Phobias
January 19th, 2010
By Evelyn Goodman, Psy.D, LMFT, Anxiety Topic Expert Contributor
Click here to contact Evelyn and/or see her GoodTherapy.org Profile
Phobias and avoidant behaviors are often a byproduct of panic attacks and high anxiety states. For example, if you have a panic attack while driving in traffic youmay want to avoid driving in traffic in the future. The two situations have become linked in your mind and just thinking about doing it can bring on some anxiety.
When this becomes an on-going problem it is termed “agoraphobia” which is defined as the “fear of fear”. You really aren’t fearful of driving in traffic; the fear is of the anxiety or panic that is triggered in that situation. Another type of phobia is social phobia, which is about the fear of embarrassment or humiliation if someone or a group of people become aware of your anxiety. The avoidance is to situations where this can happen, e.g. parties, meeting new people, speaking in front of a group. The third type of phobia is more specific to a situation or place and usually the result of a traumatic event. A child who is bitten by a dog, getting stuck in an elevator, or worse, being a victim of a crime such as an assault or rape. Also, certain obsessive-compulsive thoughts and rituals have avoidance components such as avoiding certain foods or places because of the fear of a negative consequence, even though it does not have much reality.
Overcome any of these phobic reactions involves confronting the feared situation repeatedly until the mind is desensitized and the anxiety reaction lessens or is completely gone. This type of work takes motivation and repetition. On occasion phobias may diminish spontaneously as anxiety is reduced.
There are several methods for overcoming phobic avoidance. The first and most frequently used is “systemic desensitization” or otherwise known as taking baby steps into confronting the feared situation. The anxious driver might start by driving one block or one minute in heavy traffic. While doing this they would breathe consciously when anxious and repeat supportive self-statements to themselves (e.g. “I will be okay”). When driving one block becomes easy then the person starts driving longer distances.
For social phobia the step by step process requires a little more planning, since other people are part of the anxious scenario. The socially anxious person might start by going to a party for a short time, or giving a short presentation. Sometimes it is more effective to take the risk of letting others know of the anxiety and confronting the feelings that may evoke.
The second widely used and effective technique is called “flooding” or “implosion”, sometimes known as jumping into the deep end of the pool (instead of small steps into the shallow end). Here the person immerses themselves completely into the feared situation, the anxiety rises, and the person stays until the anxiety comes down. This way one learns they can survive the situation. This usually needs to be repeated a few times until the situation losses its grip of fear. I would not recommend this technique to those who have medical conditions that would be exacerbated by high anxiety states. When using this method it is often helpful to have a supportive person with you, who understands the process you are going through and is there to remind you that you can do this. When in a state of high anxiety the rational part of the brain is overtaken by the anxiety.
Both of these techniques work more smoothly when the person has had some training in anxiety reduction techniques. This is where breathing techniques, meditation, progressive muscle relaxation, hypnosis, or guided imagery is useful tools for learning to calm an easily aroused nervous system. Some people find medication that reduces anxiety also helpful.
Phobias can be overcome with the combination of treatment methods that work best for you plus the courage and motivation to confront your fears. The sense of empowerment one feels when overcoming a phobia makes it a very worthwhile endeavor.
©Copyright 2010 by Evelyn Goodman, Psy.D, LMFT, therapist in Culver City, CA. All Rights Reserved.
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Comments
I completely agree with what’s written in this post. Sometimes it so happens tht you get into a bad situation and experience something unpleasant and from then on, you never want to do anything even related to such a situation or thing. but each one of us needs to understand that if it happened once, it does not necessarily mean that it will repeat and also, doing in again will help us overcome the fear and prove to us that it is not always negative.
It is all in the state of mind…go ahead and face your phobias… conquer them and gratify your soul…that is exactly what I did…I had stage fear…I then got help from my cousin and I started to speak in front of small audiences. Today, almost 2 years since I first seeked help, I can confidently speak in front of a crowd of hundreds :)
Thanks for the article, Evelyn. If a person wanted to address a fear of public speaking, is it helpful to give a small presentation to people they know or would that not be of help?
Martha, I would give it a try. It might be a good first step to overcoming the fear of public speaking. Even if it feels
very comfortable and easy you will still be getting some experience in presenting. When dealing with public speaking anxiety it is very helpful to learn some public speaking skills in addition to practicing methods to reduce or control anxiety. Good luck!
With all due respect, implosion sounds downright cruel. How effective is that compared with systemic desensitization?
I must not fear. Fear is the mind-killer. Fear is the little-death that brings total obliteration. I will face my fear. I will permit it to pass over me and through me. And when it has gone past I will turn the inner eye to see its path. Where the fear has gone there will be nothing. Only I will remain. – Frank Herbert (in his book, Dune).
LaScala, Flooding is not for everyone, but it’s especially helpful if one has a high tolerance for a high anxiety state for a while. The anxiety always comes down. The adrenal glands get run down and can’t keeping pumping out a lot of adrenal.
For some people this is a more rapid way to overcome a phobic avoidance pattern than systematic desensitization. In some cases it’s the only way. E.g., either you are flying in an airplane or not.
That was a good piece. My sister is terrified of snakes. She can’t even watch them in a movie. I think she would literally pass out if flooding was tried.
I like your reference there that you’re either flying or you’re not. It helps me understand that method more. Thank you Evelyn.
Thank you Evelyn for explaining the different treatment options for phobias in your interesting article. Are these the only two options or are there more?
I was wondering. Is there such a thing as an incurable phobia or are they all curable? And thanks Evelyn.
Victoria, There are other options – EMDR, NLP, TFT – are techniques that say they are helpful for overcoming phobias.
However, I’m not sure what research studies say about their effectiveness. Nor do I know anyone who used them for phobias. People who use these techniques swear by them. Hypnosis can be useful; it is primarily a combination of relaxation and visualization. The techniques I have described are well known, research validated and have a long history of effectiveness.
Joan, Did you have a particular phobia in mind or is this a general question? There are phobias such as fear of heights, falling, or being trapped in a small place that are fairly common and may be part of our wiring. One can learn to tolerate them but may never completely overcome the discomfort.
I have a horrible fear of flying and it is beginning to effect my job and my family. I have promised to make a two trips in the next 5 months and desperately need to get this under control. Can you recommend someone that can help me with this? Thanks.
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