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Phobias:
Causes and Treatments Erin
Gersley November
17, 2001
Phobia
(FO-bee-ah): a persistent irrational fear of an object,
situation, or activity that the person feels compelled to
avoid. (Wood 689) And that is only the start of it. Phobias
can interfere with your ability to work, socialize, and go
about a daily routine (American). People who have phobias are
often so overwhelmed by their anxiety that they avoid the
feared objects or situations (NIMH). For most people,
the simple pleasures of life are striped from them. Symptoms
of a phobia include the following:
·
Feeling
of panic, dread, horror, or terror
·
Recognition
that the fear goes beyond normal boundaries and the actual
threat of danger
·
Reactions
that are automatic and uncontrollable, practically taking over
the persons thoughts
·
Rapid
heartbeat, shortness of breath, trembling, and an overwhelming
desire to flee the situation all the physical reactions
associated with extreme fear
·
Extreme
measures taken to avoid the feared object or situation
(American)
There
are three classes of phobias: agoraphobia, social phobia, and
specific phobia (Wood 521). Agoraphobics have an intense
fear of being in a situation from which immediate escape is
not possible or in which help would not be available if the
person should become overwhelmed by anxiety or experience a
panic attack or panic-like symptoms (Wood 521).
Agoraphobia is the most disabling of all phobias, and
treatment is difficult because there are so many associated
fears (Hall). Specific phobia is a catchall category for
any phobias other than agoraphobia and social phobias (Wood
522). There are four categories of specific phobias:
situational phobia, fear of natural environment, animal
phobia, and blood-injection-injury phobia (Wood 522).
Between these four categories are more than 350 different
types of specific phobias. They range all the way from
cathisophobia-fear of sitting to something as severe as
arachnophobia-fear of spiders. For people with social phobia,
however, the fear is extremely intrusive and can disrupt
normal life, interfering with work or social relationships in
varying degrees of severity (NIMH).
Approximately
4 to 5% of the U.S. population has one or more clinically
significant phobias in a giving year (NIMH). Specific phobias
affect an estimated 6.3 million adult Americans and are twice
as common in women as in men (About). The average age of
onset for social phobia is between 15 and 20 years of age,
although it can begin in childhood (NIMH). Childhood phobias
usually disappear before adulthood. However, those that
persist into adulthood rarely go away without treatment
(American).
Many
psychologists believe the cause lies in a combination of
genetic predisposition mixed with environmental and social
causes (Hall). Some believe that
neurotransmitter-receptor abnormalities in the brain are
suspected to play a part in the development of social phobias
(Hall). Neurotransmitters are substances such as
norepinephrine, dopamine, and serotonin that are released in
the brain (Hall). Disorders in the physiology of these
neurotransmitters are thought to be the cause of a variety of
psychiatric illnesses (Hall). It has also been
demonstrated that identical twins may develop that same type
of phobia, even when they were reared separately soon after
birth, and educated in different places (Masci). It may
by also true that human beings are biologically prone to
acquire fear of certain noxious animals or situations, such as
rats, poisonous animals, animals with disgusting appearance,
such as frogs, slugs or cockroaches, etc.(Masci) But phobias
are not always destined in our genes.
In
a classical experiment, the American psychologist
Marting Seligman associated an aversive stimulation
(a small electric shock) to certain pictures (Masci).
Two to four shocks were enough to establish a phobia
to pictures of spiders or snakes, while a much larger
series of shocks was needed to cause phobia to pictures
of flowers, for example (Masci). One possible
explanation is that those fears where originally important
for the survival of the human species thousands of
years ago and that they lie dormant inside our brains,
just waiting to be awaken at any time (Masci).
Another reason for the development of phobias is that
we often associate danger to things and situations
that we cannot prevent or control, such as lightning
strikes during a storm, or the attack of a dangerous
animal (Masci). In this sense, patients who
have clinically-established panic disorder, often
end developing phobia to their own crisis, because
the feel totally helpless in controlling it (Masci).
