This review covers the neurobiological and psychological aspects of fear and anxiety from the perspective of creating effective horror movies. The review begins with biological mechanisms of the fear response, and then discusses the specific techniques and strategies that may be used for generating powerful simulated fear experiences in movies. Movie audiences are not actually exposed to real threats, thus the events depicted in the movie should pass the brain’s “reality check” systems and top-down emotion regulation strategies to engage the automatic fear responses in the brain. Because are social species, one powerful mechanism for this is the vicarious experience – automatic resonance of the movie character’s somatic and motor states in the viewer. Most powerful general determinants of fear are the proximity of the threats, as well as their unpredictability. These can be significantly amplified with proper timing by carefully intermixing episodes of increasing and deceasing suspense with sudden intensely shocking events. Some fears are nearly universal and thus powerful themes for horror movies. Fears of injury and illness as well as those pertaining to termination of social relationships are the most common ones in the general population. Similar fears are also sources of common clinical phobias, suggesting that that humans are genetically predisposed to fear specific life-threatening conditions and events. Survey data also show that scariest horror movies deal with this kind of universal themes. Because the fear system can potentiate learning, new fears can also be installed in the audience during the course of a movie. When coupled with the biologically universal determinants of fear, these novel, movie-specific fears can be made very potent. Soundscape is critical for horror, as auditory information is automatically and unconsciously processed even while focussing on the visuals. Specific acoustic features such as roughness constantly perceived as threatening and they also automatically activate the brain’s fear circuit. These features can also be implemented in musical soundtracks to increase their scariness. Horror movies are widely appealing, but more popular among males than females and for individuals with high personality factors of sensation seeking and aggression. Further, emotion recognition abilities increase and emotionality stabilizes towards the old age, making older audiences more difficult to scare. The paradoxical appeal of horror movies stems from three factors – universal human curiosity even towards morbid and threatening subjects, mixing of emotions of fear and excitement in the brain, as well as the capability to learn about own emotionality and dangerous situations safely in the context of movies.