Phobias: what are they?
Let’s begin with a description of what it might feel like to have a phobia of taking an airplane trip:
“I’m scared to death of flying, and I never do it anymore. I used to start dreading if I had to take a plane trip a month before I was due to leave. Getting to the airport was a nightmare, and once in the plane, it was an awful feeling when that door closed and I felt trapped. My heart would pound, and I would sweat bullets. When the airplane would start to take off, it just confirmed the sensation that I couldn’t get out. When I think about flying, I picture myself losing control, freaking out, and climbing the walls, but of course I never did that. I’m a bit afraid afraid of crashing or hitting turbulence or a bomb going off or a high-jacker taking it down. What’s even worse is just that feeling of being trapped and unable to get to safety. Whenever I’ve thought about changing jobs, I’ve had to think, ‘Would I be under pressure to fly?’ These days I only go places where I can drive or take a train. My friends always point out that I couldn’t get off a train traveling at high speeds either, so why don’t trains bother me? I just tell them it isn’t a rational fear. I haven’t seen my distant relatives in ages.”
A phobia is an intense, irrational fear of something that poses little or no actual danger, or if there is a danger, the risk is extremely unlikely. Some of the more common phobias are of things such as closed-in places, heights, escalators, tunnels, highway driving, water, flying, animals like dogs or spiders, and injuries or medical procedures where the sight of blood might be involved. Such phobias aren’t just extreme fear; they are irrational fear of a particular, often quite specific, thing. For example, the phobic person may be able to ski the world’s tallest mountains with ease but be unable to go above the fourth floor of an office building. While adults with phobias realize that these fears are irrational, they often find that facing, or even thinking about facing, the feared object or situation brings on severe anxiety, maybe even panic.
Specific phobias affect an estimated 6-7 percent of adult North Americans and are roughly twice as common in women as men. They usually appear in childhood or adolescence and tend to remain into adulthood. The causes of specific phobias are not well understood, but there is some evidence that the tendency to develop them may run in families.
How do people know if their phobia is serious?
Many people have feared situations. For example, some might get scared in an airplane at takeoff, want to run when a large dog approaches, or shudder at the thought of a mouse or spider in the kitchen. Chocolate covered insects as a snack? Not everyone’s idea of comfort food! If the feared situation or feared object is easy to avoid, people with phobias may not seek help; but if avoidance interferes with their careers or their personal lives, it can become disabling and treatment is usually pursued. Alternatively, if the situation is difficult to avoid (imagine someone with cancer who also has a needle phobia), then treatment of the phobia becomes more relevant. Happily, phobias respond very well to carefully targeted psychotherapy.
How are phobias treated?
Cognitive-behavioural therapy (CBT) is very useful in treating phobias. The “cognitive” part helps people change the thinking patterns that support their fears, and the “behavioural” part helps people change the way they react to anxiety-provoking situations.
When people are ready to confront their fears, they are shown how to use exposure techniques to desensitize themselves to situations that trigger their anxieties.
Exposure-based CBT treatment has been successfully used for many, many years to treat phobias. With the therapist’s guidance, the phobic person gradually encounters the object or situation that is feared, perhaps at first only through pictures or tapes, then later face-to-face. Usually, the patient and therapist draw up a hierarchy of situations that the phobic person feels phobic of. Items that are less scary (e.g., a picture of a dog) are at the start of the treatment hierarchy, while being in a room full of dogs might be near the end of the hierarchy. Often the therapist will accompany the person to a feared situation to provide support and guidance.
CBT is undertaken when people decide they are ready for it and with their permission and cooperation. To be effective, the therapy must be directed at the person’s specific anxieties and must be tailored to his or her needs. There are no side effects other than the discomfort of temporarily increased anxiety. As with any therapy, treatment for a phobia requires the help of a trained therapist who is sensitive and caring.
CBT for phobias often lasts only a few weeks. It may be conducted individually or with a group of people who have similar problems. Often “homework” is assigned for participants to complete between sessions. If a disorder recurs at a later date, the same therapy can be used to treat it successfully a second time.
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