30th April 2019

PHOBIAS

What are they?

A phobia is a persistent and unreasonable fear of a specific object, activity or situation that results in a compelling desire to avoid that dreaded object, activity or situation.  There are three aspects that are different from normal ordinary everyday fears.  Firstly you are persistently afraid of the object or situation over a long period of time.  Secondly you know that your reaction is exaggerated even though you cannot do anything to eliminate it. Thirdly you avoid the feared situation which serves to heighten the phobia.

If you have a social phobia you tend to avoid situations where you fear you might humiliate or embarrass yourself in front of others, for example public speaking, going to parties,  using public changing rooms and going for job interviews.  If you are claustrophobic you tend to avoid situations where you fear you can’t easily escape if you have a panic attack, such as confined spaces, lifts, aircraft, trains, or public places where there are few exits.

People may be able to trace the onset of their phobia about certain animals to a time when they were bitten or trace a fear of heights to a time when they fell down stairs or a fear of injections to a severe drug reaction.  Other typical fears in childhood are fears of water, thunderstorms and spiders.  If a child becomes fixated in his fears and does not outgrow them in adult life they can become phobias.  For example I had a phobia of rats because as a child my brother used to pick up dead rats and terrorise me with them.  My parents told me that if a rat bites you then you will die so not to touch them.  In typical childhood logic I did not equate that dead rats could not bite but rather that touching them would cause death.

The symptoms

When people are forced to face the situation or object to which they are phobic they may experience a pounding heartbeat, a racing pulse, dizziness, nausea and faintness. They may sweat profusely and their mouths may become dry.  Wanting to escape or avoid contact with the object or situation is normal.  Even though the phobic sufferer knows that their fears are exaggerated they have an inability to eliminate the fears or reduce the avoidance of the situation.  Some people are phobic about more than one object or situation.

How do these phobias develop?

The two processes most commonly responsible for developing phobias are conditioning and trauma. Trauma isn’t always involved in a phobia but conditioning is always present.  For example if you nearly have an accident on the motorway you may become fearful of driving on the motorway in the future and so avoid doing so.  This is called conditioning by avoidance.  Each time we avoid the situation we reduce the anxiety.  However, continual avoidance strengthens the fear until this fear becomes a phobia.  The other type of conditioning is association.  In other words you link your anxiety of the near accident on the motorway to “motorways are dangerous”.  Your mind forms such a strong association between motorways and fears that even the thought of motorways can elicit anxiety and panic.

The phobic sufferer needs to see how their avoidance and protective behaviour strengthens their unrealistic fearful thoughts.  This is the reasoning behind the expression “when you have fallen off your bike, you must get back on immediately or you may have trouble riding a bike in the future".  Although most people generally understand the principle of facing one’s fears to overcome them, it still needs to be repeatedly stressed.

Ways forward

Overcoming a phobia means unlearning certain responses while re-learning others.  You have to “unlearn” the negative self-talk and the anticipatory fear in advance.  Learning to confront the phobic situation and  remain calm in any phobic situation is possible if you approach it in small steps.

The most effective way to overcome a phobia is to face it and to learn to do this in small steps.  Learning how to desensitize is the process of unlearning the connection between anxiety and a particular situation.

  • Learn how to breathe well and relax your body
  • Imagine seeing the situation or object that you have a phobia about and using your breathing to keep you calm
  • Find and read information that you are phobic about and look at photographs and videos
  • Create a hierarchy of exposures to your phobic situation.  For example if you are afraid of an elevator then simply seeing an elevator but without getting on it and then progressing by going up one floor until you can feel calm about using an elevator without anxiety.  The secret is to manage your phobic situation and using your breathing to stay calm
  • You can vary the intensity of your exposure by having a person with you to provide support
  • Varying the distance from the feared situation and duration of the exposure

It is important to go at your own pace and not place yourself under pressure.  It is better to progress slowly than to take big steps and then feel discouraged by setbacks.

However, don’t give up if you should experience setbacks.  Keep doing your desensitization programme and practice these exercises regularly and systematically.

phoneenvelope