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Phobia

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Introduction

A phobia is a type of anxiety disorder, which is usually defined by an intense fear of something that, in reality, poses little or no actual danger. It is normal and even helpful to experience fear in dangerous situations. Fear is an adaptive human response. It serves a protective purpose, but with phobias the threat is greatly exaggerated or nonexistent. For example, it is only natural to be afraid of a snarling Doberman, but it is irrational to be terrified of a friendly poodle on a leash, as you might be if you have a dog phobia.

 Common phobias and fears include closed-in places, heights, highway driving, flying insects, snakes, and needles. However, we can develop phobias of virtually anything. Most phobias develop in childhood, but they can also develop in adults.

Phobias are categorized into Specific Phobias & Social Phobias.

  • Specific phobias are phobias to specific objects or environments, such as arachnophobia (spider phobia) or acrophobia (phobia of heights)
  • social phobias are phobias within social situations, such as public speaking and crowded areas. Some phobias, such as xenophobia, overlap with many other phobias.

If you have a phobia, you probably realize that your fear is unreasonable, yet you still can’t control your feelings. Just thinking about the feared object or situation may make you anxious. When you’re actually exposed to the thing you fear, the terror is automatic and overwhelming.

The experience is so nerve-wracking that you may go to great lengths to avoid it—inconveniencing yourself or even changing your lifestyle. If you have claustrophobia, for example, you might turn down a lucrative job offer if you have to ride the elevator to get to the office. If you have a fear of heights, you might drive an extra 20 miles in order to avoid a tall bridge.

Understanding your phobia is the first step to overcoming it. It’s important to know that phobias are common. (Having a phobia doesn’t mean you’re crazy!) It also helps to know that phobias are highly treatable. You can overcome your anxiety and fear, no matter how out of control it feels.

Normal fears in children

Many childhood fears are natural and tend to develop at specific ages. For example, many young children are afraid of the dark and may need a nightlight to sleep. That doesn’t mean they have a phobia. In most cases, they will grow out of this fear as they get older.

If your child’s fear is not interfering with his or her daily life or causing him or her a great deal of distress, then there’s little cause for undue concern. However, if the fear is interfering with your child’s social activities, school performance, or sleep, you may want to see a qualified child therapist.

According to the Child Anxiety Network, the following fears are extremely common and considered normal:

  • 0-2 years – Loud noises, strangers, separation from parents, large objects.
  • 3-6 years – Imaginary things such as ghosts, monsters, the dark, sleeping alone, strange noises.
  • 7-16 years – More realistic fears such as injury, illness, school performance, death, natural disasters.

Common types of phobias and fears

There are four general types of phobias and fears:

  • Animal phobias. Examples include the fear of snakes, spiders, rodents, and dogs.
  • Natural environment phobias. Examples include fear of heights, storms, water, and of the dark.
  • Situational phobias (fears triggered by a specific situation). Examples include fear of enclosed spaces (claustrophobia), flying, driving, tunnels, and bridges.
  • Blood-Injection-Injury phobia. This is the fear of blood, injury, or needles, or other medical procedures.

Common phobias and fears:

  • Fear of spiders
  • Fear of snakes
  • Fear of heights
  • Fear or closed spaces
  • Fear of storms
  • Fear of needles and injections
  • Fear of public speaking
  • Fear of flying
  • Fear of germs
  • Fear of illness or death

Some phobias don’t fall into one of the four common categories. Such phobias include fear of choking, fear of getting a disease such as cancer, and fear of clowns.

  • Social phobia and fear of public speaking
  • Social phobia, also called social anxiety disorder, is fear of social situations where you may be embarrassed or judged. If you have social phobia, then you may be excessively self-conscious and afraid of humiliating yourself in front of others. Your anxiety over how you will look and what others will think may lead you to avoid certain social situations you’d otherwise enjoy.
  • Fear of public speaking—an extremely common phobia—is a type of social phobia. Other fears associated with social phobia include fear of eating or drinking in public, talking to strangers, taking exams, mingling at a party, and being called on in class.

Agoraphobia (fear of open spaces)

Agoraphobia is another phobia that doesn’t fit neatly into any of the four categories. Traditionally thought to involve a fear of public places and open spaces, it is now believed that agoraphobia develops as a complication of panic attacks.

