Phobias

Phobias - What are they and when do they become a problem?

Phobias are grouped into different categories - Complex Phobias and Simple Phobias. Complex phobias, such as agoraphobia and social phobia, will be discussed in other blogs. Simple Phobias are outlined below and what we will be focusing on today.

What is a Phobia?

•  A marked fear or anxiety about a specific object or situation.

• When presented with that object or situation, it will provoke an overwhelming and a debilitating sense of fear or anxiety. How we might think about this is that you might have an intense fear of chairing a meeting, attending an interview, taking an exam. The anxiety you feel might be severe and intense but with a phobia, either you would run a mile or be unable to function in the situation.

• The anxiety or fear about the object or situation is out of proportion to the actual danger posed.

To be diagnosed with a Specific Phobia (like a diagnosis for depression or a diagnosis of obsessive-compulsive disorder), your fear must also be present for at least 6 months and, here is the important bit, it must cause significant distress or impairment in social, occupational or other important areas of functioning. So basically, if you can live day to day with your phobia and it only causes significant distress on the occasion you meet with it, it would not be viewed as that problematic by health professionals.

But I bet it feels problematic to you.

It is interesting to me that most people can live their whole lives with a phobia and are very clever at surreptitiously avoiding the thing they fear. People have said they are rational human beings but when faced with their phobic object or situation, without the option to run, they can turn into a screaming, unhinged reck - not my words. Not the kind of impression most of us want to give to the world.

Symptoms of a phobia.

When faced with the thing we fear, the brain triggers the fight and flight response and an uncontrollable reaction in the body occurs.

• The brain releases the stress hormones - cortisol and adrenaline.

• These flood the body making people feel a wave of anxiety and intense hypervigilance.  

• You might notice your breath begins to be shallow as your body takes in more oxygen.

• Your heart might pump fast - taking this oxygen to your muscles.

• Muscles can feel tense or tight as they prepare for danger.

• You might feel nausea or butterflies in your tummy, as energy is diverted from breaking down food to preparing the body for battle.

• You might start to sweat or feel shaky.

• Another common symptom is to feel lightheaded or dizzy.

Development and course...or Nature/Nurture.

We are born with two innate fears - a fear of falling and a fear of loud noises. These would have served us well in hunter-gather time. But there is some suggestion that we also have an innate fear of spiders and snakes.

Most phobias, however, develop through learned responses, in other works, in relation to a traumatic event. It might be that you remember the time you were stuck in a lift or your neighbour’s evil cat did not let you pass it on the stairs or the turbulence in the plane sent your parents into a spin. Or it might be that you cannot remember. Most phobias develop before the age of 10 and because we find a way to live with them (or avoid them) most phobias remain throughout a person’s life. It is also a known fact that if our parent has a fear of an animal, they will pass on that fear to us.

Types of phobias

There are a wide variety of objects or situations that someone could develop a phobia about. In fact there are over 100. Some might make more sense, such as a fear of flying or dogs. But what about a fear of air or a fear of numbers?

Specific phobias are divided into 4 main categories. I have included some of the more common phobias below.

• Fear of problems in the natural environment

  • Astraphobia - a fear of thunderstorms and lightening

  • Acrophobia - fear of heights

  • Dendrophobia - a fear of trees

• Fears of animals

  • Arachnophobia - fear of spiders

  • Ailurophobia - fear of cats

  • Cynopphbia - a fear of dogs

• Fear of Medical Treatments or Issues

  • Dentophobia - fear of dentists and dental treatment

  • Hemophobia - fear of blood

  • Trypanophobia - a fear of needles or injections

• Fears related to specific situations.

  • Claustrophobia - fear of closed in spaces, such as lifts.

  • Glassophobia - fear of heights

  • Aerophobia - fear of flying.

When does a phobia become a problem?

Most people choose to live with a phobia and take great care to avoid the thing they fear. Most individuals do not seek professional help until a situation or event in life presents itself and the phobia can no longer be avoided. Some examples of this might be:

• We are offered our dream job - but the office is on the 50th floor of a building.

