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Phobias are linked directly to anxiety and can occur as either a result of anxiety or be the cause of it. A phobia can be mild, moderate or severe and its level of severity will determine the effect that it has on someone’s ability to go about their day-to-day activities.
A phobia is not the same as a fear, and this is reflected in their definitions:
A fear is defined as: “an unpleasant emotion or feeling that occurs when someone is frightened or worried about something.”
A phobia, however, is defined as: “an extreme fear or dislike of a particular thing or situation that cannot be reasonably explained.”
It is important to differentiate between the two because, unlike a fear, a phobia is actually classed as a form of mental illness and it is important that when a phobia begins to impinge on someone’s ability to live their life normally that they seek out appropriate support and treatment.
The main groups of Phobias
The NHS (2016) identifies two main types of phobia:
- Specific or simple
Specific or simple phobias, as their name suggests, relate to something specific. An individual can develop a phobia towards anything. However, there are common ones that are relevant to most people with a phobia:
These types of phobia often originate in childhood and are usually linked with some kind of negative experience with whatever the phobia is specific to. The reaction caused by exposure to the feared item or situation is often excessive and sudden and can be described as unreasonable. The physical and psychological responses are similar to the responses of extreme anxiety (these will be discussed in greater detail later in this unit).
Complex phobias are usually much more serious than specific phobias and are thought to be related to a very deep-rooted fear about something. There are two types of complex phobias; these are agoraphobia and social phobia. These are the two types of phobia that are most likely to lead to a debilitating effect on someone’s lifestyle, often to the point where they feel unable to leave their own home. The individual’s quality of life may also be inhibited because of trying to hide their phobia from others, which can often lead to further issues and a worsening of their overall level of anxiety.
Examples of Specific and Social Phobias
Specific phobias are those that are elicited by something that is very exclusive to the individual; they are not like complex phobias, as they are more general to a set of circumstances or situation. Someone who has a specific phobia will only react in a phobic manner when faced with precisely what it is that they fear, regardless of the environment in which it occurs.
As we have seen previously, there are five main types of specific phobia:
Animal phobias involve an animal or other creature as the source of the fear. Common types of animal phobia include:
- Arachnophobia – fear of spiders
- Cynophobia – fear of dogs (or rabies)
- Ophidiophobia – fear of snakes
- Equinophobia – fear of horses
- Selachophobia – fear of sharks
- Musophobia – fear of mice
- Zoophobia – fear of animals in general
People who have an animal phobia will usually only be afraid if they come into direct contact with the animal in question. However, some individuals will resort to ‘checking behaviours’ where they will habitually check their environment for the feared animal, such as looking in a field before going past it to check for horses or checking their beds or showers before getting into them for spiders.
Some individuals’ fears are so severe that even a picture or a cartoon of the feared animal can spark the phobic response. For some people, just reading the name of their feared animal, because of its association with the real animal, can trigger their phobic response.
Environmental phobias are caused by what is contained in an individual’s surroundings. Common environmental phobias include:
- Hydrophobia – fear of water
- Acrophobia – fear of heights
- Misophobia – fear of germs or contact with germs
- Astraphobia – fear of thunder and lightning
- Climacophobia – fear of stairs or of falling down stairs
Those who have an environmental phobia will avoid going out to any place where they may come in contact with water, heights, or whatever it is that makes them irrationally scared. Someone who fears extreme weathers will often stay at home and have a place where they go until the weather has passed, such as under their stairs or even in a cellar.
Fear of heights is very common and is thought to stem from someone’s fear of losing their balance and falling. In order to combat this, if the height cannot be avoided, then individuals will usually resort to crawling around on all fours. Those who have extreme acrophobia will probably not climb ladders or stay in a hotel room that is not on the ground floor.
Someone who has misophobia is at risk of developing other mental illnesses because a fear of germs can lead to them avoiding social contact altogether. For those who can be around people, they will often wear gloves or a face mask and avoid touching door handles or taps, or any other object that someone may have touched before them. Misophobia is closely linked with obsessive-compulsive disorder (we will discuss this in detail later in the course).
