Specific Phobias
The word 'phobia' is a derivation of the Greek word 'phobos', meaning flight, which originated from the Greek deity Phobos - whose particular talent was to inspire fear and panic in his enemies1.
Fear is a common feeling or experience for all people and is generally accepted as a normal response in a variety of fear-provoking situations. For some people, however, fear develops into phobias.
The predominant symptoms of phobias are physiological and emotional anxiety, and 'flight' or avoidance behaviours. Phobic anxiety is characteristically excessive in relation to the triggering situation. While the phobic person is aware of the unreasonable nature of their fear, they are not able to rationalise their anxiety using logical explanations. Generally, exposure to the feared object or situation provokes an immediate and intense anxiety response, which may take the form of a panic attack. Typically, the feared object or situation is avoided or sometimes endured with dread, and anticipatory anxiety occurs if confronted with the necessity to enter the feared situation. The focus of the phobia may be anticipated harm from some aspect of the object or situation. It may also involve concerns about losing control, panicking, and fainting that might occur when exposed to the feared object or situation. Feelings of embarrasment and shame add to the distress caused by the phobia itself.
The degree of distress which arises from phobias varies considerably. Little disturbance or anxiety may arise for individuals whose phobias are of rarely encountered objects or situations and are therefore easily avoidable. For example, avoidance of snakes or deep water would generally impose few limitations on the lives of most surburban people with these phobias. For many people, however, their phobias are focused on everyday objects or situations, which must be continually encountered, so that phobic anxiety and avoidance become central to their lives. Examples of these phobias include: fear of closed places - claustrophobia, fear of heights - acrophobia, fear of darkness - nyctophobia, fear of storms - brontophobia, fear of blood - hemaphobia, fear of water - hydrophobia, and fear of being alone - autophobia. Where these phobias lead to a person suffering constant distress, severe limitations upon their choices and freedom, and sometimes the development of panic attacks, the phobic condition is considered to be an anxiety disorder.
Prevalence and onset
People with phobias often tend to keep their anxieties hidden from others, which may compound problems of isolation, and feelings of having a unique and unusual problem. However, the incidence of phobias is common. Research in the United States indicates a lifetime prevalence rate of 11.3 - 12.5%. The onset of a phobia or a phobic disorder may occur at any age, however the most usual time of onset is in childhood or adolescence, and generally before the age of 35.
Predisposing factors
Many research studies suggest that genetic factors may predispose an individual to developing phobias, especially where panic is a part of the symptomatology2. It appears that more females than males develop phobias, or at least more females present for treatment for phobic conditions. This is likely to be due to social and cultural factors, rather than biological sex differences. Stressful and significant life events which may involve periods of change and adjustment may instigate the beginning of a phobic process, which may then be reinforced through circumstance or an inability to adjust or cope3. The individual who develops a phobic disorder does not have an identifiable personality type. However, some personal characteristics which may pre-dispose a person to developing a phobic condition include a tendency to hyperventilate, sensitivity to physical reactions, beliefs reflecting a sense of helplessness and lack of ability to control external situations, sensitivity to pressure and low self-esteem.
Management and Treatment
There are several treatment approaches used to help the individual with a phobic disorder. Psychological approaches include: education, psychotherapy, behaviour therapy and cognitive therapy. These therapies are often combined with pharmacological treatments.
Education
Explanations of the causes, features and course of the phobic disorder help individuals to normalise their symptoms and dispel beliefs that their phobia is caused by a character flaw or personal weakness, and that others also experience similar symptoms and have found ways of managing or recovering from their phobia. Education about the disorder and treatment options will help the phobic person to establish greater feelings of personal control over their responses to the phobias, and generally enhances coping skills and motivation to persevere with treatment programs.
Behaviour therapy
Behaviour therapy is derived from learning theory, which proposes that behaviour consists of a series of learned responses. Phobias are seen as maladaptive learned responses which are able to be corrected by learning new ways of responding. Behavioural therapy generally begins with training in anxiety reduction, such as muscle relaxation and meditation. This training is then used in combination with other techniques such as desensitisation - gradual exposure to the feared situation together with relaxation, or flooding - non-gradual and full exposure to the feared situation. These procedures are based upon the principles of exposure and response-prevention and have proved particularly effective in the treatment of phobias. Other behavioural therapy techniques include modelling, self-assertion training and thought-stopping.
Cognitive therapy
Cognitive therapy is often used in combination with behaviour therapy. It is based upon the assumption that irrational patterns of thinking contribute to maladjustment and an inability to apply a rational approach to problems. Cognitive therapy aims to help the phobic person reassess their fears using rational and positive thinking.
Psychotherapy
Psychotherapies focus upon the psychological procesess at work in the individual, and generally explore these processes in relation to the person's life history and relationships. Psychotherapy on its own generally does not lead to relief of phobic symptoms, however it may be a helpful adjunct to cognitive behaviour therapy if the onset of the phobia is related to trauma, or if the current life situation is contributing to increased stress, anxiety and depression.
Pharmacological treatments
Pharmacological treatments may assist an individual to achieve a reasonable level of functioning, and ease anxiety and depressive symptoms to enable a greater capacity to learn and change. Due to the high level of anxiety which phobic people experience, tranquillisers are often the drug of first choice. Tranquillisers are an addictive drug and should only be used for very short periods.
- Mali, D. (1987). Phobias. Journal of the Australian National Association for Mental Health, 1(18), pp 5-11. [back]
- Mali, D. (1987). Phobias. Journal of the Australian National Association for Mental Health, 1(18), pp 5-11. and Pasnau, R.O., & Bystrinsky, A. (1990). An overview of anxiety disorders. Bulletin of the Menninger, 54(2), 157 - 170. [back]
- Mitchell, R. (1982). Phobias. New York: Penguin Books. [back]