The word ‘phobia’ has now become a part of jargon and almost every second person claims that they are suffering from a phobia. But is it erally so? Dr Pulkit explores the story of phobia.
What exactly is a Phobia?
The word ‘phobia’ has now become a part of jargon and almost every second person claims that they are suffering from a phobia. In a majority of these instances, phobia simply denotes a mild degree of unpleasantness and fear which would not qualify for a clinical diagnosis of phobia. Therefore, you should never jump to the conclusion that you are suffering from a phobia.
A phobia is a relentless and excessive fear of some specific object or situation that presents little or no actual danger to the individual. The fear is so intense and pervasive that the person makes huge efforts to avoid an encounter with the phobic stimulus and its reminders. Often, these efforts restrict and interfere significantly with the person’s day-to-day functioning and they feel distressed about it. Although adults and adolescents suffering from a phobia do recognize that their fear is excessive and irrational they cannot control it.
The physiological, behavioral and emotional reaction to a phobic stimulus is often identical to that which would occur in confronting a really terrifying situation. The heart rate and muscular tension increase and the person may experience sweating, giddiness, trembling, breathlessness, weakness and nausea. The individual may just freeze on the spot or try to escape hurriedly. The mind is flooded with negative thoughts such as ‘I will die, I must run’, ‘this is terrible and everyone will mock at me’, ‘this is extremely dangerous’ and so on.
Although a majority of people suffering from phobia avoid the feared object or situation, in some rare cases patients may show a counterphobic response in which they consciously do not acknowledge that they are scared and actively pursue the feared object or situation e.g. someone who is scared of water swimming in a river. The individual wishes to show themselves and the world that they are brave and not scared of anything. However, this exercise proves futile because the person does not want to acknowledge that they are scared and the fear often takes new and disguised forms.
Types of Phobia
The list of phobias is forever increasing to accommodate more and more feared objects and situations but broadly speaking there are three types of phobias:
- Specific phobia: It is a fear of some precise object or situation e.g. claustrophobia (fear of enclosed places), acrophobia (fear of heights), hydrophobia (fear of water), algophobia (fear of pain), nyctophobia (fear of darkness), pathophobia (fear of disease), zoophobia (fear of some particular animal) and so on.
- Social phobia: The person experiences fear in social situations (day-to-day social interactions, performing in public, public speaking, eating and drinking in social situations, urinating in a public bathroom). The individual fears that they may act in an embarrassing manner and consequently would be negatively evaluated by other people.
- Agoraphobia: It is the fear of being in places from which an escape might not be possible and there may be no help if the person gets panicky.
What makes someone phobic?
- A person may learn a phobia through direct experience or through observation of others. For instance, a person bitten by a dog or who sees another individual getting bitten by a dog in real life or on television may go on to develop a phobia of dogs. The individual feels anxious whenever they see a dog and as soon as they escape from that situation their fear temporarily subsides. This temporary relief encourages the individual to avoid the feared object or situation and strengthens the phobia in the long run.
- Deep-seated unconscious conflicts may present themselves as phobias. For instance, an unconscious wish to compete with others and fear of consequent retaliation takes the form of a phobia. The anxiety that the individual experiences unconsciously is displaced onto an external object which then becomes the feared object or situation. A desire to be independent and consequent fear of being abandoned by significant others can also express as a phobia. Through phobia the individual then avoids being independent.
- Maladaptive thought patterns such as excessive vigilance and focus on the feared situation or object, undermining one’s capacity to deal with adversity and exaggerating the risk involved in relatively benign encounters maintain the symptoms after they have come into the existence.
Doing away with phobia
In cases where symptoms are severe and there is considerable occupational and social impairment, treatment from a clinical psychologist and a psychiatrist may be sought. However, for mild to moderate intensity phobias one can try some self-help as outlined below:
• Graded exposure treatment: Phobias are maintained by avoidance, once in a phobic situation the person either freezes completely or runs away and therefore the phobia remains. Learning to face and master one’s anxiety in gradual steps cures the phobia. To do this firstly learn any good relaxation technique such as deep breathing, pranayam or progressive muscle relaxation and practice it regularly twice a day. Then, make a list of the situations and objects that you feel anxious about and avoid due to your phobia. After the list is complete arrange the items starting from the least feared to the scariest. Start from the first item and confront it while trying to experience and regulate your anxiety through the relaxation technique. You must not escape from the situation but remain in it until your fear subsides. Practice this until your fear of the first item subsides and then move on to the next item and so on. Do not hurry as many a times it can even take more than a week to master a single item. Ajay, a 10-year-old boy suffering from phobia of dogs made the following 10-item hierarchy with the help of his psychologist:
1. Looking at photographs of dogs
2. Touching the photographs of dogs
3. Watching images on dogs on television from a distance
4. Viewing images of dogs on television while being close to it
5. Looking at the dogs on the road while standing in the balony of his house
6. Looking at the dogs while driving his bicycle on the road
7. Looking at the dogs on the road while taking a walk with his father
8. Driving past a dog on his bicycle
9. Walking past a dog in company of his father
10. Walking past a dog all alone by himself
• Handling Maladaptive Thoughts: You must write all the thoughts that you experience while confronting the feared object or situation and then try to find arguments against them and finally challenge them. One must do away with unrealistic standards and substitute realistic ones.
Maladaptive thought: If people do not find my speech impressive, it would be proved that I’m stupid.
Adaptive thought: If some people do not find my speech good I would feel bad but that would not mean that I’m stupid as I have many other talents and capabilities.
Maladaptive thought: If I take a ship it would drown and I would die.
Adaptive thought: Many people travel by the ship everyday and return safely. I’m just exaggerating the risk.
Maladaptive thought: If I go near a dog he would tear me to pieces.
Adaptive thought: If the dog chases me I have the capability to defend myself.
• Creating Insight into Unconscious Conflicts: The phobia often impairs our personal, social and occupational functioning. Try and understand that how is the phobia preventing you from doing certain things e.g. being more successful, outdoing others and then think whether these are the things that you are really scared of than the relatively benign phobic stimulus. Alternatively, does the phobia allow you to access the love and company of the people who matter to you? In that case the fear is serving an important function for you that you are not aware of.
Keep in mind that you are always exaggerating the risk involved in the encounter and avoiding it on the basis of it. Nothing really would happen to you but the fear is so unpleasant that it ties you down. Never ridicule yourself for feeling scared but accept it as a weak area that you are trying to work upon. When you succeed confronting the anxiety in a situation remember it and remind yourself of this success in future encounters. However, if these self-help attempts fail, consult a professional.
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