A Clinical Psychologist Talks Phobia and Anxiety

This article was written by Dr Paul Williams in 2016 for YAK Magazine, University of Newcastle.

A phobia is an exaggerated and illogical fear of a particular object, class of objects, or situation. So if you have a phobia and you encounter the source of your fear, you will experience a deep sense of dread or panic.  The overwhelming physiological sensations often associated with phobias are called panic attacks, and might include a pounding heart, nausea, dizziness, tightness in the chest, and hot or cold flushes. People have phobia’s about everything from buttons  (Koumpounophobia) to bananas (Bananaphobia - seriously). Psychologists tend to consider phobia’s in 3 groups.

(1) A specific phobia is focused on a very specific object. These include well-known phobias such as claustrophobia (tight spaces) and arachnophobia (spiders), as well as the less well-known phobias such as haemophobia (blood) and bananaphobia. 

beyond blue has a nice web page for specific phobia here:

https://www.beyondblue.org.au/the-facts/anxiety/types-of-anxiety/specific-phobias

(2) Social Anxiety Disorder (aka: social phobia) is an intense fear of social  situations. People might fear being judged or humiliated even in the most ordinary situations, such as having coffee with friends. Social phobia can also be specific; where people fear a specific situation or few situations (such as being assertive at work or with their particular friends). Social phobia is the third largest mental health care problem in the world today, affecting about 7% of the population at any given time.

beyond blue has a nice web page for social phobia here:

https://www.beyondblue.org.au/the-facts/anxiety/types-of-anxiety/social-phobia

(3) Agoraphobia typically co-exists with panic disorder (recurrent panic attacks or persistently fears of having one for more than a month). It was long assumed that agoraphobia was a fear of open spaces. More accurately, agoraphobia  is a fear of being in situations from which escape will be difficult or embarrassing, or where help may not be available for panic attacks. These situations might include being in a crowd, on a train, in a queue, or being alone, etc. Panic disorder is thought to occur for at least 3% of the population at some stage of their lives (but usually not when young or very old), and agoraphobia affects up to one third of those with panic disorder.

beyond blue has a nice web page for panic disorder here:

https://www.beyondblue.org.au/the-facts/anxiety/types-of-anxiety/panic-disorder

So there are lots of phobia’s, and lots of people that have a phobia. But most people that have a phobia do not end up seeing a psychologist… that only tends to happen when the fear is really affecting their life. So as a psychologist, the phobias I most commonly see are social phobia and agoraphobia (agoraphobia typically comes with panic disorder). Without help, people only have two choices with those two:  totally avoid the situations that bring on the anxiety, or force themselves repeatedly into situations that bring on extreme dread. Both of those choices stink, because a phobia is usually accompanied by unrelenting anxiety in the lead up to an event (sometimes several days before).

The good news is there is help available, and for many people that help will involve sessions with a psychologist, medication (which I won’t cover here), or both. Usually psychological treatment for anxiety is made up of three parts:

(1) A thorough assessment: This means mapping out the history and onset of symptoms in detail, as well as carefully detailing how they affect day to day life. In some cases, a phobia or anxiety might have been triggered by a single event - so it might be best considered as a trauma response. In other cases, the predisposition to anxiety might be more genetic. Efficient treatment can only stem from a thorough understanding of the problem. 

(2) Psycho-education: This means learning about the fight-or-flight system, and why everyone has these systems. Sometimes, just understanding how anxiety works and its purpose makes people less fearful of the symptoms themselves. If I’m doing my job well, this education will motivate people to be aware of their breathing, and to do some regular relaxation- and aerobic exercise. 

(3) Deliberately experiencing manageable doses of anxiety: Anxiety slowly shrinks the world that people are able to experience, because they begin to avoid more and more situations to manage their anxiety. Unfortunately avoidance does often limit anxiety in the short term (and is therefore reinforcing) - but in the long term avoidance makes anxiety worse, and the world keeps shrinking. In therapy, our job is to work with people to slowly turn that around by helping people expose themselves to their fears - in a safe and controlled way. This might take the form of emotional exposure (as in EMDR) or actual exposure to feared stimuli.  Either way, exposure means people are choosing to put themselves in situations that provoke very real anxiety. Over time this carefully planned exposure helps increase the size of the world that people are able to experience. It is this part that I love the most when working with someone with a phobia. Helping someone challenge their fear, or confront their distressing emotions, is very rewarding. At some point people get to look back and see how far they have come, achieving things they sometimes never believed possible. 

(4) Challenging unhelpful ways of thinking: How we think can influence how we feel and behave, so often I use structured techniques, in combination with other techniques, to help people change unhelpful thought patterns over time. For example, someone might think “I will be trapped in the elevator and not be able to breathe”), and this will feel very true. With the right techniques, we can make these unhelpful thoughts feel a bit less true, while increasing the believability of more helpful thoughts (e.g. “The chances of getting stuck in there are slim, and even if that happens, I will be able to breathe”). The key is identifying the pattern, not just the thought, because once a pattern of thinking is recognised,  people can often create some emotional distance distance from their thoughts, so they ‘feel’ less true. I say ‘feel’ because people with phobias often ‘know’ their fear is irrational - and feeling and knowing are not one and the same! 

I really enjoy working with people that have anxiety or a phobia. My favourite phobia related story though is not mine, it comes from a colleague who was working with someone with a blood phobia. Blood phobia’s are really interesting because our natural physiological response when seeing our own blood is a drop in blood pressure (so we don’t bleed out). This is why many people with a blood phobia or a fear of needles will faint, because blood pressure drops and so not enough blood reaches the brain. Anyway, my colleague was working with a client with a blood phobia and as part of their their program they decided to watch a video clip that contained blood. And of course the client fainted. The funny part (all ended well, so mishap was funny) was my poor colleague was unaware at the time that fainting is pretty common for people with a blood phobia -  so he had his own mini panic attack thinking he had broken the client! In the end everything that client went on to make amazing progress. 

If you are reading with the thought of seeking help… note the best predictor of whether or not psychological support will be helpful for you in overcoming a phobia (or anything else, for that matter) is whether you have a great relationship with your psychologist. Keep that in mind. If you don’t think you have that trust after a session or two - it is probably best to move on. This usually doesn’t mean your psychologist is bad, it just means you didn’t click… and Psychologists should never take that personally, it is part of the job.



Dr Paul Williams, PhD