Caring, effective, short-term psychotherapy for Phobias

What is a phobia?

A phobia is a severe anxiety reaction that is triggered by a specific object, location, or situation. It occurs every time, or nearly every time, the person is exposed to the trigger. The anxiety is severe enough so that the trigger is avoided or only endured with severe distress. Some common phobias are:

• elevators
• flying on airplanes
• dentists
• heights
• spiders
• cats
• dogs
• bridges
• hypodermic needles
• public speaking
• eating in public
• using a public restroom

There are two primary phobic anxiety disorder diagnoses: simple phobia and social phobia. Most of the items I've listed are examples of simple phobia. The last two are examples of social phobia. Social phobia tends to be more general, and it really can become a fear of all social situations. Social phobia can sometimes be confused with Panic Disorder with Agoraphobia. Simple phobia is sometimes confused with Post Traumatic Stress Disorder (PTSD).

No one really knows why phobias develop or why some people have a tendency to develop them. Many people have one or another phobia to some degree. They successfully deal with them through avoidance, or by self-medicating with alcohol or tranquilizers when the trigger cannot be avoided. This is especially true with fear of flying in an airplane.

Social phobia tends to be a bigger problem for people than the specific phobias. It can be limited to a particular type of situation, such as public speaking, or it can cover any situation in which unfamiliar people are involved. In rare cases, people become homebound because they cannot manage being in public at all.

Social phobia is persistent, often beginning in the teen years, and lasting throughout adult life. It is distinct from normal shyness or temporary stage fright. It is much more intense, sometimes causing panic attacks. In order to be diagnosed, it must have a significant impact on the person's ability to function.

It is important for friends and family members not to underestimate the intensity of these fears. The level of fear is usually as intense as in a panic attack. There is an immediate pressure to escape the situation by any means necessary.

When a phobia begins to interfere with the person's ability to function or their enjoyment of life, treatment is almost always short-term & effective.

Short-term Therapy for Phobias

Traditional, long-term, depth-oriented psychotherapy is rarely effective in treating either social phobia or the specific phobias. However, symptom-focused, short term, cognitive behavioral therapy (CBT) has an outstanding record for effective treatment. Most people get significant relief, usually in just a few months of weekly sessions.

Phobias are treated through a process called desensitization or exposure with response prevention (ERP). Patients are first taught relaxation techniques that they can use to reduce their anxiety. Their are a variety of techniques, and almost anyone can learn to use them, even in public.

Patients then work with their therapist to develop a list of triggers for their phobia. They rate the items on the list for the amount of anxiety they produce. Here's an example based on fear of spiders:

1. talking about spiders
2. reading an encyclopedia article involving spiders
3. looking at a picture of a spider
4. seeing a video of a spider in the wild
5. seeing a video of a spider near or touching a person
6. seeing a spider in a terrarium in a pet store
7. seeing a spider web in real life
8. seeing a spider web with a small spider in real life
9. seeing a larger spider in real life
10. removing a spider web in real life
11. killing a spider in real life

After having learned to relax, we gradually expose people to the objects they fear, beginning with the easiest ones. At each stage, people learn to handle the exposure. Over a period of a few minutes to an hour, their anxiety subsides and with repetition the exposures become not only tolerable, but actually cease to be anxiety provoking.

Though treatment always starts in the office, for many phobias exposure involves going into the real world. This is especially true with social phobia. We use session time to rehearse exposure to fearful situations often using relaxation and visualization. But the hard work is done between sessions as patients gradually expose themselves to increasingly difficult situations, mastering each of them before they proceed to the next.

Desensitization or ERP is usually effective in less than six months of treatment, even when someone has a long standing problem with social situations.