The hallmarks of a phobia are persistent, irrational fears and avoidance of the specific things (for example, animals, heights, or closed spaces) or activities that induce these fears. The diagnosis of a phobic disorder is made only when the phobia significantly impairs the individual’s social or occupational functioning.
Although people can exhibit exaggerated or inappropriate fear toward almost any object or situation, certain phobias are more common than others. Common phobias include fear of dogs, spiders, snakes, open spaces, closed spaces, dental treatment, flying, heights, blood, injections, and social situations. Fortunately, many people with specific phobias experience much less fear and avoidance (often none at all) after receiving treatment for their condition.
Seeking Treatment for a Phobia
Experts recommend seeking treatment for a phobia if it interferes significantly with your social life or ability to perform your job. A good example of a candidate for phobia therapy is a person whose fear of flying limits his or her ability to visit family or leads to turning down a job that involves air travel.
Therapy begins with describing your phobia to a therapist. You then may be asked to create a list of 10 situations related to your phobia and to rank the situations in terms of how much fear and avoidance they each provoke. For example, a fearful flier may place driving to the airport and checking baggage low on the list, while being on a turbulent flight during a thunderstorm may rank the highest. This list will help the therapist gain a clearer idea of what exactly your phobia entails and help direct your treatment.
Some phobias—such as social phobia or fear of flying—inherently involve other people, and therapy is frequently conducted in group settings. However, a phobia-like fear of snakes can be addressed in one-on-one sessions with a therapist. Many people prefer one-on-one therapy because they are self-conscious about their phobia.
Cognitive Treatment for a Phobia
Once the therapist understands your phobia, you will work together to recognize and alter the thought patterns that lead to your fear and avoidance. People with phobias often feel that encountering the feared object or situation will have catastrophic results or cause a panic attack. For example, people with a phobia of snakes may fear being bitten and killed, even if the snake is far away or behind glass. The cognitive aspect of phobia treatment shows patients that their worst fears are usually unfounded.
Together, the therapist and patient work to replace the negative thinking with more realistic and accurate thoughts. Patients may also learn relaxation techniques to help them control their fear responses.
Behavioral Treatment for a Phobia
The main component of treatment for phobias is behavioral and entails exposure to the feared object or situation. Patients with a phobia are asked to confront the situation gradually, according to the hierarchy of fear and avoidance that they originally constructed. Often, therapists ask patients to confront these fears first using an imaginary setting (a process called systematic desensitization) and then in real life (in vivo desensitization).
Thus, a person who fears injections will, with the help of the therapist, first imagine preparing to go to the doctor’s office to receive a shot. After the patient is able to relax and be comfortable with that situation, the next steps might be to imagine arriving at the office, being seated in the examination room, seeing the needle, and so on, until the person is able to relax while imagining receiving an injection.
In addition, the therapist will usually ask the person to confront the phobia gradually in real life. People with a fear of spiders may begin by looking at a picture of a spider. Once they are comfortable with the picture, they may be asked to stand for a few seconds across the room from a spider in a tank. They gradually stay in the room longer, and their distance from the spider is shortened. Eventually, the patients may be asked to touch the spider and let the spider crawl across their arm. In some instances, the therapist may use systematic desensitization in therapy sessions and give the patients homework assignments that put them in real-life phobic situations.
Exposure training may be more important than cognitive therapy for phobias because successful treatment with exposure alone may bring about changes in thinking patterns. The number of exposure sessions varies (up to 14 may be necessary) and is dictated by the intensity of the person’s phobia. In some cases, cognitive-behavioral therapy may be combined with drug treatment (for example, antianxiety medication). Training in social skills may also help people with social phobia.
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