Fear is a common emotion and defense mechanism that helps us avoid dangerous situations and contributes to our survival in the world. However, it happens that fear is not justified at all, a person cannot understand and explain why he is afraid, but the very feeling of fear causes such great anxiety that his hands tremble or he is short of breath. This can happen, for example, when speaking in public, seeing a spider, or flying an airplane. When the fear is so strong that a person tries to avoid situations or objects that cause fear, but there is no rational reason for this, then this condition is already called a phobia.
Phobias are a group of mental disorders in which strong, irrational, unreasonable fear and anxiety are caused by a clearly defined situation, place, animal or any other object that is not dangerous at the time. The fear is so strong that a person tries to avoid situations that cause fear: in the case of agoraphobia, he tries not to go out of the house; in case of sociophobia – do not speak in public, avoid society; in case of aerophobia – do not fly by plane. This list can be continued for a long time. Just the thought of being in a phobia-inducing situation is already anxiety-inducing. Unfortunately, avoiding some situations can seriously make life difficult in society, as well as harm self-esteem. It should be noted that phobias often coexist with depression, panic attacks or post-traumatic stress syndrome – a condition that only worsens over time if help is not sought in time. People with phobic anxiety find it quite difficult to relax, so phobias can also contribute to the development of alcohol or drug addiction.
Phobias can be many and varied, but in the professional environment of doctors they are divided as follows:
- Agoraphobia – fear of visiting places where there are many strangers, fear of crowds, fear of leaving the house, going into shops, fear of traveling alone on trains, buses and planes.
- Social phobias – fear of the scrutinizing and evaluating gaze of people, fear of speaking, fear of criticism from others.
- Isolated phobias – phobias that are associated with strictly defined, well-known situations or objects: contact with specific animals, fear of heights, thunder, darkness, flying, closed spaces, urinating or defecating in public toilets, eating certain foods, the dentist, seeing blood or injury. Examples: cancerophobia – fear of getting cancer – , claustrophobia – fear of closed spaces – , arachnophobia – fear of spiders…
How to recognize a phobia?
- Anxiety and fear are caused by a strictly defined situation or object.
- Phobias are irrational fears that are completely out of proportion to the true extent of the threat.
- A person with a phobia tries to avoid being in a situation that causes fear or coming into contact with an object that causes fear.
- Phobias are manifested not only as a feeling of fear and anxiety, but also have a series of different physiological reactions: blushing, hand tremors, disgust or an urgent need to urinate, sweating, nausea, palpitations, watery eyes, difficulty concentrating and thinking, there may also be sudden shortness of breath lack, darkness in the eyes, even fainting.
How is a phobia formed?
The basis of the phobia formation mechanism is the creation of a conditioned reflex: at first, a stimulus appears, for example, the need to cross the road at a traffic light, when suddenly a car hits a passerby. For an eyewitness, this can cause severe fear and crossing roads will be interpreted as a dangerous situation. Later, traumatic memories will be forgotten, however, from that moment on, the need to cross the road will cause the fear of the reflector to the eyewitness of the accident. If they do not decrease within six months and the person is unable to overcome them, then it can be said that a phobia has developed. More often, the mechanisms of occurrence of phobias do not work so simply. A more complicated example: a 25-year-old woman suddenly became afraid of riding an elevator, but she cannot find any rational explanation for it. During the therapy, the patient remembered an incident from her childhood: she woke up in the middle of the night in fear of not having anything to breathe with. It turned out that the mother accidentally wrapped her in a blanket too tightly and the girl ran out of air. Later, while riding in the elevator with her mother, the patient was regularly told that “you must not shout and cry in the elevator, otherwise the elevator will get stuck.” When asked what will happen if the elevator gets stuck, the mother said that “then we will suffocate here”. You can see that a completely rational fear of suffocation was associated with a closed space (under the blanket) and combined with the threat of “getting stuck in the elevator if you scream and cry.” Several years later, this grown woman faces problems at work and in relationships. The fact that her mother’s upbringing motto was “don’t scream and cry”, the patient, not allowing herself to complain about her problems and express her feelings freely, ended up in a situation similar to when she used to ride with her mother in an elevator when she was a child. In such a situation, the anxious experiences from childhood, combined with the tension of the present, manifest themselves in a strange way, like a phobia of riding in an elevator.
