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Phobias & Fears

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.

“Normal” fear vs. phobias

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.

Common types of phobias and fears

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

  •    Fear of spiders
  •    Fear of snakes
  •    Fear of heights
  •    Fear or closed spaces
  •    Fear of storms

  •    Fear of needles and injections
  •    Fear of public speaking
  •    Fear of flying
  •    Fear of germs
  •    Fear of illness or death

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.

Signs and symptoms of phobias

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.

When to seek help for phobias and fears

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.

Phobia treatment tip 1: Face your fears, one step at a time

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.

Phobia treatment tip 2: Learn relaxation techniques

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.
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.
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.
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.

Phobia treatment tip 3: Challenge negative thoughts

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 !”
Once you’ve identified your negative thoughts, evaluate them. Use the following 
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?


  “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.”

  It’s also helpful to come up with some positive coping statements that you can tell      
  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.”
 “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.”
 “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.”

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