A situational phobia is one where the individual fears a specific set of circumstances, such as a visit to the doctor or dentist. Common situational phobias include:
- Aviophobia – fear of flying
- Nosocomephobia – fear of hospitals
- Nyctohylophobia – fear of wooded areas
- Dentophobia – fear of dentists
- Latrophobia – fear of the doctor’s surgery (or the doctor themselves)
- Didaskaleinophobia – fear of school
- Claustrophobia – fear of small spaces
- Coulrophobia – fear of clowns
Some people will successfully avoid some situations for many years but these can come at a cost – imagine never having visited the dentist for thirty years or avoiding the doctor when there are serious symptoms to diagnose. Similarly, the costs of avoiding school can result in huge issues for children when they are older.
Bodily phobias are any type of phobia that has an association with the body. This is not specific to body parts but can include fluids and specific states that bodies might be in. Common bodily phobias include:
- Hemophobia – fear of blood
- Emetophobia – fear of vomiting
- Bromidrosiphobia – fear of body smells
- Trypanophobia – fear of injections
- Pnigophobia – fear of choking
- Tomophobia – fear of surgical operations
- Tokophobia – fear of giving birth
It is estimated that up to 6% of women fear giving birth so much it stops them from having children or it makes them terminate a pregnancy in the early stages so that childbirth is never an option.
Some people’s fears of blood and vomit prevent them going to places where they may see, hear or smell some of these. This can include hospitals, clinics or places where there are a lot of children who are more likely to have an accident or to vomit. For some individuals, their fear of vomit is so great that they start to get anxious just from someone coughing.
An individual who has a choking phobia may avoid eating solid foods and exist on baby food or pureed food, meaning they almost certainly never go out for meals with their friends.
Sexual phobias occur when someone is either frightened of the actual act of sex, or anything that is related to it, such as intimate body parts. Common sexual phobias include:
- Genophobia – fear of sexual intercourse
- Contreltophobia – fear of sexual abuse
- Kolpophobia – fear of genitals, especially female
- Phallophobia – fear of penises
- Gymnophobia – fear of nudity
A sexual phobia can have an effect on someone’s ability to live normally because, especially in the case of fearing certain body parts, some individuals cannot even speak to members of the same, or opposite sex. Fear of sexual abuse may lead to someone being afraid of being alone with others, whilst fear of sexual intercourse can lead to someone always having issues with intimate relationships.
All phobias may well fit one of the categories we have mentioned; however, there are some rare phobias which are not commonly diagnosed. These include:
- Pteronophobia – fear of being tickled by feathers
- Arithmophobia – fear of numbers
- Hypnophobia – fear of sleep
- Koinoniphobia – fear of rooms
- Trichophobia – fear of loose hairs
- Ephebiphobia – fear of teenagers
- Scopophobia – fear of being looked at
- Hyelophobia – fear of glass
- Cacophobioa – fear of ugliness
- Ergasiophobia – fear of going to work
If someone were to develop one of the less common phobias above, then it is easy to see how it could negatively affect their ability to live normally as these are things that are common in an environment, such as numbers or teenagers.
There are two main social phobias:
- Social phobia
Agoraphobia is often a misunderstood condition because it is generally believed to be a fear of open spaces. However, whilst this may be characteristic of some people who experience it, agoraphobia is much more complex. It is largely caused when an individual fears being in a place or situation where they will not be able to escape if they begin to panic. An example of this is where someone may not want to walk across wide-open spaces as there will be nowhere for them to hide; this may mean that they may also avoid narrow supermarket aisles because the crowd of people in there might block their escape route.
Many people with chronic health conditions are also at risk of developing agoraphobia because they fear that they will have a medical emergency in a place where there will be no one there to help them.
Social phobia, often referred to as ‘social anxiety disorder’, is a condition that incorporates a huge variety of social situations in which someone may have a phobic reaction. Lots of people worry about some social situations, such as giving speeches or having to meet someone new, but someone who has social phobia will worry unreasonably about them before and after they happen, as well as during them. The fear is likely to stem from not wanting to say or do anything that may cause embarrassment or judgement from others; such as blushing, sweating or appearing to be incapable of doing something expected of them. For some people with this disorder, even answering a phone call can provoke anxiety.
