I Feel Scared

It’s completely natural to feel scared, especially when confronted with situations or objects that you feel pose a threat to your wellbeing. In fact, healthy fear responses can help you make choices that will keep you safe.

In some cases, however, your fear may become out of proportion to the perceived threat, making your reaction to that threat irrational and overwhelming. When this is the case, you are likely suffering from a phobia. If you do feel that you have an extreme fear of something, that far outweighs the threat it poses, this information on phobias may be of help to you.

What are Specific Phobias?

A phobia is a fear that is unreasonable in its degree or nature, yet is so powerful that the person with phobia tries to avoid the feared object or situation. They may also become extremely anxious, even panic-stricken, if forced to confront it. A person with phobia often becomes anxious simply at the thought of the feared object or situation.

When a person fears one specific type of situation or object, it is called a specific phobia. A person may have more than one type of specific phobia.

Fears include situations, such as small spaces and heights, natural phenomena such as storms and deep water, objects such as snakes and spiders, and things like blood or hypodermic syringes and needles.

Inherent in the current definition of a phobia is the requirement that the person recognises that the fear is excessive or unreasonable in some way. For example, it is normal to be wary of snakes, but a person who refuses to walk in an urban park for fear of snakes, who requires others to check their 6th floor apartment for snakes before they will enter, or who becomes extremely distressed and anxious just thinking or hearing about snakes has a fear which is excessive and unreasonable.

Specific phobia is the second most common mood and anxiety disorder (after major depression)
Most specific phobias have Latin or Greek names. They are all derived from the Latin or Greek description for the feared object or situation. These names are rarely used in diagnosis, though, as a doctor or psychologist will classify a phobia as ‘Specific phobia, Animal (or Natural Environment, Blood-Injection-Injury or Other) Type’, and then describe the feared object.

What are the Signs of Specific Phobias?

When people with specific phobias encounter their feared situation or object, they may experience panic attacks or complain of symptoms of the flight-or-fight response, such as:
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Heart palpitations
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Trembling and shaking
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Faintness or light-headedness
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Difficulty with breathing
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Sweating
The severity of the anxiety usually varies according to the nature and location of the stimulus. A person with a fear of spiders, for instance, would show varying degrees of anxiety based on their distance from a spider, the size of the spider, and whether or not the spider is moving.
People with specific phobias will attempt to avoid the feared stimulus whenever possible, to the extent that the fear or avoidance may interfere with the person’s life or causes marked distress. The feelings of anxiety are absent when the person is not in contact with the feared stimulus, or is not thinking about the stimulus. Specific phobias are usually recognised by people as being irrational or excessive.

What Causes Specific Phobias?

A great deal of research has been done to try to answer this question, but we still don’t know for sure. As usual, there are lots of theories. One theory states that humans have a predisposition to fear certain objects and situations that are potentially dangerous or even fatal. Examples would include snakes, insects, heights, and storms. It is also clear that phobias can develop after a severe fright or traumatic experience. For example, the child (or adult) who is bitten or chased by a ferocious dog may then begin to fear all dogs. Another theory suggests that fears can be learned from others. People with specific phobias may also have an inherited general tendency towards anxiety and phobias, although the particular phobia that develops may have more to do with a person’s personal experience and their environment.

In the blood-injury-injection type of specific phobia, people commonly faint when they see blood, have an injection or have blood taken, or even at the sight of a needle. There is some debate currently about whether this type of phobia is as purely psychological in origin as other types of phobia. This is because many people who report fainting at the sight of blood do not report any anxiety preceding the faint. It may be that this is a mixed group, some of whom have a typical phobic reaction, and others who have an abnormally strong reflex neurological reaction to injury or the threat of injury.

How to Deal with Specific Phobias

 

Specific phobias have the best prognosis of any anxiety disorder. Cure is a real possibility, although it will take hard work! The only proven effective treatment of specific phobias is cognitive behaviour therapy and, specifically, repeated confrontation with the feared object in a process known as exposure therapy.

The anxiety response to a feared object or situation is essentially a false alarm, in that the anxiety elicited is greatly out of proportion to the actual danger that the object or situation presents. Unfortunately, the tendency to avoid the object or situation prevents a person from ever learning that perhaps there is not so much to fear after all. The person can probably recognise this intellectually, but in some ways they do not really learn this at an emotional level. Hence, the pattern is constantly repeated: every time they are reminded of the feared objector situation, it triggers an anxiety response – even though the person recognises intellectually that it is unreasonable. When, instead of running away, the person confronts the situation or object until the anxiety begins to diminish, they take the first step in teaching themselves, emotionally, that there is not as much to fear as they have been feeling.

