What is a phobia?
Many people know what it
feels like to experience a phobic reaction. We can imagine someone
who is afraid of heights staring down from a high place, feeling
dizzy as they wipe the sweat from their palms, because most of us
have felt this type of fear before.
We've experienced these
feelings before walking onto a stage, starting a first day of school,
or first getting behind the wheel of a car. For some people this
excitement helps them perform, but for others it causes them to draw
into themselves.
Just about anyone can rattle
off a list of common phobias. Fears of tight spaces, of falling, of
bugs, of the dark, of sexuality, of lightning. These phobias are to
things, to experiences, but some phobias aren't so easily
classifiable. They are vague and difficult to explain because they
are highly subjective.
A fear of new, unknown
experiences where escape isn't possible: Agoraphobia.
A fear of criticism: Social
phobia.
These two phobias cause
millions of people to struggle and fall. They experience intense
emotional turmoil when they find themselves in new situations; where
they're not sure what to do, have no one they feel they can rely on
or trust, and fear the criticism of the strangers around them.
Some anxiety sufferers
cannot go into stores alone, or at all. Some cannot try new
experiences or do things they once loved (like going to a ball game
or a movie), even if they want to. Some cannot even stay at home by
themselves, work, or go to school, because they lack the confidence
to handle ordinary situations.
These phobias center around
people, but they don't always make sense to those who haven't
experienced them. Why, for instance, would a phobic be comfortable
around one person and not another, or feel comfortable in one
situation and not another, similar, situation.
These phobias can occur for
many reasons. In my own experience an illness triggered my panic
attacks, which eventually led to my phobias. Environmental and
biological factors were present throughout my childhood, but what
finally brought me down was my body's inability to cope with the
stress of illness.
Other people become phobic
from overbearing and overcritical parents, childhood bullying, or for
no apparent reason at all. Often the creation of a phobia is a long
process, involving years of similar life experiences that slowly
“teach” the individual to fear certain situations, or people in
general. Other times a phobia can come out of the blue, striking at
any age.
Yet
phobias are not untreatable.
~*~
Getting over a social phobia
is difficult for many reasons. The largest hurdle is a lack of
understanding. The sufferer may not understand what he or she is
experiencing, and family and friends may not understand, or want to
understand. Phobias are sometimes met with disbelief or criticism.
Getting over any phobia
requires not only an understanding of what it is, and of the process
of recovery, but it requires motivation. For those who suffer from
constant anxiety, this motivation does not always exist. As illogical
as it may seem, the disorder or fear itself becomes a sort of comfort
zone, and healing requires leaving that comfort zone, which some
anxiety sufferers view as dangerous and uncomfortable—even more
uncomfortable than living with panic attacks and distorted world
views.
Another factor for recovery
is the willingness of family and friends to help the sufferer grow.
There's a fine line between encouragement and criticism, and saying
the wrong thing can hold those with anxiety back as easily as simply
being there and showing physical support can instill confidence in
difficult situations.
Many with severe phobias do
not seek therapy, and live a secluded lifestyle. For those lucky
enough to have understanding family and friends, and are motivated
enough to overcome their predicament, finding the right treatment
becomes the most important step.
There are several methods to
treat phobias and anxiety disorders. Some doctors rely on medication
or talk therapy, but in my personal experience neither are as
effective by themselves as cognitive behavioral therapy (CBT) is,
especially when the focus of CBT is in vivo exposure
therapy.
Exposure therapy (along with
medication and talk therapy when necessary) is cognitive psychology's
answer to treating phobias, and where social anxiety disorder is
concerned, exposure therapy has the highest success rate.
What is exposure therapy?
Exposure therapy involves
desensitizing ourselves to a phobia. If we are afraid of spiders we
may start our therapy by looking at pictures of spiders. Once the
first step is conquered,d the next step would be to sit in a room
with a spider in a jar. The third step would perhaps be to touch a
non-venomous spider.
The purpose of this method
is to retrain our cognitions—our thoughts. By experiencing
spiders in a non-threatening way, over the course of weeks or even
months or years, we rewire the brain to not fear arachnids, resetting
the amygdala which before then stored our fearful memories and
reminded us to be afraid when we came across similar situations..
Treating a social phobia
works in the same way. If we have a fear of eating at restaurants, we
can break going to a restaurant down into small, convenient steps.
The first step may simply be to visualize going out to eat. The next
step may be to drive to a restaurant, but not enter. The next step
may be to go in, sit down, but not eat anything. The final step would
be to go out and have dinner.
Each step may be done as
many times as is required to master that step, or at least to face
the step with a manageable level of anxiety.
At any time in the process
the sufferer is allowed to get out of the situation. In fact, in
Edmund J. Bourne's “The Anxiety and Phobia Workbook,” he advises
sufferers to make sure they have an escape plan for each step.
It is more important to quit
than to go through a stressful event, because the purpose of exposure
therapy is not simply to accomplish each individual goal no matter
what, but to retrain the brain. If a sufferer experiences too much
fear at any given step, he may only reinforce the anxiety instead of
getting over it.
This makes exposure therapy
a very low-key exercise. It can be as difficult or as easy
(comfortable) as the sufferer wishes it to be, and there's no right
or wrong way to set it up so long as each step is a little more
difficult, or challenging, than the last, and each step is practiced
consistently.
Exposure therapy works
because it is flexible. It can be used in many different ways to fit
the needs of the sufferer, and it can be taken as slowly or as
quickly as one feels comfortable.
Other CBT methods
There are several other
therapies worth mentioning, which can by themselves make a large
difference, and are vital for making exposure therapy successful.
Using coping statements
to counter negative thinking helps to replace negative thoughts with
positive ones. Negative thinking is a major reinforcement of phobias
and anxiety. Therapists can help sufferers deal with mistaken
beliefs, guilt, and worry by teaching them how to use the mind in a
more constructive way.
A negative thought may be “I
can't do this” when confronted with a difficult social situation.
Someone trying to work through this negative thought could challenge
it (“why can't I do this?”), replace it with a positive statement
(“I am fully capable of doing this!”), or putting the thought
into perspective (“I haven't always failed at this.”).
Visualization is an
underrated practice that has the potential to transform reality.
Using visualization to counter a phobia requires nothing more than
imagining being in a difficult situation and working out ways to get
through it, mentally preparing oneself for the real event.
Visualization is especially
helpful because the mind has difficulty telling between reality and
imagination, making visualization almost as good as the real thing if
done intensely enough. We can go through the motions without taking
on the risk of a real life situation.
Visualization is a great way
to prepare for a session of exposure therapy, to practice what to do,
where to go, how to do what needs to be done so the sufferer is
mentally prepared and not entering an uncertain situation. This can
significantly reduce anxiety, and even put control back in the
sufferer's hands.
Learning to assert one's
feelings can also help lift a sufferer out of a phobia. Some
people suffer phobias because they feel trapped, as if they have no
power over the situation or even over themselves. They feel they have
to do something because others demand that they do, and this
contradicts their own needs. Learning to stand up for oneself, to ask
for things, and to voice an opinion or to say no to others' demands
can put the power back into the hands of the sufferer, reducing much
of life's pressure.
~*~
Exposure therapy when
coupled with other CBT techniques, as well as breathing and
meditation, can help sufferers make gains quickly.
For the same reason that CBT
and exposure therapy work so well, talk therapy and medications can fail, or slow progress.