The Fear Factor

Finding help for phobias

Valerie Greene* was fully aware that flying is one of the safest methods of travel. She’d actually flown for a number of years before debilitating anxiety symptoms struck in her early 20s. 

The increased security measures following 9/11 added to her anxiety about flying, but it wasn’t until she missed her sister’s wedding because she couldn’t make herself board a plane that Valerie had to admit she had a problem that was affecting her life.  

Aerophobia, the fear of flying, is a phobia that affects approximately 6.5 percent of the world’s population. Until the wedding disaster, Valerie did what most people do to “deal” with their phobias: She simply avoided flying.  

Avoidance Is Common

“The reality is that most people don’t go to mental health providers to seek professional treatment for phobias. Their ‘solution’ is to deal with their phobias by avoiding the things/situations that cause them anxiety,” notes Donald J. Baracskay II, MD, MBA, MSCIS, chief executive officer and medical director at The Centers (thecenters.us), a private, non-profit organization with two locations in Citrus County and two in Marion County. 

According to the National Institute of Mental Health, an estimated 6.3 million American adults are affected by specific phobias. Somewhat more common in women than in men, phobias that arise in adulthood often come on suddenly and tend to be longer lasting than childhood phobias, which often disappear over time. In adults, the majority of phobias don’t go away without treatment.

The word “phobia” comes from the ancient Greek word “phobos,” which means “fear.” In general, “phobia” refers to an excessive or irrational fear that causes anxiety symptoms by experiencing or even just thinking about a certain thing or situation. Physical symptoms can resemble a classic panic attack and may include increased heart rate, shortness of breath, choking feeling, sweating, upset stomach/nausea, diarrhea, trembling or shaking, numbness or tingling sensation and dizziness or lightheaded feeling.

People may experience similar anxiety symptoms due to very different types of phobias. Animal phobias (fear of snakes, spiders, dogs, etc.) are the most common specific phobias. There are also situational phobias (fear of flying, being in a closed-in space, driving over a bridge, etc.) and natural environment phobias (fear of heights, storms, water, etc.)

What Causes Phobias   ?

It’s easy to understand how someone might develop claustrophobia if they were locked in a closet while playing hide-and-seek as a child or cynophobia if attacked by a dog. Indeed, some phobias are the result of a traumatic experience. 

In the case of the hide-and-seek or dog attack traumas, if the person receives intervention and treatment promptly, this may prevent them from developing an actual phobia.

There are cases when a person can develop a phobia because of an experience and also develop post traumatic stress disorder (PTSD), but Baracskay points out that a phobia and PTSD are two very different things and can require different treatment. 

Some phobias can develop from learned behavior. For example, let’s say a child is raised by a parent who has an extreme fear of spiders, which happens to be one of the most common animal phobias worldwide. If that child is repeatedly warned about the dangers of spiders and witnesses the parent’s ongoing fear and anxiety, the child is likely to respond with fear and may develop arachnophobia, which is the fear of spiders and other arachnids, such as scorpions.

Parents should realize the importance of helping children cope with fears, rather than reinforce or avoid them. Don’t make light of fears and scary thoughts, and never ridicule a child for having them. 

Model positive behavior so children can learn how to work through fears. For example, if your child is frightened of a friendly dog, don’t reinforce that fear by avoiding the animal entirely. Show the child how to engage the dog in a safe manner and praise even small acts of mastering fear.

Talk to your pediatrician if your child’s fears continue to be excessive or interfere with normal activities.

Diagnosis and Treatment

You may have a strong dislike of snakes and avoid them at all costs, but that doesn’t necessarily mean you have ophidiophobia (fear of snakes). 

Baracskay explains that the distinction between an actual phobia and just having a general dislike or fear of something is that with a phobia you not only take extreme measures to avoid the thing/situation, but you have distressing anxiety symptoms if you can’t avoid it or even if you think about it.

Diagnosis of phobias typically involves taking the patient’s medical and psychiatric history as well as an exam to rule out any physical conditions/illness that might be causing/contributing to the fears and anxiety. A mental health provider can then use clinical interviews and assessments to evaluate a specific phobia and determine the best course of treatment, which typically includes a combination of cognitive behavioral therapy, visualization exercises or relaxation techniques.

