References:
- Course Module
Phobias are illogical, intense, and persistent fear of a specific object or a social situation that causes extreme distress and interferes with normal functioning. Phobias usually do not result from past negative experiences. In fact, the person may never have had contact with the object of the phobia. People with phobias have a reaction that is out of proportion to the situation or circumstance. Some individuals may even recognize that their fear is unusual and irrational but still feel powerless to stop it.
- Anticipatory anxiety can develop even when thinking about possible encountering the dreaded phobic object or situation. They engage in avoidance behavior that often severely limits their lives. Such avoidance behavior usually does not relieve the anticipatory anxiety for long.
There are three categories of phobias.
- Agoraphobia, which is vulnerability felt from unfamiliar spaces, especially outside the home.
- Specific phobia, which is an irrational fear of particular object or a situation.
- Natural environment phobias: fear of storms, water, heights, or other natural phenomena.
- Blood-injection phobias: fear of seeing one’s own or others’ blood, traumatic injury, or an invasive medical procedure such as as injection
- Situational phobias: fear of being in a specific situation such as on a bridge or in a tunnel, elevator, small room, hospital, or airplane.
- Animal phobias: fear of animals or insects, most commonly cats and dogs.
- Other types of specific phobias: for example, fear of getting lost while driving if not able to make all right (and no left) turns to get one’s destination
- Social anxiety or phobia, which is anxiety provoked by certain social or performance situations, such as speech, attending a social engagement alone, interacting with the opposite sex or with strangers, and making complaints. The fear is rooted in low self-esteem and concern about others’ judgments.
Many people express “phobias” about snakes, spiders, rats, or similar objects. These fears are specific, easy to avoid, and cause no anxiety or worry. The diagnosis of a phobic disorder is made only when the phobic behavior significantly interferes with the person’s life by creating marked distress or difficulty in interpersonal or occupational functioning. The presence of several social phobias is known as generalized social phobia.
Onset and Clinical Course
Specific phobias usually occur in childhood or adolescence. In some cases, merely thinking about or handling a plastic model of the dreaded object can create fear. Specific phobias that persist into adulthood are lifelong 80% of the time.
The peak age of onset for social phobia is middle adolescence; it sometimes emerges in a person who was shy as a child. The course of social phobia is often continuous, though the disorder may become less severe during adulthood. Severity of impairment fluctuates with life stress and demands.
Treatment
Behavioral therapy works well. Behavioral therapists initially focus on teaching what anxiety is, helping the client identify anxiety responses, teaching relaxation techniques, setting goals, discussing methods to achieve those goals, and helping the client visualize phobic situations.
- Systemic (Serial) Desensitization: the therapist progressively exposes the client to the threatening object in a safe setting until the client’s anxiety decreases.
- Flooding is a form of rapid desensitization in which a behavioral therapist confronts the client with the phobic object until it no longer produces anxiety. This method is highly anxiety producing and should be conducted only by a psychotherapist under controlled circumstances and with the client’s consent.
- Drugs used to treat anxiety disorders (benzodiazepines, anxiolytics, TCA, SSRI) may also be used to treat phobias.