What are specific phobias?

Coping with phobias. Specific phobia symptoms. All symptoms and signs someone with a specific phobia can experience: muscle tension, shortness of breath, trouble breathing, feeling on edge, racing heart, fear of approaching, worry, fear of injury, fright, terror, light headed, sweaty, shaky, trouble relaxing, looking for distraction, wanting to leave, avoidance.

Before we can start coping with phobias, it is important to understand what a specific phobia is. A specific phobia is characterized by an excessive and disproportionate fear of an object, situation or animal. This excessive and disproportionate fear causes phobic people to experience a lot of panic-like feelings, such as breathing problems, racing heart, sweating, and strong feelings to leave the situation as soon as possible. Common specific phobias are fear of spiders (Arachnophobia), fear of dogs (Cynophobia), and fear of heights (Acrophobia). Coping with phobias usually is very difficult for phobic people, because they do not dare to come near the phobic object/situation/animal, which makes it difficult for them to understand that their fear and anxiety is irrational.
Fortunately, coping with phobias is easier than one may think and with the help of this self-help guide, you will make a lot of progress in a short time. First, common triggers and anxiety provoking situations are being discussed, followed by some exercises (psycho-education), and eventually a gradual exposure exercise.
Please NOTE: we recommend you to contact a therapist to discuss treatment options and/or to guide you through the process discussed on this page. Coping with phobias on your own can be counter-effective if the exercises are practiced in a wrong way. For instance, using the Brazilian Wandering Spider to get over your Arachnophobia can be fatal. This self-help page is only meant for those who have mild to moderate specific phobia. Click here, to take the online and anonymous specific phobias test to see how severe your specific phobia is.

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At Barends Psychology Practice, we offer (online) counseling for specific phobias. Contact us to schedule a first, free of charge, online session. (Depending on your health insurance, treatment may be reimbursed).

Coping with phobias – Explaining triggers

Coping with phobias - triggers explained. How does smell, imagination, taste, sound, or sight trigger a specific phobia?
There is always a reason why someone experiences one or more of the specific phobia symptoms (e.g. trouble breathing, anxiety, fright, racing heart). For someone with a specific phobia, this reason is somehow related to the phobic situation, animal or object. Someone with Arachnophobia (fear of spiders) may experience these specific phobia symptoms when seeing a spider in real, on television or in a magazine. In some cases, it is even possible that there is no trace of a spider (or its web), but that the person suffering from Arachnophobia still experiences these typical specific phobia symptoms. A possible explanation could be that someone experiences a traumatic experience with a spider in that room or situation.
As can be seen in the image above or on the right side, these triggers cause symptoms typical for specific phobia. The avoidance symptoms are the ones that prevent someone from testing their irrational fear, because (1) the avoidance symptoms prevent an encounter with the phobic animal/situation/object or (2) the focus during the encounter with the phobic animal/situation/object is on the anxiety and panic they feel, and on leaving the place. In the latter situation, two things will be remembered: (1) encountering a phobic object/animal/situation produces panic-like symptoms, and (2) leaving the place makes these symptoms disappear, and not being able to leave the place early increases the panic. Coping with phobias is, therefore, extremely difficult.
Fortunately, by testing the right hypothesis, we can reduce the severity of the specific phobia symptoms. Continue reading to learn how to do this.

Coping with phobias – Reducing anxiety

Despite the fact that treatment for specific phobias is very effective, it is not always possible to finish treatment before having a (planned) encounter with the phobic object/animal/situation. For instance, when someone with Aviophobia (fear of flying) needs to fly from one city to another for work. For this person, coping with phobias is very important; it helps the person stay calm right before and during the flight. There are a couple of things you can do:

Educate yourself

Coping with phobias. Fatal aviation accidents per year 1946-2017. Permission from aviation.safety.net
This is probably the easiest: educate yourself. Browse the internet, visit a library or call an organisation specialized in the object/situation/animal you fear so much. Try to avoid reading up on case studies. A case study is a study about 1 event during a specific time and place. For instance, reading up on that one time that EL AL Flight 1862 crashed into Groeneveen and Klein-Kruitberg in 1992 will most likely increase the fear of flying significantly, and doesn’t say anything about your upcoming flight(s).
Instead of focusing on one single flight, it is better to take a look at all the flights worldwide and count the amount of aviation accidents. In the graph above/to the right you can see the amount of fatal accidents per year from 1946 – 2017. When you compare the amount of fatal accidents with the annual amount of flights per year: +30.000.000 (more than 30 million flights per year), it is clear that flying is extremely safe [1].
Next to focusing on aviation accidents, it may also be very helpful to look into the long and intensive training pilots have to complete before they are allowed to fly passengers. The Royal Dutch Airlines KLM, for instance, has a very strict and long screening procedure involving several tests and psychological assessment before someone is even allowed to start the training program. On top of that, they have annual check-ups to test their knowlegde. And before every flight, pilots and/or flight engineers check the airplane thoroughly for damage and malfunction.

