Everyone’s afraid of something. In fact, the most common fears we all share appear to be encoded in our brains due to their high relevance for our survival! But sometimes a fear can start to take over your life, and at Midpoint Counseling we know how challenging and debilitating phobias can be. Understanding how a specific phobia becomes problematic and what maintains it is important to learning how to break free from it. Let’s look at how it may be affecting you and what you can do about it.
QUICK FACTS
- Phobias are an excessive fear response to an object or situation that leads to unnecessary avoidance and interference with life.
- Specific phobias are considered the most prevalent of all anxiety disorders, affecting tens of millions of people in the U.S.
- Phobias are typically learned reactions that are also influenced by genetics and temperament.
- Building tolerance of uncertainty and uncomfortable feelings are important targets for improvement.
CLARIFYING COMMON ANXIETY TERMS
The Difference Between Fear and Phobia
Fears are emotional reactions to immediate identifiable threats that are important for self-preservation.
► Within normal limits, fear sharpens our senses and drives us toward actions that increase safety. But if it becomes too strong, fear overwhelms the body and leads to panic or dissociation. Despite their distressing nature, these may still be appropriate reactions if the threat of harm is imminent. The pounding heart, shaking muscles, and other physical changes all move your body toward some type of survival behavior.
Phobias are specific fears that are considered excessive and out of proportion to the situation.
► They lead to avoidance when avoidance is unnecessary, and the distress interferes with some aspect of your life that’s important and relevant. In this way, phobias are maladaptive and without the survival value that normal fears have.
HOW PHOBIAS ARE CLASSIFIED IN PSYCHOLOGY
5 Categories of Phobias
There are currently 5 categories that encompass a variety of specific phobias. Below is an outline of each category and a few examples of phobias within them.
Animals
- Dogs
- Snakes
- Spiders
- Rodents
- Insects
Natural Environment
- Storms
- Open water
- Heights
- Darkness
Situational
- Flying
- Driving
- Elevators
- Crowds
- Bridges
- Public speaking
Blood / Injection / Injury
- Needles
- Blood
- Medical procedures
Other
- Choking
- Vomiting
- Loud noises
- Being alone
- Clowns
Different phobias tend to cluster together, and according to the American Psychiatric Association, about 75% of people meeting the criteria for one specific phobia will also meet the criteria for another.1
If you’re in Washington state and have been struggling with a phobia, reach out today for more info.
HOW PHOBIAS TAKE ROOT OVER TIME
The Development of Phobias
Specific phobias are the most widespread of all the mental health disorders.
About 12.5% of adults in the U.S. will experience a clinically significant phobia at some point in their lives.2
That percent rises to 40% when mild or subclinical phobias are included, with many people reporting fear of specific objects or situations.
This is the result of the brain’s natural fear circuitry attempting to work to keep us safe. The amygdala, which we can think of as the “fear center” of the brain, appears to have certain universal threats to human safety hard-wired into it. This is one reason we share so many common fears, such as venomous animals, risks of falling or suffocating, and risks of being judged or outcast from a group.
Phobias tend to develop early.
The peak ages for specific phobias are between ages 10-13, with the average age of onset being around ages 7-8.3
Age 7 is when the brain has developed enough to understand the difference between real and pretend. Fears shift from things like monsters in the closet to threats that could affect them in the real world, such as natural disasters, aggressive animals, or receiving shots at the doctor. The older a child gets and the more they start to engage in the world, the more situational the type of phobia appears to become.4
These worries are often a normal part of how the brain grows and matures. Children typically “grow out” of certain anxieties as their cognitive abilities develop. But they can become problematic if the fear emerges too often, to intensely, or for too long in response to a perceived threat and gets in the way of doing age-appropriate activities.
TURNING FEAR INTO PHOBIA
The Causes of Specific Phobias
The exact origins of specific phobias aren’t fully understood, but we do know that they’re linked to interactions between genetic vulnerabilities and interactions with the environment.
