FEAR OR PHOBIA?

Fear. It’s something that’s designed to keep us safe from a range of situations such as a lion baring its teeth, a rickety bridge suspended from a great height, or when we’re in deep water where waves are pounding. Fear in these situations is ingrained and essential for us to survive, alerting us to situations that might be potentially dangerous and prompting us to fight or escape to safety (see our related article on panic).

However, sometimes we can be intensely fearful of situations or objects that aren’t directly threatening our safety or health. It may be that your fear of a certain situation or object is impacting your behaviour in that you actively try to avoid it. If this is occurring on a regular basis, this can become cause for concern. These type of feelings and behaviour can indicate a specific phobia. Common specific phobias include: animals, insects, heights, water, needles, blood transfusion, airplanes, or enclosed spaces.   

Features of SPECIFIC PHOBIA (DSM-5) [1]:

• An intense fear or anxiety about a specific object or situation e.g. spiders, thunder storms, elevators etc, that lasts at least 6months

• The phobic object/situation always provokes immediate fear or anxiety

• The phobic object/situation is actively avoided or endured with intense fear or anxiety

• The fear or anxiety is disproportionate to the actual threat posed by the phobic object or anxiety

• The fear, anxiety or avoidance is causing significant impairment to your functioning e.g. not seeing friends and family, not going to work etc.

• The fear, anxiety or avoidance isn’t better explained by another medical disorder e.g. avoiding reminders of traumatic events as in Posttraumatic Stress Disorder, feeling panic like symptoms in social situations (social anxiety) or enclosed spaces (agoraphobia).

phobia SYMPTOMS

As with any type of anxiety, there are a typical categories of symptoms to look out for - cognitive, behavioural, and physical. Here’s how they may look in specific phobias:

COGNITIVE SYMPTOMS OF PHOBIAS

Overwhelming fear or anxiety is a key feature of phobias, and these worries are targeted towards a specific object or situation (animal, natural environment, blood-injection-injury, situational or other). Even if you know the fear is irrational, or that the degree of your fear or anxiety is in excess of the actual threat, the fear or anxiety can still feel uncontrollable. It’s no wonder that even the thought of, or having conversations about, the phobia can induce anxiety.

PHYSICAL SYMPTOMS OF PHOBIAS

As with any anxiety or fear, having a phobia can be physically draining. Just the thought of the phobia, as well as experiencing the phobic object/situation can induce a racing heart, difficulty breathing, trembling, sweating, nausea, dry mouth or chest pain/tightness. Sometimes, you can experience panic attacks in the presence of these objects or situations.

BEHAVIOURAL SYMPTOMS OF PHOBIAS

The most common behavioural symptom of specific phobias is avoidance. Although this seems like  a practical solution at first, often these avoidance behaviours can impact our everyday functioning and enjoyment of life. Avoidance can take over to the point where you might find yourself:

• Take a much longer commute in to work to avoid driving over bridges or on the freeway.

• Due to a fear of flying you won’t get on a plan, not even if you desperately want to see a loved one who lives overseas.

• Walk, at a significant time cost to your day, because you would feel trapped taking public transport.

• Avoiding meetings in high rise buildings because of a fear of heights.

• Avoiding taking blood tests even if they’re much needed for your health due to your fear of needles.

TREATMENT FOR PHOBIAS

When it comes to treatment options for phobias, consider the following:

• COGNITIVE BEHAVIOUR THERAPY (CBT). Cognitive Behaviour Therapy is an effective treatment for phobias. It teaches you how to re-appraise self-talk that heightens your anxiety, and teaches you how to manage your anxiety with time and practice. Exposure therapy (see below) is used as part of CBT to increase distress tolerance.

• EXPOSURE THERAPY. Exposure therapy is a highly effective treatment for phobias. It works by gradually exposing you to the feared object/situation, in order to increase your ability to tolerate distress and change the anxiety reaction that you experience in response to the feared object/situation. This is often used as part of CBT.

• MINDFULNESS-BASED COGNITIVE THERAPY and ACCEPTANCE AND COMMITMENT THERAPY (ACT). Part of the ‘new wave’ of CBT treatments, Mindfulness-based Cognitive Therapy and Acceptance and Commitment Therapy teach individuals to have a different relationship with their thoughts (detaching). ACT also encourages individuals to live alongside their worries, and move towards living a values-based life.

• PSYCHOPHARMACOLOGY. At times performance anxiety may be so significant that medication may be indicated so that individuals are better able to engage in the ‘talking therapy’ and undertake exposure exercises. If this is the case, speak to your GP about medication options.

If you’re ready to work on a phobia that’s affecting your life, why not Contact Us for a tailored approach?

REFERENCES

[1] American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington: American Psychiatric Publishing.

[2] Evans, S. (2016). Mindfulness-based cognitive therapy for generalized anxiety disorder. In S.J. Eisendrath (ed.). Mindfulness-based Cognitive Therapy: Innovative Applications. (pp. 145-154). Switzerland: Springer International Publishing.