In consequence, they start avoiding going to or staying
in places or situations where they might become publicly
embarrassed or unable to escape, due to the onset
of the crisis (Masci).
Traumatic
events often trigger the development of specific phobias,
which are slightly more prevalent in women than men (NIMH).
Negative social experiences, such as being rejected be peers
or suffering some type of embarrassment in public, and poor
social skills also seem to be factors, and social phobia may
be related to low self-esteem, lack of assertiveness, and
feeling of inferiority (Hall). Many people with social
phobia are so sensitive to the scrutiny of others that they
avoid eating or drinking in public, using public restrooms, or
signing a check in the presence of another (Hall).
Social phobia may often be associated with depression or
alcohol abuse (Hall).
Finally,
there is also the social component or cultural influences on
phobia (Masci). For example, there is a kind of phobia
called taijin kyofusho, which occurs only in Japan (Masci).
In contrast to what happens in the social phobias (when the
patient is afraid of being humiliated or loathed by other
persons), taijin kyofusho is the fear of offending other
persons by an excess of modesty or showing respect! (Masci).
The patient is afraid that his social behavior or an imaginary
physical defect might offend or embarrass other people (Masci).
Fortunately effective relief can be gained through either
behavior therapy or medication (American).
One
of the most successful treatments is behavior therapy. In
behavior therapy, one meets with a trained therapist and
confronts the feared object or situation in a carefully
planned, gradual way and learns to control the physical
reactions of fear (American). The behaviorists involved in
classical conditioning techniques believe that the response of
phobic fear is a reflex acquired to non-dangerous stimuli
(Phobia). The normal fear to a dangerous stimulus, such
as a poisonous snake, has unfortunately been generalized over
to non-poisonous ones as well (Phobia). If the person
were to be exposed to the non-dangerous stimulus time after
time without any harm being experienced, the phobic response
would gradually extinguish itself (Phobia). In other
words, one would have to come across ONLY non-poisonous snakes
for a prolonged period of time for such extinction to occur
(Phobia). This is not likely to occur naturally, so
behavior therapy sets up phobic treatment involving exposure
to the phobic stimulus in a safe and controlled setting
(Phobia). Foa and Kozak call this exposure treatment, so
called because the patient is exposed to the phobic stimulus
as part of the therapeutic process (Phobia).
One
simple form of exposure treatment is that of flooding, where
the person is immersed in the fear reflex until the fear
itself fades away (Phobia). The key is keeping the
patients in the feared situation long enough that they can see
that none of the dreaded consequences they fear actually come
to pass (Wood 548). Some patients cannot handle flooding
in any form, so an alternative classical conditioning
technique is used called counter-conditioning (Phobia).
In this form, one is trained to substitute a relaxation
response for the fear response in the presence of the phobic
stimulus (Phobia). This counter-conditioning is most
often used in a systematic way to very gradually introduce the
feared stimulus in a step-by-step fashion known as systematic
desensitization, first used by Joseph Wolpe (Phobia).
In
desensitization, three steps are involved:
1.
Training the patient to physically relax
2.
Establish an anxiety hierarchy of the stimuli involved
3.
Counter-conditioning relaxation as a response to each
feared stimulus beginning first with the least anxiety
provoking stimulus and moving then to the next least anxiety
provoking stimulus until all of the items listed in the
anxiety hierarchy have been dealt with successfully (Phobia).
Also,
systematic desensitization can be paired with modeling, and
application suggested by social learning theorists
(Phobia). In modeling, the patient observes others (the
model(s)) in the presence of the phobic stimulus who are
responding with relaxation rather that fear (Phobia). In
this way, the patient is encouraged to imitate the model(s)
and thereby relieve their phobia (Phobia). However
relaxation therapy is not the only treatment used in curing
phobias.
