction and it usually compels us to
do something good. So if we were out in the woods,
if we hear noises, we may pick up a stick
and figure out how we're going to defend ourselves. Or
we may say it's getting dark, we should probably build
a fire, or we may want to store up food. Right,
So these are good, important things. So fear is a natural,
(02:44):
baked in part of human nature, and it's normal to
be afraid of things that are scary, like spiders, like heights,
like strange situations that we don't know the map of.
So that's fear. Does that make sense?
Speaker 2 (03:00):
Absolutely? Yeah.
Speaker 1 (03:01):
Also, the first time I've ever heard that we need fear,
But the way you you know, contextualize it, it makes
perfect sense.
Speaker 3 (03:09):
There's literally the most important part of our reptilian basic
brain is that is that amygdala, which is the fear
center in our brain. It's in all of us and
all of the animals, you know, everywhere, right right.
Speaker 1 (03:23):
So what are the signs and symptoms of anxiety when
it comes to fears and phobias.
Speaker 3 (03:28):
Yeah, so those basic physical responses. Your heart pounds, your
palms sweat, you may feel like you have to take
a nervous pee. Some people say I was so scared
I blanked my pants. All part of that. So what's
happening is there's this thing called fight, flight or freeze,
(03:49):
and so our body's preparing for that. So the blood
goes away from the extremities. That's why your palms get sweaty,
get a little shaky, and your hands get cold, your
feet get cold. That's all part of it, because the
blood is rushing to the large muscles in the arms
and the legs, so you can fight or you can run,
basic survival stuff, and sometimes nature requires us to freeze.
(04:12):
The best thing to do is to do nothing. So
fight flight or freeze, and those physical responses are part
of the natural, normal fear response.
Speaker 1 (04:20):
Definitely heard fight or flight. I haven't heard the freeze
aspect as well, probably ever honestly until right now, So
I didn't even know that was a part of the equation.
Speaker 2 (04:29):
I'll backtrack just a bit.
Speaker 1 (04:30):
I know we deep dove into fear, but what would
be your deep dive into phobias.
Speaker 3 (04:35):
Yeah, so the phobia, that's the crossover that there's a
clinical condition, there's something that is beyond just the normal fears,
but it's interfering with your daily function. That's the big
difference on every one of the mental health diagnoses. The
final criteria for all of them is impairment of social
(04:58):
or occupational function. So the phobia is maybe a fear
of spiders, and that phobia then causes you to not
go out. You're afraid to interact with friends, You're afraid
to go into the basement, and you have to do
your laundry, and you haven't done your laundry in six
months because you're not going down the basement because you
swear there's a spider down there and it's going to
(05:20):
kill you. The same thing with a fear of heights, Right,
it's normal most of us. I don't like heights very much.
I've been working on this for a long time. I
go to high places and I sit there for a
long time until my body calms down and I realize
I'm not actually going to fall and die this. But
(05:40):
the phobia would be that I maybe reroute my entire
drive and I'm not going across the bridge because I'm
afraid that I'm somehow going to fall off the bridge.
So it impairs my daily social or occupational functioning. That's
when it becomes a phobia.
Speaker 1 (05:56):
And obviously, so phobias are maybe the next of a
fear or kind of the extreme of when you are
fearful of something.
Speaker 2 (06:07):
Is that a good way to categorize.
Speaker 3 (06:08):
That's a great way to categorize it. And then the
thing that happens is that we start to avoid, right,
we start to avoid things. People develop what's called agoraphobia,
a goora open spaces, fear of open spaces. We get
stuck in our houses. I have patients who are literally
stuck in their houses. COVID was something that we all experienced.
(06:32):
For some people, they're still dealing with the isolation because
they became so afraid of the outside world that there
are germs, there's badness, and we were told don't go out,
stay away, don't be around people, be careful, wash your hands,
don't breathe any air that other people breathe. And so
what happened to some people is their world got smaller
and small. You avoid that feared stimulus, and the avoidance
(06:56):
gets bigger and bigger and bigger, to the point that
you create a safe space. And that safe space may
be at home. For some people, it's their couch, and
they're afraid that something bad will happen if they get
off their couch, if they get out of their home,
and so they won't go to doctor's appointments, they won't
interact with the outset world, they won't go to church
(07:16):
or other places that they love to do. As you
can see, again, that impairs their daily life.
Speaker 2 (07:22):
That's when we need to do something.
Speaker 1 (07:24):
So the next time my wife says that she wants
me to kill that spider, I would just tell her
to get over her fear because it's it's not a phobia.
Speaker 2 (07:32):
She can get over it.
Speaker 3 (07:32):
I'm just I am not causing problems in your marital home.