From this example, it can be seen that the formation of a phobia is based not only on conditional reflexes, but also often on unconscious internal conflicts and the resulting tension, because one of the ways in which tension that is not experienced consciously can be manifested – unreasonable irrational fear in certain situations.
Panacea for Phobias!
The fastest way to treat various phobias is cognitive-behavioral therapy (CBT). First of all, it includes a change in thinking style – irrational fears and beliefs that do not correspond to reality are found, then through “inner” dialogue they are consciously changed and replaced with other beliefs that give the most objective and rational vision of the world. Secondly, familiarization or exposure exercises are applied together with relaxation techniques. This means that the patient gradually begins to do what he is afraid of, while simultaneously using one of the relaxation techniques. At first, the fear-causing situation is imagined in the mind, then habituation continues in real conditions – the patient is placed in a fear-causing situation for a short time under the supervision of the therapist, but as the patient’s endurance increases, the time is gradually extended until the fear and avoidance behavior disappear completely. Cognitive behavioral therapy (CBT) is quite good for some patients. It is a temporary method – 5-10 sessions are enough. However, cognitive-behavioral techniques only touch the conscious part of the human mind and break the link that connects the internal, unconscious tension with the conditioned fear-inducing situation. However, CBT does not resolve internal emotional conflicts, the conflict persists and may later manifest itself in the form of other symptoms.
Internal conflict is a contradiction between a person’s personal desires and other people’s desires, demands, social norms. If a person gives up his needs, his emotions, his desires in favor of other people or foreign opinions for a long time, it creates tension. It is good that the tension is recognized and processed, but often such internal conflicts, which arose in childhood, are pushed out of consciousness and as if “forgotten”. It is in such cases that long-term psychodynamic psychotherapy comes to the rescue. Its minimum duration is 6-12 months, but the effect is more permanent and wider.
It should be mentioned that in the treatment of agoraphobia and sociophobia, medications are also widely used – antidepressants and tranquilizers, sometimes also neuroleptics. But it should be remembered that antidepressants do not work immediately – it takes at least 2 weeks to notice the effect and then they should be used for at least another 6 months under the supervision of a doctor. Antidepressants should not be stopped when you feel like you’re “all right,” because it’s very likely that symptoms will return if the course of therapy was not properly completed. Unlike antidepressants, tranquilizers work immediately, but their long-term use, on the contrary, is not recommended, as it can threaten the development of addiction. Tranquilizers do not have a long-lasting effect, they can rather be considered emergency medicine.
Authors of the article: resident doctor in psychiatry, Alina Kuznetsova doctor psychiatrist Pēteris Zālītis
Reference list:
- [1] The ICD-10 Classification of Mental and Behavioral Disorders. Diagnostic criteria for research. WHO, Geneva, 1993 https://www.who.int/classifications/icd/en/GRNBOOK.pdf
- [2] Cognitive Behavioral Therapy Explained. Authors: Graeme Whitfield, Alan Davidson. 2007
- [3] Ромек В. G. Behavioral therapy of fears. Журнал Практической Психологии и Психоанализа , 2002, №1 http://psyjournal.ru/articles/povedencheskaya-terapiya-strahov
- [4] Rita L. Atkinson, Richard C. Atkinson, Edward E. Smith, Daryl J. Bem, Susan Nolen-Hoeksema. “Hilgard’s Introduction to Psychology. History, Theory, Research, and Applications”, 13th ed., 2000.
- [5] Stein, DJ, Vythilingum, B. and Seedat, S. (2005). Pharmacotherapy of Phobias: A Review. In Phobias (eds M. Maj, HS Akiskal, JJ López‐Ibor and A. Okasha). doi: 10.1002/0470014113.ch3