Phobias & Fears
Symptoms, Treatment, and Self-Help for Phobias and Fears
Almost everyone has an
irrational fear or two—of mice, for example, or your annual dental checkup. For
most people, these fears are minor. But, when fears become so severe that they
cause tremendous anxiety and interfere with your normal life, they’re called
phobias. The good news is that phobias can be managed and cured. Self-help
strategies and therapy can help you overcome your fears and start living the
life you want.
What is a
phobia?
A phobia is an overwhelming and unreasonable fear of an object or situation that poses little real danger but provokes anxiety and avoidance. Unlike the brief anxiety most people feel when they give a speech or take a test, a phobia is long lasting, causes intense physical and psychological reactions, and can affect your ability to function normally at work or in social settings.
Several types of phobias exist. Some people fear large, open spaces. Others are unable to tolerate certain social situations. And still others have a specific phobia, such as a fear of snakes, elevators or flying.
Barbara’s fear of flying
Barbara is terrified of flying.
Unfortunately, she has to travel a lot for work, and this traveling takes a
terrible toll. For weeks before every trip, she has a knot in her stomach and a
feeling of anxiety that won’t go away. On the day of the flight, she wakes up
feeling like she’s going to throw up. Once she’s on the plane, her heart
pounds, she feels lightheaded, and she starts to hyperventilate. Every time it
gets worse and worse.
Barbara’s fear of flying has
gotten so bad that she finally told her boss she can only travel to places
within driving distance. Her boss was not happy about this, and Barbara’s not
sure what will happen at work. She’s afraid she’ll be demoted or lose her job
altogether. But better that, she tells herself, than getting on a plane again.
A phobia is an intense fear of something that, in reality, poses
little or no actual danger. Common phobias and fears include closed-in places,
heights, highway driving, flying insects, snakes, and needles. However, we can
develop phobias of virtually anything. Most phobias develop in childhood, but
they can also develop in adults.
If you have a phobia, you probably realize that your fear is
unreasonable, yet you still can’t control your feelings. Just thinking about
the feared object or situation may make you anxious. And when you’re actually
exposed to the thing you fear, the terror is automatic and overwhelming.
The experience is so nerve-wracking that you may go to great
lengths to avoid it — inconveniencing yourself or even changing your lifestyle.
If you have claustrophobia, for example, you might turn down a lucrative job
offer if you have to ride the elevator to get to the office. If you have a fear
of heights, you might drive an extra twenty miles in order to avoid a tall
bridge.
Understanding your phobia is the first step to overcoming it. It’s
important to know that phobias are common. Having a phobia doesn’t mean you’re
crazy! It also helps to know that phobias are highly treatable. You can
overcome your anxiety and fear, no matter how out of control it feels.
It is normal and even helpful to experience fear in dangerous
situations. Fear is an adaptive human response. It serves a protective purpose,
activating the automatic “fight-or-flight” response. With our bodies and minds
alert and ready for action, we are able to respond quickly and protect
ourselves.
But with phobias the threat is greatly exaggerated or nonexistent.
For example, it is only natural to be afraid of a snarling Doberman, but it is
irrational to be terrified of a friendly poodle on a leash, as you might be if
you have a dog phobia.
The difference between normal fear and a phobia
|
|
Normal fear
|
Phobia
|
Feeling
anxious when flying through turbulence or taking off during a storm
|
Not
going to your best friend’s island wedding because you’d have to fly there
|
Experiencing
butterflies when peering down from the top of a skyscraper or climbing a tall
ladder
|
Turning
down a great job because it’s on the 10th floor of the office building
|
Getting
nervous when you see a pit bull or a Rottweiler
|
Steering
clear of the park because you might see a dog
|
Feeling
a little queasy when getting a shot or when your blood is being drawn
|
Avoiding
necessary medical treatments or doctor’s checkups because you’re terrified of
needles
|
Normal fears in children
Many childhood fears are
natural and tend to develop at specific ages. For example, many young children
are afraid of the dark and may need a nightlight to sleep. That doesn’t mean
they have a phobia. In most cases, they will grow out of this fear as they get
older.
If your child’s fear is not interfering with his or her daily life
or causing him or her a great deal of distress, then there’s little cause for
undue concern. However, if the fear is interfering with your child’s social
activities, school performance, or sleep, you may want to see a qualified child
therapist.
Which of my child’s fears are
normal?
According
to the Child Anxiety Network, the following fears are extremely common and
considered normal:
- 0-2 years – Loud noises, strangers, separation from parents, large objects.
- 3-6 years – Imaginary things such as ghosts, monsters, the dark, sleeping alone, strange noises.
