Phobias
Being afraid of things is a part of human nature, as fear is a natural instinct that warns us of danger. Having a sense of caution around things like heights and wild animals is essential to keeping yourself safe in the world. However, when this instinct is heightened to an irrational degree, the fear can hinder you more than help you, leading you to avoid situations that are not objectively dangerous. When your fear of a specific situation becomes overwhelming and illogical, you may have a phobia.
What Are Phobias?
A phobia is an anxiety disorder that involves an irrational, irrepressible and continuous fear of a particular object, activity, person, animal or situation. This fear is so overpowering that it can only be experienced with great distress, and it often results in a panic attack. Because of this, those with phobias will often do everything they can to avoid the object of their fears, despite the fact that there is typically no true danger. Many people with phobias know that their fear isn’t based on real danger, but they are powerless to overcome it.
Along with having an overwhelming and long-lasting fear that is disproportionate to the situation, people with phobias are greatly impacted by their fear. The phobia significantly affects one’s life, interfering with normal activities and daily functioning.
Who is Most Affected?
Around 19 million Americans have at least one phobia, and about 12% of Americans experience a phobia at some point in their lifetime. These can range from mild and manageable to severe and debilitating. Phobias affect an equal number of men and women, but men more often seek professional help for them.
Phobias most often begin between the ages of 15 and 20, but they can also happen in childhood or adulthood. Most childhood phobias begin when the child is 5-9 years old. Some children develop a phobia that goes away after a few months, but in adults, around 80% of recently developed phobias become lifelong conditions that can only be cured with treatment.
Types of Phobias
Phobias are extremely specific to the particular situation that causes them. For instance, someone with claustrophobia, or fear of confined spaces, can live a completely normal life as long as they avoid the spaces that trigger this. However, as soon as this person is in an elevator, they will experience intense feelings of anxiety and fear. The amount that a phobia impacts one’s functioning depends on the specific phobia and how severe it is. While some people with phobias are relatively unaffected in their day-to-day life, others must avoid many common places to function, making it very difficult to live a normal life.
The three main types of phobias are:
● Specific phobia- Also called a simple phobia, this kind of phobia involves fear of something very specific, like dogs, heights, or darkness. Some common specific phobias include:
○ Enclosed spaces
○ Heights
○ The dark
○ Specific animals
○ Medical procedures
Each specific phobia has a name with the word “phobia” in it, a word that comes from the Greek word “phobos,” meaning fear.
● Social anxiety disorder- Previously called social phobia, this type of phobia involves fear of social situations, specifically the fear of being embarrassed or judged by other people. Social phobias often revolve around speaking or performing in front of people, meeting new people, using public bathrooms, eating in public, and figures of authority.
● Agoraphobia- Agoraphobia is the fear of being in public. Those with agoraphobia are often afraid of situations where escaping might be difficult or embarrassing, leading them to avoid situations where there might be crowds, like movies, public events, or public transportation. Some people with this disorder are unable to leave their homes. Those with agoraphobia often also have panic disorder, in which one feels extreme emotional fear and physical symptoms like sweating or heart palpitations.
Symptoms of Phobias
The symptoms of a phobia include:
● Extreme, irrational, enduring fear and anxiety when exposed to the object of your fear
● The inability to control your fear, despite knowing that your fear is disproportionate to the amount of risk involved
● Anxiety that worsens as you become closer, physically or in time, to the object of your fear
● Avoidance of the situation, object or person that causes the fear
● Interference in daily functioning or activities because of your fear
● Physical reactions to the fear, like sweating, difficulty breathing, heart palpitations, or dizziness. These are due to the body’s “fight or flight” reaction to danger
Causes and Development of Phobias
Scientists are unsure about the exact cause of phobias, but they have identified a number of potentials. Studies show that phobias can be caused by a combination of genetic and environmental factors. Some potential causes of phobias include:
● Genetics- people who have a close relative with a phobia are more likely to develop it.
● Negative experiences or traumas- a large percentage of phobias develop as a result of a negative experience involving a specific situation. This can be a lived experience or an experience that you hear about or witness.
● Learned behavior from childhood- if your parents or older siblings have extreme anxiety or a phobia about something specific, you can develop the same phobia through witnessing this as a child. More generally, those who are raised by very anxious guardians may learn to cope with anxiety in unhealthy ways.
● Brain structure- research suggests that people with phobias may have a different brain structure than others.
● Avoidance- some people with phobias have an intense response, like a panic attack, to a situation or object. This can cause embarrassment, leading you to develop anxiety about this happening again. You may begin avoiding the situation or object that caused the fear, further strengthening the fear response, which can eventually develop into a phobia.
● Long-term stress- stress can lead to feelings of depression and anxiety, making it difficult to cope in the situations that cause the stress. Eventually, this cycle can cause a phobia to develop related to the situation or object that causes the stress.
Some people with phobias are able to identify the cause of their intense fear, while others may have no idea how it developed. Most people with phobias will avoid the object of their fear, which only makes the fear stronger over time. Many people need professional treatment to learn how to cope with their fear and keep it from affecting their daily functioning.
