Phobias and how best to treat them

There is a big difference between a fear and a phobia. If something scares you but doesn’t interfere in your life then it is just a fear. A phobia causes an anxiety or panic response which interferes with your ability to do it and therefore impacts on your life. So if the anxiety is bad enough to stop you facing it or tackling it then it’s probably a phobia. People with fears might well benefit from the same treatment as people with phobias.

If, for example, someone was squeamish about the idea of a house spider crawling over their hand but spent a few moments in the presence of zoologist who explained to them how harmless a spider is and why it moves so fast, they could probably start to let go of their fears.

If they have a panic response to seeing a spider (arachnophobia) then the same information would probably be of some use to them in tackling the phobia but wouldn’t constitute a cure in itself. If the panic or anxiety they feel is enough to make them avoid places where they might encounter spiders then they have a phobia, and often are as adverse to the feelings of panic as they are to the spider itself.

“Are you scared of fear itself?”

That question is worth stressing. Phobic people are often phobic or petrified of the bodily physical symptoms of anxiety and panic themselves, i.e. they are scared that if they go into a lift they will panic. Obviously this thought is normally accompanied by other catastrophic thinking. What if the lift gets stuck? What if the lift plummets? What if there is a fire? What if we are stuck and no one knows we are here?

The person with a fear of spiders may think it will bite them or attack them. A person with a phobia may feel that they will lose control, go mad, pass-out, or even die if the spider comes near them.
In these cases it can be more important to deal with these feelings of anxiety and panic than anything to do with the object itself per se. When there has been a certain inoculation against the symptoms (ie the sufferer has learnt to control their flight or fight response and recognizes scary symptoms for the temporary, harmless and natural feelings that they are, and seeing that they lead neither to death nor passing out nor going mad) exposure to the feared object or situation can be much quicker and easier. For more information on this see the section on Clare Weekes.

Getting over phobias involves exposure! But before you do exposure you should consider ways of changing your faulty thinking, and modifying your behaviour by controlling your breathing and muscle tension.

What Medication is best for Phobias?

There are no medications that will simply make your phobia disappear overnight. That said, the use of the medications described above for anxiety and panic attacks can make challenging your phobia much easier, possibly to the extent where it just melts away. Certainly if a going in an elevator causes you to have panic attacks, using a benzodiazepine tranquiliser will quite possibly significantly help.

You should remember though that it might well not always be practical to take a tranquiliser each time you go in a lift. Therefore, medication should only be one aspect of your phobia treatment, it should be combined with a phobia therapy or treatment programme.

Likewise if you are on a SSRI which is helping with anxiety and/or panic attacks challenging phobias may well also be easier, as your overall anxiety levels will be lower.

Unless you have agoraphopbia I would suggest you try to tackle your phobia without SSRIs and use tranquilisers such as benzodiazepines (valium, xanax etc) sparingly. The ultimate aim is of course to respond to the stimulus in a normal healthy manner, without outside help. Using valium short term though can be helpful on your pathway to recovery.

The best therapy for Phobias

The best therapy for overcoming phobias seems to be CBT. Again and again it is shown by peer reviewed research to help phobics face their problem, control their symptoms, and eventually move on with complete normality. There are some good books that you can buy to teach yourself CBT, and depending on severity it may also be advisable to seek the help of an expert. Your doctor should be able to refer you to a well-qualified Cognitive Behavioural Therapist.

CBT helps to modify your morbid or catastrophic thinking. Then, bit by bit, you gradually expose yourself to the object of your phobia. As this exposure unfolds you start to see that your old beliefs were misguided and very soon your phobia can be made to pass. CBT is not a magic and cure and does demand commitment from the sufferer. That said, the techniques which demand no commitment from the sufferer seldom work!

People can often be put off by the notion of exposure. They shouldn’t be. Gradual exposure to a situation after your faulty cognition has been challenged does not have to be nasty, and at the end of it there is a real sense that you have achieved something for yourself. Challenging a phobia through CBT in this way leads to increased self-esteem and confidence.

Here are some other phobia related pages.

What’s the difference between a fear and a phobia?

Do I have social Phobia?

What’s the best treatment for agoraphobia?

What medication is best for phobias?

What therapies are best for phobias?

What about my fear of flying?

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