Afraid of having another panic attack, you become anxious about being in situations where escape would be difficult or embarrassing, or where help wouldn't be immediately available. For example, you are likely to avoid crowded places such as shopping malls and movie theaters. You may also avoid cars, airplanes, subways, and other forms of travel. In more severe cases, you might only feel safe at home.

Signs and symptoms of phobias

The symptoms of a phobia can range from mild feelings of apprehension and anxiety to a full-blown panic attack. Typically, the closer you are to the thing you’re afraid of, the greater your fear will be. Your fear will also be higher if getting away is difficult.

Physical signs and symptoms of a phobia include:

  • Difficulty breathing
  • Racing or pounding heart
  • Chest pain or tightness
  • Trembling or shaking
  • Feeling dizzy or lightheaded
  • A churning stomach
  • Hot or cold flashes; tingling sensations
  • Sweating
  • Emotional signs and symptoms of a phobia
  • Feeling of overwhelming anxiety or panic
  • Feeling an intense need to escape
  • Feeling “unreal” or detached from yourself
  • Fear of losing control or going crazy
  • Feeling like you’re going to die or pass out
  • Knowing that you’re overreacting, but feeling powerless to control your fear
  • Symptoms of blood-injection-injury phobia. The symptoms of blood-injection-injury phobia are slightly different from other phobias. When confronted with the sight of blood or a needle, you experience not only fear, but also disgust.

Like other phobias, you initially feel anxious as your heart speeds up. However, unlike other phobias, this acceleration is followed by a quick drop in blood pressure, which leads to nausea, dizziness, and fainting. Although a fear of fainting is common in all specific phobias, blood-injection-injury phobia is the only phobia where fainting can actually occur.

When to seek help for phobias and fears

Although phobias are common, they don’t always cause considerable distress or significantly disrupt your life. For example, if you have a snake phobia, it may cause no problems in your everyday activities if you live in a city where you are not likely to run into one. On the other hand, if you have a severe phobia of crowded spaces, living in a big city would pose a problem.

If your phobia doesn’t really impact your life that much, it’s probably nothing to be concerned about. But if avoidance of the object, activity, or situation that triggers your phobia interferes with your normal functioning, or keeps you from doing things you would otherwise enjoy, it’s time to seek help.

Consider treatment for your phobia if:

  • It causes intense and disabling fear, anxiety, and panic
  • You recognize that your fear is excessive and unreasonable
  • You avoid certain situations and places because of your phobia
  • Your avoidance interferes with your normal routine or causes significant distress
  • You’ve had the phobia for at least six months

Self-help or therapy for phobias: which treatment is best?

When it comes to treating phobias, self-help strategies and therapy can both be effective. What’s best for you depends on a number of factors, including the severity of your phobia, your insurance coverage, and the amount of support you need.

As a general rule, self-help is always worth a try. The more you can do for yourself, the more in control you’ll feel—which goes a long way when it comes to phobias and fears. However, if your phobia is so severe that it triggers panic attacks or uncontrollable anxiety, you may want to get additional support.

The good news is that therapy for phobias has a great track record. Not only does it work extremely well, but you tend to see results very quickly—sometimes in as a little as one to four sessions. Support doesn’t have to come in the guise of a professional therapist. Just having someone to hold your hand or stand by your side as you face your fears can be extraordinarily helpful.

Phobia treatment tip 1:

  • Face your fears, one step at a time
  • It’s only natural to want to avoid the thing or situation you fear. But when it comes to conquering phobias, facing your fears is the key. While avoidance may make you feel better in the short-term, it prevents you from learning that your phobia may not be as frightening or overwhelming as you think. You never get the chance to learn how to cope with your fears and experience control over the situation. As a result, the phobia becomes increasingly scarier and more daunting in your mind.

Exposure:

  • Gradually and repeatedly facing your fears
  • The most effective way to overcome a phobia is by gradually and repeatedly exposing yourself to what you fear in a safe and controlled way. During this exposure process, you’ll learn to ride out the anxiety and fear until it inevitably passes.

Through repeated experiences facing your fear, you’ll begin to realize that the worst isn’t going to happen; you’re not going to die or "lose it." With each exposure, you’ll feel more confident and in control. The phobia begins to lose its power.