Speaker 1 (07:36):
So sticking with phobia is how do they grow into
patterns that could interfere with our daily life.
Speaker 3 (07:42):
Like I said, it kind of goes in this progressive
way where we may start to avoid small things. I
don't know if you've ever had a panic attack, You
ever had a panic attack, I don't, I don't think
so not asking you to reveal your I've had panic
atten right, they're awful, and so you feel like you
can't catch your breath. It's that whole fear response, that
fight or flight response, and so then you start to
(08:05):
fear the potential of that happening, and so you avoid things.
Whether it's for the agoraphobia example, it may start that
you had a panic attack and you were out shopping,
and so then you've connected the shopping with that fear response,
(08:25):
with that panic response, and then you start avoiding shopping
and someone else does it for you. You know, you've
got a nice partner or someone in your life, a
sibling who does your shopping for you, so you feel
better about But then maybe you start avoiding going to
church or your place of worship. And maybe for a
while you can go, but you sit in the back,
(08:47):
in the corner where you know you.
Speaker 2 (08:48):
Have escape, you can get out.
Speaker 3 (08:50):
But then you stop going there. And then maybe you
loved going to ballgames, you stop going to the ball
games because you're afraid from around. How am I going
to escape? How am I going to get away? So
your world gets progressively smaller and smaller and smaller if
you don't approach that, if you don't get yourself to
do the thing that you're afraid to do, deal with
it bigger and bigger.
Speaker 1 (09:11):
So with that, what are some ways we can manage
our fears and phobias on our own?
Speaker 3 (09:17):
So doctor Barlow, Dave Barlow did the foundational research about
all these anxieties and panics, and if you boil that
literature down to one simple thing, it's what your grandmother
would have told you. What is do it?
Speaker 2 (09:32):
Do it?
Speaker 3 (09:33):
The fancy term is exposure with response prevention. So that's
the treatment of choice for any of these anxiety disorders.
You have to expose yourself to the feared situation and
prevent that response, that avoidance response. So some of these
things can be kind of dramatic, like people who have
phobias of germs and develop obsessive compulsive disorder and they
(09:56):
wash their hands all day and they're afraid. So you
may this may seem like a radical exposure, but you
may have them rub a public toilet seat.
Speaker 2 (10:05):
Oh my wife would never do that, and then hand
was washed there.
Speaker 3 (10:08):
She would not be happy. But what you do is
you realize, Okay, my hands haven't fallen off, I didn't
get some horrible disease. You expose yourself now, not usually
as dramatically as that. You may do it progressively, something
small first, you know, like you touch a door handle
and don't wash your hands, and then you get progressively
(10:28):
dirtier and dirtier until the point where you've exposed yourself
enough you're no longer afraid of that situation.
Speaker 1 (10:37):
That makes sense in my mind, but I can also
see a person having some trouble dealing with that on
their own, though, depending on obviously how severe their fear
or their phobia actually is. So when should someone seek
professional help for their fears and phobias and what does
that help actually look like.
Speaker 3 (10:57):
Yeah, that's such a good question. There are a lot
of things that we do feel like we can handle
on our own, and people may experiment themselves a little
bit trying to push themselves out there. If they're not
able to do it themselves, then the best thing to
do is start with your primary care doctor, because there's
a lot of things that can look like anxiety and fear,
but they're medical problems. There are things that can change
(11:20):
with our hormones, there are things with our blood pressure
and our blood sugar. There can be changes in our brain,
our vascular structure, so the first thing is to get
a good medical check up and make sure physically we're healthy.
Like we were talking about here at Metro. One of
the nice things is that in most of the primary
care settings, we're available right in clinic. So if you
(11:41):
see your doc they do the rule outs for the
medical issues, they'll get you in touch with us right
away through the primary care clinic and they'll get you
connected with a psychologist or a councilor right there, and
then we can talk with you about what's going on
and come up with a plan.
Speaker 2 (11:58):
I mentioned this all the time.
Speaker 1 (11:59):
One of the reasons I fell in love with the
partnership we have with Metro is the you know, their
attention to care on the mental or behavioral health side
of things, and they're just the access that they have.
Speaker 2 (12:13):
And then even.
Speaker 1 (12:16):
Before my former doctor Marcus Germany switched his role or
whatever he's doing now, he picked up on something that
was going on with me from a mental horror or
behavioral health standpoint. Our very first interaction, and that was
in the midst of us of doing this, but it
(12:37):
was like a kind of like an AHA moment for me,
just saying, like, you know, I look for little signs
just in regular life, like Okay, I'm on the right track,
or maybe this is where I'm supposed to be in
this moment, and that was one of those signs for me.
