Graded exposure

Most treatment for phobias at Priory involves a variation on what is known as ‘graded exposure’. This involves trying to tackle the fear of a situation by acknowledging how it could be approached, even at first using imagination, before trying to tackle the feared situation in reality.

This involves carefully and systematically learning to face the fear in a gradual and controlled way, thereby reducing the avoidance, which is known to worsen the problem. These techniques may, at first, involve imagining exposure to the feared situation rather than in a real life situation.

Psychotherapy

Before that can be undertaken, it is often necessary to be able to learn techniques for managing symptoms of anxiety and improving coping techniques before the procedure begins.

Priory can offer specific treatments, including talking therapies such as cognitive behavioural therapy (CBT) and other evidence-based treatments in order to help you understand more about why your phobia exists and how you can reduce associated symptoms.

CBT is widely used across the world to treat a range of mental health conditions, as it helps identify the relationship between your thoughts, feelings and behaviour, before pro-actively challenging any negative thoughts associated with your phobia by learning practical methods of managing patterns of negativity.        

It is also very important to properly assess a phobia, as they it could form part of a wider issue involving symptoms of anxiety and depression, or could be exacerbated by these co-existing conditions, in which case these conditions would need to be treated independently of your phobia.

Medication

While exposure therapy and talking therapies such as CBT are the main treatments used to relieve symptoms of phobias, taking medication alongside therapy sessions can help with any severe symptoms of anxiety you may be experiencing, which in turn can make your therapy sessions more effective.

If anxiety linked to your phobia is severe, or if you have co-existing mental health conditions such as anxiety or depression, then the most commonly prescribed drugs which can help improve symptoms include a type of anti-depressants known as selective serotonin reuptake inhibitor (SSRI) antidepressants.

Further drugs which may be recommended for severe anxiety that is impacting your day-to-day life include those with tranquilising effects such as a benzodiazepine, for example Valium. These drugs should only be taken for a short time, as they can be highly addictive.

For physical symptoms of anxiety, beta-blockers such as propranolol can help reduce the rapid-heartbeat, tremors and palpitations associated with intense anxiety and panic attacks, although they won’t help cure the psychological symptoms underpinning your phobia. If you have a specific or complex phobia that only arises occasionally, such as having to go on an aeroplane, then these drugs can be particularly effective.

Reactions to phobias will often lead to avoidance of the feared situation. These responses can be quite severe and range from a person being initially conscious of their phobia, to it becoming second nature – without them necessarily realising the extent to which it has changed their life.

The feared situation may not be avoided entirely, but will trigger anxiety in anticipation of the situation, even before it is encountered, and a sense of enduring it with discomfort.

If you are diagnosed with a phobia, it will be placed into one of two main categories of phobia known as specific phobias or complex phobias.

Specific or simple phobias

These type of phobias revolve around particular objects, situations or activities, and include animal phobias, environment phobias and bodily phobias.

This type of phobia usually develops in childhood or adolescence, and can become easier to manage as you get older.

This stage can be reached more effectively if you have attended psychotherapy sessions such as those offered at Priory, which can teach you coping techniques to prevent or reduce the severity unwanted symptoms.  

Examples of simple phobias include:

• Phobia of animals such as dogs, snakes or rodents
• Fear of your surrounding environment, including heights and open water
• Situational phobias such as an intense fear of flying
• Body related phobias such as a phobia of vomiting or blood
• Sexual phobias which can be related to performance anxiety

Although the situation is discrete, contact with such scenario mentioned above can evoke significant anxiety or even panic attacks, which can be so unpleasant that a fear of the situation occurring can last for a lifetime if it remains untreated.

Complex phobias

Tend to be more disabling in terms of how you function on a day-to-day basis.

The symptoms of anxiety associated with phobias such as agoraphobia, which is a fear of not being able to escape if you have a panic attack, and social phobia, where a person feels excessively anxious in social situations, leads you to avoiding situations such as being in a crowded place or travelling on public transport.                    

The most common types of complex phobias include:

Social phobias

Social phobias often start in early adulthood. They characteristically involve thoughts of being looked at negatively by others or fear of embarrassment in public. It can be very common to have anxiety before public speaking, which is often present to a mild degree in everyone. However, it can become increasingly more severe, leading to avoidance, and developing into a phobia.

Sufferers often find it difficult to relate to others and find it hard to make friendships. They tend to constantly go over conversations with others once they have happened, and wonder after an event how they came across to other people and what people thought of them. This can leave them struggling socially outside of the immediate family, with these difficulties impairing the formation of friendships and relationships, and even limiting career development.

Agoraphobia

Agoraphobia is far greater than a fear of open spaces, which it is often acknowledged as. This encompasses an acute fear of a variety of different, usually very busy situations, complicated by difficulty in escaping from the situation.

Agoraphobia can be easily triggered by queuing situations such as leaving a supermarket, which has the added complication of being a very public scenario. Symptoms can therefore overlap and can include fear of leaving home, entering shops, crowds and public places, or travelling on buses and planes.

In severe instances, individuals can avoid leaving their house and become very isolated. Agoraphobia can often be complicated by the fear of something negative happening in public and with its strong link to panic attacks, can often include the fear of fainting or collapsing in public and being helpless and embarrassed.

If you have any kind of phobia, having to avoid thinking about or coming into contact with whatever is causing fear and anxiety can affect the choices you make in your daily life. For example, it stands to reason that if you have a phobia of dogs, otherwise known as cynophobia, you may actively avoid visiting areas where there are likely to be dogs, such as parks or open fields.