Successfully facing your fears takes planning, practice, and patience. The following tips will help you get the most out of the exposure process.

Climbing up the “fear ladder”

If you’ve tried exposure in the past and it didn’t work, you may have started with something too scary or overwhelming. It’s important to begin with a situation that you can handle, and work your way up from there, building your confidence and coping skills as you move up the “fear ladder.”

Facing a fear of dogs: A sample fear ladder

  • Step 1: Look at pictures of dogs.
  • Step 2: Watch a video with dogs in it.
  • Step 3: Look at a dog through a window.
  • Step 4: Stand across the street from a dog on a leash.
  • Step 5: Stand 10 feet away from a dog on a leash.
  • Step 6: Stand five feet away from a dog on a leash.
  • Step 7: Stand beside a dog on a leash.
  • Step 8: Pet a small dog that someone is holding.
  • Step 9: Pet a larger dog on a leash.
  • Step 10: Pet a larger dog off leash.

Make a list.

  • Make a list of the frightening situations related to your phobia. If you’re afraid of flying, your list (in addition to the obvious, such as taking a flight or getting through takeoff) might include booking your ticket, packing your suitcase, driving to the airport, watching planes take off and land, going through security, boarding the plane, and listening to the flight attendant present the safety instructions.
  • Build your fear ladder. Arrange the items on your list from the least scary to the most scary. The first step should make you slightly anxious, but not so frightened that you’re too intimidated to try it. When creating the ladder, it can be helpful to think about your end goal (for example, to be able to be near dogs without panicking) and then break down the steps needed to reach that goal.
  • Work your way up the ladder. Start with the first step (in this example, looking at pictures of dogs) and don’t move on until you start to feel more comfortable doing it. If at all possible, stay in the situation long enough for your anxiety to decrease. The longer you expose yourself to the thing you’re afraid of, the more you’ll get used to it and the less anxious you’ll feel when you face it the next time. If the situation itself is short (for example, crossing a bridge), do it over and over again until your anxiety starts to lessen. Once you’ve done a step on several separate occasions without feeling too much anxiety, you can move on to the next step. If a step is too hard, break it down into smaller steps or go slower.
  • Practice. It’s important to practice regularly. The more often you practice, the quicker your progress will be. However, don’t rush. Go at a pace that you can manage without feeling overwhelmed. And remember: you will feel uncomfortable and anxious as you face your fears, but the feelings are only temporary. If you stick with it, the anxiety will fade. Your fears won’t hurt you.

If you start to feel overwhelmed…

While it’s natural to feel scared or anxious as you face your phobia, you should never feel overwhelmed by these feelings. If you start to feel overwhelmed, immediately back off. You may need to spend more time learning to control feelings of anxiety (see the relaxation techniques below), or you may feel more comfortable working with a therapist.

Phobia treatment tip 2: Learn relaxation techniques

When you’re afraid or anxious, you experience a variety of uncomfortable physical symptoms, such as a racing heart and a suffocating feeling. These physical sensations can be frightening themselves—and a large part of what makes your phobia so distressing. However, by learning and practicing relaxation techniques, you can become more confident in your ability to tolerate these uncomfortable sensations and calm yourself down quickly.

Relaxation techniques such as deep breathing, meditation, and muscle relaxation are powerful antidotes to anxiety, panic, and fear. With regular practice, they can improve your ability to control the physical symptoms of anxiety, which will make facing your phobia less intimidating. Relaxation techniques will also help you cope more effectively with other sources of stress and anxiety in your life.

A simple deep breathing relaxation exercise

When you’re anxious, you tend to take quick, shallow breaths (also known as hyperventilating), which actually adds to the physical feelings of anxiety. By breathing deeply from the abdomen, you can reverse these physical sensations. You can’t be upset when you’re breathing slowly, deeply, and quietly. Within a few short minutes of deep breathing, you’ll feel less tense, short of breath, and anxious.