So it makes it easier and it makes me more
excited to speak with the other health professionals within Metro
Health's kind of sphere because of that particular care that
(13:02):
you guys offer. It really is unique in my opinion,
especially from a person who didn't love going to the
doctor all the time, he made it a little bit
easier for me. And when I explain that to my wife,
she was all on board as well. But every time
I speak with any of you, you guys just kind
of reiterate that. So it's pretty it's pretty nice.
Speaker 3 (13:21):
I gotta be here, and I do agree. That's a
point of strength. And something I'm really proud of is
being one of the docs here at Metro is that
we're trying to pay attention to the whole person, absolutely,
including the social world and the barriers right that so
many of us and so many of our patients face.
Speaker 2 (13:40):
Perfect.
Speaker 1 (13:40):
Thank you so much. That was really, really, really good.
He's doctor Eric Burko. I'm Mattie Wills and of course,
if you're experiencing fears and phobias that interfere with daily life,
the Metro Health team is here to help. Call two
on six seven seven eight four four two eight to
book an appointment today.
Speaker 2 (13:57):
Doctor. Thank you again, we appreciate it.
Speaker 3 (13:59):
Thanks for having me, Es
What's up, guys on Maddie Will's back with another episode
of Be Well with Maddie Wills, of course, brought to
you by the fine folks at Metro Health, where each
episode we talk to a different healthcare expert about a
variety of topics. Today we have my good friend, doctor
Eric burko In and first and foremost, thanks for taking
some time out of your busy schedule to talk with us.
We know you guys have really important jobs, so we
(00:23):
really appreciate your time.
Speaker 2 (00:24):
Happy to be here absolutely.
Speaker 1 (00:26):
So before we get started, and of course today's topic
is what are you afraid of? Before we dive into
those questions, give our listeners and viewers just a little
bit about your journey through Metro, what your role is
here and how you got here.
Speaker 2 (00:39):
Yeah.
Speaker 3 (00:40):
So I'm a psychologist. I've been at Metro for about
twenty years. I started because they asked me to be
the behavioral science educator and the Department of Family Medicine.
So that's a requirement for family Medicine for them to
learn about psychology, good communication skills, treatment of mental health disorders.
(01:00):
So I started doing that twenty years ago and then
we created this integrated care clinic where we do some
pretty innovative work that we are immediately available in primary
care clinics if someone's having a mental health issue, so
we work side by side with the primary care docs
to take care of our patients.
Speaker 2 (01:18):
Perfect.
Speaker 1 (01:18):
So again, in other words, you're a perfect person to
talk about today's topic for our loyal listeners and fans.
So let's just jump right into it. Okay, let's talk
about fears and phobias, which I'll admit I didn't think
there was that much of a difference before I started
researching today's episode. But aren't they the same thing? And
how can you tell the difference between the two.
Speaker 3 (01:40):
It's a really good question. I will say that I
think we've as a general society, we've almost overpathologized everything,
so we label things when there are normal, natural fears,
and it's an important, baked in part of human nature.
We need to be afraid because we need to So
(02:01):
if you and I were out in the woods tonight
and we didn't have food, we didn't have water, we
better be afraid. There's a part of our brain called
the amigdala that fires and sends this hormonal rush through
our body that we all know that feeling, that feeling
of fear, like if someone cuts you off in traffic
and your heart's pounding and your palms are sweating. That's
(02:23):
a normal natural reaction and it usually compels us to
do something good. So if we were out in the woods,
if we hear noises, we may pick up a stick
and figure out how we're going to defend ourselves. Or
we may say it's getting dark, we should probably build
a fire, or we may want to store up food. Right,
So these are good, important things. So fear is a natural,
(02:44):
baked in part of human nature, and it's normal to
be afraid of things that are scary, like spiders, like heights,
like strange situations that we don't know the map of.
So that's fear. Does that make sense?
Speaker 2 (03:00):
Absolutely? Yeah.
Speaker 1 (03:01):
Also, the first time I've ever heard that we need fear,
But the way you you know, contextualize it, it makes
perfect sense.
Speaker 3 (03:09):
There's literally the most important part of our reptilian basic
brain is that is that amygdala, which is the fear
center in our brain. It's in all of us and
all of the animals, you know, everywhere, right right.
Speaker 1 (03:23):
So what are the signs and symptoms of anxiety when
it comes to fears and phobias.
