20 Unreasonable Phobias, Some We Might Already Have
Phobias and Fears – Symptoms, Treatment, and Self-Help for Phobias and Fears
Phobias
A phobia is a focused, extreme anxiety beyond what is a reasonable response for the situation. The fear cannot be reasoned away – you cannot tell a spider phobic a spider will not hurt them, and expect them to relax. The fear response is out of your voluntary control, and it is so unpleasant that it leads to avoidance of the feared situation or animal.
Agoraphobia is the commonest phobia prompting treatment. Agoraphobia means a fear of open spaces from the Greek word agora for a market place. The term is also used for a fear of shopping and crowded places. It most often develops between the ages of 15 and 25 years, and may be trigged by a big life-event (such as having a baby).
Social phobia is also common. This is a persistent fear of situations where you might be scrutinised. There is often an associated fear of doing something embarrassing or out ofcontrol, such as blushing, fainting or being sick. More women than men are affected. It often begins around puberty – when self-consciousness tends to be at its peak in all of us.
Animal phobias tend to start earlier than the other phobias. They may start in childhood.
Treatment of phobias
Drug treatment is not usually helpful (unless there is an accompanying depressive illness – which is not uncommon). Behaviour therapy is the cornerstone of the treatment of phobias – behaviour is modified with several different techniques. If you gradually expose someone to the feared situation, and teach them to relax at the same time, their anxiety will slowly fall – you learn to do it without fear.
This relearning can be done gradually, or in big chunks of exposure called flooding. The feared response is generated and you ‘stay with it’. Your body cannot sustain very high levels of extreme anxiety for long periods – you start to get used to it, or ‘habituate’.
Finally fear can be overcome by ‘modelling’ behaviour on the therapist – the therapist touches a snake and shows no sign of alarm or retreat. The patient then follows the example of behaviour in the therapist.
All these treatments are safe and are appealing in many ways – we know they work and they are logical with a very clear outcome.
I’m terrified of flying. I shake like a leaf as soon as I get on the bus to the airport. It’s ridiculous really as I’m usually up for anything. I’m grand as soon as I get there.
In this situation tranquillisers just for your flight there and back can be very helpful, or some beta-blockers. Elsewhere in this texts you’ve seen how frightfully mean we are nowadays about giving out tranquillisers like Valium. This sort of setting, however, is a ‘one-off’. Beta-blockers are helpful too, but they cannot be used if you have asthma – they can make it worse. Drinkingexcessively on the plane is not good and can compound the problem.
People who need to fly regularly for a living and have a phobia about it can be treated by behaviour therapy. Treatment involves ‘deconditioning’ you by gradual exposure to the source of your worry. A typical programme would involve learning relaxation techniques, and then making a series of supported visits to an airport, leading up to a trial flight.
My mum is afraid to go out of our home. She can get to the local shop, but can’t get into town to see us. It’s a real nuisance, and she can’t go out to work. What can we do to help her?
Your mum is showing signs of a phobic condition. Agoraphobia is defined as fear of open spaces, although phobia sufferers may be afraid of people, heights, crowds, going into public places, using public transport, speaking in public, or leaving home. There are also some specific phobias.
Some sufferers may lead progressively more limited lives. These conditions can certainly be helped by treatment. Start by helping her to define exactly what she can and cannot do,
However irrational it may seem.
Where, or how far, can she go? Can she go to some shops but not others?
Make a list so that you understand her boundaries. Start with something she really wants to do but cannot, so that she is well motivated. An example might be a visit to her favourite store to buy herself an outfit, or a Christmas present for someone.
Plan a series of small steps towards this goal: start out with a brief walk each day with someone there to reassure her. Once she gets used to this and is no longer anxious, start to do a little more each time you go out. Sometimes it can be helpful to have someone walking a little way behind when she first goes out – gradually make the distance between them longer. If she feels overwhelmed, practise some breathing and relaxation exercises with her until it passes. If she is using medication such as betablockers or tranquillisers to reduce anxiety, try to avoid using these while you are working on these steps (but never stopantidepressants if she is taking them). Keeping a diary record of how far you go is useful. Gradually increase this until she can reach the goal you set, first with you, then on her own.Self-help groups can be very helpful with tackling these symptoms.
Since my early teens I’ve had what I thought were panic attacks in restaurants and canteens. My doctor tells me I have social phobia. What is this condition?
Social phobia is an exaggerated and irrational fear of social situations. These can include visiting restaurants, the theatre, travelling on public transport, and ‘socially dense’ work situations. Although it can be considered an extreme form of social shyness, it is subtly disabling and quite difficult for others o sees and understands.
Sufferers often self-medicate their anxiety with alcohol, and there is therefore a high risk of alcohol dependence. Alcohol should be discouraged, not only because of its inherent health risks, but because of rebound increased anxiety during the hangover phase when the alcohol effect wears off. True panic attacks with hyperventilation, racing heartbeat, shaky hands, and feelings of terror or impending doom can occur in social situations. Your circulation can be affected causing fainting. You may become disabled because of panic attacks, phobic avoidance of social situations, and secondary depression.
What treatment can I have for it? The doctor suggests I try an antidepressant. Why is this?
Whether or not depression is obviously present, moclobemide (a reversible MAOI) and paroxetine (an SSRI) are licensed for treatment of social phobia. Probably all SSRIs are effective in social phobia, but only paroxetine at present is licensed for it. Besides medication, psychological therapy, namely cognitive behaviour therapy (CBT), is helpful.
How can I change my thoughts and feelings?
If your social phobia occurs in restaurants, for example, your thinking sequence might be:
• I am going to a restaurant, I am going to shake.
• I am in a restaurant; I am shaking and going red.
• I am verging on having a full-blown panic attack.
• People can see me doing this.
• They are scrutinising me, and will laugh and judge me.
• I will look a fool, be ridiculed and humbled.
CBT aims to analyse how true each of these thinking stages are, and to explore the emotions that the thoughts are associated with.
For example:
• You may indeed be shaky when in a restaurant, but how noticeable is it?
• Even if it is present, why should others be interested enough to notice?
• Even if they do notice, why should they be judgmental?
By challenging ‘negative automatic thoughts’ like these, initially guided by a therapist and then by you while in the anxiety-provoking situation, cognitive therapies aim to reduce the disability associated with social phobia.
