Specific phobias

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What is a phobia?

The term “phobia” is derived from the Greek phobos meaning ‘flight ‘panic-fear’ and ‘terror’ (Beck & Emery 1985). A Phobia is a “specific kind of fear” or excessive fear of some particular type of object or situation. This fear is often exaggerated and disabling (Beck & Emery 1985).

Exposure to the phobic stimulus immediately provokes an anxiety response or acute symptoms of panic. At this stage they may wish to escape the situation or avoid any contact with the object, situation or fear. On occasions life activities can become restricted because of it. The person is able to recognise the fear is exaggerated but is unable to eliminate the fear or reduce the avoidance (Beck & Emery 1985).

There are 3 categories of phobia identified in ICD-10: (Classification on Mental & Behavioural Disorders):

Specific Phobias:

In specific phobia there is a marked fear or avoidance of a specific object or situation, such as the sight of blood or injury, birds, insects, animals, heights, dentists and spiders amongst others. The fear revolves around becoming anxious when in contact with the object or situation. Some authorities categorise blood and injury phobias separately because they require a slightly modified form of what is known as graded exposure therapy.

Agoraphobia:

In agoraphobia there is a marked fear or avoidance of crowds, public places and /or travelling alone or away from home. The person is fearful of becoming anxious or having a panic attack in the feared situation and not being able to escape. (Gega 2004).

For further information, please see our Panic Disorder page

Social Phobia:

If your service user's anxiety is about social situations please refer to our Social phobia page.

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How common are phobias?

Phobias are extremely common within the population. Women are marginally more affected then men with a male: female ratio of 1:2. Social phobia is the third most common psychiatric disorder with a lifetime prevalence of 13%. The diagnosis is appropriate only if the avoidance, fear or anxious anticipation of encountering the phobic stimulus interferes significantly with the persons daily routine, occupational functioning, social life or if the person is markedly distressed about having the phobia (DSMIV 1994).

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Can specific phobias be treated?

Effective psychological and pharmacological therapies do exist although there is a large body of evidence which suggests psychological interventions are more effective than credible alternatives. Cognitive Behaviour Therapy is particularly effective in the treatment of phobias. Treatment usually consists of anything between 10 to 20 weekly sessions. Techniques might involve a gradual approach to the problem so that people can learn that their fears as well as the physical symptoms of anxiety die away the longer they are in the feared situation. Unhelpful or mistaken beliefs about the dangerousness of the problem can also be disconfirmed by carefully designed behavioural tests.

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Practical advice

The key to managing anxieties and fear is to accept it. Remaining in the present and accepting anxiety cause it to disappear. The acronym A-W-A-R-E can help sufferers to cope better in the phobic situation.

1) A= Accept the anxiety – with positive self comments- and go with the flow “this is anxiety it’s ok to accept this”. Remain with the experience and don’t fight it.

2) W= Watch your anxiety – Be detached and remember you are not your anxiety. – Rate it on a scale of 0-8 and watch it go up and down. – Be aware of your thoughts, feelings and actions and let the anxiety flow through you without condemning it.

3) A= Act with the anxiety and normalise the situation you are in. – Act as if you are not anxious, function with it. – Slow down if you have to but keep going. – Breathe slowly and normally.

4) R= Repeat the steps above. – Continue to accept and watch your anxiety and “act with it” until your anxiety reduces to a comfortable level. – If you run from the phobic situation your anxiety will reduce but your fear will continue to rise. – If you stay in the situation both your anxiety and fear will go down.

5) E= Expect the best. – What you fear the most rarely happens. – Recognise that a certain amount of anxiety is normal. – By expecting future anxiety you’re putting yourself in a good position to accept it when it comes again. ( Beck & Emery 1985)

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Are there support groups service users can contact?

NO PANIC (National Organisation for Phobias, Anxiety, neuroses, Information & Care)
93 Brands Farm Way, Randley, Telford, Shropshire, TF3 2JQ
Helpline: 0808 808 0545 www.nopanic.org.uk

Triumph Over Phobia (TOP UK)
PO Box 3760 Bath, BA2 3WY
Tel: 0845 600 9601 www.triumphoverphobia.com
Runs a national network of structured, self-help groups for adults (16+) suffering from phobias

Anxiety UK (formerly National Phobics Society)
Zion Community Resource Centre, 339 Stretford Road, Hulme, Manchester, M15 4ZY
Tel: 08444 775 774 www.anxietyuk.org.uk

Dental Anxiety & Phobia Association
104 Harley Street, London, W1G 7JD
Tel: 020 7935 8092 www.healthyteeth.com

Gut Reaction
PO Box 70, Ross-on-Wye, Herefordshire, HR9 5YP
www.gut-reaction.freeserve.co.uk
A life-long sufferer of emetophobia, a fear of vomiting, formed gut Reaction in 1994

Needlephobia.co.uk
www.needlephobia.co.uk
Needle phobia’s correct name is “Belonephobia”. It can be defined as a fear of sharp objects such as pins and needles. This website, run by Smith & Nephew, includes information for the general public and professionals affected by this issue with regard to healthcare.

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Recommended reading about specific phobias

These books are designed for the general reader and some have very good self-treatment instructions:

These three books give a more detailed perspective and are designed for health professionals:

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Current research

In the treatment of phobias ‘graded exposure therapy’ has been proven to be the most effective method for specific phobias. This means that during therapy a phobic person is encouraged to gradually ‘expose’ themselves to the phobic object or situation; by doing this they can learn that anxiety reduces over time even when still in the feared situation. For social phobia and agoraphobia the treatment is effective when both cognitive and behavioural techniques are combined. The cognitive techniques can involve examining unhelpful beliefs and learning how to effectively challenge upsetting or negative thoughts. Recent research has been focused on making the treatments more effective, more accessible and less distressing than earlier treatments.

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