Phobias: Symptoms & Treatments

In today’s world, treatments of phobias are often based on behavioral, educational, or medicinal approaches. A phobia is an irrational fear of a specific object or situation that interferes with a person’s ability to function normally in life. There are numerous types of phobias, including simple, animal, natural environment, blood-injection, situational, and social. Phobias usually begin as a fear of a situation or object caused by the occurrence of a traumatic experience and can escalate into a panic attack every time the person is confronted with that situation or object. Certain people are biologically predisposed to feelings of anxiety, and they may be more likely to develop a phobia. Also, women are more likely to experience a phobia, but this may be due partly to certain social factors that force men to endure their anxieties and not seek treatment (Curtis et al., 1998). There are various types of treatments for phobias. These include breathing and muscle relaxation techniques, systematic desensitization, exposure therapy, cognitive-behavioral therapy, and medication (Lindemann, 1989). Which type of treatment is used typically depends on the phobia itself.

Phobias are often divided into three categories: agoraphobia, simple, and social. Simple phobias include a fear of things such as heights, flying, closed spaces, being alone, animals, water, blood, or weather. Research has shown that agoraphobia, the fear of open spaces, is considered the most common type of phobia, with social phobia the second most common. The fear of animals and the fear of heights are also fairly common. The mean age of onset of simple and social phobias is fifteen to twenty-one years old (Lipsitz et al., 2002). These phobias are usually co-morbid with other anxiety disorders, meaning that an individual often experiences two or more disorders at the same time. With phobias that are situational, the fear of driving tends to be the most common, followed by the fear of elevators and the fear of enclosed spaces. There is a positive correlation between being female, African-American, or Hispanic and the number of fears experienced (Curtis et al., 2002).

The different techniques used to treat people suffering from phobias can be traced back to Freudian psychology. Freud described how people repressed traumatic memories during childhood, and this created symptoms like hysterical paralysis and phobias later in life. Initially, Freud focused on how to relieve the symptoms, but he later focused on understanding how the symptoms formed. Often, he found that resolutions to unconscious conflicts led to the disappearance of the symptoms. At this point in history, the development of phobias was often seen as a result of Oedipal conflicts. Freud opposed completely removing symptoms because he felt that unless the unconscious conflict itself was eliminated, one symptom would simply be replaced by a second symptom. In fact, symptoms were often used to indicate the presence of certain conflicts of the mind (Lindemann, 1989).

Behaviorists had an entirely different perspective of phobias and their symptoms from Freud’s view. The behavioral approach is based on Pavlov’s theory of classical conditioning. When a neutral object or situation becomes associated with feelings of anxiety or fear, every time the person experiences that object or situation, they become conditioned to feel anxious. Systematic desensitization is one type of treatment based on classical conditioning first developed by Joseph Wolpe. It is used for simple and social phobias. Here, a patient gradually learns how to associate a conditioned stimulus with positive images and feelings, instead of negative feelings. The patient must believe he or she is capable of overcoming their fears, and the therapist must try to reduce the patient’s anticipatory anxiety (Lipsitz et al., 2002). Exposure through brief hypnosis or visualizations is needed in successive, but gradual steps.

Aversion therapy is related to systematic desensitization. This kind of therapy uses an extremely unpleasant response in order to prevent inappropriate behaviors associated with the phobia. It is mostly used to treat simple phobias. If the unpleasant response becomes connected to the behaviors, the patient may discontinue those inappropriate behaviors. For example, say a person is very afraid of rats and screams every time she sees one in order to frighten it away. If she gets pinched hard every time she screams, she will soon learn to avoid the physical pain of the pinches by not screaming (Lindemann, 1989).

Breathing and muscle relaxation therapy is often used in conjunction with systematic desensitization. A sense of relaxation and controlled breathing is supposed to reduce a patient’s anxiety and prevent hyperventilation by slowing down the heartbeat and lowering blood pressure. By preventing panic attacks, a patient can slowly associate positive feelings with the conditioned stimulus (Federoff and Taylor, 2001). However, sometimes relaxation methods do not work because they can actually make the patient feel like they are losing control if they are not ready for the next step. A therapist and patient need a good relationship built on trust for this procedure to work (DuPont, 1982).