Speaker 3 (03:28):
Yeah, so those basic physical responses. Your heart pounds, your
palms sweat, you may feel like you have to take
a nervous pee. Some people say I was so scared
I blanked my pants. All part of that. So what's
happening is there's this thing called fight, flight or freeze,
(03:49):
and so our body's preparing for that. So the blood
goes away from the extremities. That's why your palms get sweaty,
get a little shaky, and your hands get cold, your
feet get cold. That's all part of it, because the
blood is rushing to the large muscles in the arms
and the legs, so you can fight or you can run,
basic survival stuff, and sometimes nature requires us to freeze.
(04:12):
The best thing to do is to do nothing. So
fight flight or freeze, and those physical responses are part
of the natural, normal fear response.
Speaker 1 (04:20):
Definitely heard fight or flight. I haven't heard the freeze
aspect as well, probably ever honestly until right now, So
I didn't even know that was a part of the equation.
Speaker 2 (04:29):
I'll backtrack just a bit.
Speaker 1 (04:30):
I know we deep dove into fear, but what would
be your deep dive into phobias.
Speaker 3 (04:35):
Yeah, so the phobia, that's the crossover that there's a
clinical condition, there's something that is beyond just the normal fears,
but it's interfering with your daily function. That's the big
difference on every one of the mental health diagnoses. The
final criteria for all of them is impairment of social
(04:58):
or occupational function. So the phobia is maybe a fear
of spiders, and that phobia then causes you to not
go out. You're afraid to interact with friends, You're afraid
to go into the basement, and you have to do
your laundry, and you haven't done your laundry in six
months because you're not going down the basement because you
swear there's a spider down there and it's going to
(05:20):
kill you. The same thing with a fear of heights, Right,
it's normal most of us. I don't like heights very much.
I've been working on this for a long time. I
go to high places and I sit there for a
long time until my body calms down and I realize
I'm not actually going to fall and die this. But
(05:40):
the phobia would be that I maybe reroute my entire
drive and I'm not going across the bridge because I'm
afraid that I'm somehow going to fall off the bridge.
So it impairs my daily social or occupational functioning. That's
when it becomes a phobia.
Speaker 1 (05:56):
And obviously, so phobias are maybe the next of a
fear or kind of the extreme of when you are
fearful of something.
Speaker 2 (06:07):
Is that a good way to categorize.
Speaker 3 (06:08):
That's a great way to categorize it. And then the
thing that happens is that we start to avoid, right,
we start to avoid things. People develop what's called agoraphobia,
a goora open spaces, fear of open spaces. We get
stuck in our houses. I have patients who are literally
stuck in their houses. COVID was something that we all experienced.
(06:32):
For some people, they're still dealing with the isolation because
they became so afraid of the outside world that there
are germs, there's badness, and we were told don't go out,
stay away, don't be around people, be careful, wash your hands,
don't breathe any air that other people breathe. And so
what happened to some people is their world got smaller
and small. You avoid that feared stimulus, and the avoidance
(06:56):
gets bigger and bigger and bigger, to the point that
you create a safe space. And that safe space may
be at home. For some people, it's their couch, and
they're afraid that something bad will happen if they get
off their couch, if they get out of their home,
and so they won't go to doctor's appointments, they won't
interact with the outset world, they won't go to church
(07:16):
or other places that they love to do. As you
can see, again, that impairs their daily life.
Speaker 2 (07:22):
That's when we need to do something.
Speaker 1 (07:24):
So the next time my wife says that she wants
me to kill that spider, I would just tell her
to get over her fear because it's it's not a phobia.
Speaker 2 (07:32):
She can get over it.
Speaker 3 (07:32):
I'm just I am not causing problems in your marital home.
Speaker 1 (07:36):
So sticking with phobia is how do they grow into
patterns that could interfere with our daily life.
Speaker 3 (07:42):
Like I said, it kind of goes in this progressive
way where we may start to avoid small things. I
don't know if you've ever had a panic attack, You
ever had a panic attack, I don't, I don't think
so not asking you to reveal your I've had panic
atten right, they're awful, and so you feel like you
can't catch your breath. It's that whole fear response, that
fight or flight response, and so then you start to
(08:05):
fear the potential of that happening, and so you avoid things.
Whether it's for the agoraphobia example, it may start that
you had a panic attack and you were out shopping,
and so then you've connected the shopping with that fear response,
(08:25):
with that panic response, and then you start avoiding shopping
and someone else does it for you. You know, you've
got a nice partner or someone in your life, a
sibling who does your shopping for you, so you feel
better about But then maybe you start avoiding going to
church or your place of worship. And maybe for a
while you can go, but you sit in the back,
(08:47):
in the corner where you know you.
Speaker 2 (08:48):
Have escape, you can get out.