There are four factors that contribute to the development of a phobia.
1. Temperament
Childhood temperament is the precursor to the adult personality. It involves several dimensions such as how emotionally reactive you are, how active you are, and how sociable you are.
About 10-15% of children are predisposed to be fussy, irritable infants; shy, fearful toddlers; and cautious, quiet, and introverted into childhood and adolescence.5, 6, 7 Children with these temperaments are significantly more likely to have a specific phobia compared to children who don’t possess such qualities (31.8% versus 5.3%).8
2. Observation
Learning by watching the behavior of others is one way phobias can start to develop. The facial expressions, emotional reactions, and behavior of others provide information about how to interact with the world around us. It may not directly involve us, but the proximity can still affect our lives.
For example, it’s easy to learn that spiders are to be fearfully avoided because our observations of others’ behaviors around spiders are often consistently fearful.
3. Experience
Direct learning based on the rewards and punishments we receive in response to our own behavior is another way phobias can develop.
We may have genetic vulnerabilities to problems managing fear and anxiety, and we may have common threats to humanity preinstalled, but it is our personal experiences that ultimately influence what our bodies do when faced with risky, threatening, or ambiguous situations. If something happens to you directly, your brain is going to hold onto that experience much more closely than if it happened to someone else.
For example, if you were bitten by a spider, your brain is going to encode a memory that includes pain, fear, and anger. This is going to be a much stronger memory than seeing it happen to someone else, making the fear response to another spider more robust!
4. Language
Learning by following instructions in order to avoid a negative consequence is a final way that phobias can develop. These are rules we follow without necessarily having personal experience with the consequences.
For example, this would be if a parent instructed you not to go near that spider. You now have a rule encoded in your memory that says: “Spiders are things to be avoided.” But this is likely the least robust in terms of influencing phobias because there’s relatively little emotional significance compared to learning through observation or direct experience.
It’s a combination of all these factors that ultimately contribute to the development of a phobia that can be hard to shake off.
Midpoint Counseling offers virtual and in-person appointments to adults in Washington State struggling with specific phobias. Reach out for more information.
PROVEN APPROACHES TO PHOBIA TREATMENT
3 Targets for Treating Specific Phobias
There are three core targets for treating specific phobias. These targets are less about reducing the experience of fear and more about helping you stop the patterns of avoidance that maintain it. People who work to let go of avoidance as a strategy and aim for these targets instead are much more likely to regain the sense of flexibility in their lives that has been lost.
1. Build your tolerance for uncertainty.
The goal here is flexibility that allows you to continue doing meaningful things without needing to have all the answers. When you don’t have this, life becomes about eliminating ambiguity, rigidly controlling situations, fixating on negative possibilities, and over-preparing to prevent their occurrence. Intolerance of uncertainty and overestimations of risk are at the heart of most issues with anxiety and why they’re so important to bring within healthy limits.
2. Increase your tolerance for discomfort.
This refers to your personal threshold for being with uncomfortable physical sensations and impulses before interpreting them as bad and in need of elimination. The lower the threshold, the more fixated you’ll be on signals from your body and thoughts about risk, rather than building mastery over the situation that caused the trouble. This continues the cycle of avoidance in order to achieve short-term relief but ultimately maintains the phobia.
3. Strengthen your confidence in your abilities.
Difficulties navigating feelings of uncertainty and physical discomfort can naturally bring doubt to your abilities to cope. But with phobias, the idea is not to cope with your fear, but to deliberately allow and invite feeling fearful. This target is somewhat counterintuitive because it refers to a confidence in your body’s ability to contain emotional and physical discomfort without resorting to unnecessary and unhelpful coping strategies. This is a natural byproduct of success with the previous targets to risk new healthy behavior.
RELIEF STARTS WITH THE RIGHT SUPPORT
How Therapy Can Help with Specific Phobias
Phobias can be tough to manage on your own! That’s where the help of a trained therapist comes in. While there are many approaches to these problems, some have more evidence supporting their efficacy than others.
