Specific Phobia (Irrational Fear)
What is a phobia?
A phobia is a fear which is unreasonable in its degree or nature, yet so powerful that the person with phobia tries to avoid the feared object or situation or becomes extremely anxious, even panic-stricken, if forced to confront it. The person with phobia often becomes anxious simply at the thought of the feared object or situation.
Fears include situations, such as small spaces and heights, natural phenomena such as storms and deep water, and “objects” such as snakes and spiders, but also things like blood or hypodermic syringes and needles. Inherent in the current definition of a phobia is the requirement that the individual recognises that the fear is excessive or unreasonable in some way. For example, it is normal to be wary of snakes, but a person who refuses to walk in an urban park for fear of snakes, who requires others to check their 6th floor apartment for snakes before they will enter, or who becomes extremely distressed and anxious just thinking or hearing about snakes has a fear which is excessive and unreasonable.
Specific Phobias and Other Phobias
Some phobias have been classified in categories of their own. For example, agoraphobia, which is the fear of being in a place or situation from which escape may be difficult or help may not be available in the event of sudden illness or a panic attack, has been given a category all of its own. In practice, the fear of not being able to escape or get help may cause a person to fear a wide range of situations. For example, catching trains, buses and planes (note that the fear is about not being able to get out in case of panic or illness, not about the plane crashing), driving a car, going to the cinema, crossing bridges, using lifts/elevators or being in crowded situations such as shopping centres.
Another phobia given a class of its own is social phobia (also called social anxiety disorder). An individual with social phobia fears that they will do or say something embarrassing, foolish or inappropriate that will attract criticism from others. They fear being the centre of attention in case others notice their anxiety and think less of them. Individuals with these concerns typically try to avoid a range of situations involving exposure to or interaction with others, including public speaking, parties, crowded situations such as trains and buses, and shopping centres, and standing in line/queuing. It can also be difficult doing things in front of others such as eating, drinking, using the telephone or writing.
When an individual fears one specific type of situation, it is called a specific phobia. It has also been called “simple phobia” in the past. An individual may have more than one type of phobia.
What about the fancy names?
Yes, most of the specific phobias have Latin or Greek names. They are all derived from the Latin or Greek description for the feared object or situation. These names may come in handy for trivia contests, but your doctor or psychologist will classify your phobia as “Specific phobia, Animal (or Natural Environment or Blood-Injection-Injury or Other) Types and then describe the feared object.
Who is Affected?
Specific phobias are very common, affecting approximately 5% of the population. They are even more common in childhood, but it appears that many children “grow out of” their phobias. Most adults with phobias developed them in childhood or adolescence. Women seem to be affected much more commonly than men: about 8% of women and 2% of men reported a specific phobia in a recent large scale community survey in the United States.
What Causes Phobias?
A great deal of research has been done to try to answer this question, but we still don’t know for sure. As usual, there are lots of theories. One theory states that humans have a predisposition to fear certain objects and situations which are potentially dangerous or even fatal. Examples would include snakes and insects, heights and storms. It is also clear that phobias can develop after a severe fright or traumatic experience. For example, the child (or adult) who is bitten or even just chased by a ferocious dog who then begins to fear all dogs. Another theory suggests that fears can be learned from others, for example, from one’s parents. Individuals with specific phobias may also have an inherited general tendency towards anxiety and phobias, although the particular phobia that develops may have more to do with an individual’s personal experience and their environment.
In the blood-injury-injection type of specific phobia individuals commonly faint when they see blood, have an injection or blood taken, or even at the sight of a needle. There is some debate currently about whether this type of phobia is as purely psychological in origin as other types of phobia. This is because many individuals who report fainting at the sight of blood do not report any anxiety preceding the faint. It may be that this is a mixed group, some of whom have a typical phobic reaction and others of whom have an abnormally strong and reflex neurological reaction to injury or the threat of injury.
How are phobias treated?
Specific phobias have the best prognosis of any anxiety disorder. Cure is a real possibility, although it will take hard work! The only proven effective treatment of specific phobias is cognitive behaviour therapy and specifically, repeatedly confronting the feared object in a process known as exposure therapy. The anxiety response to the feared object may be viewed as a false alarm in that the anxiety which occurs in response to the object is greatly out of proportion to the actual danger which the object (or situation) presents to the individual. Unfortunately, the tendency to avoid or run away from the object prevents the individual from ever learning that perhaps there is not so much to fear after all. The individual can probably recognise this intellectually, but in some ways they do not really learn this at an emotional level. Hence, the pattern is repeated every time: every time they are reminded of the feared object it triggers an anxiety response – even though the individual recognises intellectually that it is unreasonable. When, instead of running away the individual confronts the situation, and stays there until their anxiety begins to diminish, they take the first step in teaching themselves on a more emotional level that there is not as much to fear from the object as they have been feeling.
Exposure can be done in a graded or gradual fashion, in which a person comes gradually closer to the feared object, perhaps even starting by simply imagining the feared object as the first step. However, research has shown that there is no substitute for exposure to the actual feared object in reality. This is known as exposure in vivo as opposed to imaginal exposure. Exposure may also be carried out in massed sessions. In this technique the individual confronts the feared object or situation and does not leave until their anxiety begins to diminish. This typically takes between 2-3 hours. This type of exposure usually results in immediate improvement. Individuals tend to do better when their exposure program is supervised by an appropriately trained and experienced therapist rather than trying to do it all by themselves. This is at least partly due to the fact that although the principle underlying exposure-based treatments is quite straightforward, a successful exposure program is composed of many different factors that must be taken into account and specifically tailored to the individual in order to achieve success. Additional exposure or cognitive techniques may be added depending on the nature on the phobia. For example, exposure to internal sensations in some types of health anxiety, and the use of a technique known as applied tension in blood-injury-injection phobia.
To be effective, exposure activities must be done frequently and repeatedly. It is possible to limit the degree of anxiety that must be endured by choosing a degree of exposure that is not overwhelming. For example, someone with a fear of heights may first practice by standing 2 metres back from a 1m height guarded by a railing. They repeat this step several times per week until it seems reasonably easy. The next step may involve standing 1m away. Again it is practiced repeatedly. The next step would involve going all the way to the guard rail. Next, the person might tackle a slightly greater protected height. After that they may move indoors to a large picture window overlooking a moderate height. The steps should be specified exactly but will depend on the specific fears the individual has. Although the individual may find it easier to have someone with them when they begin to confront their fears, eventually they will need to be able to confront the situation alone in order to achieve the greatest success.
More information on treatment and self-help for Phobias are available at helpguide.org