Confronting Your Phobias

Last Editorial Review: 1/31/2005

Being afraid is natural, but irrational fear of harmless things is not. With therapy, almost anyone can get over their phobias.

By Carol Sorgen
WebMD Feature

Reviewed By Michael Smith

Refuse to fly? Can't drive across a bridge? Will do anything to avoid speaking in public? You, like millions of others, may be suffering from a phobia. The bad news is -- as you know all too well --that phobias are uncomfortable and can disrupt your life. But the good news is that phobias are not dangerous, and what's more important, they can be cured.

In "doctor-speak," a phobia is an irrational or excessive fear of a situation or a particular object, says Michael Kahan, MD, a psychiatrist who specializes in the treatment of phobias at Hillside Hospital, part of North Shore-LIJ Health System in New York.

Being afraid of something is not the same thing as a phobia, says Kahan. "Many people are afraid of snakes, for example, but it's not a phobia if it doesn't interfere with your life or sense of well-being," he explains.

Phobias can be classified by category, says Kahan: specific and social. Specific phobias are fears of such things as animals -- snakes, mice, dogs, cats, insects are particularly common -- heights, bridges, and elevators. Between 6% and 12% of people in the U.S. suffer from a specific phobia.

Social phobias -- which afflict more than 13% of the population -- have to do with the fear of such situations as public speaking, stage fright, and meeting new people.

Social phobias are frequently overlooked by healthcare professionals, says clinical psychologist Barbara Markway, PhD, author of Painfully Shy: How To Overcome Social Anxiety and Reclaim Your Life. So it may be up to you to determine if that could be causing your discomfort. Markway suggests asking yourself the following questions:

  • Do you literally become "sick with fear" at the thought of being in certain social or performance situations (such as speaking in public, participating in class, attending meetings, meeting strangers, going to parties, dating)?
  • When did you first begin feeling this way?
  • How much does it affect your everyday life?
  • Do you have any other conditions, such as depression, that frequently go hand-in-hand with phobias and anxiety?

If it looks like social anxiety is a chronic problem that is limiting your activities, you should seek treatment, says Markway, as she herself did when she first realized that she suffered from social anxiety.

In the meantime, says Markway, there are a few tips you can follow on your own:

  • Accept yourself. Don't worry about what others are thinking of you. "There's a place in the world for people who are thoughtful and quiet," says Markway.
  • Go with the flow. If your heart is racing and you're short of breath, realize that it's just anxiety. "It's uncomfortable, but it's not life-threatening," Markway says.
  • Face your fears. Set small goals for yourself. Go to a party. Raise your hand in a meeting. Ask a friend to lunch. "What's the big deal if it doesn't go as planned?" Markway asks.

Anxiety disorders (including social anxiety) can lead to another kind of phobia, known as agoraphobia, says Julian Herskowitz, PhD, director of the TERRAP Anxiety and Phobia Program in Huntington, N.Y. Contrary to popular thought, says Herskowitz, agoraphobia is not the fear of leaving home or the fear of open spaces -- as it's frequently defined -- but is really the fear of having another panic attack, that sudden rush of anxiety that can strike you out of the blue and that frequently leads to your avoiding the type of situation in which you first had the attack -- perhaps at the supermarket or in the car.

Phobias can strike anyone, says Kahan, although there is some indication that if someone in your family suffers from a phobia, you will be more likely to develop one yourself.

People with phobias also tend to be more excitable, more sensitive, and more reactive to stimuli, says Herskowitz. They also are likely to be perfectionists, have a strong need for approval, a desire to be "in control," and suppress their feelings, especially of anger and sadness. Being the victim of abuse, having overprotective parents, and growing up in a rigid household may also lead to phobias, but understanding what causes the problem does little to solve it.

That's where treatment comes in. As a rule, 80% to 90% of people who suffer from phobias recover with the proper therapy, says Kahan. The treatment approach that has been proven most effective is cognitive behavioral therapy, combined with medication (antidepressants or antianxiety drugs) if necessary.

During cognitive therapy, the phobic person is taught how to correct his or her thinking, says Kahan. "The degree of fear that a person with a phobia has is distorted. Cognitive therapy retrains the thought process."

"In cognitive behavioral therapy, you learn how to change the way you think instead of fighting how you feel," says Herskowitz.

The behavioral component involves learning to relax, Kahan says, which will calm the physical sensations (shortness of breath, rapid heartbeat, lightheadedness) that the phobia may give rise to.

Effective breathing techniques can also help you calm those troubling physical sensations. Herskowitz offers this suggestion:

  • Breathe in through your nose, expanding your diaphragm, to the count of four.
  • Breathe out slowly through your mouth to the count of seven.
  • Hold for two seconds.
  • Repeat the exercise.

Taking a brisk walk will also help you burn extra oxygen and restore your body's equilibrium, Herskowitz says.

Therapy has also gone high-tech, says Kahan, with the use of virtual reality technology. Part of therapy, he explains, is to expose the phobic person to the phobia in gradually increasing doses -- taking the elevator one flight, for example, then the next time, two flights, and so on. When it's not practical to do this -- such as flying on a plane -- a virtual reality system that uses computer technology, specially designed software, and a headset can simulate the real thing.

The length of time you may spend in therapy can range from three months to two years, says Herskowitz, depending on the severity of the phobia. Though there can be setbacks later on during stressful times, the relapse rate is low.

Although seeking professional help is highly recommended, if you want to help the process along, Herskowitz says, learn as much as you can on your own. Lucinda Bassett and Claire Weekes are two authors he particularly recommends for their books on coping with anxiety disorders and phobias.

"The more you know," says Herskowitz, "the less you imagine."

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