Social phobias are complex because they have such an effect on an individual’s life and are almost always more difficult to treat and manage than specific phobias.
The possible causes of Phobias
Like many mental illnesses, the causes of a phobia are not certain and are thought to be due to several factors:
- Classical conditioning
- Learned responses
- Long-term stress
Evolutionary causes of phobia attempts to explain why individuals still react in the way that they do based on how their ancestors would have needed to react in the face of fear millions of years ago.
In order to survive and reproduce, it is necessary for humans to take all manner of steps to protect themselves in the face of any kind of perceived danger. Therefore, this explanation of phobias argues that fear is instinctive because it helps individuals to survive. If humans did not have any sense of fear then they would put themselves in situations that might potentially harm or even kill them.
This explanation can be seen to apply to certain phobias very well. For example, when a person has acrophobia (phobia of heights) it may be caused because there is a risk of falling; or someone may have hemophobia (phobia of blood) as in the past it could have indicated injury and the presence of certain animals that may be dangerous.
However, the theory states that humans are not born with a fear of things and that they must still have a negative experience with something for a fear to develop. The theory explains that humans are prepared to fear some things that may cause them harm and so this can increase the chances of it becoming a phobia. This is why things that are more obviously linked with danger are feared more commonly.
Conditioning describes how someone can learn to fear something because of the responses that are associated with it. Classical conditioning was identified by psychologist Ivan Pavlov who noticed that his dogs would salivate to the sound of a bell ringing even when there was no food, because they associated the bell with the food (it rang when it was feeding time). To put this in the context of phobias, it is necessary to understand the steps of how classical conditioning works:
An unconditioned response (UCR) is a response that is automatic. For example, someone blinking if they were flicked close to their eyes. Other automatic responses include arousal and anxiety.
An unconditional stimulus (UCS) is something that naturally causes the unconditioned response. For example, an attractive person causing arousal or a dentist’s surgery causing anxiety.
However, sometimes responses occur because of a neutral stimulus, which is something that would not normally cause an automatic reaction. For example, someone may blink when they see gloves because when someone flicked their eye they were wearing gloves. Similarly, they may become aroused when they hear a certain song, because they associate it with the person they find attractive. In the case of anxiety, it may be that their dentist’s surgery has a red door, and the individual finds themselves anxious when faced with any red door; in other words, they have been classically conditioned to fear it because of its association with the dentist.
For example, the neutral stimulus (a red door) has now become the conditioned stimulus because it has triggered a learned response, as the individual in the case above has learned to fear red doors because of their association with the dentist. Their reaction of anxiety is now a conditioned response because they have been conditioned to associate fear with the conditioned stimulus. A conditioned response can sometimes be eradicated; for example, if someone saw several red doors every day of their life and none of them had anything to do with dentists, then this may enable them to no longer feel anxious because the association would be diluted and would eventually disappear.
However, sometimes the association will continue and this can result in a debilitating phobia. For example, someone who was once stung by a wasp as a child may not have feared them prior to the incident but since it has happened the pain has caused them to develop fear and anxiety of this particular insect for the rest of their lives.
Learned responses are usually picked up early in an individual’s life if they grow up around someone who has a particular phobia. They will witness the response to the feared stimulus and grow up thinking that this is the ‘normal’ way to react to it. So, if one parent (or both) is afraid of spiders then their child will believe that the way to react to a spider is with fear. They will internalise this behaviour and replicate it themselves when they are older. Of course, this does not always happen but learned responses can be a powerful influence on a child’s behaviour later in life.
Trauma is linked to classical conditioning in that it is a response to a situation that someone has experienced. However, a trauma is usually something that has brought about a much more powerful emotional response and, as such, is one that they might repress or bury into their unconscious mind. For example, if an individual experienced an extremely turbulent flight as a child then this may cause them to have aviophobia (fear of flying) later in life; they may have unconsciously repressed this experience and may not even remember the flight in question that has caused their phobia.