Hypnosis
can also set you free of fears and phobias. In mild cases,
where a person recognizes the triggers but would like help
controlling their reaction, posthypnotic suggestions can help
them control their breathing, slow their heart rate, and
achieve a relaxed state of mind (Wizell). This permits
them to deal with the problem in a calm and rational manner (Wizell).
More severe cases are often the result of a traumatic
childhood event (Wizell). Most of the time the event can
no longer be recalled by the conscious mind, but is still
retained in the subconscious (Wizell). In these cases,
the Hypnotherapist will often apply age regression (Wizell).
Age regression is one of the most powerful tool available to
the Hypnotherapist (Wizell). With it s/he can guide the
person back in time, and help them reexamine the event that
initially triggered the fear from an objective point of view (Wizell).
Once the cause is revealed, the fear of losing control is
eliminated (Wizell).
Medications
are also used to control the panic experience during a phobic
situation as well as the anxiety aroused by anticipation of
that situation and are the treatment of first choice for
social phobia and agoraphobia (American). Drugs
prescribed for these short-term situations include
benzodiazepine anti-anxiety agents (Hall). These include
two approved for treating anxiety disorders: Xanax (alrazolam)
and Valium (diazepam) (Hall). Beta-blockers such as
Inderal (propranolol) and Tenormin (atenolol), approved for
controlling high blood pressure and some heart problems, have
been acknowledged, partly on the basis of controlled trails,
to be helpful in certain situations in which anxiety
interferes with performance, such as public speaking (Hall).
In
addition to the anti-anxiety drugs and beta-blockers,
medications may include the monamine oxidase (MAO) inhibitor
antidepressants Nardil (phenelzine) and Parnate (tranylcypromine),
and serotonin specific reuptake inhibitors (SSRIs) such as
Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline),
and Luvox (fluvoxamine)
(Hall). Because there are fewer side effects associated
with these drugs and a very low addiction potential,
practitioners are more comfortable prescribing them
(Hall). Plus, the antidepressant action of these drugs
is helpful is treating patients who suffer from depression in
addition to social phobia (Hall).
Newer
antidepressants are being specifically designed to target
mechanisms that elevate serotonin and other neurotransmitters
in the brain; some showing promise for anxiety are venlafaxine
(Effexor) and nefazodone (Serzone). (Well-Connected) The
antidepressant drugs known as tricyclic antidepressants (TCA)
have also been effective in treating panic and
obsessive-compulsive disorders (Well-Connected). The most
common TCA used for the treatment of panic disorder is
imipramine (Tofranil, Janimine); it is also effective in
treating agoraphobia (Well-Connected). But with proper
treatment, the vast majority of phobia patients can completely
overcome their fears and be symptom free for years, if not for
life (American).
Work
Cited
About.com
Specific
Phobias. http://seniorhealth.about.com/library/men
/bl_anxiety6.htm?iam=savvy&terms=%2Bphobia
American
Psychiatric Association.
Phobias
. http:www.psych.org/public_info/eating.cfm
Hall,
Lynne L. Fighting
Phobias, The Things That Go Bump in the Mind.
http://www.fda.gov/fdac/features/1997/297_bump.html
Masci,
MD Cyro.
Phobia: When Fear is a Disease.
http:www.edub.org.br/cm/n05/doencas/fobias_i.htm
NIMH
(National Institute of Mental Health).
Anxiety Disorders: Quick Facts
http://www.nimh.nih.gov/Anxiety/anxiety/phobia/phqfax.htm
Phobia
List. Treatment for
Phobias.
http://www.phobialist.com/treat.html
Well-Connected.
How is Anxiety Disorder Diagnosed and Treated.
http://my.webmd.com/content/article/1680.5027
Wizell,
Victoria. Hypnosis can set you free of fears and
phobias. http://www.hyptalk.com/Articles/Fears/htm.
Wood,
Samuel E. & Ellen Green Wood.
The World of Psychology: 3rd Edition.
Needham Heights: Viacom, 1999
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