What Are Phobias?
Overview
Phobias are diagnosed as a “Specific Phobia” due to a phobia being a fear of a specific object or situation. It is an intense, irrational fear that leads to increased anxiety and panic attacks when encountering the fear.
People can experience anxiety just thinking about their phobia. Most people with phobias will experience extreme anxiety and panic attacks when exposed to their phobia.
It is also possible that a panic disorder is triggered after exposure to a phobia. In these situations a person will need to treat the phobia in addition to any symptoms of panic.
Common Phobic fears include flying, driving, enclosed places, heights, animals, insects, water, seeing blood, getting an injection, and choking or vomiting.
These fears are irrational and out of proportion to any actual danger.
Most people actively avoid their phobia because it almost always causes immediate fear and anxiety.
Common Phobias
Animal phobias: People can develop a fear of almost anything. Common animal phobias are fear of snakes, spiders, and dogs. People can even develop a phobia of butterflies.
Environmental phobias: These are fears of the natural environment and include fear of heights, water, storms, and the dark.
Situational phobias: These fears are very specific such as fear of driving, enclosed spaces (claustrophobia), bridges, flying, and tunnels.
Blood-Injection/Injury phobia is the fear of blood, needles, illness, injuries, and other medical procedures.
Social Anxiety Disorder (Social Phobia)
Social Anxiety Disorder used to be referred to as social phobia. People with social anxiety disorder experience fear and anxiety about one or more social situations where they could be observed and judged by others.
Meeting new people, having conversations, being observed by others, eating or drinking around others, and performing or giving a speech are some of the situations that someone struggling with social anxiety would likely want to avoid.
Even writing and signing your name in front of others could cause anxiety.
There is a fear that others will notice that you are anxious, that you will be evaluated negatively, and then you will feel embarrassed and possibly rejected.
These social situations always produce fear, are avoided or endured with intense anxiety, and the fear is totally out of proportion for the actual situation.
Agoraphobia
Agoraphobia is an anxiety disorder in which people develop a fear of being in public places, and in some cases a fear of leaving their home.
It is a fear of being in situations where the person believes that escape would be very difficult or where help might not be available.
Places such as theaters, parking lots, and buses are believed to be difficult to escape and cause extreme fear that often leads to a panic attack or feeling embarrassed.
The fear of public places can cause intense anxiety that often leads to panic attacks. After experiencing a first panic attack, people fear experiencing the next one.
People will avoid situations that they believe will cause a panic attack. This can ultimately lead to Agoraphobia if you experience a panic attack in a public place, in a crowd, while using public transportation, or where escape seems difficult. The place is associated with extreme fear, anxiety, and the public place will be avoided.
Symptoms
An intense irrational fear of a specific object or situation will cause emotional, physical, and behavioral symptoms.
Emotional
Specific Fear
Panic
Physical
Pounding heart
Sweating
Trembling
Shortness of breath
Feeling of choking
Chest pain
Nausea
Feeling dizzy faintness
Numbness or tingling
Chills or hot flashes
Behavioral
Fleeing or running away
Freezing or being immobilized
Avoidance
Causes
Specific phobias usually begin in childhood and continue into adulthood. Approximately 19.2 million American adults are affected by phobias with women being twice as likely as men to have this experience.
Learned: Also known as “Classical Conditioning,” most phobias develop after a person has a negative experience or a panic attack with the feared object or situation. We begin to associate anxiety and panic with object or situation.
Examples include being bitten by a dog (fear of dogs) or as a toddler being startled by a loud noise while petting a dog. You may also learn specific fear from your parents.
Genetics: Research as suggested a possible link between anxiety and genetics. For example, research indicates that first-degree relatives of patients with panic disorder have higher rates of panic disorder than relatives of patients with major depression and relatives of healthy controls (Goldstein et al 1994).
Avoidance: Avoidance is the major way that you feed the fear and develop a phobia. Escaping and avoiding only temporarily reduces the fear and anxiety.
Avoidance also confirms and maintains the belief that the object or situation is dangerous. You might not have a panic attack by avoiding the feared object but you have also reinforced that whatever you just avoided is dangerous.
Avoidance becomes a viscous cycle:
The more you avoid things that trigger anxiety and panic attacks, the more fearful those things become.
The more fearful those things become, the worse your anxiety and panic attacks become.
The worse your panic attacks become, the more you avoid those objects and situations.
Treatment
If you believe you could have a Specific Phobia it will be helpful and important to seek consultation with a mental health professional to first verify the diagnosis and then receive appropriate treatment.
The most effective treatment for phobias is a form of Cognitive Behavioral Therapy called Exposure Therapy. Treatment sometimes consists of a combination of medication and psychotherapy. Medication helps take the edge off the physical symptoms of anxiety and psychotherapy helps to challenge irrational thinking and beliefs that lead to the anxiety and avoidance.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is a well-researched and highly effective form of talk therapy that focuses on learning more helpful ways of thinking and behaving.
You learn different ways of responding to the feared object or situation and to your feelings of anxiety. CBT helps challenge and change unhelpful beliefs that cause anxiety by restructuring your automatic thinking.
CBT sessions also provide education on the symptoms of phobias and how to manage the emotional and physical symptoms of anxiety such as how to stop a panic attack.
Cognitive Restructuring
Cognitive restructuring is used to identify and dispute unhelpful, automatic, and irrational thinking so that you can create highly effective thoughts with the power to alter your emotions and behavior.
An example of an irrational thought is “What if I there is bad turbulence on the airplane. I’ll panic and lose control.”