Some traumas, such as sexual abuse, can cause both complex and specific phobias. A specific phobia may relate to an item of clothing that the abuser would wear or the place where the abuse would take place, both of which would have such strong associations with the abuse that they would lead to extreme anxiety and, very possibly, a phobia.
Genetics are thought to play some part in the development of phobias because of their links to anxiety. If a close relation experiences anxiety, this makes an individual’s chances of developing anxiety higher than those people who do not have anxiety prone relatives.
Long-term stress can lead to anxiety and panic and both of these have a significant impact on an individual’s ability to cope with what they perceive as a stressful situation. When an individual is prone to anxiety, this makes the likelihood of them developing a phobia much higher because they will relate stressful situations to a time when they could not cope. Any future experiences in a similar situation will likely prompt a panic or phobic response.
Feelings when experiencing a Phobia
The symptoms of a phobia are caused by the anxiety and panic that the individual experiences when being exposed to that phobia. The symptoms can be categorised into four different types:
When someone is exposed to something that causes a phobic reaction the physical symptoms can be extremely frightening, and because of this it is unsurprising to learn that someone who has a phobia of something will go to extraordinary lengths to avoid it.
Physical symptoms are caused by anxiety, due to the instigation of the ‘fight or flight’ response. This means that the individual has sensed something that they believe is a threat to them, whether or not this really is the case. When this happens, their automatic nervous system is activated which causes many physical changes that prepare them to either fight what they fear or to run away from it. This is an evolutionary response to when humans had to regularly face threats to their survival, such as from wild animals or other humans.
Physical symptoms that will be felt by someone experiencing a phobia include:
- Dizziness and light-headedness
- Rapid heart rate
- Pins and needles
- A feeling of choking
- Tightening of the chest
- Chest pains
- Tinnitus – ringing in the ears
To experience the symptoms mentioned above is frightening enough on their own but they are also accompanied by other psychological symptoms that worsen the experience for the individual. These types of symptoms include:
- Fear of losing control
- Fear of dying
- Fear of fainting
- Feelings of being detached from reality
- Completely irrational fear
When someone experiences psychological symptoms because of their phobia, they can feed into the anxiety already being felt and this can make the feared object seem even more frightening. For example, if someone is afraid of water and they are suddenly splashed by a car going past, the sudden sensation of water on their skin could prompt physical symptoms. Once these symptoms start to take over their body, they fear that they are losing control, which causes them to panic more. Once the panic has completely set in, many individuals report that they feel as though they will die. This is unsurprising because many of the physical symptoms are very similar to serious medical incidents such as a heart attack. Eventually, the fear response will lessen and their physical symptoms will disappear, but each time the person experiences those symptoms it is likely that their phobia will become even worse.
It seems that the combination of both psychological and physical factors are what influence an individual to have changes in their behaviour. Changes in a person’s behaviour can have a huge impact on their ability to live normally. Behavioural symptoms include:
- Avoiding people
- Avoiding objects
Avoiding something does not just mean not going to where the source of the phobia might be located but it can also mean avoiding things that are associated with it. For example, if someone has a fear of dogs, they may avoid visiting parks because there may be dogs; they may even avoid supermarket aisles that sell dog food because of the pictures on the tins. This type of behaviour can even damage the individual’s relationships. For example, they may avoid seeing a friend who has a dog because they may talk about it or the friend may have dog hair on their clothing which can trigger a phobic reaction in the individual.
Cognitive symptoms of a phobia are divided into two characteristics:
- Selective attention
- Irrational thinking
Selective attention leaves an individual unable to focus on anything else but the source of their phobia. For example, if someone has a phobia of spiders and they spot one across the room, they will be fixated upon that spider to the point where they feel paralysed to do anything else. Often, this means that they feel unable to move away from it in case it moves. This can start a chain of panic as the individual may feel unable to escape.
The fixation occurs because of the irrational thoughts surrounding the source of the phobia. So in the case mentioned, the individual may believe that all spiders are dangerous and deadly, even though in the UK there are no poisonous spiders, making their thoughts irrational.
