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January 2011



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Telephobia – when someone has the fear of talking on the phone.
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Cognitive-Behavioral Treatment for Phobias

The hallmarks of a phobia are persistent, irrational fears and avoidance of the specific things (for example, animals, heights, or closed spaces) or activities that induce these fears. The diagnosis of a phobic disorder is made only when the phobia significantly impairs the individual’s social or occupational functioning.


Although people can exhibit exaggerated or inappropriate fear toward almost any object or situation, certain phobias are more common than others. Common phobias include fear of dogs, spiders, snakes, open spaces, closed spaces, dental treatment, flying, heights, blood, injections, and social situations. Fortunately, many people with specific phobias experience much less fear and avoidance (often none at all) after receiving treatment for their condition.

Seeking Treatment for a Phobia
Experts recommend seeking treatment for a phobia if it interferes significantly with your social life or ability to perform your job. A good example of a candidate for phobia therapy is a person whose fear of flying limits his or her ability to visit family or leads to turning down a job that involves air travel.

Therapy begins with describing your phobia to a therapist. You then may be asked to create a list of 10 situations related to your phobia and to rank the situations in terms of how much fear and avoidance they each provoke. For example, a fearful flier may place driving to the airport and checking baggage low on the list, while being on a turbulent flight during a thunderstorm may rank the highest. This list will help the therapist gain a clearer idea of what exactly your phobia entails and help direct your treatment.

Some phobias—such as social phobia or fear of flying—inherently involve other people, and therapy is frequently conducted in group settings. However, a phobia-like fear of snakes can be addressed in one-on-one sessions with a therapist. Many people prefer one-on-one therapy because they are self-conscious about their phobia.

Cognitive Treatment for a Phobia
Once the therapist understands your phobia, you will work together to recognize and alter the thought patterns that lead to your fear and avoidance. People with phobias often feel that encountering the feared object or situation will have catastrophic results or cause a panic attack. For example, people with a phobia of snakes may fear being bitten and killed, even if the snake is far away or behind glass. The cognitive aspect of phobia treatment shows patients that their worst fears are usually unfounded.

Together, the therapist and patient work to replace the negative thinking with more realistic and accurate thoughts. Patients may also learn relaxation techniques to help them control their fear responses.

Behavioral Treatment for a Phobia
The main component of treatment for phobias is behavioral and entails exposure to the feared object or situation. Patients with a phobia are asked to confront the situation gradually, according to the hierarchy of fear and avoidance that they originally constructed. Often, therapists ask patients to confront these fears first using an imaginary setting (a process called systematic desensitization) and then in real life (in vivo desensitization).

Thus, a person who fears injections will, with the help of the therapist, first imagine preparing to go to the doctor’s office to receive a shot. After the patient is able to relax and be comfortable with that situation, the next steps might be to imagine arriving at the office, being seated in the examination room, seeing the needle, and so on, until the person is able to relax while imagining receiving an injection.

In addition, the therapist will usually ask the person to confront the phobia gradually in real life. People with a fear of spiders may begin by looking at a picture of a spider. Once they are comfortable with the picture, they may be asked to stand for a few seconds across the room from a spider in a tank. They gradually stay in the room longer, and their distance from the spider is shortened. Eventually, the patients may be asked to touch the spider and let the spider crawl across their arm. In some instances, the therapist may use systematic desensitization in therapy sessions and give the patients homework assignments that put them in real-life phobic situations.

Exposure training may be more important than cognitive therapy for phobias because successful treatment with exposure alone may bring about changes in thinking patterns. The number of exposure sessions varies (up to 14 may be necessary) and is dictated by the intensity of the person’s phobia. In some cases, cognitive-behavioral therapy may be combined with drug treatment (for example, antianxiety medication). Training in social skills may also help people with social phobia.

Source: Johns Hopkins Health Alerts Depression and Anxiety Treating Phobia with Cognitive-Behavioral Therapy 

Arachnophobia – Fear of Spiders

In moderation, fear is actually a good thing. It’s a survival instinct that helps us avoid activities and creatures that can harm us. But sometimes that fear increases out of proportion to the actual danger. While most of us eventually get past our fears — or at least learn to live with them — people with phobias are held prisoner by an irrational sense of panic.

Some experts estimate that nearly 80% of people with phobias don’t seek treatment because the thought of facing their fear is too overwhelming. But the benefit of treatment for a phobia is well worth it: a life without limitations imposed by fear.

