Phobias, Fear and Exposure Therapy

An irrational fear of a situation, person, place, or thing that becomes so severe that it can cause an intense physical reaction is a phobia. Typically, phobias develop when someone overestimates the risk or danger in an identified situation and underestimates their ability to handle it appropriately.  If you quiver at the thought of a dog licking you, or your heart pounds at the idea of getting onto an elevator, this may be the blog for you. According to the American Psychiatric Association, phobias are classified under anxiety disorders because symptoms resemble those of a panic attack or anxiety attack when exposed. Symptoms may include:

  • Crying
  • Dizziness
  • Shaking
  • Twitching
  • Excessive sweating
  • Rapid heart rate
  • Nausea
  • Breathlessness or hyperventilation
  • Fear of death

There are different types of phobias, such as Social Phobias and Agoraphobia. 

Agoraphobia -The irrational fear of public crowded spaces where escape seems challenging. They are usually territorial and can include driving over bridges, entering shopping malls, stores, or being on trains or buses. 

Social Phobias-  The fear of social situations such as stage fright before a performance, public speaking, presentations, being a member of a group, dating, test-taking, or attending social functions.

A Specific phobia is a fear of one particular object or situation. Examples of this include flying, being in an elevator, specific animals such as snakes or dogs, fear of needles, heights, or going to the dentist. 

Where do Phobias originate?

Recent studies suggest that past experiences heavily influence phobias. According to Psychology Today, genetic factors can also affect response to a stressful experience, such as a person’s ability to move on from an incident or hold onto it. When a person has a phobia or fear, a typical response is avoidance of situations that cause exposure to this unpleasant situation. While this might be effective in reducing fear at the moment, it is ultimately counterproductive. The longer one engages in avoidance of the stimuli, the more reinforcement is provided to negative thoughts and anxiety around the phobia and intensified. When a person does this, they condition themselves to be afraid at the mere thought of the phobia. For more information on fear and some of the psychological, biological, neurological, and behavioral ways we cope with anxiety and fear, check out our Associate Therapist Caroline Brown’s Blog on Fear here. 

What is Exposure Therapy? 

One of the most effective phobia treatments is Exposure Therapy.  It utilizes cognitive behavior therapy in a series of steps to help you unlearn the connection between the phobia and your feelings, find comfortability, and build confidence in your ability to handle the situation.

Exposure therapy is the process of facing your fears in a controlled setting to overcome them; this takes a solid and unwavering commitment to the cause and an understanding that you are willing to:

Accept the risk; this means diving into experiences you might have avoided for years.

Get comfortable being uncomfortable: learning to tolerate the discomfort as we change the thoughts behind a phobia.

Persistence: Progress is not always a straight line, and that there can be setbacks. Setbacks are okay, and they help us grow. Lean into them and keep going with the knowledge that you have support behind you. 

Types of Exposure

Coping Exposure- In this stage, The use of Anxiety management strategies helps negotiate the lines of where the exposure can begin. Significant time is spent in sessions understanding the history behind the fear, including self-report of upbringing and developing trust and rapport between the client and clinician. The clinician helps the person to label their worries about their phobia using a fear hierarchy. The hierarchy is used to understand the ranking of fear and some of the thought processes behind them. It also allows for discussion about what a person’s reactions and warning signs of panic are. Clinicians then place a heavy focus on coping techniques during stressful situations such as deep breathing, mindfulness, and meditation. During this time, to diffuse and replace the unhelpful thoughts behind a phobia, implementing coping statements is essential. The introduction to psychoeducation Is helpful to the person to recognize the reality and facts surrounding their fears. For example, if a person experiences dog phobia, treatment might begin with looking at standard dog behavior videos to learn to recognize real threat vs. Perceived threat. During this phase, it is also common for medications such as a low-dose tranquilizer to facilitate exposure or other person’s support to accompany them during manifestation. 

Full Exposure– During this stage, you enter a situation including your phobia without support or coping skills. This stage is imperative because it teaches a person to handle a situation they previously avoided without any crutch. This step allows the person to understand that they don’t need to place limitations on themselves, such as “I can only be around a cat if I take medication.” Instead, they begin to understand, “I can be around a cat regardless of what my anxiety tells me.” Full exposure is the quickest way to overcome a phobia, but it can be intense. For this reason, some people prefer a more gentle and gradual approach in the beginning. 

How to Get started

Are you ready to control your phobia? Let our team at Gateway to Solutions help you build your confidence to manage your fears! Maybe this will even include our emotional support Animal, Jaxxi too!

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