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.
Find out why in my next post.
Tao of Anxiety: Series
Tao of Anxiety: Series