What are you afraid of? Flying? Public speaking? Heights? These are among the more common fears or phobias. Less common fears can cover a wide range of objects, animals and social situations such as fear of driving or fear of death. The National Institute of Mental Health estimates that about 9% of adults are affected by a specific phobia – an intense, irrational fear of something that poses little or no real danger – and of those, 22% are classified as severe. Specific phobias are twice as common in women as in men. A social phobia (also known as social anxiety disorder) is an intense, persistent fear of being watched, judged and embarrassed in the presence of others, making it difficult to do ordinary things – eat or sign one’s name, for example – in public. Social phobias affect about 7% of American adults, of which 30% of cases are considered severe.
“Some people are able to manage their lives in order to avoid the feared object or situation and they never seek treatment,” says clinical psychologist Dr. Francine Rosenberg of Morris Psychological Group. “Those who fear snakes, for example, don’t walk in the woods. For others, however, elaborate avoidance routines can disrupt their personal or professional lives – think of the suburban mom who can’t drive her children to activities and play dates or the business executive who doesn’t fly to meetings or conferences.” Those with social phobias avoid places or situations where they may have to do something that will embarrass them, often putting severe constraints on their lives. Complex phobias such as agoraphobia – fear of open spaces or crowds or places where escape might be difficult – may confine people to their homes.
Phobias typically emerge in childhood or adolescence and persist into adulthood. It is unusual for a phobia to develop after the age of 30 unless it is the result of a traumatic event. The causes aren’t well understood but are generally thought to involve a combination of factors – genetics, brain chemistry, situational triggers and learned behaviors. Phobias sometimes appear to run in families but it isn’t always clear if heredity or learned behavior is more responsible. Some specific phobias are caused by frightening or traumatic events that occur in childhood, such as being bitten by a dog, being trapped in a confined space or even witnessing or experiencing nausea and vomiting for the first time. Some phobias may have an evolutionary basis when, for example, a child’s survival may have depended on avoiding dangers such as poisonous spiders and snakes.
“People with phobias almost always know they have them,” says Dr. Rosenberg. “They know that the intensity of their fear is irrational and out of proportion to any actual danger but they find that facing – or even anticipating facing – the object of their fear causes severe anxiety, often in the form of symptoms of a panic attack, such as
sweating, rapid heart rate, difficulty breathing, dizziness or faintness, and an overwhelming feeling of dread. They feel they must do everything possible to avoid the feared object or situation. In fact, it is the intensity of the avoidance effort and its impact on one’s life that often leads to seeking treatment and sometimes distinguishes a true phobia from an intense fear. Fortunately, phobias are readily treatable with psychotherapy or medication or a combination of the two.”
Treating Phobias: Tips on What to Expect
Psychotherapy for phobias may involve one or more therapeutic approaches designed to reduce anxiety and to help patients manage their reactions to the feared object.
• Systematic desensitization (or exposure therapy) aims to change the patient’s response to the source of the fear by exposure in gradual steps. Those who are afraid of flying, for example, might first board an airplane on the ground or even a model of the interior of an airplane, perhaps progressing to a simulated flight before actually taking off. Those with a fear of spiders or snakes might start by looking at drawings then photographs and motion pictures of the feared object before in-person exposure.
• Cognitive behavioral therapy might also include exposure therapy but would emphasize learning ways to think about the feared object or situation differently, changing the beliefs associated with the source of fear. The goal is for the patient to be able to control his or her thoughts and feelings. Cognitive behavioral therapy is particularly effective in treating social phobias.
Medications to treat phobias seek to balance chemicals in the brain. They primarily treat the symptoms of the phobia and are generally most effective when combined with psychotherapy.
• Antidepressants such as SSRIs (selective serotonin reuptake inhibitors) are commonly prescribed to elevate mood.
• Beta blockers, typically used to manage high blood pressure, may be prescribed to counter symptoms such as palpitations and trembling.
• Tranquilizers (sedatives) may help reduce symptoms of anxiety.
“Many people don’t seek treatment for phobias because they believe they aren’t serious, they think they’re under control or they feel they can manage with avoidance strategies,” Dr. Rosenberg concludes. “This may work for some. But for those with severe phobias or phobias that constrain everyday activities and social and professional lives, treatment is advised and is generally effective. There’s no need to live in fear.”