Exposure can be done in a graded or gradual fashion, in which a person comes gradually closer to the feared object, perhaps even starting by simply imagining the feared object as the first step. However, research has shown that there is no substitute for exposure to the actual feared object. This is known as exposure in vivo, as opposed to imaginal exposure.

Exposure may also be carried out in massed sessions. In this technique the person confronts the feared object or situation and does not leave until their anxiety begins to diminish. This typically takes between 2-3 hours. This type of exposure usually results in immediate improvement.

People tend to do better when their exposure program is supervised by an appropriately trained and experienced therapist rather than trying to do it all by themselves. Although the principle underlying exposure-based treatment is quite straightforward, a successful exposure program is composed of many different factors, and it must be specifically tailored to the person to achieve success.

Additional exposure or cognitive techniques may be added depending on the nature of the phobia. For example, exposure to internal sensations in some types of health anxiety, and the use of a technique known as applied tension in blood-injury-injection phobia.

Management of Specific Phobias

The management of specific phobias usually involves doing the following:

1. Providing ongoing assessments.

2. Education about anxiety, tailored to each person’s needs.
Find out more information on anxiety

3. Training in strategies, such as mindfulness, to manage anxiety symptoms, and encouragement in practicing these techniques regularly.

4. Graded exposure to feared situations is the principal treatment.

For example, if a person is afraid of snakes, the following hierarchy could be arranged depending on how fearful the person finds each step:

1. Looking at pictures of snakes.
2. Touching pictures of snakes.
3. Looking at snakes in the zoo.
4. Touching a fake snake.
5. Touching a snake through a sheet of glass (i.e. a hand on one side of the glass and the snake on the other side).
6. Imagining how it would feel to touch a snake (scaly skin, cool, firm, etc.).
7. Touching a harmless snake.

 5. Cognitive interventions to identify and challenge irrational beliefs are also effective

A person with any kind of anxiety should avoid the use of alcohol or sedative medication to control their anxiety, as this can often lead to complications with dependency.

People with a blood/injury phobia who faint may require additional intervention.

Coping with Symptoms of Specific Phobias

Slow Breathing

Your breathing rate increases automatically as part of the fight or flight response. Learning to slow down your breathing rate when you are anxious can settle some of the other anxious sensations, as well as help you to focus your mind.

– First, time your breaths for one minute (1 breath in and out equals one).
– Then sit down comfortably in front of a clock or a watch with a second hand and start to focus your mind on your breathing.
– Breathe only through your nose.
– Try to breathe using your lower stomach/ diaphragm, rather than your chest muscles. Relax your stomach as much as possible.
– Take a regular breath in for 3 seconds and then breathe out for 3 seconds. Each time you breathe out, think to yourself the word “relax” and let a little more tension go from your muscles – let your shoulders drop, and relax your face.
– Continue breathing in this 6-second cycle for 5 minutes.
– At the end of this, count your breaths again for one minute. Write this down.
– The average person takes 10 to 12 breaths per minute at rest. Your breathing rate may be higher than it should be. Some people with social phobia over-breathe constantly, while other people find that their breathing rate only goes up when they are anxious. In both cases slow breathing can help.
– To begin, you will need to practice when already relaxed. Then you can gradually practice in anxious situations. Like learning any new skill, slow breathing takes time and regular practice. You should practice this at least 4 times a day.

Blood/Injury Phobia: A Special Case

 

The majority of people who fear stimuli associated with blood or injury (e.g., visiting the dentist, getting a needle, any medical procedure) will faint with exposure to these stimuli as well as become anxious. These people experience initial sympathetic arousal (the fight-or-flight response) followed by a rapid switch to parasympathetic arousal (decrease in heart rate and blood pressure). This switch in arousal leads to fainting (i.e. vasovagal syncope). Therefore, in addition to graded exposure to the feared stimuli, the person will also need to learn how to prevent the fainting response.

 

The main method of preventing the fainting response is to train the person to deliberately tense the major muscle groups (e.g., the legs, buttocks, and abdomen) in response to the first signs of fainting. This technique effectively minimizes the rapid parasympathetic response that leads to the drop in blood pressure.

Take our free Coping With Stress course

THIS WAY UP does not have a course for people with specific phobia that can be done on the prescription of a GP or on a self-help basis.

We would advise the free ‘Coping with stress’ course to learn the key issues in managing anxiety and then return to this specific phobia fact sheet to see how a graded exposure program for overcoming feared situations is done.

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