What is specific phobia

A specific phobia is a strong, irrational and intense fear of something that, in reality, poses little or no actual danger.

Common phobias and fears include closed-in places, heights, highway driving, flying insects, snakes, and needles. However, you can develop phobias of virtually anything. Most phobias develop in childhood, but they can also develop in adults.

If you have a phobia, you probably realize that your fear is irrational, yet you still can’t control your feelings. Just thinking about the feared object or situation may make you anxious. And when you’re actually exposed to the thing you fear, the terror is automatic and overwhelming.

The experience is so nerve-wracking that you may go to great lengths to avoid it—inconveniencing yourself or even changing your lifestyle. If you have claustrophobia, for example, you might turn down a lucrative job offer if you have to ride the elevator to get to the office. If you have a fear of heights, you might drive an extra 20 miles in order to avoid a tall bridge.

Specific phobias commonly focus on animals, insects, germs, heights, thunder, driving, public transportation, flying, dental or medical procedures, and elevators.

Although people with phobias realize that their fear is irrational, even thinking about it can often cause extreme anxiety.

Specific phobias affect an estimated 19.2 million adult Americans and are twice as common in women as men. They usually appear in childhood or adolescence and tend to persist into adulthood. Their onset is usually sudden, and they may occur in situations that previously did not cause any discomfort or anxiety. The causes of specific phobias are not well understood, but there is some evidence that the tendency to develop them may run in families.

Some of the more common specific phobias are:

• Closed-in places
• Heights
• Escalators
• Tunnels
• Highway driving
• Water
• Flying
• Dogs
• Injuries involving blood

Each specific phobia is referred to by its own term. Examples of more common terms include acrophobia for the fear of heights and claustrophobia for the fear of confined spaces.

Common categories of specific phobias are a fear of:

• Situations, such as airplanes, enclosed spaces or going to school
• Nature, such as thunderstorms or heights
• Animals or insects, such as dogs or spiders
• Blood, injection or injury, such as needles, accidents or medical procedures
• Others, such as choking, vomiting, loud noises or clowns

Some phobias don’t fall into one of the five common categories. Such phobias include fear of choking, fear of getting a disease such as cancer, and fear of clowns.

Specific phobias aren’t just extreme fear; they are irrational fear of a particular thing. You may be able to ski the world’s tallest mountains with ease but be unable to go above the fifth floor of an office building. While adults with phobias realize that these fears are irrational, they often find that facing, or even thinking about facing, the feared object or situation brings on a panic attack or severe anxiety. People who experience these seemingly excessive and unreasonable fears in the presence of or in anticipation of a specific object, place, or situation have a specific phobia.

No matter what specific phobia you have, it’s likely to produce these types of reactions:

• An immediate feeling of intense fear, anxiety and panic when exposed to or even thinking about the source of your fear
• Awareness that your fears are unreasonable or exaggerated but feeling powerless to control them
• Worsening anxiety as the situation or object gets closer to you in time or physical proximity
• Doing everything possible to avoid the object or situation or enduring it with intense anxiety or fear
• Difficulty functioning normally because of your fear
• Physical reactions and sensations, including sweating, rapid heartbeat, tight chest or difficulty breathing
• Feeling nauseated, dizzy or fainting around blood or injuries
• In children, possibly tantrums, clinging, crying, or refusing to leave a parent’s side or approach their fear

Normal fears in children

Many childhood fears are natural and tend to develop at specific ages. For example, many young children are afraid of the dark and may need a nightlight to sleep. That doesn’t mean they have a phobia. In most cases, they will grow out of this fear as they get older.

If your child’s fear is not interfering with his or her daily life or causing him or her a great deal of distress, then there’s little cause for undue concern. However, if the fear is interfering with your child’s social activities, school performance, or sleep, you may want to see a qualified child therapist.

It’s important to note the difference between normal fear & everyday anxiety vs a phobia:

If the feared situation or feared object is easy to avoid, people with specific phobias may not seek help. Treatment is needed if the phobia hurts a person’s career or personal life.

