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Abstract:
An overview about diagnosis, causes and treatment of phobias.
Phobias belong to the group of anxiety disorders (How common?). Anxiety is an unpleasant feeling of fear and apprehension, that can occur in many psychopathologies. But it also plays an important role in the study of the psychology of normal people, as in most of the people the emotion that we would call anxiety or fear occurs more or less once a week. But of course the fear a normal person experiences is hardly comparable in intensity and duration to the fear that someone with an anxiety disorder suffers from. More about anxiety disorders.
When feelings of anxiety are explicitly present, anxiety disorders are diagnosed. Never the less Anxiety Disorders are more often characterized by the avoidance of the potentially fearful situation or object than by the presence of anxiety itself.
DSM-IV (More) (Diagnostic and Statistical Manual of Mental Disorders) suggests the following anxiety disorders:
Often someone with one anxiety disorder also fulfills the criteria of another anxiety disorder. This is because the various anxiety disorders do not consist of exclusively disorder-specific criterias (for example somatic signs of anxiety can arise with panic disorder, generalized anxiety disorder and PSD).
More information about anxiety disorders:
Handling anxiety disorders.
Severe anxiety attacks - not as serious as they feel!
Panic attacks at night.
How people restrict their life to avoid anxiety and phobia.
Phobia comes from the greek word phobos that stands for fear.
A Phobia is an extreme fear, a disrupting, fear-mediated avoidance that is disproportionate to the danger of the feared object or situation. The person who suffers from a phobia recognizes his/her fear as groundless.
As (according to the behavioral theories, see below) fear can be caused by every object and situation, you can find innumerable Phobias. Here you can see a small selection of Phobias:
A lot of specific fears do not make the person suffer from it so that he/she would seek treatment. For example if a person with an extreme fear of snakes lives in an urban area, he/she would have little or no contact with the feared object. And therefore he/she would not think that there is something wrong. The term phobia assumes an intensive suffering and harm for the person.
Specific Phobias are unjustified fears caused by the presence of specific object or situation.
Subgroups of Specific phobias:
The most common forms of specific phobias are Zoophobia (Fear of Animals), Acrophobia (Fear of heights) and Hemophobia (Fear of blood).
Lifetime prevalence is between 5% and 16%. In western countries more women are affected (between two and four times more than men). Most of the phobias start in childhood or early adolescence.
Specific phobias vary cross-culturally. In China for example there is a fear of loss of body heat, which is related to the Chinese Philosophy.
A social phobia is a persistent fear of social or performance situations, generally linked to the presence of other people. The person with a social phobia usually tries to avoid a particular situation that might be humiliating or embarrassing. These situations can be performing in public, eating in public, using public lavatories (more info), etc.
Depending on the margin of situations that are feared or avoided, a phobia can be generalized or specific.
Lifetime prevalence is between 6% and 15%.
Social phobias can be different in different cultures as well. As for example in Japan the fear of giving offense is important, in the US fear of being evaluated by others occurs more often.
The psychotherapeutic approach depends strongly on the etiological ideas of the respective paradigms.
According to Psychoanalyst Freud, phobias are a defense against anxiety produced by repressed impulses. Anxiety is moved to an object or situation and then becomes the phobic stimulus. In order to not deal with the repressed conflict, the person tries to avoid the object or situation.
Psychoanalytic treatments tend to uncover the repressed conflicts. As the phobia is seen as the result of an underlying conflicts, the patient and therapist usually don't deal with it directly. The techniques that a psychoanalyst uses are for example free association and analysis of the dreams.
The main idea of behavioral theories is that the phobic reactions are learned. But which exact learning mechanism is activated and what is actually learned in the development of a phobia are seen differently in different behavioural theories.
As psychological treatment for phobias mainly systematic desensitization is used. The phobic person has to relax and then imagines a series of increasingly frightening situations. Many therapist then expose their patients to real-life phobic situations. The patient has to learn to control his fear and eventually very much reduce it. This technique is proven to be the most effective one.
For blood and injection phobias it is a little different. As a patient with this kind of phobia often faints because of the sudden drop of blood pressure and heart rate, it is more advisable not to relax in this situation but to tense the muscles when confronted by the scaring situation.
Learning social skills can help a socially phobic person. Role plays and rehearsal of interpersonal meetings are very effective for the case of a social phobia.
In addition to that and depending on the underlying theory, there are other techniques such as modeling (exposure to filmed or live demonstration of other people acting with phobic object without showing any fear), flooding (client is exposed to phobic object/situation at full intensity), etc.
Cognitive theories assume that anxiety is linked to being more likely to notice negative stimuli and to believe that negative events are more likely to occur in the future. For example some people who have had a traumatic experience with a dog, did not develop a dog phobia, whereas others did develop a phobia. This is because people that developed a phobia focus more on the possible appearance of the fearful situation and become scared.
A cognitive therapy for phobias may seem not so effectual, as the phobic person recognizes the fear as unrealistic and unreasonable. Therefore it is probably not appropriate to eliminate the phobia without any exposure to the fearful object or situation.
There are more theories concerning phobias, such as Biological approaches, which cannot all be named here.
Only when your phobia is interfering with your life and the characteristics or symptoms produce personal harm and suffering you should do something about it.
Often it is much easier to overcome a phobia with the help of a psychotherapist.
Especially if
In order to treat a phobia effectively, there are two elements:
It is very important not to avoid the feared situation/object anymore. As confronting can be a very hard task, the usual approach is by a graded exposure. Therefore you should write up a hierarchy of your feared situation/object.
Example: The hierarchy for a person with a snake phobia could be the following:
More about the hierarchy for snake phobia treatment.
After creating your personal hierarchy you should start confronting the least frightening item and try to regulate your anxiety. It is very important to remain in the situation until the anxiety decreases. Even though this could take a long time (up to 40 minutes, always depending on the person and the confronted item) you have to wait until the anxiety will eventually disappear. Then you can move on to the next item. (Some therapist start to confront the patient with the most feared object right away. This can help as well.)
During the confrontation relaxation and/or breathing exercises can be used.
If you can find any thoughts that are related to your phobia, you should write them down and find some good arguments against them.
Examples:
I cannot fly because the plane will crash.
=> I have flown many times before and nothing happened. Statistically, flying is the safest way to travel.
Remember all the time, that nothing can happen to you except that your fear is unpleasant. When you managed to get over your anxiety in a certain situation, remind yourself that you did it, you didn't die, you did not lose control etc.!
However, if you can not manage to deal with your phobia, you should seek professional help. Ask your medical doctor to support you in finding a therapist.
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