What is specific phobia?
Specific phobia is an anxiety disorder characterized by an unreasonable fear and avoidance of some type of stimuli (the phobia). The stimulus expands a broad range of different possibilities, such as animals or insects, situations in the nature or environment (e.g., storms, heights), specific situations (e.g., being on a plane or an elevator), blood and injections, among many others.
Specific phobia is pretty common in the population, with one review study finding a lifetime prevalence rate of 3 to 15 percent (Eaton et al., 2018). The common ones found in the study were about heights and animals.
Specific phobias are diagnosed when the fear is excessive (the person usually has good insight that the danger doesn’t warrant their levels of fear); when it lasts long enough (at least 6 months); and affects their lives significantly. For example, some people might never travel and miss out on important events because of their plane (aerophobia). For more information on anxiety disorders, check out this post on six anxiety disorders.
A cognitive behavioural approach to specific phobias
Specific phobias are tricky to deal with because the fear makes people want to avoid their phobia. The avoidance makes it difficult for the anxiety to reduce because our brain is allowed to continue creating catastrophic thoughts in our mind.
Cognitive behavioural therapy is an evidence-based treatment for a number of psychological challenges, including specific phobia. The idea is that we can reduce our anxiety targeting our behaviours and thoughts and maintain our fears.
Below, I discuss a few behavioural and cognitive strategies geared towards handling specific phobia.
Behavioural strategies for specific phobia
You might be wondering why I’m starting with behaviours even though CBT starts with the cognitive part. For me, I think behavioural strategies are typically stronger for dealing with anxiety compared to simply working through the thoughts. However, cognitive strategies are helpful in supporting the behavioural changes, especially when scary thoughts take over.
1. Exposures. Perhaps unsurprisingly, exposures are one of the most effective strategies in reducing anxiety about phobias. If avoidance maintains our anxiety, then exposures give us a chance to recognize that the fear is not as substantiated as we first thought. Through exposures, our body and brain learn over time that our feared belief is not going to come true. It’s important to keep the exposure going for a period of time because our anxiety is going to spike at the beginning. But if we stay with it, our physiological sensations are going to reduce over time.
We also don’t necessarily want to go all out in the beginning when it comes to exposures. It’s usually helpful to take a gradual approach by developing an exposure hierarchy. Below I give an example of a hierarchy if the phobia was about cars.
Exposure hierarchy for driving a car (least to most fearful)
– Looking at pictures of a car (10%)
– Seeing cars on the street from my home (20%)
– Standing next to an unmoving car (30%)
– Touching the unmoving car (40%)
– Being inside the car without turning the engine on (50%)
– Being inside the car with the engine on (60%)
– Being inside the passenger seat with a friend driving slowly (70%)
– Being inside the passenger seat with a friend driving (80%)
– Driving the car myself in a safe residential area (90%)
– Driving the car myself in a highway (100%)
2. Relaxation exercises / behavioural experiments. Although exposures are likely the best behavioural strategy for specific phobias, other behavioural strategies can be helpful to support exposures. For example, relaxation strategies can be a great way to reduce anxiety in order to get ourselves to face our fear. Doing relaxation strategies during the day or before the exposure could be helpful if it’s too hard to engage in the exposure. Behavioural experiments are another exercise that allows us to clearly write down what our feared prediction is and then write down what actually happened. This gives us a nice systematic way to investigate whether our fears are true (and how we can cope). The articles embedded give a nice introduction into both relaxation exercises and behavioural experiments.
Cognitive strategies for specific phobia
1. Thought records. Thought records are a powerful cognitive skill to realistically evaluate our negative thoughts by using the facts. Thought records work well because they aren’t just a way to push away negative thoughts, but it honours them by accepting that our thoughts aren’t necessarily always completely wrong while presenting facts against the thought.
To give a balanced thought example for a fear of planes: “Although it is true that plane crashes can happen, the odds of that happening on a commercial flight is 1 in 4.7 million. There is risk in everything in life, such as driving cars (which has a higher risk of an accident than flying)”
If you’re interested in how to develop a formal thought record, check this post out!
2. Mindfulness. Mindfulness is a way to take power away from our scary thoughts. Mindfulness allows us to evaluate our external and internal experiences in a non-judgmental way. In that way, we are less likely to immediately react to our thoughts and emotions, and simply observe them as experiences. Mindfulness is therefore a way to change our relationship with our experiences, rather than reduce anxiety.
I hope this post was helpful in learning a little more about some evidence-based therapy strategies to start facing your fears!
Featured photo credits: Vadim Bogulov on Unsplash