We develop beliefs about ourselves, other people, and the world. These beliefs influence how we think.
If you believe that the world is basically a dangerous place, then your thoughts will follow. If you believe that you are defective and not a capable person, then your thoughts will reflect those beliefs.
It is not the feared object or situation that causes the anxiety, it’s your thinking and beliefs that cause the fear and anxiety.
Exposure Therapy
Exposure therapy, also known as prolonged exposure, is a form of CBT.
As with most anxiety disorders, in order to learn how to overcome the symptoms of anxiety and to know that you can cope with anxiety and master the symptoms, you need to have the experience of successfully managing the symptoms.
This often means exposing yourself to the thoughts, images, and to the object or situation that triggers the fear, and then applying the coping strategies until the thoughts, images, and feared object no longer produce the same level of fear.
Exposure therapy gradually exposes people to the feared object. This helps to systematically desensitize you from the feared object.
First imagining it (Imaginal exposure). You will get relaxed, close your eyes, and imagine the feared object. You will identify all of your thoughts and beliefs about what would happen if you were near it.
Second, you will learn to manage the symptoms of anxiety you experience while doing the imaginal exposure. Then you can make a fear hierarchy and gradually expose yourself to this list.
1. A picture of a butterfly.
2. Then a video of a butterfly.
3. Then watch a butterfly behind glass.
4. Then standing nearby a butterfly.
5. You will continue to gradually work your way up to holding a butterfly until your fear is gone.
By repeatedly imagining and then exposing yourself to this hierarchy and at the same time learning to decrease your symptoms of anxiety and develop more balanced beliefs, you will become more desensitized to the butterfly and no longer fear it.
Medication
Please consult with your primary care physician or a psychiatrist regarding the use of any medication.
Medication can help reduce the symptoms of anxiety that occur with specific phobias. Commonly prescribed medications include benzodiazepines and beta-blockers.
Benzodiazepines are quick acting sedatives that are generally safe and effective for short term use. However, the long term use of benzodiazepines is associated with the risk of developing tolerance, dependence, and possible other adverse effects.
Commonly prescribed benzodiazepines are:
Alprazolam (Xanax)
Lorazepam (Ativan)
Diazepam (Valium)
Clonazepam (Klonopin)
Beta Blockers are used to treat high blood pressure, heart arrhythmias, and migraines. They are also prescribed for off-label use by physicians to help reduce the physical symptoms of anxiety.
Beta blockers have the ability to control rapid heartbeat, shaking, trembling, and blushing in response to anxiety.
Commonly prescribed Beta Blockers:
Propranolol (Inderal)
Atenolol (Tenormin)
Acebutolol (Sectral)
Bisoprolol (Zebeta)
Metoprolol (Lopressor, Toprol-XL)
Nadolol (Corgard)
Nebivolol (Bystolic)
Managing Anxiety
Feeling confident in your ability to manage the symptoms of anxiety will help with your fear of embarrassment and fear of panic attacks in public places.
Turn on Your Parasympathetic Nervous System
The parasympathetic nervous system is also called the “Rest and Digest” system. It produces a calm and relaxed feeling by:
Decreasing the heart rate
Dilating the blood vessels
Increasing salivation
Stimulating tear production
Stimulating the digestive system
Increasing a feeling of calm
Improves sexual arousal
The parasympathetic nervous system is activated by stimulating something called the vagus nerve. This nerve is very long and it runs from the hypothalamus in the brain to the chest, diaphragm, and intestines.
The vagus nerve can therefore be stimulated through diaphragmatic breathing, humming, and singing.
You can also turn on your parasympathetic nervous system with progressive muscle relaxation and by exposing yourself to cold temperatures.
Diaphragmatic Breathing Exercise
1. Inhale through your nose slowly by expanding from your belly first then fill your upper lungs for a count of 5
2. Hold your breath for a count of 2.
3. Exhale slowly and forcefully through pursed lips for a count of 10.
4. Repeat this 5 to 10 times or do it for at least 1 minute.
Progressive Muscle Relaxation
1. From a seated position begin by tensing your legs and buttocks for a count of 5, then relax.
2. Tense your abdomen for a count of 5, then relax for a count of 5.
3. Tense your arms for a count of 5, then relax for a count of 5.
4. Shrug your shoulders to your ears and tense for a count of 5, then relax for a count of 5.
5. Press your tongue to the roof of your mount for a count of 5, then relax for a count of 5.
Tips: Let all of the tension release and flow out or your muscles. Exhale as you release the tension and relax. You should feel the muscles become loose and limp.
Focus on the difference between the tension and relaxation as this is the most important part of the exercise.
Exposure to Cold
Research indicates that your sympathetic (fight or flight) system slows down and your parasympathetic system increases when your body adjusts to cold temperatures (Makinen et. al. 2008).
It appears that any kind of cold exposure works such as drinking cold water, running hands under cold water, and splashing cold water on your face.
Take care of your physical health
Get regular exercise or physical activity to flush the stress hormones out of your body.
Get adequate sleep.
Eat a healthy diet and be mindful of your caffeine and alcohol intake.
For more information:
Please purchase my book “Attacking Panic: The Power to Be Calm” for more in depth information on how to stop panic attacks quickly and how to treat the root cause (Amygdala/Sympathetic Nervous System).
The book shows you how to go beyond just giving up control and allowing yourself to experience a panic attack.
The book has more powerful strategies that will short-circuit your fight or flight system, stop a panic attack very quickly, and even prevent a panic attack from occurring.
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