Some Basics on Phobias

Specific phobias may develop rapidly, such as after a traumatic event, or gradually over the years, as in childhood learning and the examples set by parents and others. Some phobiacs have not gained enough knowledge and experience during their childhood to successfully face new, frightening life experiences -- whether real or imaginary -- as adults. Instead of gaining some perspective during fearful times, the phobic becomes a passive victim to his fear. The only action he takes is to back away.

Diagnosing the true fear is an essential part of the cure. For instance, the person with a flying phobia may be afraid of heights or, instead, might actually be afraid of being contained, being far away from home, having a panic attack or a combination of these. (If you are troubled by the fear of flying, our information will help you in sorting through your fears and guide you in how to respond to them.)

Phobias are in the category of ailments known as anxiety disorders which are themselves the most common mental health problem. It is estimated that up to 12% of adult Americans, perhaps twenty million people, will suffer from a phobia during their lifetime. The good news is that researchers and therapists have developed treatment programs that bring about significant improvement and enable the vast majority of individuals to regain control of their lives.

Treating Phobias

There are a number of standard approaches used by therapists to modify the actions and thought patterns of people suffering from phobias. Unfortunately, about three quarters of people with phobias never get help. Many people with phobias are reluctant to seek assistance because of embarrassment. Others don't understand what they have or where to find help. And some fear the treatment itself.

A key component of most treatments is behavior therapy, designed to alter the way a person acts. Behavior therapy typically involves gradual exposure of the patient to the feared situation.

Behavior techniques are often combined with cognitive therapy that aims to change the way that people view themselves and their fears. Rather than thinking, "I am frightened and might have a panic attack," the individual is encouraged to assess the situation in a more positive way, perhaps thinking, "I am frightened, but I am not in danger." The patient is trained to analyze his feelings and separate realistic from unrealistic situations.

Exposure therapy, which is part of behavior therapy, works by gradually exposing the individual to the feared object or situation. Facing the feared situation helps the patient see that he can cope successfully, and that escape is unnecessary. Over time, the individual gains greater control over the anxiety so that ultimately he can face the threatening situation or object with little or no fear.

There are a number of variations to exposure therapy. The degree of exposure will vary depending on the therapist's assessment of the patient. The feared situation, such as giving a speech, may be simulated, or the person with the disorder may be placed in a real situation that he fears, such as driving over a bridge. Treatment of a phobia can be conducted individually or in a group.

If you want to find out way to help yourself overcome your phobia, start here:
The Panic Attack Self-Help Program

Complex Cases

When a person has several specific phobias, the relationship between them may not seem evident at first. One agoraphobia client also developed an intense fear of knives and of children. While discussing the problem during a treatment session, she reported that one day several months earlier she had found her seven-year-old son threatening his sister with a kitchen knife. After admonishing her son, she found herself dwelling on the many dangers of knives. Within a day, she began to question her own ability to control a knife. She then developed a spontaneous mental image of herself hurting a child with a knife. In a brief few days she began avoiding knives as well as becoming anxious whenever she looked at young children. The internal belief that has driving her fear was: "I don't have enough self-control [to handle knives, to be with children]."

This case illustrates another pattern present in some phobias. The phobia can develop from a current internal conflict and/or a real life fear. With this client, the real life fear was of her young son hurting someone by poor self-control with a knife. This legitimate fear was coupled with her own internal conflict. She was considering having a third child. At the same time, her marriage was unstable. Her husband was consumed with his business, and she felt unsupported and unloved. As we talked I realized that she was not consciously aware of the degree of her conflict. Notice, though, how her phobia was, in a sense, helping her solve a problem while at the same time causing her distress. By unconsciously developing these fearful thoughts about her personal inability to control her aggression, she could now say, "Obviously I'm not capable enough to have another child." This irrational fear resolves her internal conflict. It also prevents her from confronting the pain in her marriage.

For instance, if she maintained her desire to have a third child, she would want her husband to offer her more emotional support. What if he refused? What if he decided their marriage was no longer "workable" for him and suggested that they get divorced? Her fear of abandonment probably played a major role in the development of her new phobia. By increasing her self-doubt, she no longer had the ego strength to risk making demands on her husband. Instead, she became more dependent and less likely to speak up for her needs.

Phobias, therefore, are often more complex than they at first seem. And their "irrational" nature may relate to their attempt to solve a real life problem. After a time the irrational fear takes on a life of its own, just like a habit, regardless of its initial unconscious purpose.

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