How Phobias Affect Your Life
Living with a phobia is difficult, from the anxiety you experience to the inconvenience of avoiding the focus of your phobia. Having a phobia can impact many parts of one’s life, from work and school to interpersonal relationships. Here are some ways that having a phobia affects your daily life:
● Mental illnesses- many people with phobias also have other disorders, making it all the more difficult to cope. People with phobias are more likely to have other anxiety disorders and depression than the general population.
● Substance abuse disorders- abusing substances is a common way for people with phobias to cope.
● Social isolation- avoiding situations that might trigger a fear reaction can be very difficult for those with phobias, especially when someone is afraid of things like public spaces or unfamiliar people. This can result in social isolation and loneliness, making it difficult to access support from others.
● Strain on relationships- it can be draining to maintain a relationship with someone who has a phobia. Some people with phobias may depend on their close relationships to an unhealthy degree, causing strain on the relationships.
● Suicide- people with phobias may have a higher risk of suicide than the general population.
Treatment Options
Getting treatment from a mental health professional is often the only way to reduce the symptoms of a phobia. Depending on the person and the kind of phobia, a mixture of psychotherapy and medication is typically recommended.
Although treatment is individualized for each patient, the medications commonly prescribed for phobias are antianxiety medications or antidepressants. Antianxiety medications can be helpful if your phobia focuses on a specific situation. In some circumstances, a mental health professional may prescribe a beta-blocker, which reduces the physical sensations of anxiety. For instance, if you have social anxiety disorder, you might take a beta blocker right before giving a performance or entering a social space.
The type of psychotherapy used for phobias is exposure and response prevention (ERP). ERP is a type of cognitive behavioral therapy (CBT), which involves changing one’s thought patterns to then change one’s behaviors, and it’s especially useful in treating anxiety related disorders. Although ERP is best known for treating obsessive compulsive disorder (OCD), it can also be very effective for phobias.
ERP for Phobias
The goal of ERP is to decrease the anxiety that someone with a phobia feels and help the patient to face the fear without using safety behaviors. It accomplishes this by repeatedly exposing patients to the things that cause anxiety, and then helping them to cope with their feelings. Over time, a process called habituation occurs, which is when patients become less physiologically activated to the triggers.
Once the therapist has identified the situation, object, activity, person, or animal that the patient is afraid of, ERP can begin. There are two steps in ERP:
● Exposure: the patient is exposed to the triggers, which are the circumstances or objects that cause fear.
● Response prevention: the patient confronts their fears, using therapeutic techniques to resist the urge to use safety behaviors like avoidance, distraction and seeking reassurance.
Since this exposure can cause a great deal of distress, the therapist starts the process gradually, beginning with the situations, images or other stimuli that will cause the least amount of anxiety. Once the patient has habituated to a triggering stimulus, the therapist will introduce a slightly more difficult one, ensuring that the patient is ready for each new step.
For instance, when working with a patient who has a fear of germs, the therapist may begin ERP with having the patient imagine touching a doorknob without washing their hands afterward. When doing this becomes bearable, the patient may then touch an actual doorknob, using coping skills to resist the urge to wash their hands or ask for reassurance.
Once the patient is successfully able to do this, the therapist might ask them to touch the doorknob and then touch their face. By being exposed to gradually more distressing situations, the patient conquers their fears and learns to cope.
What to Expect in ERP
During ERP, the patient will initially feel a great amount of anxiety and distress. Resisting the urge to use safety behaviors will be extremely difficult. However, after sitting in the discomfort and distress without seeking reassurance or distraction, the patient will eventually feel a decrease in anxiety, showing the patient that their fears are less of a threat than they realized. This means that habituation has happened, and the patient’s nervous system has become less activated by the trigger.
Throughout the process, the therapist guides the patient, helping them to feel the anxiety while curbing the impulse to act out a safety behavior. Using a plan for exposure, the patient can experience a trigger without running away or having a panic attack. Over time, the therapist will transition to more and more distressing stimuli, until the patient has conquered their fears.
Sessions will typically be done in the therapist’s office, but they will sometimes involve a specific location that triggers anxiety for the patient. For instance, if the patient has a fear of tight spaces, the session might happen in a building with an elevator. Eventually, patients will learn to do ERP exercises on their own, allowing them to manage symptoms in their daily lives. At the end of ERP, the therapist and patient create a plan for what to do if the patient relapses.
How ERP Works
Exposure and response prevention is a method to rewire your brain, training it not to see anxiety triggers as threats. The habituation that occurs during ERP means that the neural pathways telling the patient to be afraid have weakened, allowing for different pathways to form.
Along with changing how your brain reacts to stimuli, ERP teaches patients that their fears are less threatening than they previously thought. Throughout the process, patients discover that being exposed to the object of their fears doesn’t cause the consequences they are afraid of, and that they can cope with the anxiety without having to avoid the situation or object.
Although ERP can be difficult and scary, it can be an effective treatment for those with phobias. Some therapists will recommend ERP on its own, while others might use a combination of ERP and medications. Despite its initial difficulty, ERP can break the cycle of fear and avoidance, allowing those with phobias to enjoy a higher quality of life and function more successfully.
If you’re missing out on the things that you would like to be able to do with your life because of your fears, it’s time you started to conquer those fears and be the person you want to be.
Reach out now to get started overcoming your phobias and reclaim your life.