Exercises

How working memory affects subjective fear. Coping with phobias.
Although coping with phobias is not the same as a phobia treatment, it is very effective, especially when it comes to calming down. There are a few exercises you can do to calm down:

  • Breathing exercises: breathing exercises reduce the effects of stress and strain on the body and improve the physical and mental health [2],[3],[4],[5]. An example:
    (A) Close one nostril with the thumb and slowly inhale through the other nostril for 6 seconds. (B) Hold breath for 6 seconds and then exhale for 6 seconds through the other nostril. (C) Close one nostril with the thumb and slowly inhale through the other. Hold your breath for 6 seconds while keeping both nostrils closed, after which you can exhale through the other nostril. Repeat these three steps for about 30 minutes.
  • Distraction: Distracted exposure (distracting yourself while being exposed to a phobic situation/animal/object) reduces the subjective fear significantly compared to no distraction at all [6],[7]. External distracters work better than internal distracters to reduce fear levels [7]. Be sure to find distractions that require some active thinking/working memory, because passive distracters (such as music) is not an effective distracter. Passive distracters allow the person to keep thinking of the phobic stimulus [8]. In case you are afraid of car rides, it may be an idea to make sentences with letters on license plates. For those who are afraid of spiders, focusing on your phone or others around you may be very helpful.
  • Medication: Anxiety reducing medications, Beta-blockers, reduce your blood pressure by blocking the effects of the hormone epinephrine (also known as adrenaline). This helps people to stay calm when they are facing a phobic animal/situation/object [9].
  • Preparation: a good preparation helps people to stay calm as well. Knowing what you can expect, creates peace and offers distraction: you can focus on your preparation. A good example is studying the airport plan before arrival, especially when you have to change flights.

Coping with phobias – Exposure

Exposure to phobic animal, situation or object. Exposure treatment and anxiety levels. Coping with phobias.

Theory: Emotions, feelings, and thoughts are temporary: they come and go. Fear, for instance, may come up suddenly (especially when facing a feared object or animal) and disappears after a while. Even if someone stays near the feared object or animal, the emotion fear will disappear eventually.

It’s this principle (emotions, feelings, and thoughts come and go) that we’ll use in the exposure exercise. This principle will be combined with a good hypothesis to make sure that the exercise is as effective as possible.

Before we focus on the good hypothesis, we need to know what a bad hypothesis is. A bad hypothesis is a hypothesis we cannot really work with. A bad hypothesis focuses on superficial emotions and feelings without going deeper. For instance, someone with a fear of heights may be afraid of cliffs or lighthouses. A bad hypothesis would be: Whenever I climb a lighthouse, I panic. <– this hypothesis is probably always true and only tests fear on a superficial level. The fear will return each time. It does not tackle the real fear: jumping or falling down. Only by tackling the real fear, we’ll see a reduction in anxiety levels.

A good hypothesis can only be formed once we know what your biggest fear is regarding the specific phobia. For instance, the biggest fear of someone with a fear of spiders may be the fear of a fatal bite from a spider. Of course, the chance that this actually happens is extremely small. Therefore, it is safe to test this biggest fear. After a few times, someone will understand that a spider does not even attack a person, which in turn reduces anxiety levels. This is a success experience and will be registered in your brains.
It is important to understand that someone will experience panic-like symptoms when facing a spider. This is not something to worry about. Now that we understand some of the theory behind the exercises, we can get started with effectively coping with phobias.

