Everyone is afraid of something. It doesn't matter how tough or successful someone is, if a crazed clown with a knife jumped out at you on a dark night you would probably have some sort of fear-filled action. The perceived threat causes your body to react to the potential danger. For some people, however, the feelings they experience in relation to a specific fear are much greater, more impactful to their every day life. These are known as phobias.
There are many different kinds of phobias, from agliophobia (meaning a fear of pain) to zoophobia (a fear of animals). Fear itself is generally built within us – it protected our ancestors from things that were dangerous to them and ensured the continuation of the species – but phobias go far beyond this. A person with a phobia of snakes (ophidiophobia) may be unable to touch a snake or even go near one. They may experience extreme anxiety at the prospect of being near a snake, even if that closeness is imagined, with the possibility of panic attacks. Repetitive worries that they may encounter a snake, even when the possibility of doing so is exceedingly small, can hinder their ability to function in everyday society due to their need to avoid a chance encounter with the source of their fear.
While some phobias can be dealt with largely through avoidance of the object of fear – you're unlikely to run into a snake unexpectedly in your average UK town after all – others may require some intervention to help the sufferer live a life without constant fear. Whether you're afraid of windows or wide open spaces, there are many tools and techniques available to help deal with a phobia.
There are many different forms of therapy available, allowing an individual experiencing an unreasonable fear to choose the method most suited to their needs. These processes take time, and it may take a while to find the right option for a specific phobia, but they can have long-lasting results when it comes to helping someone cope with a phobia.
Exposure therapy is probably one of the best known treatments for individuals with a phobia. The basic premise of this treatment option is that repeated interactions with the object of fear without any negative outcomes will show the phobic individual that their reaction is excessive, building their ability to cope with their phobia. It's a slow process and generally begins with imaginative exercises where the fear is visualised, and then gradually building this up until the individual is able to manage their responses to the source of their phobia. For exposure therapy to be at its most effective, the individual suffering from a phobia must eventually come into contact with the thing they are afraid of.
In recent years, advancements in technology have allowed exposure therapy to take place in virtual environments. This method has been found to be particularly effective for certain phobias, including aviophobia and arachnophobia, and can also be more practical in some cases, such as conquering the fear of driving. While this particular form of exposure therapy is still in its early stages, with research ongoing, it is thought that it is more effective than purely imagined exposures and has comparable results to facing the feared object or situation in person.
Cognitive Behavioural Therapy (CBT)
Cognitive Behavioural Therapy focuses on adjusting the individual's thought processes and behaviours to help them manage their reactions to the phobia. The treatment often involves a great deal of self-analysis as the phobic individual looks into their reactions to their object of fear – including both emotions and physical feelings – and determines their usefulness. Working with a professional, they will then work on ways to moderate and change these unwanted reactions.
As CBT is very focused on the now rather than the past, it doesn't generally look into what caused the fear and instead the treatment of a phobia can often involve some exposure therapy the development of coping tools. This is so that the individual can get the truest assessment of their own reactions and their improvement over time. For example, someone with a fear of heights may work their way up to a reasonable height while analysing how facing their fear makes them feel and whether the techniques they are using is helping them deal with their phobia.
While Cognitive Behavioural Therapy may focus on the now, more traditional forms of counselling may look at why a phobia formed in the first place. While many fears are innate, having been formed to protect humanity from potential harm long before we were born, a phobia is an extreme and often irrational level of fear. It is thought that most phobias develop in childhood and early adulthood, and this is usually down to a stressful experience (though a parent known to have a specific phobia themselves is likely to pass that fear onto their child).
Talking about these past experiences can help the phobic individual come to terms with their fear and allow them to process it rationally. A better understanding can then help them develop the tools to deal with their phobia.
Therapeutic options like CBT and counselling are the preferred options when it comes to dealing with phobias, as they generally have a greater level of long-term effectiveness and no expected side effects, but medication can occasionally be prescribed to help an individual cope on a temporary basis. These are generally prescribed by a GP to deal with issues like social anxiety or to aid someone in facing a specific fear, such as flying.
There are two main types of anti-depressants used to treat phobias. The first kind is known as Selective Serotonin Reuptake Inhibitors, or SSRIs, by blocking the reabsorption of the neural transmitter serotonin in the brain to make more of it available and improve the moods of the individual.
Monomanine Oxidase Inhibitors, or MAOIs, are another option in the anti-depressant family but are less commonly used because of the greater side effects attributed to them. Like SSRIs, MAOIs work by preventing the reabsorption of certain chemical messengers in the brain (in this case serotonin, norepinephrine, and dopamine) to make them more available and improve mood.