- 7-16 years – More realistic fears such as injury, illness, school performance, death, natural disasters.
There are four general types of phobias and fears:
Animal phobias. Examples include fear of snakes, fear of spiders, fear of rodents,
and fear of dogs.
Natural environment
phobias. Examples
include fear of heights, fear of storms, fear of water, and fear of the dark.
Situational
phobias (fears triggered by a specific situation). Examples include fear of enclosed spaces (claustrophobia), fear of
flying, fear of driving, fear of tunnels, and fear of bridges.
Blood-Injection-Injury
phobia. The fear
of blood, fear or injury, or a fear of needles or other medical procedures.
Common phobias and fears
|
|
Some phobias don’t fall into one of the four common categories.
Such phobias include fear of choking, fear of getting a disease such as cancer,
and fear of clowns.
Social phobia and fear of public speaking
Social phobia, also
called social anxiety disorder, is fear of social situations where you may be
embarrassed or judged. If you have social phobia you may be excessively
self-conscious and afraid of humiliating yourself in front of others. Your
anxiety over how you will look and what others will think may lead you to avoid
certain social situations you’d otherwise enjoy.
Fear of public speaking, an extremely common phobia, is a type of
social phobia. Other fears associated with social phobia include fear of eating
or drinking in public, talking to strangers, taking exams, mingling at a party,
and being called on in class.
Agoraphobia (fear of open spaces)
Agoraphobia is another phobia
that doesn’t fit neatly into any of the four categories. Traditionally thought
to involve a fear of public places and open spaces, it is now believed that
agoraphobia develops as a complication of panic attacks.
Afraid of having another panic attack, you become anxious about
being in situations where escape would be difficult or embarrassing, or where
help wouldn't be immediately available. For example, you are likely to avoid
crowded places such as shopping malls and movie theaters. You may also avoid
cars, airplanes, subways, and other forms of travel. In more severe cases, you
might only feel safe at home.
The symptoms of a phobia can range from mild feelings of
apprehension and anxiety to a full-blown panic attack. Typically, the closer
you are to the thing you’re afraid of, the greater your fear will be. Your fear
will also be higher if getting away is difficult.
Physical signs and symptoms of a phobia
Difficulty
breathing
Racing or pounding
heart
Chest pain or
tightness
Trembling or
shaking
|
Feeling dizzy or
lightheaded
A churning stomach
Hot or cold
flashes; tingling sensations
Sweating
|
Emotional signs and symptoms of a phobia
Feeling of
overwhelming anxiety or panic
Feeling an intense
need to escape
Feeling “unreal”
or detached from
yourself |
Fear of losing
control or going crazy
Feeling like
you’re going to die or passout
Knowing that
you’re overreacting, but
feeling powerless to control your fear |
Symptoms of
Blood-Injection-Injury Phobia
The
symptoms of blood-injection-injury phobia are slightly different from other
phobias. When confronted with the sight of blood or a needle, you experience
not only fear but disgust.
Like
other phobias, you initially feel anxious as your heart speeds up. However,
unlike other phobias, this acceleration is followed by a quick drop in blood
pressure, which leads to nausea, dizziness, and fainting. Although a fear of
fainting is common in all specific phobias, blood-injection-injury phobia is
the only phobia where fainting can actually occur.
Although phobias are common, they don’t always cause considerable
distress or significantly disrupt your life. For example, if you have a snake
phobia, it may cause no problems in your everyday activities if you live in a
city where you are not likely to run into one. On the other hand, if you have a
severe phobia of crowded spaces, living in a big city would pose a problem.
If your phobia doesn’t really impact your life that much, it’s
probably nothing to be concerned about. But if avoidance of the object,
activity, or situation that triggers your phobia interferes with your normal
functioning or keeps you from doing things you would otherwise enjoy, it’s time
to seek help.
Consider treatment for your phobia if:
It
causes intense and disabling fear, anxiety, and panic.
You
recognize that your fear is excessive and unreasonable.
You
avoid certain situations and places because of your phobia.
Your
avoidance interferes with your normal routine or causes significant distress.
You’ve
had the phobia for at least six months.
Self-help or therapy for phobias: which
treatment is best?
When it comes to treating phobias, self-help strategies and therapy can both be effective. What’s best for you depends on a number of factors, including the severity of your phobia, your insurance coverage, and the amount of support you need.
As a general rule, self-help is always worth a try. The more you can
do for yourself, the more in control you’ll feel—which goes a long way when it
comes to phobias and fears. However, if your phobia is so severe that it
triggers panic attacks or uncontrollable anxiety, you may want to get
additional support.