  • Sit or stand comfortably with your back straight. Put one hand on your chest and the other on your stomach.
  • Take a slow breath in through your nose, counting to four. The hand on your stomach should rise. The hand on your chest should move very little.
  • Hold your breath for a count of seven.
  • Exhale through your mouth to a count of eight, pushing out as much air as you can while contracting your abdominal muscles.
  • The hand on your stomach should move in as you exhale, but your other hand should move very little.
  • Inhale again, repeating the cycle until you feel relaxed and centered.
  • Try practicing this deep breathing technique for five minutes twice day. You don’t need to feel anxious to practice. In fact, it’s best to practice when you’re feeling calm until you’re familiar and comfortable with the exercise. Once you’re comfortable with this deep breathing technique, you can start to use it when you’re facing your phobia or in other stressful situations.

Phobia treatment tip 3: Challenge negative thoughts

Learning to challenge unhelpful thoughts is an important step in overcoming your phobia. When you have a phobia, you tend to overestimate how bad it will be if you’re exposed to the situation you fear. At the same time, you underestimate your ability to cope.

The anxious thoughts that trigger and fuel phobias are usually negative and unrealistic. It can help to put these thoughts to the test. Begin by writing down any negative thoughts you have when confronted with your phobia. Many times, these thoughts fall into the following categories:

Fortune telling. For example, “This bridge is going to collapse;” “I’ll make a fool of myself for sure;” “I will definitely lose it when the elevator doors close.”
Overgeneralization. “I fainted once while getting a shot. I’ll never be able to get a shot again without passing out;” “That pit bull lunged at me. All dogs are dangerous.”
Catastrophizing. “The captain said we’re going through turbulence. The plane is going to crash!” “The person next to me coughed. Maybe it’s the swine flu. I’m going to get very sick!”

Most phobias are classified into two categories and, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), such phobias are considered to be sub-types of anxiety disorder.

The two categories are:

1. Specific phobias: Fear of particular objects or social situations that immediately results in anxiety and can sometimes lead to panic attacks. Specific phobia may be further subdivided into five categories: animal type, natural environment type, situational type, blood-injection-injury type, and other.

2. Agoraphobia: a generalized fear of leaving home or a small familiar 'safe' area, and of possible panic attacks that might follow. It may also be caused by various specific phobias such as fear of open spaces, social embarrassment (social agoraphobia), fear of contamination (fear of germs, possibly complicated by obsessive-compulsive disorder) or PTSD (post traumatic stress disorder) related to a trauma that occurred out of doors.

Phobias vary in severity among individuals. Some individuals can simply avoid the subject of their fear and suffer relatively mild anxiety over that fear. Others suffer full-fledged panic attacks with all the associated disabling symptoms. Most individuals understand that they are suffering from an irrational fear, but are powerless to override their panic reaction.

Specific phobias

A specific phobia is a marked and persistent fear of an object or situation which brings about an excessive or unreasonable fear when in the presence of, or anticipating, a specific object; the specific phobias may also include concerns with losing control, panicking, and fainting which is the direct result of an encounter with the phobia. Specific phobias are defined in relation to objects or situations whereas social phobias emphasize social fear and the evaluations that might accompany them.

The DSM breaks specific phobias into five subtypes: animal, natural environment, blood-injection-injury, situational, and other. In children, phobias involving animals, natural environment (darkness), and blood-injection-injury usually develop between the ages of 7 and 9, and these are reflective of normal development. Additionally, specific phobias are most prevalent in children between ages 10 and 13.

Social phobias

Unlike specific phobias, social phobias include fear of public situations and scrutiny which leads to embarrassment or humiliation in the diagnostic criteria.

Causes

Environmental

Rachman proposed three pathways to acquiring fear conditioning: classical conditioning, vicarious acquisition and informational/instructional acquisition:

  • Much of the progress in understanding the acquisition of fear responses in phobias can be attributed to classical conditioning (Pavlovian model). When an aversive stimulus and a neural one are paired together, for instance when an electric shock is given in a specific room, the subject can start to fear not only the shock but the room as well. In behavioral terms, this is described as a conditioned stimulus (CS) (the room) that is paired with an aversive unconditioned stimulus (UCS) (the shock), which leads to a conditioned response (CR) (fear for the room) (CS+UCS=CR).
  • For instance, in case of the fear of heights (acrophobia), the CS is heights such as a balcony on the top floors of a high rise building. The UCS originates from an aversive or traumatizing event in the person's life, such as almost falling down from a great height. The original fear of almost falling down is associated with being on a high place, leading to a fear of heights. In other words, the CS (heights) associated with the aversive UCS (almost falling down) leads to the CR (fear).

