AAMFT Consumer Update
Phobias

Phobias are constant, excessive fears of an object or situation that interfere with one's life and/or cause personal distress. Phobias are among the most common types of psychiatric disorders, with 11% of the population subject to a phobia at some point in their lives, and 5.5% of the population subject to a phobia within a given 30-day period. Many people learn to manage their phobia with minimal difficulties. For example, a person with a spider phobia might avoid activities such as camping, but otherwise does not notice a disruption in his or her life. However, for phobias that cause noticeable life interference, there are effective treatments that are successful in up to 90% of cases.

How do I know if I have a phobia?

Most people admit they are afraid of certain things, such as snakes, blood, and/or public speaking. It could be said that some fears are useful, as they alert us so that we can prepare for potential danger. Fears of certain objects or situations are considered a phobia when:

·         The fear is excessive or unreasonable.

·         The person almost always has an anxiety reaction when he or she encounters the feared object or situation.

·         The feared object or situation is either avoided or endured with extreme distress.

·         The avoidance, anxious apprehension, or distress in the presence of the feared object or situation disrupts one or more aspects of a person's normal routine.

In other words, when a person notices a specific fear getting in the way of routine activities or life satisfaction, then it is possible that he or she is suffering from a phobia. Phobias are typically grouped into one of five categories:

·         Animal Type (fears of spiders, snakes, cats, dogs, mice, birds, or other animals)

·         Natural Environment Type (fears of being near water, storms, and high places)

·         Blood-Injection-Injury Type (fears of seeing blood, medical procedures, and injuries, receiving injections, and having blood drawn)

·         Situational Type (fears of driving, flying, and being in enclosed spaces)

·         Other Type (fears of vomiting, choking, loud sounds and other fears not belonging to any of the other categories)

 What causes phobias?

There are many ways a person can develop a phobia. Some individuals remember a particularly traumatic experience with the feared object or situation. More often than not, however, people report that they have had the phobia as long as they can remember, or that they were always fearful of an object or situation and that it gradually developed into a phobia. Most psychologists believe that a combination of factors explains why phobias develop, including biological vulnerability, such as the tendency to be startled or alarmed, traumatic experiences with feared objects or situations, observations of others reacting fearfully to certain objects or situations, and learning information about the danger of certain objects and situations. These circumstances, in turn, make it likely that phobic individuals will develop problematic ideas about the feared object or situation, such as the amount of danger it poses, the frequency with which they will encounter it, and their ability to cope with it. Interestingly, people are more likely to develop phobias of insects and storms rather than guns or knives. Many researchers believe things like insects and storms posed a threat to our ancestors, and it helped them to survive if they had a moderate level of fear toward them.

How do phobias affect relationships and family life?

At times, phobias can cause disagreements in close relationships, as they can limit the activities that partners and families can do together. Families of children with phobias often create time-consuming rituals to structure the phobic child's environment so that the child either successfully learns to deal with the phobia, or so that the family can avoid a "scene" caused by the phobia. Partners and family members often find themselves trying to strike an unstable balance between showing love and concern toward the phobic individuals, and encouraging them to overcome their fears.

What kinds of treatments are commonly used?

Medications are rarely used to treat phobic individuals (if there are no other psychiatric symptoms). Instead, most clinicians believe that a therapeutic method called "in vivo," or "real life" exposure to the feared object or situation is necessary to reduce fear. Although real life exposure might be uncomfortable for the phobic individual, it is conducted in a way that allows the individual a sense of control and maximizes effectiveness. Real life exposure in a therapy session is typically one to three hours, which is different than the brief moments the phobic individual usually encounters the feared object or situation before escaping. Such prolonged exposure allows plenty of practice with the feared object or situation and the opportunity to learn that the danger he or she perceives is exaggerated. Unlike encounters with feared objects or situations in their everyday lives, in therapy, phobic individuals know what to expect and must give their permission at each step of the exercise. Individuals also work to deal realistically with their exaggerated ideas about the feared object or situation. For example, learning that there will not be a catastrophic consequence to the exposure. Most phobic individuals can be treated successfully using this method in one to five sessions.

Partners and family members can assist with exposure therapy. In some instances, it is helpful for them to attend sessions so that they can learn therapist behaviors that make the exposure exercise effective. Between sessions, they can serve as a coach as phobic individuals practice exposure to feared objects or situations at home. Although the support of partners and family members can help therapy to run smoothly (and may result in relationship improvements), it also is important for the phobic individual to practice exposures alone, so that he or she does not rely on the presence of another person to signal safety.

Consumer Resources

Anxiety and Phobia Workbook, 4th edition, by E. Bourne, 2005. Oakland, CA: New Harbinger Publications, Inc. This is a self-help guide for anyone struggling with anxiety or phobias, and incorporates medical and spiritual treatments. 

Mastery of Your Specific Phobia: Client Workbook, by Antony, Craske, and Barlow, 1995. San Antonio, TX: Psychological Corporation/Graywind Publications Inc. This workbook can be used in conjunction with the Mastery of Your Specific Phobia Therapist Guide and a therapist who uses exposure to treat specific phobias.

Overcoming Specific Phobia-Client Manual: A Hierarchy and Exposure-Based Protocol for the Treatment of All Specific Phobias (Best Practices Series), by E. Bourne, 1998. Oakland, CA: New Harbinger Publications. This manual provides specific instructions for a 10-session, exposure-based treatment for specific phobias. Used in therapy or self-directed, this workbook contains cognitive (self-talk) and behavioral (relaxation and exposure) exercises with instructions for consumers.

National Institute of Mental Health

www.nimh.nih.gov
Describes symptoms and treatments of all major anxiety disorders including phobias and information on new developments, statistics, and organizations related to phobias (http://www.nlm.nih.gov/medlineplus/phobias.html) and other anxiety disorders (http://www.nlm.nih.gov/medlineplus/anxiety.html), as well as links to local resources, including clinical trials involving free treatment.

Nemours Foundation
http://kidshealth.org/kid/feeling/emotion/phobias.html
Information on phobias tailored to children.

The text of this brochure was written by Amy Wenzel, PhD, Sabine P. Schmid, PhD, and Aaron T. Beck, MD.

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