I was halfway through sleep and consciousness when I heard the words: The year of no fear. I woke up right away. The voice had been so clear, so tangible — as if someone were cupping their hand around my ear and whispering to me. I rubbed my eyes and sat up. How could a year already marked by cancer be one that contained no fear?
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Hundreds came up. Over and over and over again, God encouraged His people to be strong and have courage. He will not fail you or forsake you. Even in the midst of my year of no fear, there were some days I woke up afraid and trembling. And yet — even in my fear — God was the One who went with me. Who went with my mom. Again and again, God went with us. He was the one who gave me courage.
And over and over, I clung to the promises He had made me. Through clinging to those promises, I began to become more courageous. Choose to be brave. Show up to the things that scare you. God will give you the strength and the courage. Ask God for bravery.
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Find the plethora of verses in the Bible where God tells his people to have courage, and write some of them down on cue cards or sticky notes. Stick them on your car, on your bedside table, on your bathroom mirror, on your fridge, or on your laptop, so you can constantly be reminded that God is making you be brave. Start a journal where you write down the steps of courage you are taking. You will be surprised when you read it back how much braver you have become.
Hold tight to the promises God has given us. You were born to be courageous.
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This is your Year of No Fear. It is your year to grow into the courageous woman God has created you to be. Primary is morbid fear of childbirth in a woman, who has no previous experience of pregnancy.
Secondary is morbid fear of childbirth developing after a traumatic obstetric event in a previous pregnancy. A case of tokophobia with depression who responded to fluoxetine is being described.
Pregnancy is a major physical, psychological, and social event in every woman's life. Instead of being a joyful experience, pregnancy may become a worrisome and fearful event in few patients and the fear may assume a pathological dimension and becomes a disorder worth recognition and treatment. Majority of women are able to cope up with fear and anxieties by self-help efforts, social support, and medical help.
However, when it becomes pathological dread, it is called tokophobia. Primary tokophobia is morbid fear of childbirth in a woman, who has had no previous experience of pregnancy. The dread of childbirth may start in adolescence or early adulthood. Although sexual relations may be normal, several different methods of contraceptive use to delay the pregnancy is often scrupulous.
Some suffering women go for abortion, caesarean, or adoption. However, it could also occur after an obstetrically normal delivery, miscarriage, stillbirth, or termination of pregnancy. Less commonly, prenatal depression may be present with tokophobia.
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A year-old married housewife of high socioeconomic status presented to the psychiatry out-patient department with a 2 years history of morbid dread of pregnancy. This started 2 years after marriage when she contacted a gynecologist for menstrual irregularity. She asked the physician about the complications of pregnancy. On hearing the dreaded complications like having a deformed fetus, change in body figure, eclampsia, caesarean, and even death, she developed excessive fear of pregnancy.
When also informed that no contraceptive method is fully protective, she started avoiding sexual contact with husband. On stopping all sexual activity, she gradually developed sad mood, hopelessness, helplessness, worthlessness, difficulty in falling asleep, weeping spells, loss of appetite and suicidal ideation. She also started having less interaction with husband, parents, and other relatives.
Even after being counseled by relatives and two obstetricians, she could not get rid of the fear of pregnancy. There was no past or family history of mood disorder, schizophrenia, epilepsy, or drug dependence. Her vitals, routine investigations, and physical examination were normal. On mental state examination, she was a tidy, cooperative lady of pyknic build. There were no disturbances in orientation or memory. Her mood was sad with reduced psychomotor activity and monotonous low volume speech.
There were ideas of hopelessness and worthlessness and also, feeling of guilt and suicidal ideation. There was no formal thought disorder. Insight and judgment were intact. She was diagnosed as a case of tokophobia with major depressive disorder. She was started on fluoxetine, 20 mg once daily and clonazepam 0. The dose of fluoxetine was increased to 40 mg daily and over the next 4 weeks, there was reduction in her morbid fear of pregnancy along with symptoms of depression. She started having normal sexual activity.
Tokophobia: A dread of pregnancy
At follow-up after 3 months while still on medication, there was no recurrence of symptoms. Pregnancy and anxiety related to childbirth are very common in women. The various hypotheses put forward to explain fear of childbirth include disturbance in neurohormonal homeostasis i. Most of the women with fears seek support from their spouses, mothers, sisters or other family members, while some look to friends and colleagues for support.
Cognitive behavior therapy Because of short duration, lack of deep analysis, and focus on a specific symptom and psychotherapy aimed at controlling emotions and feelings give satisfactory results. Prenatal and antenatal education[ 11 , 10 ] and antenatal screening tests certifying normalcy[ 12 ] is an effective way to alleviate fears.
Preventive programs for management of pregnancy-related fears should be implemented in modern obstetrics.
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