The cognitive behavioral therapy used to treat phobias usually involves systematic desensitization or exposure and response prevention (ERP) therapy, during which the patient is gradually exposed to the thing/situation that frightens them until they are able to deal with it calmly. For some people, visualization is helpful, as they “see” themselves dealing with various aspects of the thing/situation and, especially, visualizing themselves after having successfully dealt with the issue. 

Relaxation techniques (deep breathing, pressing your fingertips together, closing your eyes and repeating a specific calming word, etc.) can reduce anxiety symptoms by helping the patient focus on mentally and physically relaxing.

There is presently no medication that is U.S. FDA-approved to treat phobias. When someone has a situational phobia, such as fear of flying or claustrophobia, the health care provider may recommend temporarily taking a benzodiazepine, such as Xanax or Ativan, which are sedative-hypnotic, short-acting drugs that can help reduce anxiety caused by the person anticipating the situation. This can be useful when someone has to confront their phobia for one specific time, say, taking a flight to an important event. These medications don’t deal with the phobia itself, only the anxiety symptoms brought on by the phobia.

“As a psychiatrist, I don’t recommend using drugs as the primary treatment for phobias,” says Baracskay. “Even if you try to use antidepressant drugs to deal with the resulting anxiety symptoms, in my opinion the risks outweigh the benefits because the patient is having to take medicine every day for a phobia, which may only cause anxiety symptoms for a few minutes a month. Also, many of these drugs have side effects and are addictive.”

Baracskay explains that when dealing with mental health issues, a complete “cure” may not be the ultimate goal so much as the person being able to live a normal life.

“If someone is spending an inordinate amount of time avoiding something because of a phobia, that’s not having a normal life,” he notes. “They can get therapy and find themselves where the phobia is no longer controlling them and impairing their life. The real question is not whether they’re completely ‘cured’ but whether they can live a life of quality without the thing they fear causing significant impairment. If they can’t avoid the thing/situation, learning how to tolerate it may be the ‘cure.’”

Baracskay recalls that when he was doing his residency at Cleveland Clinic, there was a patient who sought help due to overwhelming obsessive compulsive behaviors, in particular, excessive cleaning due to fear of germs.

“When he came to the clinic, this individual was spending up to 22 hours a day compulsively cleaning and sterilizing items,” says Baracskay. “With treatment, his behaviors were reduced to about nine hours a day, but that’s still not living a ‘normal’ life.”

In most cases, specific phobias can be successfully treated. (It should be noted that social phobias are a distinctly different phenomenon from phobias about a specific thing/situation and require different treatment methods.)

As Baracskay noted, most people with phobias don’t seek professional help, but that doesn’t mean other help isn’t available.

“There are many self-help books on getting over fear of fill-in-the-blank,” he says, noting that some such books can teach techniques on dealing with phobias. He adds that chat rooms and online support groups are also available, and people may find these beneficial.

Flying Fearlessly

Let’s catch up with Valerie. After 10 years of no flying (and missing her sister’s wedding), she decided to confront her phobia with professional help.

She also had an incentive: Her husband had raised the idea of an overseas vacation, and Valerie really wanted to go, even though it meant getting on a plane. Rather than just take medication to “get through” the flights, she decided to seek therapy to overcome her phobia.

Over the course of six sessions, Valerie worked with the therapist using systematic desensitization and visualization. The therapist also helped her create a series of relaxation techniques to employ when she felt anxiety rising.

Eventually, Valerie was able to visualize herself going through each step of the process, from packing, arriving at the airport and going through security to then boarding the plane, taking off and landing. Any time anxiety arose during the visualization process, the therapist walked her through using her relaxation techniques to regain a feeling of calmness and emotional control. With practice and repetition, Valerie was able to return to a relaxed state more quickly.

Valerie and her husband did indeed take that overseas vacation. She later reported to her therapist that she was able to maintain a feeling of calm throughout the flight.  

*name has been changed to protect privacy

Top 10 Phobias

  1. Arachnophobia: fear of spiders
  2. Ophidiophobia: fear of snakes
  3. Acrophobia: fear of heights
  4. Agoraphobia: fear of open or crowded spaces
  5. Cynophobia: fear of dogs
  6. Astraphobia: fear of thunderstorms
  7. Claustrophobia: fear of small spaces
  8. Mysophobia: fear of germs
  9. Aerophobia: fear of flying
  10. Trypophobia: fear of holes
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