Speaker 3 (08:50):
But then you stop going there. And then maybe you
loved going to ballgames, you stop going to the ball
games because you're afraid from around. How am I going
to escape? How am I going to get away? So
your world gets progressively smaller and smaller and smaller if
you don't approach that, if you don't get yourself to
do the thing that you're afraid to do, deal with
it bigger and bigger.
Speaker 1 (09:11):
So with that, what are some ways we can manage
our fears and phobias on our own?
Speaker 3 (09:17):
So doctor Barlow, Dave Barlow did the foundational research about
all these anxieties and panics, and if you boil that
literature down to one simple thing, it's what your grandmother
would have told you. What is do it?
Speaker 2 (09:32):
Do it?
Speaker 3 (09:33):
The fancy term is exposure with response prevention. So that's
the treatment of choice for any of these anxiety disorders.
You have to expose yourself to the feared situation and
prevent that response, that avoidance response. So some of these
things can be kind of dramatic, like people who have
phobias of germs and develop obsessive compulsive disorder and they
(09:56):
wash their hands all day and they're afraid. So you
may this may seem like a radical exposure, but you
may have them rub a public toilet seat.
Speaker 2 (10:05):
Oh my wife would never do that, and then hand
was washed there.
Speaker 3 (10:08):
She would not be happy. But what you do is
you realize, Okay, my hands haven't fallen off, I didn't
get some horrible disease. You expose yourself now, not usually
as dramatically as that. You may do it progressively, something
small first, you know, like you touch a door handle
and don't wash your hands, and then you get progressively
(10:28):
dirtier and dirtier until the point where you've exposed yourself
enough you're no longer afraid of that situation.
Speaker 1 (10:37):
That makes sense in my mind, but I can also
see a person having some trouble dealing with that on
their own, though, depending on obviously how severe their fear
or their phobia actually is. So when should someone seek
professional help for their fears and phobias and what does
that help actually look like.
Speaker 3 (10:57):
Yeah, that's such a good question. There are a lot
of things that we do feel like we can handle
on our own, and people may experiment themselves a little
bit trying to push themselves out there. If they're not
able to do it themselves, then the best thing to
do is start with your primary care doctor, because there's
a lot of things that can look like anxiety and fear,
but they're medical problems. There are things that can change
(11:20):
with our hormones, there are things with our blood pressure
and our blood sugar. There can be changes in our brain,
our vascular structure, so the first thing is to get
a good medical check up and make sure physically we're healthy.
Like we were talking about here at Metro. One of
the nice things is that in most of the primary
care settings, we're available right in clinic. So if you
(11:41):
see your doc they do the rule outs for the
medical issues, they'll get you in touch with us right
away through the primary care clinic and they'll get you
connected with a psychologist or a councilor right there, and
then we can talk with you about what's going on
and come up with a plan.
Speaker 2 (11:58):
I mentioned this all the time.
Speaker 1 (11:59):
One of the reasons I fell in love with the
partnership we have with Metro is the you know, their
attention to care on the mental or behavioral health side
of things, and they're just the access that they have.
Speaker 2 (12:13):
And then even.
Speaker 1 (12:16):
Before my former doctor Marcus Germany switched his role or
whatever he's doing now, he picked up on something that
was going on with me from a mental horror or
behavioral health standpoint. Our very first interaction, and that was
in the midst of us of doing this, but it
(12:37):
was like a kind of like an AHA moment for me,
just saying, like, you know, I look for little signs
just in regular life, like Okay, I'm on the right track,
or maybe this is where I'm supposed to be in
this moment, and that was one of those signs for me.
So it makes it easier and it makes me more
excited to speak with the other health professionals within Metro
Health's kind of sphere because of that particular care that
(13:02):
you guys offer. It really is unique in my opinion,
especially from a person who didn't love going to the
doctor all the time, he made it a little bit
easier for me. And when I explain that to my wife,
she was all on board as well. But every time
I speak with any of you, you guys just kind
of reiterate that. So it's pretty it's pretty nice.
Speaker 3 (13:21):
I gotta be here, and I do agree. That's a
point of strength. And something I'm really proud of is
being one of the docs here at Metro is that
we're trying to pay attention to the whole person, absolutely,
including the social world and the barriers right that so
many of us and so many of our patients face.
Speaker 2 (13:40):
Perfect.
Speaker 1 (13:40):
Thank you so much. That was really, really, really good.
He's doctor Eric Burko. I'm Mattie Wills and of course,
if you're experiencing fears and phobias that interfere with daily life,
the Metro Health team is here to help. Call two
on six seven seven eight four four two eight to
book an appointment today.
Speaker 2 (13:57):
Doctor. Thank you again, we appreciate it.
Speaker 3 (13:59):
Thanks for having me, Es
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