Phobia: What is it?
Phobia is an extreme or irrational fear that is often persistent. It compels sufferers to avoid a feared
object or situation (Fleming, 2017).
We all get scared. We all experience fear.
But not everything we fear and get scared of develops into a “Phobia”.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) categorized it under Anxiety Disorders, with the name “Specific Phobia”.
When we have a specific phobia, we become afraid, anxious or avoid that particular stimulus (it can be heights, blood, spiders etc), as it causes intense distress for the sufferer (Fleming, 2017).
DSM-V Criteria for Phobia:
The criteria are as follows:
- The individual suffers from a persistent fear that is either unreasonable or excessive, caused by the presence or anticipation of a specific object or situation.
- Exposure to the stimulus usually results in an anxiety response, often taking the form of a panic attack in adults, or a tantrum, clinging, crying or freezing in children.
- The sufferer recognizes that their fear is disproportionate to the perceived threat or danger (not always present in children).
- Individuals take steps to avoid the object or situation they fear, or endure such experiences with intense distress or anxiety.
- The phobic reaction, anticipation or avoidance interferes with the individual’s normal routine and relationships, or causes significant distress.
- The phobia has persisted for a period of time, usually six months or longer.
- The symptoms cannot be attributed to another mental condition, such as obsessive-compulsive disorder or post-traumatic stress disorder.
Specific Types of Phobia (DSM-V):
- Animal Type
- Natural Environment Type (Ex: heights, storms, water)
- Blood-Injection-Injury Type
Situational Type (Ex: airplanes, elevators, enclosed places)
- Other Type (Ex: phobic avoidance of situations that may lead to choking, vomiting, or contracting an illness; in children, avoidance of loud sounds or costumed characters)
Causes of Specific Phobia
There are various causes that trigger the development of a specific phobia. Dr. Kevin Fleming (2017), in his article, have listed out the following possible causes:
Traumatic experiences – Individuals who have a traumatic childhood experience, might develop a fear towards an object or situation related to that experience. For example, if you were bitten by a dog at a young age, you may develop a fear of dogs later in life.
Learned behavior – The family environment may be a cause of specific phobias – being around relatives who have particular fears, or deal with anxiety in a certain way, is thought to influence children and may contribute to the onset of phobias.
Genetics – Some individuals may be genetically predisposed to having an anxious personality, making them more prone to phobias.
Fear response – Having a panic attack or other pronounced response to fear or panic in a certain situation can lead to feelings of embarrassment or fear of a repeat episode, which over time may develop into a phobia.
Ongoing stress – Over the long term, stress can result in feelings of anxiety, depression and inability to cope in certain situations, which may progress into a phobia.
Phobia magnifies a seemingly non-threatening situation, object, animal etc., making someone tremble at his/her knees, and disrupts a person’s daily living.
We can use a number of interventions to help lessen the symptoms of specific phobia. They are: Cognitive Behavioral Therapy (CBT), Exposure Therapy, Relaxation Techniques, Hypnotherapy, Mindfulness, and Medications.
Let’s us use a case study to illustrate the treatment process of phobia. Consider, “JC”, a real client who lived with “Pediophobia” (fear of dolls), and how exposure therapy can help him overcome his irrational fear.
Case Study of “JC”: Pediophobia
Client “JC” (male) was 25 years old during the time he joined the therapy program. He described himself as a generally sociable and a happy person. However, he is also an easily scared and startled person.
He doesn’t recall any traumatic events associated with dolls when he was a kid, and he also doesn’t have any family members who have anxiety disorders.
All he knows was that when he was young he had a doll named “Jay-R”. He recalled that he felt like this doll is going to blink its eyes, talk and move whenever he looked at it. He emphasized how the eyes of dolls are so scary for him, especially the porcelain ones.
Whenever he saw dolls, he would immediately close his eyes, screech, or feel paralyzed. Also, there’s a strong desire for him to run away from it. He his heart beats rapidly, and he felt nauseated. And he would beg tearfully for the doll to be taken away, even if the doll was far away from him.
Exposure therapy for JC’s phobia:
To help “JC” recover from his phobia, we used exposure therapy. Exposure therapy is a form of Behavioral Therapy. The person undergoes various phases, where they modify their behavior, as the person exposes themselves to the feared stimulus (systematic desensitization).
There are 3 phases in his exposure therapy program. But before the first phase, he learned some relaxation techniques, such as progressive muscle relaxation and deep breathing. This is so that he could calm himself down, and manage his anxiety when he faced his feared objects. Every time he faced the feared stimulus, he will also rate his anxiety levels. This is so that we could know if there are changes in the anxiety level of the client.
Once he displayed positive behavior, the therapist will always give reinforcement, through verbal praises and physical gestures such as giving a pat on the back, high-five or even a hug. JC will also have worksheets as a follow-up task after every session. As such, JC can generalize the effect into his daily life.
3 Phases of Exposure Therapy for JC
“Imaginal Exposure”: First Phase
In this phase, the client was asked to close his eyes and imagine going back in time when he first encountered the doll “JAY-R.” He went through various steps according to directions, imagining he was performing certain actions, such as going inside the room where the doll is, walking near the doll and touching it.
Then JC rated how anxious he felt at each step. The therapist will ask JC to stay in the imagined moment together with the feared object. Then, the therapist will ask JC to think about what dolls really are (inanimate, non-threatening toys for children). Through such imaginings, we will diminish the fear the client felt towards the object, helping the client break their irrational thoughts.
“Fear Hierarchy”: Second Phase
This is the phase where we present to the client pictures and videos of dolls. The client then established a hierarchy, ranking the pictures and videos according to how anxious he felt to each one. Starting with images that were less anxiety-provoking (such as a cartoony image of a doll) to his most feared ones (images of porcelain dolls’ and a video of dolls). The therapist created a safe environment for exploration, assuring that the client is safe. During the session, JC stayed with the image, and not close his eyes.
The therapist asked questions to challenge the client’s thought processes (cognitive restructuring through dispute), such as “Are the dolls really moving?”, “Are they going to attack you?” etc. The client then rated each picture according to how anxiety-provoking each was. The therapist will utilize the higher rated pictures in further exposures until his anxiety level decreases.
“In-Vivo Exposure”: Third Phase
This was the most anxiety-provoking phase. Because the client now needs to face the actual feared object. The therapist will first orient the client before he entered the room with dolls. As the therapist guided the client into the room, he saw the dolls and he burst into tears and trembled. He closed his eyes and uttered, “They are looking at me!” The therapist guided and encouraged the client to open his eyes and look at the dolls from a distance. And then the therapist assured JC’s safety. Once again, the therapist asked questions to challenge the client’s irrational thoughts.
When the client did it successfully, and reported a decreased anxiety level, the therapist asked JC to come near the dolls and sit with them on the sofa. The anxiety level shoot up once again and he started to cry and felt nauseous. The therapist sat with the dolls to demonstrate how non-threatening they are. After a while, JC opened his eyes and slowly touched the dolls. Then, the therapist instantly praised and encouraged JC, to reinforce his behavior. He even started to carry the dolls one by one. After that, he felt dizzy and passed out for a few minutes.
When he woke up, he started to look and touch the dolls instantly, as if he has reset his system after passing out. He reported that his anxiety level zeroed out gradually. He had the therapist take a picture of him with the dolls hanging around him, something he wouldn’t do when he had his phobia.
We discover wider rooms in our potentials when fear is kicked out. We realize that thriving and not just merely surviving is possible even when vulnerability to fear is present. Even if phobia is beyond fear, the person itself is still beyond phobia. It all starts with a conscious decision that we are able to overcome what our minds conceive as our limits.
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