What type of treatment is most effective for phobias? Does the treatment change based on the specific phobia?
The most effective treatment for phobias is a specific form of Cognitive Behavioral Therapy known as exposure therapy. Exposure therapy involves gradually exposing a person to a particular stressor in a safe and systematic manner in order for that person to desensitize to the perceived threat. By encouraging a person to face fears through this type of active treatment approach, you are empowering them to live life in a more optimal way without the typical avoidance that usually accompanies these phobias.
Treatment is specifically tailored to each individual, based on symptom presentation, triggers, and phobia types. Sometimes in vivo exposures (real life exposures) are used and sometimes imaginal exposures (mental visualizations) are used. Systematic desensitization is a method whereby relaxation techniques are used in combination with exposures to help the individuals mitigate anxiety starting with the least triggering stimuli and graduating to the most feared stimuli. Medication may be used to facilitate treatment or give instant relief when necessary.
What are examples of some common phobias you have treated?
I have treated a wide array of phobias including fear of city pigeons, kitchen knives, heights, water, insects, dogs, needles, blood, vomit, sounds, elevators, planes, death, the phobia of public speaking, etc. It is important to understand the exact nature of the fear in order to implement exposure therapy in the most effective way.
What does it feel like to have a phobia?
When a person is having a phobic response, they generally experience intense physical symptoms similar to what one would experience with a panic attack. A person’s heart rate might increase, their mouth might become dry, hands may excessively sweat, the body might tremor, there might be nausea, dizziness or a sudden urge to urinate. A person will have an intense urge to avoid the trigger that is causing them to feel phobic.
What is the difference between a phobia and a fear?
A fear is a natural protective instinct in which the nervous system appropriately warns us of the potential for danger. If the said fear significantly impacts one’s functioning and is irrationally exaggerated, it can become a full blown phobia. The phobic person is likely to avoid the perceived threat, which in turn causes disruption in one’s personal or professional life.
What are some examples of success stories where people were able to overcome a particular phobia?
I treated a woman with a severe snake phobia. She had debilitating fear reactions from merely seeing a toy rubber snake. Through gradual exposure exercises including education about snakes, images of snakes, videos of snakes and then attending a reptile exhibit and holding a snake, she was able to effectively control her nervous system response and overcome her phobia.
A man sought out treatment to help overcome his fear of choking on food. This fear of swallowing is known as phagophobia. He had lost 20 lbs within a few months due to avoidance of solid foods. His fear started with an uncomfortable sensation in his throat. As he became progressively more concerned about choking, he stopped eating most solid foods and relied solely on liquids for nutrients. Through an effective course of CBT treatment, this young man graduated from a liquid diet to small thoroughly chewed bites to a full return of his prior eating habits.
A middle aged man with a fear of needles required medical attention for an untreated condition. Just like his father, he had a long history of vasovagal syncope which is a condition in which the blood pressure and heart rate drop suddenly, leading to a loss of consciousness. His fainting was triggered by needles, blood, or even the mere mention of a medical intervention.
After a few months of CBT treatment, this gentleman was successfully able to get a physical examination including a full panel blood test followed by a colonoscopy without fainting. His general practitioner who had known him to pass out at nearly every visit was very pleased with his ability to stay calm and conscious.
Are there any phobias that cannot be treated?
There are some complex phobias that tend to be more resistant to treatment and there are certain treatments that are not effective in treating phobias. In these cases, some people opt to use medication to help manage their phobias.That said, phobias are generally treatable.
People can learn to manage their fear responses through the use of frequent and comprehensive exposure therapy, diaphragmatic breathing exercises, and believing in their own abilities to overcome their fears.
What type of person is most prone to developing phobias?
Phobias are more likely to develop based on genetics, specific sensitivities, negative life experiences, and challenges in physical or emotional health rather than someone’s personality type. A phobia can also develop as a result of a learned response. Women are typically at increased risk for developing phobias.
At what age are phobias most likely to develop?
Phobias can emerge at any stage in life. For instance, I have seen people who develop a sudden fear of public speaking after having been avid public speakers for years. One negative experience can shake someone’s confidence, setting off a perpetual cycle of fear and avoidance.
Most phobias will emerge in early childhood and some will develop in the adolescent years. Some phobias may resolve on their own due to maturation or the eventual removal of the trigger while others will persist without proper intervention.
Dr. Suzanne Feinstein is a Columbia University-trained Clinical Psychologist who specializes in evidence-based treatments such as Cognitive Behavioral Therapy to help people with a wide array of phobias and anxiety disorders. She uses Exposure Therapy and Response Prevention (ERP), mindfulness, meditation, cognitive reframing, and other techniques to help people get over their phobias.