Facing down a phobia—an irrational fear—can be daunting but breaking free from the shackles that hold you back from living your life is possible. Here’s a roadmap to help you.
Irrational fears can be the stuff of family legend—the uncle who never left his house; the sister who missed a family trip to Alaska because she wouldn’t get on an airplane, or the 10-year-old nephew so terrified of shots he refused to see a doctor.
While most of us wouldn’t be thrilled to find a snake in the toilet or a hairy spider under the covers when these fears trigger digestive distress or interfere with a good night’s sleep, it’s probably time to get help.
The term “phobia” gets thrown around a lot these days, but having a fear and having a phobia aren’t exactly the same thing.
Essentially, fear is temporary; phobia isn’t.
Having a phobia creates a stumbling block in your life, and the fear it causes can be so strong that you’ll do anything to avoid the object of that phobia. Phobia that becomes debilitating is a type of anxiety disorder. Take, for example, a job offer. You made it through the hardest part—landing your dream position—only to find out that your office will be on the 20th floor of an office building…and you have a phobia of heights. In order to avoid being so high off the ground, you turn the position down and pass up a significant job opportunity because of your phobia.
Phobias can be debilitating and crippling, and they can keep you from enjoying the things you love with the people you love. But it doesn’t have to be this way. There is hope and help for people with phobias.
A phobia is an intense as well as irrational fear toward one or more things or situations for which the level or intensity of fear does not match the actual danger of what you fear.
A phobia can be specific, like a fear of dogs or being high off the ground. But it can also be overarching, like being in any social setting or public place.
While fear is a natural and universal human emotion, having a “phobia” is a medical diagnosis and not a word to be tossed around lightly. To understand phobias, it is helpful to have a deeper understanding of fear and why we experience it.
How Fear Works in the Brain
One of the ways the brain helps keep you alive is by warning you of dangers. When the brain senses danger, an internal alarm system is activated, sending out various signals that trigger feelings of fear or anxiety. These are physical and cognitive reactions triggered in response to whatever it is that your brain perceives as dangerous or scary.
Sometimes, we should be fearful—without fear, we would unknowingly put ourselves into life-threatening situations without taking proper precautions. But the difference between having healthy, occasional bouts of fear and having a phobia is that a phobia is by definition irrational: Despite the intense fear you feel, the circumstance or object of your fear poses little or no actual threat to you.³
Think of a phobia as the brain’s alarm system in overdrive—it overestimates the threat of a particular situation, triggering intense anxiety and leading you to avoid that situation in the future. That avoidance actually makes a phobia worse because it solidifies the brain’s overblown association between the situation and its threat level.
For example, someone who has a phobia of dogs will feel their brain’s alarm system go off every time they are near a dog, explains Steve Mazza, PhD, a senior clinical psychologist at the Columbia University Clinic for Anxiety and Related Disorders in New York. If this person continues to avoid dogs, the brain’s “miscalibration is reinforced, and the person never has the opportunity to recalibrate their alarm system to the actual threat of the environment,” Mazza says.
Knowing that phobias result from brain processes that are meant to protect us from danger can help people de-stigmatize phobias, according to Joe Bienvenu, MD, a professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine in Baltimore. Our brains are adapted to be afraid of things like snakes for safety reasons. But even social phobias, like a phobia of public speaking, can be adaptive because “we’re social animals, and how other people evaluate us often does have consequences,” says Dr. Bienvenu.
What Are the Three Types of Phobias?
There are three main types of phobias, and all of them fall under the category of anxiety disorders: specific phobias (the most common type of phobia), social anxiety disorder, and agoraphobia. What they have in common, according to Mazza, is an intense emotional reaction that is not commensurate with what is actually happening in the environment, and the avoidance of the stimuli is what maintains the intense, emotional reaction.
Causes of Specific Phobia
The reasons why phobias develop are not fully understood. Specific phobias tend to begin in children, whose developing brains are still developing patterns about how to respond to the world around them. A common example of this is a child who develops a phobia of dogs after being bitten by one, but there are many more subtle ways that a child’s brain can take in information that teaches them to fear something. For example, they could learn to fear a dog by watching a movie that features a scary dog or watch a family member flinch in response to a dog’s bark.
Still, experiences in childhood are only one of many potential reasons why one may go on to develop a specific phobia. Genetics may also play a role.¹ Many specific phobias may be due to a complex interplay between genetics and life experiences. The same goes for social anxiety disorders and agoraphobia. Teens are more vulnerable to developing social anxiety disorders, likely because the teen years are marked by hormonal changes and new social pressures. Agoraphobia and panic disorders have a lot of overlap, and they both tend to start in young adulthood.