Understanding your phobia is the first step to overcoming it. It’s important to know that phobias are common. Having a phobia doesn’t mean you’re crazy. It also helps to know that phobias are highly treatable. You can overcome your anxiety and fear, no matter how out of control it feels.

Having phobias can disrupt your daily routines, limit your work efficiency, reduce your self-esteem, and place a strain your relationships because you will do whatever they can to avoid the uncomfortable and often-terrifying feelings of phobic anxiety.

If you think you have an anxiety disorder such as specific phobia, the first person you should see is your family doctor. A physician can determine whether the symptoms that alarm you are due to an anxiety disorder, another medical condition, or both.

Specific phobias respond very well to carefully targeted psychotherapy.

Specific phobia disorder complications

Although specific phobias may seem silly to others, they can be devastating to the people who have them, causing problems that affect many aspects of life.

• Social isolation. Avoiding places and things you fear can cause academic, professional and relationship problems. Children with these disorders are at risk of academic problems and loneliness, and they may have trouble with social skills if their behaviors significantly differ from their peers.
• Mood disorders. Many people with specific phobias have depression as well as other anxiety disorders.
• Substance abuse. The stress of living with a severe specific phobia may lead to abuse of drugs or alcohol.
• Suicide. Some individuals with specific phobias may be at risk of suicide.

Screening for Specific Phobias

If you suspect that you might suffer from a specific phobia, answer the questions below and share them with your health care professional.

Are you troubled by the following?

Having more than one illness at the same time can make it difficult to diagnose and treat the different conditions. Depression and substance abuse are among the conditions that occasionally complicate specific phobias and other anxiety disorders.

More days than not, do you feel

During the last year, has the use of alcohol or drugs

Specific phobia disorder causes

Much is still unknown about the actual cause of specific phobias. Causes may include:

• Negative experiences. Many phobias develop as a result of having a negative experience or panic attack related to a specific object or situation.
• Genetics and environment. There may be a link between your own specific phobia and the phobia or anxiety of your parents — this could be due to genetics or learned behavior.
• Brain function. Changes in brain functioning also may play a role in developing specific phobias.

Risk factors for specific phobia disorder

These factors may increase your risk of specific phobias:

• Your age. Specific phobias can first appear in childhood, usually by age 10, but can occur later in life.
• Your relatives. If someone in your family has a specific phobia or anxiety, you’re more likely to develop it, too. This could be an inherited tendency, or children may learn specific phobias by observing a family member’s phobic reaction to an object or a situation.
• Your temperament. Your risk may increase if you’re more sensitive, more inhibited or more negative than the norm.
• A negative experience. Experiencing a frightening traumatic event, such as being trapped in an elevator or attacked by an animal, may trigger the development of a specific phobia.
• Learning about negative experiences. Hearing about negative information or experiences, such as plane crashes, can lead to the development of a specific phobia.

Specific phobia disorder prevention

If you have a specific phobia, consider getting psychological help, especially if you have children. Although genetics likely plays a role in the development of specific phobias, repeatedly seeing someone else’s phobic reaction can trigger a specific phobia in children.

By dealing with your own fears, you’ll be teaching your child excellent resiliency skills and encouraging him or her to take brave actions just like you did.

Specific phobia symptoms

Symptoms of having a specific phobia often include uncomfortable and terrifying feelings of anxiety:

• a feeling of imminent danger or doom
• the need to escape
• heart palpitations
• sweating
• trembling
• shortness of breath or a smothering feeling
• a feeling of choking
• chest pain or discomfort
• nausea or abdominal discomfort
• feeling faint, dizzy or lightheaded
• a sense of things being unreal, depersonalization
• a fear of losing control or “going crazy”
• a fear of dying
• tingling sensation
• chills or heat flush

Symptoms of blood-injection-injury phobia

The symptoms of blood-injection-injury phobia are slightly different from other phobias. When confronted with the sight of blood or a needle, you experience not only fear, but also disgust.