Another example of irrational thinking is where someone who has a fear of blood may irrationally believe that because they have got a paper cut that they will subsequently die from blood loss. This is an irrational thought because the chances of dying from a paper cut are virtually non-existent. In addition, if the same person sees someone else with a minor cut, they will irrationally believe that person will die and thus leave themselves traumatised by the event.
How a specific phobia can affect a person’s life
Specific phobias focus on certain people, objects, places or circumstances. Whilst they are not as difficult to treat as complex phobias, their effects on someone’s life can be devastating unless they are managed and treated effectively. The first issue that someone with a specific phobia may experience is the effect that it has on their overall self-esteem and confidence. Someone with a phobia, especially an unusual one, may struggle to find a way of explaining it to others because they fear that they will be judged. People with low self-esteem and confidence may constantly berate themselves because of their phobia. They may not understand themselves why they are so scared. Just in the way other people may judge them, they also judge themselves. When someone gets themselves into a pattern of negative self-thinking like this, then it can be difficult to change because it results in them avoiding people. This can then lead to withdrawal and isolation, which can affect someone’s mental and physical health. Someone’s normal life may be impeded by the fact that they constantly avoid situations where they fear they might encounter the source of their phobia. Let’s look at the case study of Gavin who has acrophobia (a fear of heights).
When an individual lives in constant fear of encountering the source of their phobia, it can have an effect on their mental and physical health because it means that they are in a constant state of anxiety. This can lead to a lowering of the effectiveness of the immune system, being constantly tired and (in extreme circumstances) coronary heart disease. It also puts individuals at risk of developing mental illnesses such as depression, which is linked to withdrawal and isolation, two things that are common in individuals who have specific and complex phobias.
A major problem linked with an individual’s ability to lead a normal life is the fact that they become exhausted from constantly trying to avoid the source of their phobia. This can enhance their chances of withdrawal due to them being too tired to want to socialise with others. When someone has a phobia, they are continually checking to see if there is a chance that the source is somewhere around them. For example, someone who is afraid of flying insects may begin to panic if a leaf falls near them or something touches their skin. Being ‘on alert’ constantly is physically and emotionally draining and this can impact someone’s daily life quite significantly.
Someone who has a specific phobia may also encounter problems with their work. For example, someone may need to take time off because of the constant stress that they are experiencing that has led to illness. They may fear that they will encounter their phobia on their journey to and from work and this may ultimately lead them to having to leave their employment. Someone whose life is completely ruled by their phobia would rather do this than come into contact with their fear. This can lead to financial loss, which will likely serve to make problems with anxiety even worse.
How Agoraphobia can prevent someone from leading a normal life
Agoraphobia is a life-changing condition that severely impacts someone’s ability to lead a normal life. It is characterised by an individual’s extreme fear of being somewhere where they cannot escape if they begin to panic. Many people mistakenly believe that it is simply a fear of open spaces but it is far more complicated than that. It is thought to affect up to 3.5% of the UK population, and this figure may actually be higher due to undiagnosed cases.
People who have agoraphobia will be unable to attend places where there may be a lot of people. This can include concerts, supermarkets or public transport. They may also avoid social situations that may be as simple as having a conversation or even greeting someone in the street.
Agoraphobia is different to a specific phobia, because with specific phobias someone may be able to amend their lifestyle to accommodate their fear. For example, if someone is afraid of horses, they will avoid a place where a horse might be, such as a field or a farm. They can happily go through their day socialising, eating and conversing with people as long as the subject of their fear is not raised.
However, someone with agoraphobia cannot face any situation where they may panic. Because their anxiety is constantly high, this increases the possibility of them experiencing panic anywhere and at any time, even in their own home – although it is usually reduced in that particular location.
People who have agoraphobia will try and avoid situations where they have to queue because there will be a lot of people around who will be able to see them if they panic. They may not be able to get out of the queue in time before panic sets in and so their condition rules out attending anywhere that this could happen. They may also avoid attending places where they may feel trapped, such as in a hairdressers, a café or even in a friend’s house.
Additional social fears that often accompany agoraphobia include the fear of doing certain things in front of other people. These include:
Many people with agoraphobia do not like it when someone looks at them because they fear that they are being judged, even if the person looking at them knows nothing about them or their condition.