The good news is that therapy for phobias has a great track record. Not only
does it work extremely well, but you tend to see results very quickly—sometimes
in as a little as 1-4 sessions.
However, support doesn’t have to come in the guise of a professional therapist. Just having someone to hold your hand or stand by your side as you face your fears can be extraordinarily helpful.
However, support doesn’t have to come in the guise of a professional therapist. Just having someone to hold your hand or stand by your side as you face your fears can be extraordinarily helpful.
It’s only natural to want to avoid the thing or situation you
fear. But when it comes to conquering phobias, facing your fears is the key.
While avoidance may make you feel better in the short-term, it prevents you
from learning that your phobia may not be as frightening or overwhelming as you
think. You never get the chance to learn how to cope with your fears and
experience control over the situation. As a result, the phobia becomes
increasingly scarier and more daunting in your mind.
Exposure: Gradually and repeatedly facing
your fears
The most effective way to overcome a phobia is by gradually and
repeatedly exposing yourself to what you fear in a safe and controlled way.
During this exposure process, you’ll learn to ride out the anxiety and fear
until it inevitably passes.
Through repeated experiences facing your fear, you’ll begin to
realize that the worst isn’t going to happen; you’re not going to die or “lose
it”. With each exposure, you’ll feel more confident and in control. The phobia
begins to lose its power.
Successfully facing your fears takes planning, practice, and
patience. The following tips will help you get the most out of the exposure
process.
Climbing up the “fear ladder”
If you’ve tried exposure in the past and it didn’t work, you may
have started with something too scary or overwhelming. It’s important to begin
with a situation that you can handle, and work your way up from there, building
your confidence and coping skills as you move up the “fear ladder.”
Facing a fear of dogs: A sample
fear ladder
Step 1: Look at pictures of dogs.
Step 2: Watch a video with dogs in it.
Step 3: Look at a dog through a window.
Step 4: Stand across the street from a dog on a
leash.
Step 5: Stand 10 feet away from a dog on a leash.
Step 6: Stand 5 feet away from a dog on a leash.
Step 7: Stand beside a dog on a leash.
Step 8: Pet a small dog that someone is holding.
Step 9: Pet a larger dog on a leash.
Step 10: Pet a larger dog off leash.
Make a list. Make a list of the frightening situations related to your phobia. If you’re afraid of flying, your list (in addition to the obvious, such as taking a flight or getting through takeoff) might include booking your ticket, packing your suitcase, driving to the airport, watching planes take off and land, going through security, boarding the plane, and listening to the flight attendant present the safety instructions.
Build your fear ladder. Arrange the items on your list from the least scary to the most scary. The first step should make you slightly anxious, but not so frightened that you’re too intimidated to try it. When creating the ladder, it can be helpful to think about your end goal (for example, to be able to be near dogs without panicking) and then break down the steps needed to reach that goal.
Work your way up the ladder. Start with the first step (in this example, looking at pictures of dogs) and don’t move on until you start to feel more comfortable doing it. If at all possible, stay in the situation long enough for your anxiety to decrease. The longer you expose yourself to the thing you’re afraid of, the more you’ll get used to it and the less anxious you’ll feel when you face it the next time. If the situation itself is short (for example, crossing a bridge), do it over and over again until your anxiety starts to lessen. Once you’ve done a step on several separate occasions without feeling too much anxiety, you can move on to the next step. If a step is too hard, break it down into smaller steps or go slower.
Practice. It’s important to practice regularly. The more often you practice, the quicker your progress will be. However, don’t rush. Go at a pace that you can manage without feeling overwhelmed. And remember: you will feel uncomfortable and anxious as you face your fears, but the feelings are only temporary. If you stick with it, the anxiety will fade. Your fears won’t hurt you.
If you
start to feel overwhelmed…
While it’s natural to feel
scared or anxious as you face your phobia, you should never feel overwhelmed by
these feelings. If you start to feel overwhelmed, immediately back off. You may
need to spend more time learning to control feelings of anxiety (see the
relaxation techniques below), or you may feel more comfortable working with a
therapist.
As you’ll recall, when you’re afraid or anxious, you experience a
variety of uncomfortable physical symptoms, such as a racing heart and a
suffocating feeling. These physical sensations can be frightening themselves—and
a large part of what makes your phobia so distressing. However, by learning and practicing relaxation
techniques, you can become more confident in your ability to
tolerate these uncomfortable sensations and calm yourself down quickly.
