Phobias: How are they established, maintained and treated? 

What is a phobia?

According to the NHS, phobias are “an overwhelming and debilitating fear of an object, place, situation, feeling or animal.” Phobias are exaggerated and irrational fears that are generally ‘learned’. The actual danger from the situation, object, etc is greatly over estimated and leads to fear out of proportion to the real danger they are facing. 

The most common phobia is Social Phobia. This affects up to 5% of the population and can leave people feeling extremely self-consciousness in social situations. It is often accompanied by an excessive fear of judgment by others too. It makes normal social situations like presenting work to colleagues or meet new people very challenging. 

Other common phobias include:

Agoraphobia: a fear of open spaces which can prevent people from leaving their homes or leading a normal life. 

Acrophobia: a fear of heights. This can cause a feeling of vertigo (dizziness) which for some can occur due to being on a higher floor of a building or on an escalator. 

Pteromerhanophobia: a fear of flying, despite the fact that you are actually more likely to be hit by lightning than be involved in a plane crash. 

Claustrophobia: a fear of enclosed spaces

Entomophobia: a fear of insects

Ophidiophobia: a fear of snakes

Cynophobia: a fear of dogs, which is often more common amongst children than adults. 

Astraphobia: a fear of storms

Trypanophobia: a fear of needles. Those with this phobia feel faint or even pass out when exposed to needles. 

Some phobias, like agoraphobia and ophidiophobia, are thought to be a dormant evolutionary survival instinct – it was helpful for our ancient ancestors to be wary of heights for their own survival. I’m sure you know if someone with one of these phobias, or perhaps you recognise one of these in yourself? There are just the ten most common phobias and there are obviously plenty more. 

What’s the difference between fear and phobias?

At first glance these may appear to be the same thing but there are important differences. Fear is a natural, automatic response to danger and is temporary. It alerts us to the threat of danger and/or harm. Phobias are extreme fears that are irrational (out of proportion from the danger) and are much longer-lived or even stay with us for a lifetime without treatment. 

How phobias develop?

Phobias are thought to be learned behaviour. For example, a bad experience with a dog as a child may create a life-long extreme fear of dogs. Or having a parent with a phobia can be a risk factor because they model fear of a particular situation, object, etc. So a child seeing a parent responding fearfully to a spider can quickly learn that spiders, or all insects, are a danger. 

Psychologists Watson and Rayner (1920) created a phobia of rats in a baby they called “Little Albert”. Albert enjoyed playing with a small white rat. However, they would make a very loud noise that startled the baby every time the rat came close to him. Very soon the baby exhibited an extreme fear reaction to the rat and would become very distressed without any accompanying noises. Even a month later, the fear reaction remained. Although the ethics of this experiment are very questionable, it is a clear demonstration of how phobias can be learned quickly and stay with us. However, like Albert, many phobias have their origins in childhood and we don’t remember the initial cause any longer. Despite this, they can continue for a significant time. 

How phobias get maintained

Due to the extreme fear of the object, place, situation, feeling or animal, we tend to avoid the thing we fear. So if we have a phobia of dogs (cynophobia) it could prevent us from visiting parks, forests or beaches where we are likely to come into contact with them. We might turn back or cross the road from a dog being walked towards us. We will go out of our way to avoid the object of our fear. However, this also serves to maintain the phobia because we never ‘learn’ that our fear is out of proportion to the actual danger. So the mental link between “dog” and “danger” is maintained. The phobia can even grow stronger through avoidance because every time we see a dog and avoid it we are ‘safe’ so it is strengthening that connection. 

Treating phobias

Not all phobias need treatment but if they are limiting your quality of life or causing distress, there are ways to overcome the phobia or reduce the fear to a manageable level, often permanently. It normally involves some talk therapy like CBT to help reduce overall anxiety. Sometimes medication like a short-term dose of beta-blockers are recommended by GPs too. Some people find hypnotherapy or mindfulness helpful too. There is no one size fits all approach. 

We also know from research that Exposure Therapy can be very effective. This is a gentle, graded exposure to the fear in question, in a safe, controlled environment. For example starting with a photo of a dog whilst working on relaxation techniques, slowly working up to seeing a dog at a distance with relaxation to even petting a dog at the other extreme. Of course this is more difficult with some phobias like fear of flying. It is helpful to work with a professional to develop a safe program of exposure that works at your individual pace and is conducted in a safe and empathic manner. 

phobia, fear, treatment, counselling, exposure therapy

“The fears we don’t face become our limits”

-Robin Sharma

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