Phobias

When you or someone you know has a phobia, the anxiety can feel so intense that you may fear coming into contact with the thing that makes you feel anxious. You may find that you either avoid situations that you fear or you become extremely anxious in them. When someone has a phobia of something, they often notice changes to their thoughts (for example, noticing frightening thoughts such as “this is extremely dangerous”), their emotions (for example, feeling extremely anxious), and their behaviours (for example, taking precautions to avoid coming into contact with the feared thing).The fear is often so strong that it can impact on your day to day life.

If you have a phobia, you may also experience anxiety if you believe that you may come into contact with the feared situation or object. In some cases, you may find that you experience anxiety even when thinking about the thing that you are scared of. For example, if you have a phobia of spiders (arachnophobia), you may feel anxious when you come into contact with a spider, when you see a photo of a spider or when you think about a spider. You may also have thoughts that pop into your mind about spiders without trying to think about spiders. These are sometimes called “Intrusive thoughts”. Sometimes, your anxiety might lead to the experience of panic attacks. In addition, you may experience a number of unpleasant physical symptoms such as:

• Racing heart rate
• A sensation of a “thumping heart” (palpitations)
• Difficulty breathing or fast breathing
• Feeling sick or nauseous
• Dizziness or feeling lightheaded
• Trembling or shaking
• Sweating
• Dry mouth
• Chest feels tight or painful
• Confusion
• “Butterflies” in the stomach
• Feeling restless
• Tingling or numbness in toes and/or fingers
• A sudden need to use the toilet.

If you do not often come into contact with the animal, object place or situation that is the source of your phobia, it may not have as much impact on your day to day life. However, if you have agoraphobia (extreme fear of open or public places), it may seem much more difficult to live your life day to day. People who have a phobia can often also experience other mental health difficulties such as other anxiety disorders and depression.

There are two types of phobias. These are specific and complex phobias.

A Specific Phobia is a fear of a single object, situation or activity. These phobias often develop when a person is a child or an adolescent. For many people, these phobias can lessen as they grow older.

There are many different types of specific phobias. Some of the most common ones are:

• Animals (such as dogs, insects, snakes, and rodents)
• The environment (such as heights, water, and darkness)
• Situations (such as flying, visiting the dentist, medical interventions, and tunnels)
• Body-based phobias (such as blood, vomit, choking, injections, and injury).

A Complex Phobia is one that involves multiple anxieties. These phobias, therefore, tend to have more of an impact on a person’s day to day life. They also tend to develop when someone is an adult. Common complex phobias include:

• Agoraphobia: This is a fear of situations such as open spaces, travelling alone, busy environments and public environments.   If you experience Agoraphobia, you may find that you fear going into situations where it would be difficult to leave or escape to somewhere safe, such as your home. This can lead to someone with Agoraphobia avoiding a lot of situations which can include leaving their house, using public transport, being in lifts or going to busy shops.  Often people who experience Agoraphobia can find it difficult to seek help and support as they find it difficult to visit their GP surgery or to leave their home for appointments.
• Social Phobia: If you have a Social Phobia, you may have a fear of situations that are social or involve some kind of performance, such as a party or public speaking. A lot of people can find social situations difficult and they may feel shy or awkward.  That is a very normal way to feel.  If you have a Social Phobia, there will be a more intense feeling of fear or dread, and you may find that you often try to avoid these situations.  If you experience Social Phobia, you may worry that the way you act may seem unacceptable or embarrassing to others, or you may be worried about being judged negatively.  Sometimes people who experience Social Phobia can find it very difficult to seek support as they find it difficult to phone or meet people who might be able to help them.

There is now a lot of research which has helped us to understand what can help someone who is experiencing a phobia.  There is also evidence that many phobias can be successfully treated. Sometimes, a person will decide that they do not want to or feel unable to address their phobia. These individuals may take a lot of care to ensure that they avoid the situation or object that they fear. 

Without treatment, people can develop what we call “safety behaviours”, such as avoiding drawing attention to themselves, planning ways to escape feared situations, or avoiding the feared situation or object.  While these behaviours are understandable and may make you feel that you are keeping yourself safe, these behaviours actually help to maintain the phobia and can make it worse over time.  Often, treatments focus on helping the person to understand their phobia, reduce their use of their safety behaviours and learn more helpful ways of coping with their anxiety. This is done in a way and at a pace that is agreed with the person experiencing the phobia.

If you would like to access treatment for your phobia, the first place you would normally visit is your GP surgery.  Your GP should explain all of your options to you and your views should be considered before choosing any treatment.  There are three main treatments that are most frequently recommended:

• Self-help materials;
• Psychological or talking therapies; and
• Medication.

 Self-help Material

There are individual self help courses and materials that you may find online or that your GP may direct you to. These can help you to better understand your phobia.  These materials also often recommend ways to manage or cope with phobias.  As a result, the aim of these materials is to help you to take the first steps towards managing your phobia.  Your GP may also refer you to self-help groups where you can learn more about phobias with other individuals who are experiencing phobias.  There are a lot of resources available that can explain phobias and describe ways of managing them. 

