individuals to regain control of their lives.
Treating Phobias
There are a number of standard approaches used by therapists to modify the actions and thought patterns of people suffering from phobias. Unfortunately, about three quarters of people with phobias never get help. Many people with phobias are reluctant to seek assistance because of embarrassment. Others don't understand what they have or where to find help. And some fear the treatment itself.
A key component of most treatments is behavior therapy, designed to alter the way a person acts. Behavior therapy typically involves gradual exposure of the patient to the feared situation.
Behavior techniques are often combined with cognitive therapy that aims to change the way that people view themselves and their fears. Rather than thinking, "I am frightened and might have a panic attack," the individual is encouraged to assess the situation in a more positive way, perhaps thinking, "I am frightened, but I am not in danger." The patient is trained to analyze his feelings and separate realistic from unrealistic situations.
Exposure therapy, which is part of behavior therapy, works by gradually exposing the individual to the feared object or situation. Facing the feared situation helps the patient see that he can cope successfully, and that escape is unnecessary. Over time, the individual gains greater control over the anxiety so that ultimately he can face the threatening situation or object with little or no fear.
There are a number of variations to exposure therapy. The degree of exposure will vary depending on the therapist's assessment of the patient. The feared situation, such as giving a speech, may be simulated, or the person with the disorder may be placed in a real situation that he fears, such as driving over a bridge. Treatment of a phobia can be conducted individually or in a group.
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Complex Cases
When a person has several specific phobias, the relationship between them may not seem evident at first. One agoraphobia client also developed an intense fear of knives and of children. While discussing the problem during a treatment session, she reported that one day several months earlier she had found her seven-year-old son threatening his sister with a kitchen knife. After admonishing her son, she found herself dwelling on the many dangers of knives. Within a day, she began to question her own ability to control a knife. She then developed a spontaneous mental image of herself hurting a child with a knife. In a brief few days she began avoiding knives as well as becoming anxious whenever she looked at young children. The internal belief that has driving her fear was: "I don't have enough self-control [to handle knives, to be with children]."
This case illustrates another pattern present in some phobias. The phobia can develop from a current internal conflict and/or a real life fear. With this client, the real life fear was of her young son hurting someone by poor self-control with a knife. This legitimate fear was coupled with her own internal conflict. She was considering having a third child. At the same time, her marriage was unstable. Her husband was consumed with his business, and she felt unsupported and unloved. As we talked I realized that she was not consciously aware of the degree of her conflict. Notice, though, how her phobia was, in a sense, helping her solve a problem while at the same time causing her distress. By unconsciously developing these fearful thoughts about her personal inability to control her aggression, she could now say, "Obviously I'm not capable enough to have another child." This irrational fear resolves her internal conflict. It also prevents her from confronting the pain in her marriage.
For instance, if she maintained her desire to have a third child, she would want her husband to offer her more emotional support. What if he refused? What if he decided their marriage was no longer "workable" for him and suggested that they get divorced? Her fear of abandonment probably played a major role in the development of her new phobia. By increasing her self-doubt, she no longer had the ego strength to risk making demands on her husband. Instead, she became more dependent and less likely to speak up for her needs.
Phobias, therefore, are often more complex than they at first seem. And their "irrational" nature may relate to their attempt to solve a real life problem. After a time the irrational fear takes on a life of its own, just like a habit, regardless of its initial unconscious purpose.
Most people have met someone with a significant fear of a particular object or situation, such as closed spaces (claustrophobia), heights (acrophobia), water (aquaphobia), snakes (ophidiphobia), or lightning (astraphobia). When a person has a persistent, irrational fear of an object or situation and a strong urge to avoid that object or situation, they have a "specific phobia" -- an inappropriately intense reaction triggered by a single stimulus.
The most common phobias are of specific animals and insects, of the natural elements, such as storms or water, of heights and of closed-in spaces.
The person with a specific phobia may react with mild anxiety or even with panic when confronted with the prospect of facing the fearful situation. However, his fear is not of his symptoms (as in panic disorder or agoraphobia) but of the situation itself, which he believes to be a dangerous one.
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Some may fear that they will lose their senses and do something foolish. The person with a height phobia, for instance, might fear that he will forget what he is doing and accidentally leap off the cliff on which he is standing. Others with phobias fear that something will go wrong with their circumstances. The individual with a flying phobia might vividly imagine the tail falling off the plane, or the pilot losing consciousness with no one to take over, or the oxygen running out in mid-flight.
Such fears defy rational thinking. Most phobics know that they are being excessive and unreasonable in their thoughts, but this knowledge is of no use to them. The fearful thoughts come automatically in spite of rational thought and thus the phobic may believe the only recourse is to avoid the problematic area.
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