Like other phobias, you initially feel anxious as your heart speeds up. However, unlike other phobias, this acceleration is followed by a quick drop in blood pressure, which leads to nausea, dizziness, and fainting. Although a fear of fainting is common in all specific phobias, blood-injection-injury phobia is the only phobia where fainting can actually occur.

Specific phobia disorder diagnosis

Diagnosis of specific phobias is based on a thorough clinical interview and diagnostic guidelines. Your doctor will ask questions about your symptoms and take a medical, psychiatric and social history. He or she may use the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Specific phobia DSM 5

Specific phobia DSM 5 criteria ¹:

• A. Marked fear or anxiety about a specific object or situation (e.g. , flying, heights, animals, receiving an injection , seeing blood).
  Note: I n children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging.
• B. The phobic object or situation almost always provokes immediate fear or anxiety.
• C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
• D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
• E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
• F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social , occupational , or other important areas of functioning.
• G. The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in posttraumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).

Specify if based on the phobic stimulus:

• Animal (e.g., spiders, insects, dogs) .
• Natural environment (e.g., heights, storms, water) .
• Blood-injection-injury (e.g., needles, invasive medical procedures).
  • fear of blood ;
  • fear of injections and transfusions; F40.232 fear of other medical care; or
  • fear of injury.
• Situational (e.g., airplanes, elevators, enclosed places) .
• Other (e.g., situations that may lead to choking or vomiting; in children, e.g., loud sounds or costumed characters).

Specific phobia treatment

The best treatment for specific phobias is a form of psychotherapy called exposure therapy. Sometimes your doctor may also recommend other therapies or medication. Understanding the cause of a phobia is actually less important than focusing on how to treat the avoidance behavior that has developed over time.

The goal of treatment is to improve quality of life so that you’re no longer limited by your phobias. As you learn how to better manage and relate to your reactions, thoughts and feelings, you’ll find that your anxiety and fear are reduced and no longer in control of your life. Treatment is usually directed at one specific phobia at a time.

Psychotherapy

Talking with a mental health professional can help you manage your specific phobia. Exposure therapy and cognitive behavioral therapy are the most effective treatments.

• Exposure therapy focuses on changing your response to the object or situation that you fear. Gradual, repeated exposure to the source of your specific phobia and the related thoughts, feelings and sensations may help you learn to manage your anxiety. For example, if you’re afraid of elevators, your therapy may progress from simply thinking about getting into an elevator, to looking at pictures of elevators, to going near an elevator, to stepping into an elevator. Next, you may take a one-floor ride, then ride several floors, and then ride in a crowded elevator.
• Cognitive behavioral therapy (CBT) involves exposure combined with other techniques to learn ways to view and cope with the feared object or situation differently. You learn alternative beliefs about your fears and bodily sensations and the impact they’ve had on your life. CBT emphasizes learning to develop a sense of mastery and confidence with your thoughts and feelings rather than feeling overwhelmed by them.

Medications

Generally psychotherapy using exposure therapy is successful in treating specific phobias. However, sometimes medications can help reduce the anxiety and panic symptoms you experience from thinking about or being exposed to the object or situation you fear.

Medications may be used during initial treatment or for short-term use in specific, infrequently encountered situations, such as flying on an airplane, public speaking or going through an MRI procedure.

• Beta blockers. These drugs block the stimulating effects of adrenaline, such as increased heart rate, elevated blood pressure, pounding heart, and shaking voice and limbs that are caused by anxiety.
• Sedatives. Medications called benzodiazepines help you relax by reducing the amount of anxiety you feel. Sedatives are used with caution because they can be addictive and should be avoided if you have a history of alcohol or drug dependence.

Self-help therapy for phobias

When it comes to treating phobias, self-help strategies and therapy can both be effective. What’s best for you depends on a number of factors, including the severity of your phobia, your insurance coverage, and the amount of support you need.

As a general rule, self-help is always worth a try. The more you can do for yourself, the more in control you’ll feel—which goes a long way when it comes to phobias and fears. However, if your phobia is so severe that it triggers panic attacks or uncontrollable anxiety, you may want to get additional support.