Specific Phobia Risk Factors
Risk factors for developing a specific phobia are temperamental, environmental, and genetic. For instance, negative affectivity (a propensity to feel negative emotions such as disgust, anger, fear, or guilt) or behavioral inhibition are temperamental risk factors for a variety of anxiety disorders, including specific phobias.
Parental overprotectiveness, physical and sexual abuse and traumatic encounters are examples of environmental risk factors that increase the likelihood of an individual developing a specific phobia.
There may also be a genetic susceptibility to a certain category of a specific phobia; for example, if an individual has an immediate relative with a specific situational phobia of flying, the individual is more likely to have the same specific phobia than any other category of phobia.
Phobia Symptoms
Symptoms common to all types of phobias include feelings of panic and fear; racing heart; difficulty breathing; shaking or trembling; a strong urge to exit the situation. Each type of phobia can also have unique symptoms related to the type of fear it causes and its source.
Symptoms can also be broken down into physical and emotional symptoms.
Physical Symptoms
Racing heart
Difficulty breathing
Trembling or shaking
Sweating
Nausea
Dry mouth
Chest pain or tightness
Emotional Symptoms
Feeling overwhelming anxiety or fear
Knowing that your fear is irrational, but feeling powerless to overcome it
Fear of losing control
Feeling an intense need to escape
Social anxiety disorder symptoms often manifest as the avoidance of social situations or intense discomfort in social situations that are difficult to avoid.
Similarly, signs of agoraphobia include fear or avoidance of certain situations. like being outside your home alone and being in a crowded or enclosed space. However, avoiding these situations is usually rooted in fear of experiencing anxiety or a panic attack in these settings and being unable to escape or find help.
Specific Phobia Symptoms
If you have a specific phobia (a fear of clowns or dogs, for example) you may experience the following symptoms:
Sudden fear, anxiety, and panic in the presence of (or when thinking about) the source of the phobia
The inability to control or subdue the fear
Anxiety that intensifies as you get closer to the source of the fear
Avoiding the source of the fear at all costs
If avoidance is impossible or difficult, experiencing debilitating anxiety when facing the source
Difficulty functioning normally or to the best of your ability as a result of the phobia.
Specific Phobia Treatment
With the proper treatment, many phobias can be cured. While specific phobias may seem less complex than the other types, treatment for all phobias actually is quite similar.
“That’s one of the things that should be encouraging for people with anxiety,” says Lily Brown, PhD, an assistant professor and the director at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania in Philadelphia. “There’s actually a lot of data that the same principles that are efficacious for treating specific phobia are also really efficacious for treating social anxiety disorder and agoraphobia.”
Those principles are cognitive behavioral therapy (CBT) and exposure therapy, she says.
Cognitive Behavioral Therapy (CBT)
The clinical term for talk therapy is psychotherapy. CBT is one type of psychotherapy and involves working with a trained mental health professional in a group or in one-on-one sessions. “Homework” (or therapy exercises) is frequently assigned and expected to be completed outside of the sessions—think of them as mental health homework. CBT’s goal in treating phobias is to change thinking, behavior, and reactions surrounding your anxiety. Through sessions and outside exercises, you’ll be encouraged to identify negative or irrational thinking patterns and alter them.
One facet of CBT that is particularly important in treating phobias is exposure therapy. Exposure therapy involves exposing you to the object or situation you fear. By facing it and not experiencing a scary outcome. the thinking is that you’ll get used to it and stop responding to it with anxiety.
“You’re exposing the person to the feared stimuli until their body naturally calibrates to the threat level. So, the alarm system becomes less sensitive and it becomes more based on reality,” says Mazza.
Using exposure therapy to treat a dog phobia may work like this:
In early sessions, you may be asked to think about dogs and explain what comes to mind.
Then you may be asked to look at pictures of dogs.
Then you may be asked to go near a dog.
Then someone may ask you be asked to pet a dog.
We can use the same general approach to treat social anxiety disorder or agoraphobia.
Research has shown that, in some cases, CBT can be equally or even more effective than medications and other forms of talk therapy in treating mental illnesses like phobias.
Other Treatments for Phobias That Don’t Involve Medication
Alternatives to medication can be effective for treating phobias. Other treatments for phobias that don’t involve medication include:
Social Skills Training
For people with social anxiety disorder, social skills training may be a part of treatment alongside CBT. Social skills training may involve role-playing social interactions with a therapist. exposure to social situations, or general exercises to practice social skills.
Mindfulness
Mindfulness is a type of meditation that may help with a phobia or other anxiety disorders. It’s somewhat similar to CBT in that it encourages awareness of feelings and sensations in the present moment.
Support Groups
Joining an in-person or online support group for people who share the same or a similar type of phobia can help you learn more about your condition and about effective ways that other people cope with it.
