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Health and Disease

Phobias and How We Can Treat Them

Phobia: the irrational fear of an object or situation. Almost everyone has some irrational fears, however, phobias are when this fear inhibits you from staying grounded and makes you uncontrollable. Specific phobias are one of the most common mental disorders, with an estimated prevalence ranging from ~7% to ~15%.

By Nara Ito

Published 11:58 PM EST, Tues April 27, 2021

Introduction

All phobias are characterized by excessive fear and anxiety, initiated by a phobic stimulus. The extent of the fear is most typically blown out of proportion in contrast to the real threat the phobic stimulus actually poses.

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), published by the American Psychiatric Association, is a system that many researchers and clinicians use to identify and diagnose mental health problems. It recognizes the following categories of phobia and related anxiety disorder: 

  • Specific phobia: phobia of a particular object, such as an animal or body part, or a certain situation. 
  • Social anxiety (social phobia): phobia of a social situation such as public speaking. 
  • Agoraphobia: phobia of being outside or being in a public place.

Phobias can be diagnosed as clinical phobias and be disabling by causing tremendous suffering and the inability for a person to function adequately. In fact, a clinical phobia is only diagnosed if anxiety is considerable and it impacts the sufferer’s life. But regardless if the phobia is clinically mild or not, individuals exhibit certain characteristics when they have a phobia falling under three categories of behavioral, cognitive, and emotional.

Behavioral characteristics of phobias 

Evolutionarily, we have a fight or flight response when we feel like we are in the presence of a threat. We respond to things or situations we fear by behaving in particular ways. Phobias cause the individual to feel high levels of anxiety and try to escape, even if the level of fear is irrational, out of all proportion to the phobic stimulus. 

Panic: Someone with a phobia may panic in response to the phobic stimulus. This may be recognized by a range of behaviors including screaming, running away, or crying heavily. Amongst children, some may express panic by freezing, clinging to an object or person, or having a tantrum. 

Avoidance: Unless the phobic person requires to or makes a conscious effort to face their fear, most of the time they attempt to avoid coming into contact with the phobic stimulus. For many with phobias of specific objects that stay in particular areas and spaces, this may be easy to avoid, however, avoidance can easily affect the individual’s daily life. For example, someone with a fear of pigeons would have to heavily limit the time spent outside, as a pigeon can fly over or appear at any moment as they are a very common bird to see around.

Endurance: The alternative to avoidance is endurance, in which the individual remains in the presence of the phobic stimulus and somewhat tolerates it but only with very high levels of anxiety. In some situations, this may be unavoidable, for example for a person who has an extreme fear of flying having to sit through a flight.

Emotional characteristics of phobias 

Anxiety: In the DSM-5 phobias are classed as anxiety disorders. Anxiety being an unpleasant state of high arousal, phobias prevent the individual from relaxing and make it very difficult to experience any positive emotion as they are continually tense.

Emotional responses are unreasonable: Being heavily irrational fears, emotional responses we experience in relation to a phobic stimulus often exceed what is considered reasonable to most others.

Cognitive characteristics of phobias 

Cognitive characteristics affect the ways people process information and think. 

Selective attention to the phobic stimulus: When phobic people can see the phobic stimulus their attention remains constantly on it as they see the stimulus as a threat. When in actual danger, this ability to have selective attention is crucial so that we can react quickly to a threat,  however, this isn’t useful when the fear is irrational.

Irrational beliefs:Someone with a phobia may hold irrational beliefs in relation to phobic stimuli. This is particularly prevalent when it comes to social phobias as the individual starts to create irrational beliefs about the self that can foster toxic mindsets and increase the pressure on the sufferer to perform well in social situations. 

So how are phobias treated?

The two main methods of treatment when it comes to phobias are systematic desensitization and flooding.

Systematic desensitization (SD) is a behavioral therapy designed to reduce unwanted responses to the phobic stimulus, this may include emotional characteristics such as anxiety. SD involves drawing up a hierarchy of anxiety-provoking situations related to the phobic stimulus, teaching the patient to relax, and then slowly exposing them to phobic situations, working their way through the hierarchy whilst maintaining relaxation. As the patient gets more accustomed to the stimulus, a new response to the phobic stimulus is learned by which the phobic stimulus is paired with relaxation instead of anxiety. This learning of a different response is called counterconditioning. 

Flooding on the other hand is a behavioral therapy in which a phobic patient is exposed to an extreme form of high concentrations of the phobic stimulus in one go in order to reduce anxiety triggered by that stimulus. This takes place across a small number of long therapy sessions, but sometimes only one long session is needed to cure a phobia, making it quick and efficient.

Flooding stops phobic responses very quickly because without the option of avoidance behavior or escaping, the patient has to tolerate and withstand the stimulus, thus quickly learning that the phobic stimulus is harmless. In classical conditioning terms, this process is called extinction. In some cases, the patient may achieve relaxation in the presence of the phobic stimulus simply because they become exhausted by their own natural fight or flight response.

Nara Ito, Youth Medical Journal 2021

References

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By Nara Ito

Nara Ito is a student from London, England. She is interested in neurology, immunology, and genetics

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