The good news is that therapy for phobias has a great track record. Not only does it work extremely well, but you tend to see results very quickly—sometimes in as a little as one to four sessions.

However, support doesn’t have to come in the guise of a professional therapist. Just having someone to hold your hand or stand by your side as you face your fears can be extraordinarily helpful.

Phobia self-help tip 1: Face your fears, one step at a time

It’s only natural to want to avoid the thing or situation you fear. But when it comes to conquering phobias, facing your fears is the key. While avoidance may make you feel better in the short-term, it prevents you from learning that your phobia may not be as frightening or overwhelming as you think. You never get the chance to learn how to cope with your fears and experience control over the situation. As a result, the phobia becomes increasingly scarier and more daunting in your mind.

Exposure: Gradually and repeatedly facing your fears

The most effective way to overcome a phobia is by gradually and repeatedly exposing yourself to what you fear in a safe and controlled way. During this exposure process, you’ll learn to ride out the anxiety and fear until it inevitably passes.

Through repeated experiences facing your fear, you’ll begin to realize that the worst isn’t going to happen; you’re not going to die or “lose it.” With each exposure, you’ll feel more confident and in control. The phobia begins to lose its power.

Successfully facing your fears takes planning, practice, and patience. The following tips will help you get the most out of the exposure process.

Climbing up the “fear ladder”

If you’ve tried exposure in the past and it didn’t work, you may have started with something too scary or overwhelming. It’s important to begin with a situation that you can handle, and work your way up from there, building your confidence and coping skills as you move up the “fear ladder.”

• Make a list. Make a list of the frightening situations related to your phobia. If you’re afraid of flying, your list (in addition to the obvious, such as taking a flight or getting through takeoff) might include booking your ticket, packing your suitcase, driving to the airport, watching planes take off and land, going through security, boarding the plane, and listening to the flight attendant present the safety instructions.
• Build your fear ladder. Arrange the items on your list from the least scary to the most scary. The first step should make you slightly anxious, but not so frightened that you’re too intimidated to try it. When creating the ladder, it can be helpful to think about your end goal (for example, to be able to be near dogs without panicking) and then break down the steps needed to reach that goal.
• Work your way up the ladder. Start with the first step (in this example, looking at pictures of dogs) and don’t move on until you start to feel more comfortable doing it. If at all possible, stay in the situation long enough for your anxiety to decrease. The longer you expose yourself to the thing you’re afraid of, the more you’ll get used to it and the less anxious you’ll feel when you face it the next time. If the situation itself is short (for example, crossing a bridge), do it over and over again until your anxiety starts to lessen. Once you’ve done a step on several separate occasions without feeling too much anxiety, you can move on to the next step. If a step is too hard, break it down into smaller steps or go slower.
• Practice. It’s important to practice regularly. The more often you practice, the quicker your progress will be. However, don’t rush. Go at a pace that you can manage without feeling overwhelmed. And remember: you will feel uncomfortable and anxious as you face your fears, but the feelings are only temporary. If you stick with it, the anxiety will fade. Your fears won’t hurt you.

Facing a fear of dogs: A sample fear ladder

• Step 1: Look at pictures of dogs.
• Step 2: Watch a video with dogs in it.
• Step 3: Look at a dog through a window.
• Step 4: Stand across the street from a dog on a leash.
• Step 5: Stand 10 feet away from a dog on a leash.
• Step 6: Stand five feet away from a dog on a leash.
• Step 7: Stand beside a dog on a leash.
• Step 8: Pet a small dog that someone is holding.
• Step 9: Pet a larger dog on a leash.
• Step 10: Pet a larger dog off leash.

While it’s natural to feel scared or anxious as you face your phobia, if you start to feel overwhelmed, immediately back off and use the techniques outlined below to quickly calm your nervous system.

Phobia self-help tip 2: Learn to calm down quickly

When you’re afraid or anxious, you experience a variety of uncomfortable physical symptoms, such as a racing heart and a suffocating feeling. These physical sensations can be frightening themselves—and a large part of what makes your phobia so distressing. However, by learning how to calm yourself down quickly, you can become more confident in your ability to tolerate uncomfortable sensations and face your fears.