This distressing cycle of avoidance can even extend to not wanting to see a picture of the phobia, or even involve yourself in a discussion about the subject of your phobia. Depending on how severe your phobia is and how much you have to adjust your daily routine to avoid the subject of you fear, this can lead to severe anxiety and depression as co-existing mental health disorders.

Having a phobia of any kind will involve both psychological and physical symptoms, with panic attacks being particularly common. Panic attacks can occur when coming into contact with your phobia or even when thinking about it, as your brain has actually created an inbuilt reaction to your most feared situation or object even if you are not in a the expected situation which would usually cause worry or panic.

Psychological symptoms of panic associated with phobias

If you have a phobia that is particularly severe, you may experience intense thoughts and emotional difficult which can include the following symptoms:

• Fear of losing control
• Fear that you are going to die
• Overwhelming feeling of dread
• Fear of fainting
• Fear of experiencing the uncomfortable anxiety associated with the phobia

Physical symptoms of panic associated with phobias

The physical symptoms of having a phobia can be almost as distressing as the fear of the situation or object itself.  If you find yourself within the situation or in contact with your phobia, symptoms of overwhelming anxiety and panic can occur, which may involve the following:

• Shortness of breath and problems breathing
• Hot flushes or feeling cold
• Trembling
• Sweating
• Headaches
• Dizziness
• Pain in the chest area
• Nausea
• Feeling as if you are about to faint
• Dry mouth
• Confusion

Symptoms of complex phobias

While having a specific or simple phobia can be significantly distressing, complex phobias are perhaps the most difficult to manage. This is primarily due to the fact that they tend to be involved with many aspects of modern life, which means an individual has to face their fears on a regularly basis, and is not as easily avoided without having an adverse effect on your relationships, career and overall quality of life and wellbeing.        

Symptoms you may experience if you have a complex phobia include:

Agoraphobia

Signs and symptoms vary from person to person, as there are often several different phobias making up an overwhelming fear of being in open or crowded spaces combined with an anxiety of not being able to escape or easily find help if you have a panic attack.

This means that symptoms of intense anxiety and panic can set in to the point where you may fear going shopping or even leaving your house, and can leave you feeling lonely and isolated in the most severe cases.

Triggering situations and psychological symptoms which can cause panic in agoraphobia include:

Situations triggering agoraphobia

• Spending too much time alone
• Being in crowded, open or small spaces without a clear exit or help point
• Environments where people may look at you for an extended amount of time

Psychological symptoms of agoraphobia

• Fearing death or that a panic attack may cause you to die
• Fear of losing control in a public place
• Fear of being embarrassed because of your panic symptoms

Social phobia

Actively avoiding social situations, particularly those where you may have to meet people you don’t know very well. The very idea of being seen in public or at a social event may cause you to feel frightened or anxious. Much of these symptoms stem from being pre-occupied with what others think of you, or that you will embarrass yourself in some way, no matter how unlikely this may be.

If you have severe social phobia, as with agoraphobia, your levels of fear and anxiety can become so high that you feel unable to leave your home.

Triggering situations and psychological symptoms which can cause panic in social phobia include:

Situations triggering social phobia

• Job interviews
• Shopping
• Eating in public
• Public speaking
• Talking on the phone
• Formal meetings

Psychological symptoms of social phobia

• Excessively worrying for days or weeks before a social event
• Worried about being embarrassed and people witnessing
• Using alcohol as a ‘social lubricant’ to mask symptoms of anxiety
• Takings days off work, college or university due to anxiety
• Fear of talking during social situations, particularly if around people you are unfamiliar with
• Fear that people will notice physical signs that you are anxious (blushing, trembling)

Phobias don’t have one single cause, and there can be a number of factors during your lifetime which can make you more likely than others to develop a phobia.

Phobias are most often diagnosed during childhood, adolescence or early adulthood, and can often be linked to a particularly stressful situation or traumatic event in early life, which becomes entrenched in your mind as something to be feared intensely.

To determine why a phobia may happen in some people and not others, it helps to analyse the two different categories of phobia, which include specific or simple phobias and complex phobias.

Causes of specific or simple phobias

Specific or simple phobias involve a fear of a specific object or situation, including animal based phobias, phobias related to nature such as heights or water, and phobias of medical procedures such as having injections or seeing blood.   

Negative experiences in childhood are often the root cause of these phobias. As an example, being trapped for an extended period in an enclosed space when you are younger can cause a fear of confined spaces to develop, known as claustrophobia.

If you are living with family members who also have a specific phobia, such as a fear of rodents or spiders, it is also believed that you can learn this behaviour and may develop the same fear yourself. Genetic influences can also be a factor, which include your inherited ability to deal with anxiety inducing situations, and can impact how you cope with your fears in later life.                     

Causes of complex phobias      

The causes of complex phobias such as agoraphobia and social phobia are more unclear, although a combination of genetics, environmental factors and your brain chemistry are believed to play a role.

The abnormal release of adrenalin causing symptoms of panic in situations that present no immediate danger, such as large crowds in agoraphobia or social situations which may cause you severe discomfort in social phobia may have developed from a series of embarrassing or uncomfortable events during childhood.

If you were particular shy or lacking in self-esteem as a child, or have suffered from long-term stress, this can cause symptoms of depression and anxiety which reduces your ability to cope in certain situations.