All of these symptoms and fears mean that the individual who has agoraphobia leads a severely restricted lifestyle. Some people who have the condition may be able to very occasionally fight their fears and do something that they are not entirely comfortable with. This may include attending a local pub with a friend, or even walking to the shop at the end of the street. For many people though, these activities take a lot of effort and can leave the individual feeling exhausted and despondent that something so simple has taken such a lot of time and effort. Whilst some individuals may be inspired by a successful outing to the pub, others may simply be reminded how difficult their life has become, and this can have a very negative effect on them.
Social isolation often occurs as a consequence of agoraphobia, with some individuals not leaving their homes for months or even years at a time. If they live alone, this can have an effect on their mental health and can lead to severe depression. Other factors that may occur as a result of social isolation include a reliance on substances such as drugs and alcohol for a person to be able to feel as though they can face their day. Whilst these may seem to be helping the individual in the short term, they are in fact doing the opposite because they are additional factors in the development of mental health issues, as well as physical health issues, such as liver problems and issues with cognitive functioning.
The individual may experience intense guilt and shame if they have to have a carer to help them manage their daily activities. Many people who have agoraphobia feel like a burden on others and this can affect their self-esteem and confidence to the point where they feel like there is no other option than suicide. It is believed that up to 18% of people who have some kind of panic disorder will attempt suicide and up to 38% of them will have suicidal feelings.
How phobias may impact others
Someone who has a phobia may have to rely on others more because of the effect that their fear has on their daily life. For example, someone who has a severe or a complex phobia may be unable to go out of their house alone and as a result may need someone to do errands for them. This can include going to the supermarket for them as they cannot leave their house. For some people, even the option of having groceries delivered to them is removed because their phobia is so debilitating that they cannot open the door to a stranger.
Over-reliance on someone can lead to a strain on relationships especially if the person being relied upon has health issues of their own. This is often the case if the person has to rely on elderly parents to support them. Additionally, problems in a relationship can occur because the other person may feel smothered by the individual’s reliance on them – having to be responsible for another person’s entire existence can be very draining and sometimes they may also feel as though they cannot cope with the situation.
In addition, problems can occur for the children of the individual who has a phobia. It can be embarrassing for some children to tell others that their mum or dad cannot leave the house or that they have to have someone with them just to go to the shops. Children may become frustrated at the fact that the simple tasks take a lot longer for them than it does for their friends. For example, someone with a specific phobia will need to plan in great detail where they are going during the day so that they do not encounter their phobia. It may be frustrating for the child to understand how an adult can possibly be afraid of an inanimate object or a gentle creature.
Someone with a phobia will be reluctant to go to a new place because they do not know if they will encounter their phobia. When someone is familiar with an area, they know where to avoid and where they can go without fear. However, somewhere new provides opportunities for a phobia to be triggered without warning, and for this reason individuals will take steps to avoid new places. This means that many families will not be able to go on holiday or even on day trips because of the anxiety that it provokes.
Whilst it can be stressful and tiring for others to be around someone who has a phobia, care should always be taken to ensure that the attitudes of others do not make their condition worse. The individual may heavily rely on some family members but this does not promote recovery from the phobia and instead promotes over-reliance on others.
Instead, the individual should be empowered to self-manage their condition. This is crucial in enabling them to seek help and support to change a lifestyle that they are unlikely to be satisfied with. It is vital that individuals are encouraged to communicate openly about their experience of their phobia as this can help others to empathise and understand how they feel. It is also crucial that the individual feels supported and accepted to avoid making their condition worse. Wherever possible, individuals should be encouraged to seek professional help if they are struggling with self-management techniques to care. Both of these types of support will now be discussed in detail in the next section.
Self-help for Phobias
Phobias are directly linked with anxiety, so self-help for phobias usually involves individuals managing their anxiety levels. For many people, this can mean learning about appropriate relaxation techniques. Some people have anxiety issues that worsen because they do not breathe effectively. Short, shallow breaths are not adequate to fill the lungs with oxygen and they can often also cause a quickening of the pulse, which can then make the individual believe that they are about to start panicking. Learning about breathing techniques can enable someone to focus on their breathing properly, reducing anxiety and lessening the chances of a panic attack from occurring when a phobic reaction is triggered.