Exposure therapy is the most common method of treatment for phobias. It’s a form of cognitive-behavioral therapy and involves putting yourself into increasingly stressful scenarios involving your particular phobia and overcoming your fear with new learning.

Although direct exposure therapy is usually the best way to treat specific phobias, it’s not always the most convenient. For example, if you want to confront your fear of flying by going to the airport and sitting at the gate, most airports today will not let you pass through security without a plane ticket.


Likewise, if you have a driving phobia, having a therapist take you on the road can be unsafe, as you may panic when driving through a tunnel or merging onto the highway. In these kinds of situations, virtual reality exposure therapy may be preferable to the real thing.

Virtual treatments for phobia. Virtual reality treatments involve computer programs that simulate, for example, sitting on a plane or driving a car. You wear a head-mounted display equipped with video cameras and earphones so that you can receive both visual and audio cues. To increase the sense of realism, some clinics may treat aviophobia (the fear of flying) by having you sit in an airplane seat on top of vibrating platforms to simulate the plane’s engines running beneath you.

A study published in Behavior Therapy compared virtual reality exposure therapy with standard exposure therapy in people afraid to fly and found that both treatments resulted in a 76% success rate. The majority of participants in both groups also maintained their success at the 12-month follow-up.


Ophidiophobia – Fear of Snakes

How The Brain Stores Memories Of Specific Fears

The brain is capable of holding and retrieving memories for specific fears, revealing a more sophisticated storage and recall capacity than previously thought, neuroscientists have found. The study, which appears in the journal Nature Neuroscience, may have implications for treating post-traumatic stress syndrome – as scientists begin to understand how different fears are stored in the brain, they can move toward addressing specific fear memories.

The research was conducted by researchers at New York University’s Center for Neural Science, the Department of Psychiatry at NYU School of Medicine-Bellevue Hospital Center, the Copernicus Center for Interdisciplinary Studies in Krakow, Poland, Université Paris-Sud, and the Emotional Brain Institute at the Nathan S. Kline Institute for Psychiatric Research.

The research focused on the brain’s amygdala, which has previously been shown to store fear memories. However, prior studies have indicated that the amygdala does not discriminate among the different threats it holds and processes. In other words, whether you are afraid of dogs because you were once bitten by a dog or you are afraid of pizza because you once nearly choked to death eating it, all the amygdala remembers is that both of these experiences were scary. By contrast, other brain areas, such as cortex, ensures that all other aspects of these fearful events in your life are remembered.

The scientists on the Nature Neuroscience study sought to determine if there were differences in how the amygdala processes and remembers fears. To do so, they focused on a process called memory consolidation in which an experience is captured, or encoded, then stored. Once consolidation occurs, memories may be long lasting – one experience may create memories that last a lifetime. However, whenever recalled, memories become labile – that is, susceptible to changes. This process is called reconsolidation. In life, reconsolidation allows updating existing memories. But this process also serves as a valuable methodological tool as it lets researchers control the modification of memories.

When it comes to developing fear memories, one model posits that during a fear experience, a neutral stimulus (e.g., a musical passage) becomes associated with a negative encounter (e.g., a dog bite). Therefore, future occurrences of this neutral stimulus, or conditioned stimulus (CS), forewarns the onset of the negative encounter, or unconditioned stimulus (US). Previous research shows that the association between a CS and a US is processed and stored in the amygdala.

To replicate this process, the researchers devised an experiment using laboratory rats. In it, they paired two distinct audio tones, which served as the neutral stimulus, or conditioned stimulus (CS), with mild electric shocks to different parts of the rats’ bodies. As a result, the rats linked a mild shock to a certain part of their bodies with a certain tone.

Under the memory reconsolidation model, exposing an organism to any aspect of the learned experience brings this memory back to mind and makes it susceptible to changes. Thus, if two distinct tones were each paired with two distinct electric shocks and if the amygdala does not discriminate among different threats, then re-exposing a rat to any of these shocks should cause lability of all fear memories stored in the amygdala.

However, the Nature Neuroscience study yielded quite different results. The researchers found that re-exposing a rat to a particular shock (that is, one applied to a certain part of the body), followed by an injection of an antibiotic known to disrupt reconsolidation processes, impaired only these associations that were linked to this particular shock. Despite the disruption of one type of fear memory, rats were still able to express fear behavior to the tone which had been paired with a shock applied to another part of the body.

The finding demonstrates that the amygdala makes distinctions among the fear memories it holds and retrieves.

James Devitt
New York University


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