Fear is a part of everyday life. Although it may be unpleasant, it is a perfectly normal and natural response to threats or danger. However, sometimes fear can become uncontrollable and develop into a disabling phobia. Fortunately, many fears and phobias can be effectively treated by psychotherapy and other techniques.
If you believe someone is following you down the street at night, your body starts to show the typical fear response: your heart speeds up, you breathe faster, your palms sweat, your mouth becomes dry, and blood pressure rises. All of these changes divert blood to the muscles so that you have more energy either to get away from or confront the pursuer. This ‘ fight or flight response to danger has obvious survival value in helping us to deal with all manner of threats, not just imagined stalkers on the street. Our emotional and physical responses to situations that we fear can also help us to take practical steps. For example, if your home has been robbed, you are more likely to find the time and money to fit secure locks to doors and windows or install a telephone in the bedroom in case you need to call for help. While such practical action can ensure, it is natural to feel a sense of anxiety that takes a while to dissipate.
But fear and anxiety can get out of hand. Roughly one person in ten has a phobia – an irrational fear of an object or situation that may be harmless in itself. Phobias are nothing new: the ancient Greek physician Hippocrates described patients disabled by irrational fear more than 2000 years ago. King James of England was terrified by the sight of unsheathed swords, and Henry III of France was scared of cats.
Sigmund Freud, the founder of psychoanalysis, believed that phobias stemmed from childhood trauma. In some cases, this is true: one woman with a fear of feathers traced the problem back to a large feather in the hat of an unknown woman who leaned over her pram when she was a baby, causing her to scream with fear. Fears and phobias vary in severity. Some people feel mildly uncomfortable when talking about their phobia and will avoid it if possible. Others will go to any lengths to avoid the object or situation because it produces such intense fear – so bad that they feel they might be about to die. In these cases, a phobia can seriously disrupt everyday life. People with a fear or phobia usually have a clear insight into their problem and know their fear is exaggerated, so in addition, they often feel ashamed of their weakness.
Treating fears and phobias
Behavior therapy can help people overcome most phobias and fears, and sometimes antidepressant drugs can be effective. Behavior therapy exposes the sufferer to the object or situation they fear. There are two ways of doing this: through fantasy, which is a useful approach in situations that cannot easily be reproduced, such as thunderstorms, or by directly confronting the phobia. Fantasy involves the person imagining the phobia object or viewing it via video, slides, or computer simulations while being repeatedly told to relax. Fear and relaxation cannot be present in the mind at the same time, so the fear should begin to fade and be replaced by a relaxed feeling.
For confrontation, there are two main approaches. Systematic desensitization exposes a fear gradu ally. If, for example, a person fears going out at night after being mugged, the victim might begin by going out for short periods with friends, gradually reducing reliance on others until confident enough to walk alone. The alternative approach, called ‘ flooding,’ is like jumping straight into the deep end of a swimming pool. The person is exposed to the full extent of their fear – with agora phobia, for instance, they might go to a shopping center for a few hours. Floo din g demands more of the patient, but it yields quicker results. However, the patient must agree to see it through – fleeing halfway would reinforce the phobia.
THE THREE CLASSES OF PHOBIA
Simple phobias
These are fears of specific objects or situations and include:
- Acrophobia (heights and high places)
- Arachnophobia (spiders)
- Astraphobia (thunderstorms)
- Bacillophobia (germs)
- Claustrophobia (enclosed spaces, e.g., small rooms or lifts)
- Haematophobia (the sight of blood)
- Hydrophobia (water, such as rivers and oceans)
- Nyctophobia (the dark or darkness)
- Zoophobia (animals)
Social phobia
This is a feeling of insecurity or fear in specific social situations, coupled with a fear of being publicly embarrassed. Social phobia may include a reluctance to eat or drink if anyone is watching.
Agoraphobia
This is one of the most common phobias and involves the fear of being alone in public places or an unfamiliar setting.