Relaxation techniques may also involve listening to music as someone can shift their focus from their anxiety onto the music. This serves as a very good distraction technique, allowing the body to revert to a calmer state whilst the individual is listening to music.
Other individuals might find that attending Yoga or Pilates classes can help them to relax because these exercises are designed to help fitness and to also help reduce stress and anxiety levels. Exercise in general is useful in helping combat anxiety and panic because it promotes good levels of overall well-being which can reduce the chances of panic from occurring. If someone is able to feel good about themselves, their self-esteem will be improved and they are more likely to be able to deal with a stressful situation, such as confronting a phobia.
Stress management also involves being alert about what triggers the anxiety. In the case of individuals who have a phobia, it may seem obvious that they are going to feel stressed about what they fear but individuals prone to phobias are more likely to be stressed than other people. Being educated about their own behaviour can enable individuals to regain control, something that is often linked to stress- and anxiety-related issues.
Online therapy courses are very useful for individuals whose phobia affects them leaving their house. They are also good for people who may not want to admit that they have a phobia and would like to manage it in private. Some courses are available free of charge and they teach individuals the basics of some popular types of therapy such as CBT (cognitive behavioural therapy) so that the individual can apply them when they are experiencing stress or anxiety. Although these courses are likely to benefit some individuals, for someone whose anxiety is caused by a severe phobia it may be more suitable for them to see a therapist. This is because some of the online content may be too overwhelming for the individual; however, a therapist will know how to deliver the therapy in a manner that suits the individual.
Communicating openly about a phobia can help an individual feel comforted that they are supported by the people around them. Knowing that they have someone to discuss their fears with, or someone who will not be distressed by their panic, is very useful and this in itself can help to reduce anxiety levels. It also assures the person that they are not ‘weird’ or ‘a freak’ if they have an unusual phobia. Acceptance by others can enable individuals to seek help more easily if this is what they feel that they need.
Lifestyle changes that address anxiety might make a difference to someone’s anxiety levels. For example, as well as exercising regularly, individuals should cut down on caffeine intake as well as alcohol because both of these are stimulants that mimic the signs of panic (quickening of heart rate for example). Additionally, some mental health groups, such as Mind, suggest having something known as a ‘tech check’. This involves the individual taking a break from electronic gadgets. Whilst they can be very useful, they can also make individuals feel stressed and overwhelmed. Mind suggests switching mobile phones and other gadgets, including the television, off for a minimum of an hour and going outside instead.
Treatments for Phobias
When someone is experiencing a phobia that is affecting their daily routines, they are likely to visit their GP as a first course of action. The GP has several options open to them regarding types of treatment and support that they can offer. Medication is sometimes offered to individuals whose anxiety levels are the cause of their phobia. The most common type of medication that is prescribed to help anxiety is some form of antidepressant. These usually work by increasing the amount of serotonin available in the brain. Serotonin is a ‘feel good’ hormone and its reduction is thought to be directly linked to low mood and depression. The most common type of antidepressants are SSRIs – selective serotonin reuptake inhibitors – which stop too much serotonin being reabsorbed so more is available in the brain. These act to lift or maintain a person’s mood and can help with anxiety and panic disorders.
Sleeping pills and tranquillisers are almost exclusively used for severe anxiety and related insomnia. They work by making users feel calmer and less anxious and to help break a pattern of not sleeping in the hope that a normal pattern can be returned to. These are, however, not usually prescribed for long-term usage as they can become addictive.
When someone’s anxiety is reduced, this is likely to have a positive effect on the way that they react to their feared stimulus, and whilst it might not eradicate the phobia completely, it can quall the anxiety whilst the individual undergoes a course of therapy.
The GP can also offer to refer someone for therapy, of which there are a number of choices. CBT – cognitive behavioural therapy – works by enabling the individual to look at their thinking patterns and readjust them so that they do not automatically fear the worst. They are taught to self-question their thoughts in times where they may catastrophise. For example, if they hear that there has been a car crash on the radio, many people prone to anxiety will immediately ‘predict’ that it involves someone close to them. Anxiety is strongly linked to phobias, and CBT will enable individuals to ask themselves how likely the situation they fear actually is, enabling them to calm themselves when they realise how unlikely their prediction is.
