We’ve all heard the term “phobia”. Perhaps we’ve even joked with friends about having certain phobias, like arachnophobia (fear of spiders). Ultimately, however, phobias are no laughing matter and they are a serious anxiety disorder that currently affects 19 million Americans.
The way phobias are often portrayed indicates that many people don’t fully understand what phobias are or how they function. Although most people can acknowledge that phobias have a lot to do with fear, many don’t understand the relationship between fear, the individual, and the source of their phobia. This begs the question, what are phobias?
The National Institute of Mental Health defines a phobia as “an intense, irrational fear of something that poses little or no actual danger.” The definition continues to mention that “Although adults with phobias may realize that these fears are irrational, even thinking about facing the feared object or situation brings on severe anxiety symptoms”.
Harvard Health further breaks down phobias into three main categories: specific, social, and agoraphobia. Specific phobias refer to the fear of a specific thing or situation. Examples can include the fear of specific animals, people, environments, or situations. Social phobia, also commonly called social anxiety disorder, is a fear of social situations. Social phobia can be specific to a single event, like giving a presentation, or more generalized where all social situations cause fear. Finally, agoraphobia is the fear of public places. Agoraphobia is also closely associated with panic disorder.
To understand what a phobia is, we must first understand what fear is and what its role is within our bodies. Simply stated fear is an emotion that is experienced during times of anticipation. Its presence indicates that we perceive a stimulus is threatening our safety or the safety of others. Once our body recognizes a potential threat, it responds accordingly.
Our bodies respond to fear in one of three ways: freeze, flight, or fight. This is also known as the FFF survival response. In our evolutionary past, freezing while hiding from predators, outrunning dangerous situations, or fighting an enemy helped ensure our survival. The thing that all the survival responses have in common is that they are all a change in behavior.
Because the body prepares for a change in behavior during a fearful situation, it prepares more for action and less for reflection. This means that the parts of the brain responsible for reasoning and judgement effectively shut down. Although this may have been helpful during our evolutionary past, in modern times it can be quite detrimental for responding to most situations.
The fear response becomes especially problematic when it becomes dysfunctional. Dysfunctional fear responses are the reason for a variety of psychiatric disorders, including phobias. When it comes to phobias, there are two different types of phobias that can occur based on how fear is processed by the brain. Namely, these are: experiential-specific or non experiential-specific.
Experiential-specific phobias are those that are derived from a negative experience with the stimulus. This type of phobia is further developed by fear conditioning. This is a phenomenon where fear is essentially learned through incorrectly associating neutral cues with the negative experience. This generally results in the avoidance of any cues that are reminiscent of the experience or an extremely fearful response when exposed to the cues.
Non Experiential-specific phobias, also known as nonassociative specific phobias, are derived from a stimulus that causes fear without a direct experience or event. This type of phobia is usually the result of genetic, familial, environmental, or developmental factors. A common example of an experiential-specific phobia is a child’s fear of the dark. Although some of these phobias can arouse a reaction is most people, the fear response is hyperactive in those who are diagnosed as having a phobia, rather than just being wary.
Furthermore, individuals with non experiential-specific phobias generally have a deficiency in the part of the brain that regulates habituation. Habituation is the process of dispelling fear through repeated reduced emotional reactions. For example, most children eventually grow out of their fear of the dark because they endure several uneventful nights and realize there’s nothing to fear regarding the dark. However, in those with a phobia, the process of habituation never occurs and the individual maintains their fear.
Although it is not clear why this happens, there may be a genetic component. An article written in Scientific American notes that an estimated 25-65% of specific phobias have been found to have genetic contributions. However it is not presently clear what gene carries phobias, nor if only a single gene is to blame.
Nevertheless, both types of phobias indicate different ways the fear response can become dysfunctional. In the case of experiential-specific phobias, it is a specific event or experience which incorrectly interrupts and corrupts the fear response, while in non experimental-specific phobias it is likely a deficiency in the habituation mechanism. Although these are just theories and modern science is still evaluating just how fear works within the body and how phobias and fear are related.
Now that we have a better idea of what fear is and how it operates within us, let’s take a look at how it affects people. As mentioned before, when the body is confronted with a fearful stimulus, it reacts in one of three ways: freeze, flight, or fight. Because most people with phobias tend to avoid situations that can trigger fear, flight is generally the response of choice.
When confronted with a fearful stimulus, the brain directs activity towards behavioral changes rather than reasoning, which can cause a range of physical symptoms to occur despite the fact that there may be no serious threat. These can include: extreme anxiety, shortness of breath, increased heart rate, elevated blood pressure, trembling, chest pain or tightness, dry mouth, inability to speak or speaking too fast, dizziness, sweating, or nausea.
It is important to realize that because the brain is predominantly focused on behavior changes rather than reasoning, just saying “everything is fine” is not always enough to ground a person suffering from a phobia. This is the reason why so many people with phobias continue to experience fear and eventually learn to avoid fearful situations altogether.
However, there are therapeutic treatments that can help a person recognize the beginnings of the fear response and teach them to redirect their behaviors. Cognitive behavioral therapy (CBT) is a highly popular approach because it is based on recognizing the relationship between thoughts and actions, and using this relationship to make positive changes. It can also help with the management of phobia symptoms, such as helping you develop strategies to soothe the panic associated with phobias.
Another approach, called exposure therapy, works to slowly expose a person, in person or through their imagination, to the source of their fear slowly and safely. The intent is that through habituation, the source of their fear will become normalized and will no longer trigger a fearful response. Both approaches take time, however studies have proven that they can help with the long-term treatment of a variety of phobias.
Are you affected by phobias? Don’t live in fear and avoidance any longer, schedule a consultation with NJ Family Psychiatry and Therapy and our phobia therapists can help you regain control of your life!