CBT and ERP are currently considered the most effective treatments for phobias.9
Cognitive Behavioral Therapy (CBT) consists of scientifically informed interventions that address unhelpful beliefs, perceived inabilities to cope, and patterns of behavior that can keep you feeling stuck.
Exposure and Response Prevention (ERP) is a type of cognitive behavioral therapy that focuses on willingly facing triggering situations while refraining from doing whatever you would normally do to protect yourself from fear. This is done with the guidance of a mental health professional to engage in realistic tasks, with manageable steps, in a systematic way, and consistently over time.
Following these steps helps to gradually invite situations that trigger discomfort without becoming flooded and overwhelmed. It creates opportunities to associate feared situations with a lack of danger and a confidence in being with uncertainty and other uncomfortable feelings. This new learning is considered to inhibit old fearful thoughts in order to break free from unhelpful coping strategies.
SETTING THE RIGHT INTENTION FOR TREATMENT
Three Cs for Successful Exposures
Calm. You have to be calm enough to pull it off. This doesn’t mean feeling completely calm, but rather not losing your edge due to catastrophic thinking or being unable to breathe.
Competent. You need the skill base to do it so that you know exactly what to do when the uncomfortable thoughts and feelings start to emerge.
Confident. You need to have some expectation of success. This involves preparation and coping ahead, role playing, rehearsing, and practicing.
GETTING THE MOST OUT OF EXPOSURE WORK
Optimizing Exposure Therapy
The goal of ERP is not to eliminate anxiety, but to stay in the situation until fully violating your expectation of something intolerably bad happening. Here are some questions to ask yourself before and after each exposure practice.
Questions to Ask Before
- What do you expect will happen?
- What do you expect this will feel like?
- How high do you think your distress will be?
- How well do you think you’re going to be able to manage that?
- Do you think you can tolerate that and choose to do this and still be standing at the end?
Questions to Ask After
- Did anything surprise you?
- What did you notice that you didn’t expect?
- What was your experience not acting on rituals?
- Did you notice a greater tolerance for uncertainty?
- What can you take from your experience in this situation that you can apply next time?
Exposure therapy creates opportunities to test your beliefs about what might happen.
This can't be done by simply thinking your way through it. You need to go and face what’s been avoided with a curious attitude and a willingness to learn through experience.
CREATING NEW MEMORIES OF SUCCESS
The Role of Learning in Phobia Recovery
If you face a triggering situation prepared to have a positive experience, old memories can be changed! But the circuitry in your brain that holds the memory of the fearful experience must be activated to do so.
You have between 10 minutes and 6 hours to have a better, more successful experience.
This is the time during which memories appear to be less stable and more susceptible to change after they’ve been retrieved.9
This is how exposure treatments work. New memories of successful experiences become encoded with the original fear cue. The more healthy and successful behaviors are rehearsed, the more the brain reconsolidates memories as less dangerous and more manageable. But you have to have the right attitude of willingly moving toward the uncomfortable situation in order to learn something new, rather than willfully pushing away.
FINDING SUPPORT
Break Free From Phobias
Breaking free from a specific phobia means aiming for new targets. A new approach and a new mindset can help bring fear and anxiety that’s gotten out of hand back under healthy control. If you’ve been struggling with a phobia and having a hard time doing the things you want to be doing, consider reaching out to us at Midpoint Counseling. We’re here to help you find greater balance and freedom from fear.
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Schiller, D., Monfils, M. H., Raio, C. M., Johnson, D. C., Ledoux, J. E., & Phelps, E. A. (2010). Preventing the return of fear in humans using reconsolidation update mechanisms. Nature, 463(7277), 49-53. https://doi.org/10.1038/nature08637
Jason Peruchini, LMFT
Jason Peruchini is a licensed psychotherapist and anxiety treatment professional who helps people address issues in mental health to live better lives.