• Our child is getting married, but the wedding is taking place the other side of the world.

• The office for our current job moves and either we take 3 hours to get there by public transport or 1 hour by car, but this involves driving on a motorway.

• We have booked our dream trip but realise that we will arrive in the rainy season and thunder and lightning strikes will be a daily occurrence.

Treating Phobias

One of the problems with living with a phobia is that by trying to constantly avoid the thing you fear you are telling your brain there is actually a problem.

• So, every time you cross the street to avoid the dog, your brain will believe it was a lucky miss because that dog was definitely going to bite you.

• Every time you avoid going on a train, your brain is convinced that you had avoided a certain disaster.

• Every time you avoid a hospital appointment your brain will be convinced the doctor was going to carry out a procedure that would lead to certain death.

The point here is that unless you actually face the thing you fear your brain can never find out whether the thing you fear is actually a problem. This is the important bit... we have to show our brains that the thing that it is frightened of is actually benign. How do we do that? The obvious answer is to face our fears. But when we approach the object or situation of our phobia our brains tells us:

RUN!!!!! YOU WILL DIE IF YOU DO NOT RUN!!!!!!

So overcoming a phobia is not easy...but it can be done.

Step 1: Understanding Anxiety

It is important to understand anxiety and why your body responds in the way it does when faced with your fear.

Step 2: Practice Anxiety Reducing Techniques.

It is important to practice this outside of the feared situation. When we are in a situation where our brain is telling us we are going to die, stopping to try to remember how to breath properly does not work.

Step 3: Develop an exposure program that involves a graded hierarchy or a 'fear ladder'.

This involves coming up with several steps starting with things we have mild anxiety towards and moving towards things we have intense anxiety for.

An example of exposure therapy for fear of spiders:

1.     Look at a picture of a small spider.

2.     Look at a dead spider in a jar.

3.     Look at a picture of a larger spider.

4.     Watch a video of a small spider.

5.     Watch a small alive spider in a jar.

6.     Be in a room with a small spider.

7.     Be in a room with a larger spider.

8.     Be in a room with a number of spiders.

9.     Hold a small spider in our hands.

10.  Hold a large spider in our hands.

An example of exposure therapy for a fear of heights:

1.     Stand on a low stool.

2.     Go up 5 rungs on a ladder.

3.     Go up one flight of stairs and look over the banister from a distance

4.     Go up 10 rungs on a ladder

5.     Go up one flight of stairs and look over the banister close by.

6.     Go up two flights of stairs and look over.

7.     Go up five flights of stairs and look over.

8.     Go up 10 flights of stairs and look out a window.

9.     Go up 20 flights of stairs and look out of a window.

10.  Go up 20 flights of stairs and look out from a balcony.

An example of exposure therapy for a fear of needles

1.     Think about having an injection

2.     Listen to someone talking about having an injection

3.     Look at photos of needles

4.     Look at photos of someone having an injection

5.     Watch a video of someone handling a needle

6.     Watch a video of someone having an injection

7.     Hold a needle in your hand

8.     Watch someone having an injection in the same room as you

9.     Place or hold a needle close to the site of injection

10.  Have an injection in your arm

Step 4: Prior to carrying out the first point on your fear ladder, carry out relaxation techniques to calm the body.

Step 5: Begin working through the hierarchy.

Top tips:

• Ask friends and family to celebrate your journey with you.  This can help with motivation.

• There will be items on the fear ladder that feel quite easy. Enjoy the feeling of achievement and watch your brain dismissing how hard it actually was to do it.

• Often, we will get to a point in a ladder where we feel stuck and cannot do the thing. Break this item down again as perhaps there are more steps involved.

• Plan a celebration at the end - maybe buying your child the dog they always wanted or throw a party on the top floor of a high building. Or maybe just have a cup of tea and bask in the wonderful feeling that you have overcome your fear, and it will never plague you again.