This direct conditioning model, though very influential in the theory of fear acquisition, is not the only way to acquire a phobia.

Vicarious fear acquisition is learning to fear something, not by a subject's own experience of fear, but by watching others reacting fearfully (observational learning). For instance, when a child sees a parent reacting fearfully to an animal, the child can become afraid of the animal as well. Through observational learning, humans are able to learn to fear potentially dangerous objects;a reaction which also been observed in non-human primates. In a study focusing on non-human primates, results showed that the primates learned to fear snakes at a fast rate after observing parents’ fearful reactions. An increase of fearful behaviors was observed as the non-human primates continued to observe their parents’ fearful reaction. Even though observational learning has been proven to be effective in creating reactions of fear and phobias, it has also be shown that by physically experiencing an event, chances increase of fearful and phobic behaviors.
A conditioned fear response to an object or situation is not always a phobia. To meet the criteria for a phobia there must also be symptoms of impairment and avoidance. Impairment is defined as being unable to complete routine tasks whether occupational, academic or social. In acrophobia an impairment of occupation could result from not taking a job solely because of its location at the top floor of a building, or socially not participating in a social event at a theme park. The avoidance aspect is defined as behavior that results in the omission of an aversive event that would otherwise occur with the goal of the preventing anxiety.

Mechanism

Regions of the brain associated with phobias

Beneath the lateral fissure in the cerebral cortex, the insula, or insular cortex, of the brain has been identified as part of the limbic system, along with cingulated gyrus, hippocampus, corpus callosum, and other nearby cortices. This system has been found to play a role in emotion processing and the insula, in particular, may contribute through its role in maintaining autonomic functions. Studies by Critchley et al. indicate the insula as being involved in the experience of emotion by detecting and interpreting threatening stimuli. Similar studies involved in monitoring the activity of the insula show a correlation between increased insular activation and anxiety.

In the frontal lobes, other cortices involved with phobia and fear are the anterior cingulate cortex and the medial prefrontal cortex. In the processing of emotional stimuli, studies on phobic reactions to facial expressions have indicated these areas to be involved in processing and responding to negative stimuli. The ventromedial prefrontal cortex has been said to influence the amygdala by monitoring its reaction to emotional stimuli or even fearful memories. Most specifically, the medial prefrontal cortex is active during extinction of fear and is responsible for long term extinction. Stimulation of this area decreases conditioned fear responses and so its role may be in inhibiting the amygdala and its reaction to fearful stimuli.

The hippocampus is a horseshoe shaped structure that plays an important part in the brain’s limbic system because of its role in forming memories and connecting them with emotions and the senses. When dealing with fear, the hippocampus receives impulses from the amygdala that allows it to connect the fear with a certain sense, such as a smell or sound.

Amygdala

The amygdala is an almond shaped mass of nuclei that is located deep in the brain’s medial temporal lobe. It processes the events associated with fear and is being linked to anxiety disorders and social phobias. The amygdala's ability to respond to fearful stimuli occurs through the process of fear conditioning. Similar to classical conditioning, the amygdala learns to associate a conditioned stimulus with a negative or avoidant stimulus, creating a conditioned fear response that is often seen in phobic individuals. In this way the amygdala is responsible for not only recognizing certain stimuli or cues as dangerous, but plays a role in the storage of threatening stimuli to memory. The basolateral nuclei (or basolateral amygdala) and the hippocampus interact with the amygdala in the storage of memory, which suggests why memories are often remembered more vividly if they have emotional significance.

In addition to memory, the amygdala also triggers the secretion of hormones that affect fear and aggression. When the fear or aggression response is initiated, the amygdala releases hormones into the body to put the human body into an "alert" state, which prepares the individual to move, run, fight, etc. This defensive "alert" state and response is generally referred to in psychology as the fight-or-flight response.

Inside the brain, however, this stress response can be observed in the hypothalamic-pituitary-adrenal axis (HPA).This circuit incorporates the process of receiving stimuli, interpreting it, and releasing certain hormones into the blood stream. The parvocellular neurosecretary neurons of the hypothalamus release corticotropin-releasing hormone(CRH) which is sent to the anterior pituitary. Here the pituitary releases adrenocorticotropic hormone (ACTH) which ultimately stimulates the release of cortisol. In relation to anxiety, the amygdala is responsible for activating this circuit, while the hippocampus is responsible for suppressing it. Glucocorticoid receptors in the hippocampus monitor the amount of cortisol in the system and through negative feedback can tell the hypothalamus to stop releasing CRH.