A simple deep breathing exercise

When you’re anxious, you tend to take quick, shallow breaths (also known as hyperventilating), which actually adds to the physical feelings of anxiety. By breathing deeply from the abdomen, you can reverse these physical sensations. You can’t be upset when you’re breathing slowly, deeply, and quietly. Within a few short minutes of deep breathing, you’ll feel less tense, short of breath, and anxious. You don’t need to feel anxious to practice this technique. In fact, it’s best to practice when you’re feeling calm until you’re familiar and comfortable with the exercise.

• Sit or stand comfortably with your back straight. Put one hand on your chest and the other on your stomach.
• Take a slow breath in through your nose, counting to four. The hand on your stomach should rise. The hand on your chest should move very little.
• Hold your breath for a count of seven.
• Exhale through your mouth to a count of eight, pushing out as much air as you can while contracting your abdominal muscles. The hand on your stomach should move in as you exhale, but your other hand should move very little.
• Inhale again, repeating the cycle until you feel relaxed and centered.
• Practice this deep breathing technique for five minutes twice day. Once you’re comfortable with technique, you can start to use it when you’re facing your phobia or in other stressful situations.

Use your senses

One of the quickest and most reliable ways to relieve anxiety is by engaging one or more of your senses—sight, sound, taste, smell, touch, or movement. But since everyone is different, you’ll need to do some experimenting to discover what works best for you.

• Movement – Go for a walk, jump up and down, or gently stretch. Dancing, drumming, and running can be especially effective at relieving anxiety.
• Sight – Look at anything that relaxes you or makes you smile: a beautiful view, family photos, cat pictures on the Internet.
• Sound – Listen to soothing music, sing a favorite tune, or play a musical instrument. Or enjoy the relaxing sounds of nature (either live or recorded): ocean waves, wind through the trees, birds singing.
• Smell – Light scented candles. Smell the flowers in a garden. Breathe in the clean, fresh air. Spritz on your favorite perfume.
• Taste – Slowly eat a favorite treat, savoring each bite. Sip a hot cup of coffee or herbal tea. Chew on a stick of gum. Enjoy a mint or your favorite hard candy.
• Touch – Give yourself a hand or neck massage. Cuddle with a pet. Wrap yourself in a soft blanket. Sit outside in the cool breeze.

Meditation for stress and anxiety relief

Meditation is a relaxation technique that can help to prevent anxiety—and it can actually change your brain as well. With regular practice, meditation boosts activity in the area of the brain responsible for feelings of serenity, helping to quell fear and panic before they strike.

Beginning meditation – 16 minutes

Learn how to relax and open yourself up to discovering physical and emotional sensations throughout your body. Move up to the intermediate meditation when you feel alive to the feelings and sensations throughout your body.

Intermediate meditation – 18 minutes

Learn how to identify the physical and emotional sensations in your body that stand out from the rest—that feel stronger or different. Move up to the deeper meditation when you are able to pinpoint and focus on different or unusual sensations and feelings in your body.

Deeper meditation – 24 minutes

Learn how to stay emotionally connected even in situations that make you feel uncomfortable or mildly stressed. Move up to the deepest meditation when you are completely confident of your ability to remain calm and focused in mildly stressful or uncomfortable situations.

Deepest meditation – 30 minutes

Learn how to remain focused, alert, and emotionally aware at all times, even in the most stressful situations. Move on to Step 5 when you’re secure in your ability to remain calm and focused in even the most stressful situations.

Meditation Music – 18 minutes

This original meditation music was composed and performed by Roger Goodman to accompany the Ride the Wild Horse meditations. Roger is a Los Angeles-based musician and song writer.

After each meditation session

At the end of each meditation, it’s important to shift your attention away from an exclusively internal focus on your physical and emotional feelings. Return your attention to your everyday, external concerns such as work, leisure, and relationships.

