Phobias: Causes and Treatments
November 17, 2001
Phobia (FO-bee-ah): a persistent irrational fear of an object, situation, or activity that the person feels compelled to avoid. (Wood 689) And that is only the start of it. Phobias can interfere with your ability to work, socialize, and go about a daily routine (American). People who have phobias are often so overwhelmed by their anxiety that they avoid the feared objects or situations (NIMH). For most people, the simple pleasures of life are striped from them. Symptoms of a phobia include the following:
· Feeling of panic, dread, horror, or terror
· Recognition that the fear goes beyond normal boundaries and the actual threat of danger
· Reactions that are automatic and uncontrollable, practically taking over the person’s thoughts
· Rapid heartbeat, shortness of breath, trembling, and an overwhelming desire to flee the situation – all the physical reactions associated with extreme fear
· Extreme measures taken to avoid the feared object or situation (American)
There are three classes of phobias: agoraphobia, social phobia, and specific phobia (Wood 521). Agoraphobics have an intense fear of being in a situation from which immediate escape is not possible or in which help would not be available if the person should become overwhelmed by anxiety or experience a panic attack or panic-like symptoms (Wood 521). Agoraphobia is the most disabling of all phobias, and treatment is difficult because there are so many associated fears (Hall). Specific phobia is a catchall category for any phobias other than agoraphobia and social phobias (Wood 522). There are four categories of specific phobias: situational phobia, fear of natural environment, animal phobia, and blood-injection-injury phobia (Wood 522). Between these four categories are more than 350 different types of specific phobias. They range all the way from cathisophobia-fear of sitting to something as severe as arachnophobia-fear of spiders. For people with social phobia, however, the fear is extremely intrusive and can disrupt normal life, interfering with work or social relationships in varying degrees of severity (NIMH).
Approximately 4 to 5% of the U.S. population has one or more clinically significant phobias in a giving year (NIMH). Specific phobias affect an estimated 6.3 million adult Americans and are twice as common in women as in men (About). The average age of onset for social phobia is between 15 and 20 years of age, although it can begin in childhood (NIMH). Childhood phobias usually disappear before adulthood. However, those that persist into adulthood rarely go away without treatment (American).
Many psychologists believe the cause lies in a combination of genetic predisposition mixed with environmental and social causes (Hall). Some believe that neurotransmitter-receptor abnormalities in the brain are suspected to play a part in the development of social phobias (Hall). Neurotransmitters are substances such as norepinephrine, dopamine, and serotonin that are released in the brain (Hall). Disorders in the physiology of these neurotransmitters are thought to be the cause of a variety of psychiatric illnesses (Hall). It has also been demonstrated that identical twins may develop that same type of phobia, even when they were reared separately soon after birth, and educated in different places (Masci). It may by also true that human beings are biologically prone to acquire fear of certain noxious animals or situations, such as rats, poisonous animals, animals with disgusting appearance, such as frogs, slugs or cockroaches, etc.(Masci) But phobias are not always destined in our genes.
In a classical experiment, the American psychologist Marting Seligman associated an aversive stimulation (a small electric shock) to certain pictures (Masci). Two to four shocks were enough to establish a phobia to pictures of spiders or snakes, while a much larger series of shocks was needed to cause phobia to pictures of flowers, for example (Masci). One possible explanation is that those fears where originally important for the survival of the human species thousands of years ago and that they lie dormant inside our brains, just waiting to be awaken at any time (Masci). Another reason for the development of phobias is that we often associate danger to things and situations that we cannot prevent or control, such as lightning strikes during a storm, or the attack of a dangerous animal (Masci). In this sense, patients who have clinically-established panic disorder, often end developing phobia to their own crisis, because the feel totally helpless in controlling it (Masci). In consequence, they start avoiding going to or staying in places or situations where they might become publicly embarrassed or unable to escape, due to the onset of the crisis (Masci).
Traumatic events often trigger the development of specific phobias, which are slightly more prevalent in women than men (NIMH). Negative social experiences, such as being rejected be peers or suffering some type of embarrassment in public, and poor social skills also seem to be factors, and social phobia may be related to low self-esteem, lack of assertiveness, and feeling of inferiority (Hall). Many people with social phobia are so sensitive to the scrutiny of others that they avoid eating or drinking in public, using public restrooms, or signing a check in the presence of another (Hall). Social phobia may often be associated with depression or alcohol abuse (Hall).
Finally, there is also the social component or cultural influences on phobia (Masci). For example, there is a kind of phobia called taijin kyofusho, which occurs only in Japan (Masci). In contrast to what happens in the social phobias (when the patient is afraid of being humiliated or loathed by other persons), taijin kyofusho is the fear of offending other persons by an excess of modesty or showing respect! (Masci). The patient is afraid that his social behavior or an imaginary physical defect might offend or embarrass other people (Masci). Fortunately effective relief can be gained through either behavior therapy or medication (American).
One of the most successful treatments is behavior therapy. In behavior therapy, one meets with a trained therapist and confronts the feared object or situation in a carefully planned, gradual way and learns to control the physical reactions of fear (American). The behaviorists involved in classical conditioning techniques believe that the response of phobic fear is a reflex acquired to non-dangerous stimuli (Phobia). The normal fear to a dangerous stimulus, such as a poisonous snake, has unfortunately been generalized over to non-poisonous ones as well (Phobia). If the person were to be exposed to the non-dangerous stimulus time after time without any harm being experienced, the phobic response would gradually extinguish itself (Phobia). In other words, one would have to come across ONLY non-poisonous snakes for a prolonged period of time for such extinction to occur (Phobia). This is not likely to occur naturally, so behavior therapy sets up phobic treatment involving exposure to the phobic stimulus in a safe and controlled setting (Phobia). Foa and Kozak call this exposure treatment, so called because the patient is exposed to the phobic stimulus as part of the therapeutic process (Phobia).