Studies on mice engineered to have high concentrations of CRH showed higher levels of anxiety, while those engineered to have no or low amounts of CRH receptors were less anxious. In phobic patients, therefore, high amounts of cortisol may be present, or alternatively, there may be low levels of glucocorticoid receptors or even serotonin (5-HT).

Disruption by damage

For the areas in the brain involved in emotion—most specifically fear— the processing and response to emotional stimuli can be significantly altered when one of these regions becomes lesioned or damaged. Damage to the cortical areas involved in the limbic system such as the cingulate cortex or frontal lobes have resulted in extreme changes in emotion. Other types of damage include Klüver–Bucy syndrome and Urbach–Wiethe disease. In Klüver–Bucy syndrome, a temporal lobectomy, or removal of the temporal lobes results in changes involving fear and aggression. Specifically, the removal of these lobes results in decreased fear, confirming its role in fear recognition and response. Bilateral damage to the medial temporal lobes, which is known as Urbach–Wiethe disease exhibits similar symptoms of decreased fear and aggression, but also an inability to recognize emotional expressions, especially angry or fearful faces.

The amygdala’s role in learned fear includes interactions with other brain regions in the neural circuit of fear. While lesions in the amygdala can inhibit its ability to recognize fearful stimuli, other areas such as the ventromedial prefrontal cortex and the basolateral nuclei of the amygdala can affect the region's ability to not only become conditioned to fearful stimuli, but to eventually extinguish them. The basolateral nuclei, through receiving stimulus info, undergo synaptic changes which allow the amygdala to develop a conditioned response to fearful stimuli. Lesions in this area, therefore, have been shown to disrupt the acquisition of learned responses to fear. Likewise, lesions in the ventromedial prefrontal cortex (the area responsible for monitoring the amygdala) have been shown to not only slow down the speed of extinguishing a learned fear response, but also how effective or strong the extinction is. This suggests there is a pathway or circuit among the amygdala and nearby cortical areas that process emotional stimuli and influence emotional expression, all of which can be disrupted when an area becomes damaged.

Treatments

There are various methods used to treat phobias. These methods include:

  • systematic desensitization
  • progressive relaxation
  • virtual reality
  • modeling
  • medications
  • hypnotherapy.
  • Therapy

Cognitive behavioral therapy (CBT) can be beneficial. Cognitive behavioral therapy allows the patient to challenge dysfunctional thoughts or beliefs by being mindful of their own feelings with the aim that the patient will realize their fear is irrational. CBT may be conducted in a group setting. Gradual desensitisation treatment and CBT are often successful, provided the patient is willing to endure some discomfort. In one clinical trial, 90% of patients were observed to no longer have a phobic reaction after successful CBT treatment.

CBT is also an effective treatment for phobias in children and adolescents, and it has been adapted to be appropriate for use with this age. One example of a CBT program targeted towards children is the Coping Cat. This treatment program can be used with children between the ages of 7 and 13 to treat social phobia. This program works to decrease negative thinking, increase problem solving, and to provide a functional coping outlook in the child. Another CBT program was developed by Ann Marie Albano to treat social phobia in adolescents. This program has five stages: Psychoeducation, Skill Building, Problem Solving, Exposure, and Generalization and Maintenance. Psycho education focuses on identifying and understanding symptoms. Skill Building focuses on learning cognitive restructuring, social skills, and problem solving skills. Problem Solving focuses on identifying problems and using a proactive approach to solving them. Exposure involves exposing the adolescent to social situations in a hierarchical approach. Finally, Generalization and Maintenance involves practicing the skills learned.

Eye movement desensitization and reprocessing (EMDR) has been demonstrated in peer-reviewed clinical trials to be effective in treating some phobias. Mainly used to treat post-traumatic stress disorder, EMDR has been demonstrated as effective in easing phobia symptoms following a specific trauma, such as a fear of dogs following a dog bite.