You may notice that even though you are no longer giving your full attention to your feelings, some awareness of what you are feeling will remain with you, in the background of your consciousness. This means that you are integrating the process into your everyday life, which will give you a greater sense of control over your emotions.

Talk to someone about your experience

It’s important to find a person you can talk to about your experiences with the meditation within 36 hours. What did you learn about yourself? What did you discover about your emotions? Speaking to someone face-to-face will help you retain what you’ve learned.

Frequently asked questions about the meditations

How much time do I need to invest in meditation?

It takes about 21 to 28 consecutive days to create a new habit, but if you do the process correctly and often, you’ll experience daily benefits. As you want the process to become second nature to you—so you don’t “forget” to apply the skills in times of extreme stress—it may take a little longer. Practice the Ride the Wild Horse meditation until you are comfortable using the skills in the most challenging circumstances.

What should I do if I initially feel something in one part of my body, and a stronger sensation occurs somewhere else?

Always follow the intensity. Focus on the strongest sensation you feel.

What if I don’t feel anything or I just feel empty?

That’s normal. Pay attention to the feeling of having no feeling, or of being numb or empty.

I’m getting emotional during the meditation, is that normal?

Yes. Releasing repressed feelings can be intense. If you cry, tremble, moan, or make other sounds, remember to breathe deeply and hold your focus. It is okay to experience these emotions—as long as you can calm and focus yourself and feel in control of the process.

If after numerous attempts you still feel uncomfortable, consider seeking the support of a trauma specialist.

Do people really have to learn to experience joy?

Some do. There are those for whom any kind of emotional intensity feels intimidating because they fear a loss of control.

Would writing in a journal be similar to talking to someone?

No! Writing engages different parts of the brain than speaking face to face.

Phobia self-help tip 3: Challenge negative thoughts

Learning to challenge unhelpful thoughts is an important step in overcoming your phobia. When you have a phobia, you tend to overestimate how bad it will be if you’re exposed to the situation you fear. At the same time, you underestimate your ability to cope.

The anxious thoughts that trigger and fuel phobias are usually negative and unrealistic. It can help to put these thoughts to the test. Begin by writing down any negative thoughts you have when confronted with your phobia. Many times, these thoughts fall into the following categories:

• Fortune telling. For example, “This bridge is going to collapse;” “I’ll make a fool of myself for sure;” “I will definitely lose it when the elevator doors close.”
• Overgeneralization. “I fainted once while getting a shot. I’ll never be able to get a shot again without passing out;” “That pit bull lunged at me. All dogs are dangerous.”
• Catastrophizing. “The captain said we’re going through turbulence. The plane is going to crash!” “The person next to me coughed. Maybe it’s the swine flu. I’m going to get very sick!”

Once you’ve identified your negative thoughts, evaluate them. Use the following example to get started.

Negative thought: “The elevator will break down and I’ll get trapped and suffocate.”

Is there any evidence that contradicts this thought?

• “I see many people using the elevator and it has never broken down.”
• “I cannot remember ever hearing of anyone dying from suffocation in an elevator.”
• “I have never actually been in an elevator that has broken down.”
• “There are air vents in an elevator which will stop the air running out.”

Could you do anything to resolve this situation if it does occur?

• “I guess I could press the alarm button or use the telephone to call for assistance.”

Are you making a thinking error?

• “Yes. I’m fortune telling, as I have no evidence to suggest that the elevator will break down.”

What would you say to a friend who has this fear?

• “I would probably say that the chances of it happening are very slim as you don’t see or hear about it very often.”

It’s also helpful to come up with some positive coping statements that you can tell yourself when facing your phobia. For example:

• “I’ve felt this way before and nothing terrible happened. It may be unpleasant, but it won’t harm me.”
• “If the worst happens and I have a panic attack while I’m driving, I’ll simply pull over and wait for it to pass.”
• “I’ve flown many times and the plane has never crashed. In fact, I don’t know anyone who’s ever been in a plane crash. Statistically, flying is very safe.”

1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders. 5. Washington, DC: American Psychiatric Association; 2013.[↩]