Cold Fear is a survival horror third-person shooter played from either a third-person fixed camera perspective or an over-the-shoulder camera, depending on the player’s preferences.

The main enemies in the game are Russian mercenaries and various types of zombie-like creatures known as “Exos” (creatures infected by a parasitic organism known as an “Exocel”). Exos include “Exomutants” (mercenaries infected with Exocels), “Exoshades” (creatures which can see perfectly in the dark), “Exospectres” (which can turn transparent for brief periods of time) and “Exomasses” (a hugely strong but deformed creature created as a result of a failed experiment).

Most infected enemies can be knocked down with two or three shots, but unless the brain is destroyed, they will not die, and will eventually attack Hansen again. Players can destroy the brain either by shooting enemies in the head or knocking them down and stomping on their heads. If an enemy gets close to Hansen, the player can perform a critical hit by pressing a combination of buttons. All exos carry at least one exocel within them. When the exo is killed, the exocel may emerge and attack Hansen, or, if there are any other dead bodies in the area, infect and re-animate that body. Exocels are fast, but very weak and can be killed with one gunshot.

The first half of the game is set on a whaler in the middle of a storm, and the conditions on the deck affect the degree of control the player has over Hansen. As the ship sways continuously from side to side, aiming is made more difficult, although Hansen can grab onto a ledge to steady himself, if one is available. In some instances, the ship can sway to such a degree that Hansen will slide towards the edge and potentially fall overboard. There are also numerous environmental hazards on the deck that react to the motion of the ship, such as swinging electrical wires and crates hooked up to ropes. If any of these items hit Hansen, he will lose health. Waves crashing onto the ship’s deck can also cause Hansen damage.