Specific phobias: symptoms & CBT treatment (reader question)

Phobia symptoms and CBT treatment

Phobias respond to an evidence-based technique called cognitive behavioral therapy (CBT).

Question: Basically, I wanted to know from an expert, what can a phobia do to a person? How does it affect them mentally? Also I see that you’ve got a new treatment philosophy — is there any way you can talk me through it?

One of the goals of cognitive behavioral therapy (CBT) is to learn to better understand the interrelationships among thoughts, feelings, and behaviors.  Once you understand how these things are connected, it gives you a lot of power to implement change.

Most people who seek therapy do so because they are experiencing an emotion they don’t want to have.  In the case of depression, the person might feel sad.  In the case of a phobia, the person might feel scared.  People often have trouble modifying these feelings directly because emotions tend to be somewhat involuntary.  If you’re sad or scared, there isn’t really a switch you can flip to feel better.  We, as humans, can’t modify our emotions through sheer act of will.  Fortunately, CBT gives us the tools to modify our thoughts and behaviors, which then indirectly affect how we feel.  Relative to our emotions, we have much more control over our behavior and (to a somewhat lesser extent) our thoughts.  Through behavioral and cognitive changes, we can effect changes in how we feel.

My treatment philosophy acknowledges this explicitly.  If you are trying to overcome a fear of heights (acrophobia), for example, you could talk about your fear everyday for the rest of your life.  However, talk alone would never help you overcome your fear.  When it comes to overcoming an anxiety disorder, there’s a place for talking, but there’s a larger place for action.  When I work with people on overcoming fears, I help them understand what creates and maintains fear, but my larger goal is to help them develop the confidence and willingness they need to face the fear directly.  We then go out together in the real world to challenge the fear.  We would proceed in a very systematic way (going from easier “exposure” exercises to more challenging ones), but if the person really wanted to get a handle on the fear, we would eventually go up in skyscrapers, ride roller coasters, take a plane ride, etc…whatever we would need to do to help the person overcome his/her phobia.  There are many unique in-vivo exposure opportunities throughout the greater Palm Beach, Fort Lauderdale, and Miami areas, and we’ll visit as many as necessary to overcome the fear.

Being able to overcome this fear would be incredibly liberating for the person.  For most individuals with phobias, the presence of the phobic object causes a great deal of fear and distress.  Individuals may experience panic attacks when they are around their fear stimulus; these attacks are often associated with a lot of physical symptoms, such as sweating, nausea, dizziness, racing thoughts, increased heart rate, disorientation, choking sensations, and all sorts of other uncomfortable symptoms.  Cognitively, individuals may worry that these symptoms could cause them to lose control or faint.  In some cases, the person may worry about having a heart attack or having some other serious health problem.  These symptoms can be incredibly distressing, so people with phobias often avoid situations in which they might be exposed to their phobic object.  Depending on the fear stimulus, this avoidance can create many other problems for the individual.  They might avoid going to work, going out with friends or family members, or other important situations.  This avoidance is sometimes subtle, though, so the person might not even be aware of the extent of their own avoidance.  Taken together, all of these symptoms can leave a person feeling very frustrated and powerless, which is one of the reasons why many individuals ultimately decide to seek treatment.

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