Another behavioral treatment is exposure therapy, which is a more recent type of treatment. This therapy involves continued exposure to a stimulus that will evoke anxiety until the discomfort gradually goes away. It has become a very effective therapy for three reasons. First, there was a realization that exposure therapy was a reliable method of reducing fear. Second, exposure therapy initially involved fantasy exposure before it made the transition to real-life exposure. Third, therapists began to see that what patients did outside of the therapy sessions was just as or even more important than sessions at clinics (Marks, 1987). Today, the treatments of desensitization and relaxation have been replaced somewhat by exposure therapy, which is used to treat people suffering from agoraphobia, simple phobias, and social phobia (DuPont, 1982).

Cognitive-behavioral therapy, based on Bandura’s social-cognitive theory, uses many of the behavioral therapies already described in combination with cognitive treatments. Patients using cognitive-behavioral therapy become educated about their disorder and symptoms and learn skills to control the anxiety. Relaxation, cognitive therapy, and exposure are often used together to help the patient. Cognitive therapy includes presentation of educational material, self-monitoring of automatic thoughts and statements in a daily diary, hypothesis testing, and homework assignments (DeRubeis and Crits-Christoph, 1998). This type of therapy can be used to treat agoraphobia, simple phobias, and social phobia. Education and family support are two important parts of this treatment, as well as all phobia treatments. Panic attacks often cause an overwhelming sense of loss of control, so people feel that they are “losing their mind.” Information about panic attacks can greatly alleviate people’s fears. It can communicate valuable ideas to people in an organized and supportive manner. Family and friends can also help people suffering from phobias by learning about the phobia, offering support, and
improving the overall effects of treatment (DuPont, 1982).

Medicine has been an effective treatment for phobias, especially in more recent years. New drugs have been very successful in treating the symptoms of phobias. Medicine can reduce the effects of panic attacks without taking away a person’s sense of control. However, medicines can be highly effective for one type of phobia and not be useful for another type (Lindemann, 1989). Agoraphobia seems to respond best to medicine followed by an educational treatment. Exposure and behavioral therapy can then be used. Social phobia responds to medicine some of the time. Beta-adrenergic blocking drugs and MAOIs are effective, but behavioral treatments seem to work best. However, some research has shown that medicine is more successful than psychological therapies at treating social phobia in the short-term. Simple phobias tend not to respond well to medicines. Exposure therapy appears to be the most effective treatment (Fedoroff and Taylor, 2001).

Freud had believed that treatment of the unconscious conflicts of the mind was needed before any of the symptoms could be cured. Today’s view of therapy shows that relief from symptoms is the most important aspect because it allows people to live more normal lives. Phobias respond to treatments in various ways. Exposure therapy seems to be effective for most types of phobias. According to research, exposure plus cognitive-behavioral therapy is very useful for social phobia. Medicine and behavior therapy works best for agoraphobia. However, more research is needed to further test which treatments are the most effective.

References

Curtis, G. C., Magee, W. J., Eaton, W. W., Wittchen, H.-U., & Kessler, R. C.
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DeRubeis, R. J. & Crits-Christoph, P. (1998). Empirically supported individual
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DuPont, R. L. (1982). Phobia: A comprehensive summary of modern treatments. New
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Fedoroff, I. C. & Taylor, S. (2001). Psychological and pharmacological treatments
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Lindemann, C. (1989). Handbook of phobia therapy: Rapid symptom relief in anxiety
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Lipsitz, J. D., Barlow, D. H., Mannuzza, S., Hofmann, S.G., & Fyer, A.J. (2002).
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Marks, I. M. (1987). Fears, phobias, and rituals: Panic, anxiety, and their
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