One simple form of exposure treatment is that of flooding, where the person is immersed in the fear reflex until the fear itself fades away (Phobia). The key is keeping the patients in the feared situation long enough that they can see that none of the dreaded consequences they fear actually come to pass (Wood 548). Some patients cannot handle flooding in any form, so an alternative classical conditioning technique is used called counter-conditioning (Phobia). In this form, one is trained to substitute a relaxation response for the fear response in the presence of the phobic stimulus (Phobia). This counter-conditioning is most often used in a systematic way to very gradually introduce the feared stimulus in a step-by-step fashion known as systematic desensitization, first used by Joseph Wolpe (Phobia).
In desensitization, three steps are involved:
1. Training the patient to physically relax
2. Establish an anxiety hierarchy of the stimuli involved
3. Counter-conditioning relaxation as a response to each feared stimulus beginning first with the least anxiety provoking stimulus and moving then to the next least anxiety provoking stimulus until all of the items listed in the anxiety hierarchy have been dealt with successfully (Phobia).
Also, systematic desensitization can be paired with modeling, and application suggested by social learning theorists (Phobia). In modeling, the patient observes others (the “model(s)”) in the presence of the phobic stimulus who are responding with relaxation rather that fear (Phobia). In this way, the patient is encouraged to imitate the model(s) and thereby relieve their phobia (Phobia). However relaxation therapy is not the only treatment used in curing phobias.
Hypnosis can also set you free of fears and phobias. In mild cases, where a person recognizes the triggers but would like help controlling their reaction, posthypnotic suggestions can help them control their breathing, slow their heart rate, and achieve a relaxed state of mind (Wizell). This permits them to deal with the problem in a calm and rational manner (Wizell). More severe cases are often the result of a traumatic childhood event (Wizell). Most of the time the event can no longer be recalled by the conscious mind, but is still retained in the subconscious (Wizell). In these cases, the Hypnotherapist will often apply age regression (Wizell). Age regression is one of the most powerful tool available to the Hypnotherapist (Wizell). With it s/he can guide the person back in time, and help them reexamine the event that initially triggered the fear from an objective point of view (Wizell). Once the cause is revealed, the fear of losing control is eliminated (Wizell).
Medications are also used to control the panic experience during a phobic situation as well as the anxiety aroused by anticipation of that situation and are the treatment of first choice for social phobia and agoraphobia (American). Drugs prescribed for these short-term situations include benzodiazepine anti-anxiety agents (Hall). These include two approved for treating anxiety disorders: Xanax (alrazolam) and Valium (diazepam) (Hall). Beta-blockers such as Inderal (propranolol) and Tenormin (atenolol), approved for controlling high blood pressure and some heart problems, have been acknowledged, partly on the basis of controlled trails, to be helpful in certain situations in which anxiety interferes with performance, such as public speaking (Hall).
In addition to the anti-anxiety drugs and beta-blockers, medications may include the monamine oxidase (MAO) inhibitor antidepressants Nardil (phenelzine) and Parnate (tranylcypromine), and serotonin specific reuptake inhibitors (SSRIs) such as Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), and Luvox (fluvoxamine) (Hall). Because there are fewer side effects associated with these drugs and a very low addiction potential, practitioners are more comfortable prescribing them (Hall). Plus, the antidepressant action of these drugs is helpful is treating patients who suffer from depression in addition to social phobia (Hall).
Newer antidepressants are being specifically designed to target mechanisms that elevate serotonin and other neurotransmitters in the brain; some showing promise for anxiety are venlafaxine (Effexor) and nefazodone (Serzone). (Well-Connected) The antidepressant drugs known as tricyclic antidepressants (TCA) have also been effective in treating panic and obsessive-compulsive disorders (Well-Connected). The most common TCA used for the treatment of panic disorder is imipramine (Tofranil, Janimine); it is also effective in treating agoraphobia (Well-Connected). But with proper treatment, the vast majority of phobia patients can completely overcome their fears and be symptom free for years, if not for life (American).
Specific Phobias. http://seniorhealth.about.com/library/men…/bl_anxiety6.htm?iam=savvy&terms=%2Bphobia
American Psychiatric Association. Phobias . http:www.psych.org/public_info/eating.cfm
Hall, Lynne L. Fighting Phobias, The Things That Go Bump in the Mind. http://www.fda.gov/fdac/features/1997/297_bump.html
Masci, MD Cyro. Phobia: When Fear is a Disease. http:www.edub.org.br/cm/n05/doencas/fobias_i.htm
NIMH (National Institute of Mental Health). Anxiety Disorders: Quick Facts http://www.nimh.nih.gov/Anxiety/anxiety/phobia/phqfax.htm
Phobia List. Treatment for Phobias. http://www.phobialist.com/treat.html
Well-Connected. How is Anxiety Disorder Diagnosed and Treated. http://my.webmd.com/content/article/1680.5027
Wizell, Victoria. Hypnosis can set you free of fears and phobias. http://www.hyptalk.com/Articles/Fears/htm.
Wood, Samuel E. & Ellen Green Wood. The World of Psychology: 3rd Edition. Needham Heights: Viacom, 1999