Let’s think about someone with aviophobia (a fear of flying) undergoing CBT. When the person reports fears that the plane will crash, the therapist will enable them to see how unlikely this is. They will likely work on some relaxation techniques as well so that the individual can apply these outside of the therapeutic environment.
Psychotherapy is another type of ‘talking therapy’ that may be useful in getting to what the root cause of a phobia is. It is more useful for complex therapies, which are often fixed in a subconscious trauma that the individual cannot bring into their conscious mind because it is too painful. Because they cannot think about it, they cannot identify the cause and therefore they cannot resolve it.
Systematic desensitisation is a very specialised type of therapy that involves the individual being slowly introduced to their feared stimulus. It uses what is known as a ‘hierarchy of fear’ and individuals can move along the hierarchy when they feel comfortable at the level below. Individuals will be encouraged to be in a calm and relaxed state of mind whilst they encounter what it is that makes them so afraid. This calm and relaxed state of mind is intended to be the response the individual goes to, rather than one of anxiety and panic, in the future. For example, if someone has ornithophobia (fear of birds), the first step on the hierarchy might be just thinking about them whilst remaining calm. When this has been achieved, they will be encouraged to retain a sense of calmness whilst looking at a picture. This continues over a number of sessions until the individual is able to face their fear in a calm manner. The technique is useful for mild and moderate specific phobias but not so much for complex or severe phobias.
Exposure therapy (flooding) is a therapy that is used for severe phobias and has also been shown to be useful for complex phobias as well. It works on the principle that anxiety and panic are not finite – they cannot keep going up and up and eventually they will peak and then decline. As the name suggests, this technique involves the individual being completely immersed, or flooded, in their fear. At first, this may be utterly terrifying for them, but eventually they will see that their phobic stressor can be faced when they are not in a state of extreme panic.
For someone who has aviophobia (fear of flying) this would mean taking a flight, for someone who has hydrophobia (fear of water) getting in a swimming pool or for someone who had agoraphobia going into a crowded street and speaking with a stranger. This may cause severe initial trauma, and some individuals may be completely hysterical at first. However, eventually, many will calm and realise that they are no longer afraid.
Many therapists will not use exposure therapy as they see it as being unethical to deliberately put an individual into a state that may cause them further trauma. Be that as it may, it is a very quick technique and can be very successful in some cases.
Local resources for treating Phobias
Libraries are an excellent source of information where individuals can educate themselves about their condition. Often an understanding of why someone is behaving in the way that they are reduces anxiety levels and this can lead to a decrease in the fear of a phobic trigger. The act of going out into a town and visiting a library can also be a good way for someone to try and face their fears as well, if they have a social phobia. Even if they have to do this with help at first, it may eventually lead them to being able to go there alone, which would be great progress in conquering their fear.
If someone cannot face visiting a library, then the internet can be an invaluable source of information. Websites from the NHS, Mind and TOP (Triumph Over Phobias) are excellent sources of help and information for people when they do not understand what is happening to them or want to know what kind of help is available to them. When using the internet, it is worth pointing out that only reputable sites should be used because many websites do not have accurate information and this can cause more harm than good.
Support groups are very common for mental health problems, and organisations such as Mind offer them in many towns. It is said that the people who experience the issue are the biggest experts about it, and joining a support group can be rewarding on many levels. Individuals feel understood and accepted when they are speaking with others who have gone through or are going through the same thing that they are. Helping someone else is also beneficial for an individual’s self-esteem and confidence and can also be very rewarding.
Local mental health teams may be accessible for people who have more severe phobias. These teams consist of a variety of health professionals who may be able to help someone live with their phobia or take steps to overcome it. For example, there may be psychiatrists, counsellors and support workers who, along with the individual, will put together a plan of support so that everyone can work together in enabling the individual to retain a sense of normality and live in a meaningful manner.