Understanding Phobias

A person suffering from a phobia is persistently afraid of a particular object or situation.

A Phobia is a persistent, irrational fearOpens in new window attached to an object or situation that objectively does not pose a significant danger.

The person with a phobiaOpens in new window experiences a compelling desire to avoid dreaded object or situation, even though he or she usually recognizes that fear is unreasonable or excessive in proportion to the actual threat.

The individual can remain calm as long as he can avoid the feared object, but if not, the phobia can be quite disrupting. For instance, if any individual develops a car phobia, many aspects of his life can become more difficult.

Categories of Phobia

The Diagnostic and Statistical Manual of Mental DisordersOpens in new window (DSM-IV-TR; American Psychiatric Association 2000) describe three categories of phobias: specific phobiaOpens in new window, social phobiaOpens in new window, and agoraphobiaOpens in new window.

1.   Specific Phobia

The most common is a specific phobia, a persistent and unreasonable fear of a specific object, activity, or situation. Examples of common specific phobias include fears of particular animals, blood, heights, enclosed spaces, and flying in an airplane.

Up to 9 percent of the population experiences a specific phobia in any given year. When exposed to the dreaded object or situation, the individual immediately exhibits intense fear. Many people with a specific phobia experience more than one phobia simultaneously.

The most common effective treatments for specific phobias are behavioral treatments called exposure treatments. These involve being exposed to the feared object or situation. For instance, in systematic desensitization, the individual is taught a relaxation technique and, while relaxed, is exposed to a mild stimulus of the fear (e.g., if the person fears spiders, she may be placed in a room with an aquarium in which a spider is present).

The idea is to associate the feared object with relaxation. When success is achieved with the mild stimulus, the person will be taught to relax while experiencing a more intense version of the feared object, and so on. Other exposure treatments are modeling, flooding, and implosive therapy. Exposure treatments are very effective for simple phobias (Wolfe, 2005).

2.   Social Phobia

A social phobia is a persistent, irrational fear linked to the presence of other people, which includes public speaking, meeting people, or speaking in groups. Some social phobias are quite specific, such as a fear of eating in public.

Up to 7 percent of the U.S. population experiences a social phobia each year (Kessler et al., 2005). People with social phobias are tremendously anxious about embarrassing themselves in social situations. Some sufferers become reclusive, and this avoidance may lead them to seek treatment.

Social phobias are commonly accompanied by such physical symptoms as blushing, trembling, and nausea. The individual’s fears persist for days and weeks before the feared situation.

Effective treatment for social phobias is more complex than treatment for simple phobias. First, a psychological approach is recommended. This could be an exposure therapy of the sort used for simple phobias or cognitive therapy such as rational emotive therapy, in which a clinician or counselor encourages the individual with the phobia to question her irrational and self-defeating beliefs.

As an adjunct to the psychological approach, social skills training is utilized. Techniques include the therapist modeling appropriate behavior, role-playing between phobic person and therapist, and honest feedback from the therapist.

A final treatment is antidepressantOpens in new window or anxiolytic medications, which function to reduce social anxiety in some individuals. Each of these treatment is at least somewhat helpful, and combinations of treatments may be more effective than utilizing a single approach (Heimberg, 2002).

3.   Agoraphobia

Agoraphobia refers to fear of leaving one’s house or an environment that is considered safe. Sufferers have sometimes experienced panic attacks and begun to worry that an attack could occur in a public place. Overall, it is the most debilitating phobia; individuals may lose their jobsor friendships or be unable to properly care for their children.

Around 2.7 percent of the population suffers from agoraphobia per year (Kessler et al., 2005). Exposure therapy, in which the individual is instructed to go outside the house and remain for a certain period of time, even if fear occurs, is a common treatment for agoraphobia (e.g., Emmelkamp, 1982). This treatment is used over a number of sessions with moderate success.

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Theories That Explain the Causes of Phobias

Although the cause of phobias is unknown, the behavioral theories—classical conditioning and modeling—receive the most support.

Classical conditioning occurs when an individual associates two events that occur close together in time and reacts similarlry to these events. For instance, if a person falls down the stairs and break her legs, the fear that she naturally experiences with the broken legs might lead to a fear of stairs.

Another way of developing a phobia is through modeling. By observing other people who are afraid of a certain object, people may develop fear of the same object. Although research has clearly shown that phobias can be caused through classical conditioning or modeling, phobias do not always develop under these circumstances. Thus a more complex causal model for phobias is suggested.

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