Fear is a normal response to situations in which our safety may be at risk.
It’s reasonable to feel alert to threat when faced with a dangerous situation (eg a venomous snake on the path you’re taking) and in fact it is that reasonable sense of fear that helps to keep us safe.
For some people though, that fear generalises to situations in which no actual threat is present so that, for example, seeing a picture of the feared object or event or even thinking about it is enough to trigger a fear response. This kind of response might indicate a specific phobia.
Signs and symptoms of specific phobia:
- A marked fear or anxiety about a specific object or situation (e.g. flying, heights, animals, receiving an injection, seeing blood).
- The object or situation almost always provokes immediate fear or anxiety.
- The object or situation is actively avoided or endured with intense fear or anxiety.
- The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
- The fear, anxiety or avoidance is persistent, typically lasting for 6 months or more.
- The fear, anxiety or avoidance causes significant distress or impairment in social, occupational, or other important areas of functioning.
Specific phobias are generally divided into the following categories:
- Animal type: fear that relates to animals or insects (eg fear of dogs or spiders).
- Natural environment type: fear associated with the natural environment (eg fear of thunder or heights).
- Blood/injection/injury type: fear associated with invasive medical procedures (eg injections), or with seeing blood or injury
- Situational type: fear of specific situations (eg elevators, bridges or driving).
- Other: any other specific phobias (eg fear of choking, fear of vomiting).
The Cycle of Avoidance and Anxiety
When we feel fear we might have a tendency to avoid the object or situation (the stimulus) that makes us fearful. When we remove the fear stimulus, our anxiety reduces quickly, making it more likely that we’ll avoid the stimulus in the future. However the stimulus will still provoke the same fear response if/when encountered again, further reinforcing avoidance.
Treating Specific Phobias with Exposure Therapy
Exposure therapy is an evidence based treatment approach used frequently to treat specific phobias. It involves gradual exposure to the feared stimulus without avoiding or escaping from it and waiting until anxiety levels naturally decrease to an agreed upon point. This is called habituation.
Exposure therapy is not about forcing you to identify and endure your most feared experience by the end of session one. It is intended to be:
- Graded – your psychologist will help you to develop a list of conditions or situations from relatively easy to endure (but still somewhat anxiety-provoking), to very difficult to endure, and you will progress through the conditions as habituation occurs.
- Prolonged – you will be supported to stay in the anxiety-provoking condition until your level of anxiety has reduced to an agreed upon point.
- Repeated – you will need to repeat each step on your exposure list until the condition no longer makes you feel anxious (ie your anxiety levels at the start of the exposure are at the level you aim to get to by the end of the exposure).
- Without distraction – your psychologist will talk to you about removing things that reduce your anxiety artificially or allow you to be distracted during exposure. These things might make you feel more comfortable during the exercise but they prevent habituation from occurring.
Exposure therapy has been shown to be an effective treatment for specific phobias with both short and long term positive effects. It is a targeted approach to breaking the cycle of avoidance and anxiety, and can allow people to live rich and fulfilling lives free from the shackles of phobia.
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.Washington, DC, American Psychiatric Association, 2013
- Lipsitz, J.D. (2014) Specific Phobia. In G.O. Gabbard, Ed. Gabbard’s Treatment of Psychiatric Disorders Fifth Edition.American Psychiatric Publishing: Arlington.
- Cochran, H., Michiyo, H., & Vernon, L.L. (2006). Exposure Therapy for Phobias. In D.C.S. Richard & D. Lauterbach. Handbook of the Exposure Therapies. Academic Press: Burlington.