13. June 2022
Specific phobias – A very broad spectrum. What makes one person smile, sends another into panicked anxiety. But why is that? Why do some people love to fly or eagerly await their next ride in a free-fall tower, while others break out in a sweat just thinking about it? Why do so many people keep pets, while others deliberately avoid parks and public places to avoid encountering those very things? Current data indicate that one in ten people in Germany is affected by a specific phobia, thus drawing attention to the great need for action. Fortunately, behavioral therapy shows a way out – but it leads sufferers directly through the fear itself.
The term specific phobia describes an exaggerated and persistent fear of certain situations or objects. When confronted, it is not uncommon to experience panic attacks with the following symptoms:
Already the expectation of the feared object or situation can cause the above symptoms. Affected people try to avoid them as best they can for this reason and endure corresponding situations only under intense fear and discomfort. Consequently, it is conceivable that those affected suffer more or less severe impairments in social, occupational, or other areas of life, depending on the degree of severity.
Almost half of the German population suffers from fears of certain objects or situations. However, these only have disease value when they significantly restrict the quality of life. Anxiety disorders in general are particularly common among mental disorders, especially specific phobias. Almost ten percent of Germans are affected in the course of their lives, women almost three times as much as men. The comorbidity with other mental illnesses is also considerable, at over 50 percent. In principle, a specific phobia can start at any age, but it usually appears for the first time in childhood or adolescence.
Just as varied as the fears are the courses and associated limitations. For example, a person with a spider phobia may be barely affected if he or she lives in a large city in a country with a cool climate and is automatically less likely to experience his or her fear. In contrast, a person with a fear of vomiting would suffer greatly if they are pregnant, have young children at home with regular gastrointestinal infections, or have to fly frequently for work.
Through these examples, it becomes apparent that some fears are more manageable in everyday life than others. For example, someone who is afraid of flying probably travels by car or train. Likewise, heights or elevators (unless you live in New-York City) are often easy to avoid. Fear of contracting various diseases, on the other hand, is less controllable and thus ubiquitous. Nevertheless, every phobia restricts the person affected in some way and usually persists permanently without treatment.
The most common is fear of animals (zoophobia), especially spiders, snakes and mice. Also great heights (acrophobia) and thunderstorms and forces of nature (astraphobia or brontophobia) bother many people.
As is so often the case, the causes of the development – also those of a specific phobia – are multifactorial. The following aspects are involved:
Genetic factors: The role of genetic factors is widely recognized. Family studies show that first-degree relatives are up to 30 percent likely to also have a specific phobia. The effects are even stronger in identical twins.
Psychological factors: Especially a pronounced withdrawal behavior, lack of adaptability to new situations and an unstable mood increase the risk. So does an impaired emotion regulation as well as an increased focus of attention on anxiety-related stimuli.
Social factors: Stressful life events (such as arguments, poor school grades, and abuse) as well as family factors (parenting behavior, role modeling by parents) represent a major risk factor.
Learning psychology concepts: However, probably the most crucial component is the association of an initially neutral stimulus (e.g., a dog) together with an experience of fear caused by a threatening or traumatic event (e.g., attack or bite from the dog). Similar stimuli are avoided in the future and promote anxiety. Also significant is the adoption of behaviors of the environment.
How can sufferers learn to control their fears? Because most phobic disorder symptoms involve avoidance of the feared situations or objects, the so-called exposure method in cognitive behavioral therapy has been shown to be most effective. This approach to therapy involves patients stepwise exposing themselves to the fearful situations and stimuli and attempting to remain in the situation until the fear subsides through the process known as habituation.
A Habituation describes accordingly an accustoming to the appropriate stimulus, so that this is experienced in the future no longer as threatening. Likewise, it is by no means a matter of directly exposing oneself to the worst fear, but of slowly approaching it with a so-called “fear hierarchy”. In this way, it can be learned that many fears do not come true at all. Since a large proportion of patients feel a high level of suffering and know that their own fears are exaggerated and not appropriate, the motivation to confront is usually higher than one might think.
After the reasons for the development and maintenance of the problem have been explored, the confrontation is initially mental. The therapist is supportive throughout the confrontation. For example, he or she can guide the patient with relaxation-promoting methods in case of palpitations or shortness of breath and give him or her security if he or she believes he or she must break off the confrontation. Moreover, this does not necessarily have to take place in the therapy room.
The therapist can take the patient on a train ride, climb the TV tower, go to the petting zoo, or visit a restaurant. Once the patient is comfortable at an exposure level, the next stage can be approached. Until acceptance of a stimulus is achieved, patients take varying lengths of time and are not pushed at all. Once only small successes are achieved, there is often great relief and motivation to continue, increases yet again. The success rates of over 90% of successfully treated patients of specific phobias with this method speak for themselves and may give great encouragement to those affected as well as their relatives.