Relaxation techniques such as deep breathing, meditation, and
muscle relaxation are powerful antidotes to anxiety, panic, and fear. With
regular practice, they can improve your ability to control the physical
symptoms of anxiety, which will make facing your phobia less intimidating.
Relaxation techniques will also help you cope more effectively with other
sources of stress and anxiety in your life.
A simple deep breathing relaxation
exercise
When you’re anxious, you tend to take quick, shallow breaths (also
known as hyperventilating), which actually adds to the physical feelings of anxiety.
By breathing deeply from the abdomen, you can reverse these physical
sensations. You can’t be upset when you’re breathing slowly, deeply, and
quietly. Within a few short minutes of deep breathing, you’ll feel less tense,
short of breath, and anxious.
Sit or
stand comfortably with your back straight. Put one hand on your chest and the
other on your stomach.
other on your stomach.
Take a
slow breath in through your nose, counting to four. The hand on your stomach
should rise. The hand on your chest should move very little.
should rise. The hand on your chest should move very little.
Hold
your breath for a count of seven.
Exhale
through your mouth to a count of eight, pushing out as much air
as you can
while contracting your abdominal muscles. The hand on your stomach should move in
as you exhale, but your other hand should move very little.
while contracting your abdominal muscles. The hand on your stomach should move in
as you exhale, but your other hand should move very little.
Inhale
again, repeating the cycle until you feel relaxed and centered.
Try practicing this deep breathing technique for five minutes
twice day. You don’t need to feel anxious to practice. In fact, it’s best to
practice when you’re feeling calm until you’re familiar and comfortable with
the exercise. Once you’re comfortable with this deep breathing technique, you
can start to use it when you’re facing your phobia or in other stressful
situations.
Learning to challenge unhelpful
thoughts is an
important step in overcoming your phobia. When you have a phobia, you tend to
overestimate how bad it will be if you’re exposed to the situation you fear. At
the same time, you underestimate your ability to cope.
The anxious thoughts that trigger and fuel phobias are usually
negative and unrealistic. It can help to put these thoughts to the test. Begin
by writing down any negative thoughts you have when confronted with your
phobia. Many times, these thoughts fall into the following categories:
Fortune telling. For example, “This bridge is going to collapse;” “I’ll make a fool of myself for sure;” “I will definitely lose it when the elevator doors close.”
Over generalization. “I fainted once while getting a shot. I’ll never be able to get shot again without passing out;” “That pit bull lunged at me. All dogs are dangerous.”
Catastrophizing. “The captain said we’re going through turbulence. The plane is going
to crash!” “The person next to me coughed. Maybe it’s the swine flu. I’m going to get very sick !”
Fortune telling. For example, “This bridge is going to collapse;” “I’ll make a fool of myself for sure;” “I will definitely lose it when the elevator doors close.”
Over generalization. “I fainted once while getting a shot. I’ll never be able to get shot again without passing out;” “That pit bull lunged at me. All dogs are dangerous.”
Catastrophizing. “The captain said we’re going through turbulence. The plane is going
to crash!” “The person next to me coughed. Maybe it’s the swine flu. I’m going to get very sick !”
Once you’ve identified your negative thoughts, evaluate them. Use
the following
example to get started.
example to get started.
Negative
thought: “The elevator will break down and I’ll get trapped and suffocate.”
Is there any evidence that contradicts this thought?
Is there any evidence that contradicts this thought?
“I see
many people using the elevator and it has never broken down.”
“I
cannot remember ever hearing of anyone dying from suffocation in an elevator.”
“I
have never actually been in an elevator that has broken down.”
“There
are air vents in an elevator which will stop the air running out.”
Could
you do anything to resolve this situation if it does occur?
“I
guess I could press the alarm button or use the telephone to call for
assistance.”
Are
you making a thinking error?
“Yes.
I’m fortune telling, as I have no evidence to suggest that the elevator will
break down.”
What
would you say to a friend who has this fear?
“I
would probably say that the chances of it happening are very slim as you don’t
see or
hear about it very often.”
hear about it very often.”
It’s also helpful to come up with some positive coping statements
that you can tell
yourself when facing your phobia. For example:
yourself when facing your phobia. For example:
“I’ve
felt this way before and nothing terrible happened. It may be unpleasant, but
it
won’t harm me.”
won’t harm me.”
“If the
worst happens and I have a panic attack while I’m driving, I’ll simply pull
over
and wait for it to pass.”
and wait for it to pass.”
“I’ve
flown many times and the plane has never crashed. In fact, I don’t know anyone
who’s ever been in a plane crash. Statistically, flying is very safe.”
who’s ever been in a plane crash. Statistically, flying is very safe.”
Comments
Post a Comment