Another method psychologists and psychiatrists use to treat patients with extreme phobias is prolonged exposure. Prolonged exposure is used in psychotherapy when the person with the phobia is exposed to the object of their fear over a long period of time. This technique is only tested when a person has overcome avoidance of or escape from the phobic object or situation. People with slight distress from their phobias usually do not need prolonged exposure to their fear.

Systematic desensitization

A method used in the treatment of a phobia is systematic desensitization, a process in which the patients seeking help slowly become accustomed to their phobia, and ultimately overcome it. Traditional systematic desensitization involves a person being exposed to the object they are afraid of over time, so that the fear and discomfort do not become overwhelming. This controlled exposure to the anxiety provoking stimulus is key to the effectiveness of exposure therapy in the treatment of specific phobia's. One form of systematic desensitization involves, humor. It has been shown that humor is an excellent alternative to the traditional systematic desensitization, when it does not efficiently rid someone of a phobia. Humor systematic desensitization involves a series of treatment activities that consist of activities that elicit humor with the feared object. Previously learned progressive muscle relaxation procedures can be used as the activities become more difficult in a person’s own hierarchy level. Progressive muscle relaxation helps patients relax their muscles before and during exposures to the phobic object.

Participant modeling has been proven to be effective for children and adolescents. Participant modeling consists of a therapist modeling how the patients should respond to their fears. This encourages the patients to practice this behavior and reinforces their efforts. Similar to systematic desensitization, patients are gradually introduced to the phobic objects. The main difference between participant modeling and systematic desensitization, involves observations and modeling. Participant modeling encompasses a therapist modeling positive behavior(s), observing the positive behavior(s), and gradual exposure to the phobic object.

Virtual reality therapy is a type of therapy that helps patients imagine scenes with the phobic object, like systematic desensitization therapy. Using virtual reality, virtual reality therapy generates scenes that may not have been possible in the physical world. There are several advantages that virtual reality therapy has over systematic desensitization therapy: patients have the ability to control the scenes produced, patients can endure more phobic scenes (i.e. they may not be able to experience/handle these harsh scenes in real life), it is more realistic than simply imagining a scene, it occurs in a private room, and is very efficient.

Medications

Medications can help regulate the apprehension and fear that comes from thinking about or being exposed to a particular fearful object or situation. Antidepressant medications such as SSRIs or MAOIs may be helpful in some cases of phobia. SSRIs (antidepressants) act with serotonin, a neurotransmitter in the brain. Since serotonin impacts mood, patients may be prescribed an antidepressant. Another type of medication used for treating patients with phobias are sedatives. Benzodiazepines are sedatives, which can help patients relax by reducing the amount of anxiety they feel. Benzodiazepines may be useful in acute treatment of severe symptoms, but the risk-benefit ratio is against their long-term use in phobic disorders. Though once believed to be highly addictive, these prescriptions have been recently shown as addictive if used with negative behaviors (i.e. alcohol abuse). Despite this recent positive finding, benzodiazepines should be used with caution. Beta blockers are another medication that can be used as a treatment for phobias. Beta blockers stop the stimulating effects of adrenaline in a person’s body. These effects include: sweating, increased heart rate, elevated blood pressure, tremors, and the feeling of a pounding heart. By taking beta blockers before a phobic event, these symptoms are decreased, causing the event to be less frightening.

Hypnotherapy

Hypnotherapy can be used alone and in conjunction with systematic desensitization to treatment phobias. Hypnotherapy can help people with phobias, resolve their issue, by uncovering the underlying cause of the phobia. The cause of phobias may be from a past event that the patient does not remember. When a traumatic event has occurred and the person who experienced it does not remember the event, the term is called repression. Repression is a mechanism our mind uses to keep the memory of the trauma out of our conscious mind until we are ready to deal with it. Hypnotherapy may also eliminate the conditioned responses that occur during different situations: the phobic object is within eyesight of the patient, the patient is placed in a phobic situation, or the patient is attempting to complete a phobic task. Patients are first placed into a hypnotic trance (i.e. an extremely relaxed state). The unconscious can be retrieved during the hypnotic trance. This state always for patients to be open to suggestion, which helps bring about a desired change. Addressing old memories consciously helps individuals understand the event and see the event in a way which is no longer threatening.

References

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