Recent research does suggest, however, that those suffering from social phobias and anxiety may actually have an unusually high level of serotonin and therefore may not benefit from this kind of treatment.
While anti-depressants are largely focused on adjusting the chemicals working within the brain to treat phobias, beta-blockers are generally targeted towards treating the symptoms of a fear reaction like rapid heart rate and palpatations. Drugs in this family, such as propranolol, work by blocking certain messages being sent to the heart. Without these messages, the heart pumps more slowly and with less force, reducing the overall blood pressure and symptoms of a panic response.
In the case of propranalol, recent research suggests that it could reduce the stress responses to the object of fear even after treatment has ended but wider sample groups and longer studies are still needed to confirm these findings.
For very severe and impactful phobias, a GP may recommend a low dose of a benzodiazepine tranquilliser to reduce the anxiety associated with the object or situation of fear. These type of drugs work by reducing the activity in the brain and making the central nervous system slow down, therefore reducing the thoughts and feelings associated with the phobia.
Benzodiazepine tranquillisers, such as diazepam, can be highly addictive, even at low doses, and the effects of continued use are not very long lasting, so they are typically only prescribed for short periods of time. The temporary relief they offer means that they are not ideal for the long term treatment of phobias but they can be very useful for a phobia that the individual only has to confront occasionally, such as a fear of flying.
While is a multitude of different therapies available to help get to the root of a phobia and medications available to help with some of the effects, there is also a great number of different ways to deal with a phobia that won't necessarily involve a trip to the GP. Many of these techniques can be done from the comfort of home and could be a good starting point for those who wish to conquer their phobia but don't consider it to be a large enough concern that they would wish to involve the family doctor.
Mindfulness and relaxation techniques
Mindfulness is a process where the individual works to become more aware of their thoughts and feelings, with this awareness increasing their understanding of the temporary nature of negative thoughts and leading them to the point where they can choose how to think and feel in stressful situations. When dealing with phobias, paying attention to how the mind is working in response to the object of fear can help the individual come to terms with their phobia and find new ways to react that are more helpful. This may be through breathing exercises, paying attention to fine details in the surroundings, or through tensing and relaxing muscles to alleviate the stress responses.
There are professionals available to help an individual learn mindfulness and relaxation techniques may be an integral part of other forms of therapy. It is, however, something that is widely available online to allow the general public to develop these skills in their own time. There are numerous websites, podcasts, youtube videos, and even apps that can help individuals learn how to live more mindfully.
While many people visualise hypnosis as a man on a stage getting grown adults to act like babies through a watch on a chain, it can actually be a very effective solution for many people dealing with a phobia. In hypnotherapy, the assumption is that a phobia is rooted in a repressed event and facing up to this repression can help the individual develop a more reasonable response. The phobic individual is put into a trance state to allow unconscious memories to be brought forward into conscious awareness. They are taken back to the key moment in which their phobia developed so that they can begin to see their object of fear in a more rational way, allowing them to deal with their phobia.
As with mindfulness, there are a number of professionals available to help someone with a phobia conquer their fear through hypnotherapy, but there are also self-help podcasts and recordings that can assist for more typical fears, like needles and driving.
As with many aspects of mental health care, sometimes practical changes to lifestyle are the best place to start when dealing with a phobia. Improved health can help alleviate the symptoms of a phobia, such as panic attacks, and thus improve the individual's relationship with the object of fear.
Following a fitness plan with a healthy diet can be a good starting point as the routine involved may help the individual gain more structure in their lives and encourage them to push through their fear responses to complete their goal. A well-balanced diet with regular exercise and the right amount of sleep can also greatly improve overall mental health.
It may also be necessary for someone with a phobia to remove certain stimulants, like coffee and caffeinated drinks, from their everyday routine as these could have an effect on the symptoms of a phobia, such as increased heart rate and breathing. By replacing these with something hydrating, like water, the individual can continue to improve their overall health while reducing the likelihood of extreme panic responses.
A phobia can be debilitating and hugely impactful to an individual's life. It can also be tricky to deal with, due to the various kinds of phobias and symptoms associated with them, but there is also many different ways to cope with a phobia to suit the needs of the individual. Whether it's a one-off dose of a benzodiazepine tranquilliser to help with a transatlantic flight or a steady course of cognitive behavioural therapy, there are options available to help deal with a phobia.
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