Phobia Treatment: Therapies, Methods, and Medications

Phobias are often portrayed in fiction and media, and they’re sometimes given a humorous spin. However, phobias are a form of anxiety that can represent a serious impairment in a person’s life. A phobia is a severe or irrational fear of an object or situation that causes problems in your life. 

The object of a phobic person’s fears is called a phobic stimulus. Fears are often sudden and immediate, and the reaction to the stimulus is disproportionate to the threat presented. For instance, an encounter with an inanimate object can cause a severe panic attack. In other cases, avoidance behavior can lead to becoming isolated, which is often seen in agoraphobia. 

What are Phobias?

There are several types of phobias that are designated based on the phobic stimulus. Specific phobias surround a specific object or situation that can be narrowed down to one thing as opposed to a broad range. Specific phobias can include things like spiders or air travel. Specific phobias are further divided into four types, including animal types, natural environment type, situational type, and blood-injection-injury type. 

The second major category of phobia is agoraphobia. Agoraphobia is often misunderstood as the specific fear of leaving home or of open species. It’s actually a more generalized fear that causes people to retreat to familiar, safe surroundings like their own home. 

Agoraphobia can often come with panic attacks and other specific fears that may fall into other categories like the fear of open spaces. The last category of phobias is social phobia. Social phobia is also called social anxiety disorder, and it is characterized by fears of being judged by others or being embarrassed in front of other people.

Phobias range in severity. Some people experience mild anxiety and avoid their phobic stimulus. Others experience severe panic attacks and practice extreme avoidance behavior. Severity may also depend on the object of fear. For instance, the fear of clowns may not be a present issue in the average person’s life, but the fear of flying might lead to more inconveniences.

What Causes Phobias?


The exact cause of phobias is unknown, but some are believed to be rooted in human ancestral adaptation. Some of the most common specific phobias are the fear of spiders (arachnophobia) and the fear of snakes (ophidiophobia). Spiders and snakes may be a serious threat in some parts of the world, especially among people and cultures that spend a lot of time outdoors in natural surroundings.

Our ancestors may have developed certain fears to help them survive. People who reacted quickly to the presence of a venomous snake in their path may have had a better chance of avoiding them. Likewise, a social phobia may be rooted in the need to integrate with other people to benefit from the strength in numbers. Humans are social creatures, and being rejected by a group may have threatened the survival of our ancestors, leading to social anxiety today. 

For some people, phobias may be rooted in childhood traumas that were never effectively addressed. For instance, cynophobia, the fear of dogs, is often rooted in a frightening childhood experience with an aggressive or rambunctious dog. People who come from cultures where dogs are seen more as feral vermin may also carry childhood fears into adulthood. 

While this could explain the cause of certain kinds of fear, we still aren’t sure why some people experience intense fear that gets in the way of their lives. Like other anxiety disorders, phobias are thought to be linked to the part of the brain called the amygdala, which controls your fight-or-flight response. In most people, other parts of the brain are able to manage your fear response. If your fears are triggered by something that is determined not to be a threat, you may be able to get over your fear without disrupting your life. 

For instance, flying in an airplane is something that’s unnatural to human beings, and the average person may not be aware of how flying works. However, statistics show that flying is safe, even safer than other modes of transportation. For someone with a phobia of flying, rationalization may not help manage the fear. 

How is Phobia Diagnosed?

The first step in treating a phobia is getting a diagnosis. Anxiety disorders can be complicated, and there are many different types you might experience. Plus, phobias tend to come with other phobias that also need to be addressed. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), fear has to meet a specific set of criteria to be diagnosed as a phobia. Social disorders and agoraphobia may be treated differently from specific phobias. 

The latter is characterized by marked fear about an object or situation. That fear is intense or severe, not a mild discomfort. Fear or anxiety that’s caused by a phobia is immediate. In other words, it’s not generally fear that comes on hours after a stimulus, or fear that only happens every once in a while when you encounter a specific stimulus.  

Phobias are also identified by avoidance, or it is endured with intense anxiety. This avoidance can get in the way of your life, and when your fear can’t be avoided, the anxiety it causes can be debilitating. Another factor in phobias is that fear is out of proportion to the perceived threat. For instance, encountering a friendly dog at a friend’s house might cause a person with cynophobia to stream and run out the door, even if the dog was showing no signs of aggression. 

Another important factor is that the fear or anxiety around a specific stimulus is persistent, usually lasting six months or more. If you have a panic attack, at a party but you don’t experience anxiety at parties before or after, you may not have a social phobia. Persistence is a common factor in diagnosing mental health issues, and it helps rule out fleeting anxieties and other mental health disorders.

Finally, to qualify as a phobia, the fear or avoidance of stimulus must lead to impairment of normal functioning. Like other officially diagnosed mental health issues, phobias can get in the way of your everyday life. For instance, someone with a fear of heights may feel unable to live or work in tall buildings.

How are Phobias Treated?

Phobias can be treated in several ways, including psychotherapy and medication. One of the leading methods of treating phobias is exposure therapy. Exposing you to your fears may sound like a terrible experience, but exposure therapy is carefully orchestrated to help you set your own pace and slowly overcome fears. Exposure therapy is designed to help you build up your coping strategies and ability to calm yourself down when something triggers fear or anxiety. 

Your therapist may start by working with you to make a list of your fears in the order of mild to severe. This is called a hierarchy of fears. As an example, if you have arachnophobia, you may be extremely panicked around real spiders, anxious around toy spiders, and just a little uncomfortable looking at pictures of spiders. When you’ve made a hierarchy of fears, your therapist will help you work your way up the list, starting with exposure to the most minor fears. 

In therapy, you set your own pace, and you have the ability to slow down when things are too frightening for you to endure. With each step, you’ll develop and employ coping mechanisms to help you overcome irrational fears. By the time you reach the top of your list, like handling a spider, you will have the tools to cope with fear effectively. Ultimately, the goal of exposure therapy is to allow you to live your life without phobias getting in the way.

Another common therapy used to address phobias is cognitive-behavioral therapy (CBT). CBT is used in the treatment of a variety of mental health issues, including anxiety, depression, trauma, and behavioral disorders. CBT examines cognitive processes and how they can influence your thinking and behavior. People with phobias often have irrational or intrusive thoughts about the dangerous outcome of a relatively harmless situation.

For instance, someone with a fear of heights may be afraid that a bridge will collapse when they go over it. CBT will examine and challenge those thoughts with reason. CBT may also borrow some techniques from exposure therapy to help build up coping strategies.

If your phobia is severe, you may not be able to participate in exposure therapy without extreme fear and anxiety. In such cases, medications may be an effective option. Like other anxiety disorders, phobias may be treated with SSRIs or SNRIs, which can help alleviate symptoms of anxiety and depression by increasing serotonin levels in your nervous system. 

Beta-blockers may be used to block adrenaline, which can take some of the intensity out of your fear response and help you to calm down. Finally, sedatives like benzodiazepines can be used to slow down your nervous system, allowing you to relax. These medications may allow you to participate in treatment to help you more effectively address the problem.

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