Exercise:

  • Create a hierarchical list of the things you fear the most. For instance, 2 floors, 3 floors, 4 floors, 6 floors, top of a lighthouse, close to a cliff, and on top of the Burj Khalifa, UAE, in case you are afraid of heights. For people with Arachnophobia: being in the same room with a caged spider, sitting on a chair in a room with a caged spider, sitting close to the caged spider, being in the room with a spider, standing near a spider, approaching a spider, touching a spider. A benefit of a hierarchical list, compared to no list, is that it is easier to get started with exposure.
  • Determine what your biggest fear is in regards to your specific phobia. Ask yourself the following question over and over: What do I fear most when I encounter the animal/object I fear the most?…. and if this happens, what is the worst thing that can happen?… and if this happens, what is the worst thing that can happen? and so on. A tip: your biggest fear often has something to do with death, severe injuries or loss.
  • Create a good hypothesis and make sure that there is at least 80% chance of a success experience when you expose yourself to the phobic object, animal or situation. Discuss this hypothesis with someone you trust. An good hypothesis could be: I will not faint/die/get fatally injured when I expose myself to a spider. This step is very difficult and we strongly recommend you to contact a therapist or specialist in this field. A negative experience may result in a stronger case of phobia and may result in losing faith in therapy altogether. Worst case scenario, you may injure yourself. 
  • Prepare well: Practice breathing techniques as described above, and in cases of fear of objects or animals: read up on their behaviour/movements, and use a safety object or safety behaviour during the first times you expose yourself to these animals, objects or situations. Take, for instance, a friend with you when you are entering a lighthouse if you are afraid of heights. Your friend will be able to calm you down and gives you a sense of protection/safety. The friend in this example is the safety object.
  • Select the phobic situations, animals or objects. You don’t want to try to get rid of your Cynophobia (fear of dogs) by exposing yourself to a vicious dog. Neither would exposure to a Banana spider (Phoneutria) be a very wise thing to do. Instead, pick a calm (old) dog, a harmless little non-jumping spider, balconies with enough protection, and so on.
  • Focus on progress and not on success or failure. You cannot expect yourself to succeed each time. Every tiny bit of positive exposure to the phobic situation, object or animal is important. The end goal is to reduce the anxiety levels and to be able to deal with the phobic situation, animal or object when needed. The end goal is not to be the best dog handler or to become a skydiver.
  • Calm down right before you exposure yourself to the least difficult/anxiety provoking situation on your list. Then try to exposure yourself to the feared animal, object or situation.
  • During the exposure, do not leave the situation before you are fully calmed down. You’ll notice that the moment you see, feel or hear the presence of the fear object, animal or situation, that you’ll experience panic-like feelings. Remember: they are temporary and will go away.  Try to stay in the situation for as long as possible and only try to leave when you are completely calm.
  • Ask yourself the question if your worst fear came true?
  • Repeat this exercise until you feel comfortable enough to move to the next one on your list. Don’t forget to stay in the situation until you are completely calm, and don’t forget to ask yourself if your worst fear came true.

NOTE: this exercise is only for those people who have a mild or moderate specific phobia and who are able to expose themselves in a controlled and safe way to the phobic object, situation or animal without.

Doing the above mentioned exercise is at your own risk and responsibility.

We are more than happy to assist you along the way. Also we offer specific phobia treatment.

Literature

  • [1] Aviation safety network.
  • [2] Bhargava, R., Gogate, M. G., & Mascarenhas, J. F. (1988). Autonomic responses to breath holding and its variations following pranayama. Indian J Physiol Pharmacol, 32, 257-64.
  • [3] Telles, S., Nagarathna, R., & Nagendra, H. R. (1994). Breathing through a particular nostril can alter metabolism and autonomic activities. Indian Journal of Physiology and Pharmacology, 38, 133-133.
  • [4] Mohan, M., Saravanane, C., Surange, S. G., Thombre, D. P., & Chakrabarty, A. S. (1986). Effect of yoga type breathing on heart rate and cardiac axis of normal subjects. Indian J Physiol Pharmacol, 30, 334-40.
  • [5] Pal, G. K., & Velkumary, S. (2004). Effect of short-term practice of breathing exercises on autonomic functions in normal human volunteers. Indian Journal of Medical Research, 120, 115.
  • [6] Kamphuis, J. H., & Telch, M. J. (2000). Effects of distraction and guided threat reappraisal on fear reduction during exposure-based treatments for specific fears. Behaviour research and therapy, 38, 1163-1181.
  • [7] Oliver, N. S., & Page, A. C. (2008). Effects of internal and external distraction and focus during exposure to blood-injury-injection stimu.li. Journal of Anxiety Disorders, 22, 283-291.
  • [8] Lahmann, C., Schoen, R., Henningsen, P., Ronel, J., Muehlbacher, M., Loew, T., … & Doering, S. (2008). Brief relaxation versus music distraction in the treatment of dental anxiety: a randomized controlled clinical trial. The Journal of the American Dental Association, 139, 317-324.
  • [9] Patston, T., & Loughlan, T. (2014). Playing with performance: The use and abuse of beta-blockers in the performing arts. Victorian Journal of Music Education, 3.