Psychological or Talking Therapies

Talking therapies can help people with phobias. A healthcare professional will often meet with you for one hour each 1-2 weeks to help you to develop ways of coping with and managing your phobia.  The talking therapy shown to have the best effectiveness with phobias is Cognitive Behavioural Therapy (CBT). CBT involves helping you to look at and challenge some of your thoughts which may be making you feel anxious and fearful of the specific situation or object. Therapy can also help you to learn new ways of dealing with the phobia. Your GP might refer you to a Cognitive Behavioural Therapist, a Mental Health Practitioner, or a Clinical Psychologist to help you with this.  You can read more about Cognitive Behavioural Therapy.

Medication

If you prefer not to try talking therapies or self-help materials, or if you continue to struggle with your phobia, your GP may discuss medication options with you.  Antidepressant medications are commonly used when people experience depression.  However, sometimes they also help to reduce the symptoms of phobias, particularly agoraphobia and social phobia, even if you are not depressed. Sometimes GPs will prescribe these to help with phobias.  It is important to remember that these do not work straight away and can often take two to four weeks before people notice a change.  If you visit your GP to discuss your phobia, they may also recommend benzodiazepines such as Diazepam. These often reduce symptoms of phobias and anxiety.  However, they are addictive, can make you feel drowsy, and can stop being as effective after a few weeks.  As a result, they are not a useful long term treatment for phobias.

If you or someone you know is living with a phobia, you may notice an impact on their day to day life.  A phobia can make it very difficult for a person to live their life the way they used to or the way that they would like to.  If you have a phobia, you may experience significant distress and anxiety when you come into contact with the object or situation that you fear.  You may also experience anxiety if you believe that you may come into contact with the feared situation or object.  In some cases, you may find that you experience anxiety even when thinking about the source of your phobia. 

Sometimes, the impact that a phobia can have on a person’s life can depend on the type of phobia.  If you do not often come into contact with the animal, object place or situation that is the source of your Specific Phobia, it may not have as much impact on your day to day life.  However, if you have a Complex Phobia such as agoraphobia or social phobia, it may seem much more difficult to live your life day to day.

Witnessing someone close to you living with a phobia can be very difficult to see.  It can be hard to know how to support a family member or a friend with any type of anxiety disorder.  It can also be difficult to see the impact it might have on their daily life, including a possible effect on their work or how they interact with other people.

If you are trying to care for or support someone with a phobia, it is important to be supportive and sympathetic to what they are going through.  Sometimes you might find it difficult to understand why they are so afraid of the source of their fear. It may not make sense to you.  However, it is important to remember that their fear and anxiety is real.  Individuals who experience phobias can find it distressing if they believe others do not understand them or do not take their difficulties seriously.

When reading about phobias, you may learn that avoiding situations or objects can make a phobia worse over time.  Sometimes, this might lead you to want to push your family member or friend to face their phobia.  It is important to remember not to put pressure on the person who is experiencing the phobia to do any more than they feel ready to do.  It can be very distressing for the person to be forced to do more than they feel comfortable doing.  Instead, it might be helpful to ask your family member or friend if there is anything you can do to help.  This might be things such as talking to them calmly about how they are feeling or doing slow, calming breathing exercises with them.

You may also find that you can support your friend or family member by encouraging them to seek treatment for their phobia.  This might mean supporting them to visit their GP or a therapist, or providing them with some information that you have found about phobias.  Remember, it will be up to the person with the phobia to decide when they feel ready to seek help from services.

Further information for carers is available on the NHS Greater Glasgow and Clyde carers site.

If you would like further information on phobias, you might find the following websites helpful. 

NHS Choices website provides further information on phobias including symptoms, causes and treatments, as well as the real life stories of people who have experienced a phobia.

Centre of Clinical Interventions also has some self-help workbooks that you can work through yourself

MIND also provides a booklet which gives information about phobias, including how to support someone experiencing a phobia.

Anxiety UK, No Panic and Triumph over Phobia are other online resources developed to help and support individuals who experience phobias and other anxiety disorders.

GP surgeries also often offer leaflets or booklets on a number of mental health difficulties including phobias.  They sometimes also offer information on treatments such as psychological therapy.

Acknowledgements

Understanding Phobias (2014) © Mind. This information is published in full at mind.org.uk

Phobias – what, who, why and how to help? (2008) © British Psychological Society

A phobia is a type of anxiety disorder. It is an extreme form of fear or anxiety triggered by a particular situation (such as going outside) or object (such as spiders), even when there is no danger. For example, you may know that it is safe to be out on a balcony but feel terrified to go out on it or even enjoy the view from behind the windows inside the building. Likewise, you may know that a spider isn’t poisonous or that it won’t bite you, but this still doesn’t reduce your anxiety.

Someone with a phobia may even feel this extreme anxiety just by thinking or talking about the particular situation or object

Please note that this video is from a range of BSL videos published by NHS Greater Glasgow & Clyde.