Offaly-based clinical psychologists, Julie O'Flaherty and Imelda Ferguson
IN ordinary conversation we often hear the word “phobia” when people want to convey just how much they fear or dislike something. The clinical term refers to a condition that can cause significant psychological distress, avoidance behaviours and interference with a person’s normal routine and social and occupational functioning. Indeed, the Diagnostic and Statistical Manual, fifth edition (DSM V) commonly used in clinical practice by psychiatrists and psychologists to diagnose psychiatric disorders, describes a specific phobia as an intense or irrational fear of a specified object or situation.
Furthermore, the DSM V categorises specific phobias into four types: natural, such as a fear of the water; mutilation, which includes a fear of the dentist or fear of injections; animal, for example, a fear of dogs; situational, for example a fear of confined spaces or a fear of flying.
Phobias affect more men than women and commonly emerge in childhood and persist into adulthood. Sometimes, it may be possible to trace the origin of the phobia to a specific incident. For example, if you have been bitten by a dog as a child that might explain your phobia of dogs as an adult. But many people who have been bitten by a dog do not develop a phobia. So it is not that straightforward. Maybe there is a genetic predisposition to anxiety which is triggered by the dog bite, maintained by stress and results in a phobia of dogs.
Phobias are more than just fear. Of itself, fear as an emotion can serve a protective and adaptive function; fear of water when you cannot swim is a sensible thing. However, with phobias, the fear is out of proportion to the actual danger. So perhaps you want to learn how to swim at the local pool.
However, a phobic fear of water will cause you extreme distress (and often avoidance) despite the fact that you know you will be supervised by qualified instructors and remain within your depth at all times. Indeed, most people who suffer from phobias will realise that their fear is out of proportion. Fear symptoms can include dizziness, nausea, increased blood pressure and heart palpitations, sweating, digestive discomfort. These symptoms are caused by the arousal of the sympathetic nervous system and can mimic panic attacks.
Hence, it is easy to see how specific phobias can really limit a person’s life. Getting the right treatment is therefore really important. The general consensus from the psychological literature is that cognitive behaviour therapy works best. Techniques include graded exposure to the feared object, use of specific psychological tools such as breathing and relaxation exercises, cognitive therapy to address thought distortions. Mindfulness attitudes to help you accept and stay with the distress, knowing that it will pass and not judging or shaming yourself for having a condition that is so distressing.
Two more complicated phobias which we come across in clinical practice are agoraphobia and social phobia (social anxiety). Most people will have heard of agoraphobia, a fear of open spaces. Howard Hughes, the reclusive American aviator and billionaire is believed to have suffered from agoraphobia amongst other psychiatric diagnoses.
Social phobia or social anxiety is more than just the common nervousness that most of us feel particularly when entering new social settings or meeting new people. The anxiety experienced is intense and is accompanied by such an elevated sense of dread and apprehension that the sufferer often avoids or opts out of the situation altogether. There is also a sense of critical self-monitoring, during which the sufferer is monitoring how they must be coming across to others in a very harsh unforgiving way. Safety behaviours, or habits that make people feel more secure but actually cause more problems in the long run, are often a part of the picture. For example, the person feels so anxious that he or she avoids eye contact with others and averts his/her gaze.
However, this very safety behaviour results in other people finding the person’s behaviour somewhat strange, the very thing which the sufferer is trying to avoid in the first place. Unlike the other specific types of phobia described earlier, the treatment approach can be more complicated. No matter how often people with social anxiety (phobia) are exposed to social situations (exposure therapy), this alone will not diminish the phobia. The focus of therapy is really about teasing out irrational beliefs and thought patterns and helping the client develop new adaptive ones.
The good news is that the psychological treatment of phobias - the specific ones (such as the fear of water, flying, animals) agoraphobia and social – can be very successful. However, if left untreated, living with a phobia can be extremely disabling. Your GP may be a good first port of call to rule out any potential complicating physical factors. Onward referral to a mental health specialist can result in often significant improvements in daily functioning and quality of life.
Julie O'Flaherty and Imelda Ferguson are chartered clinical psychologists, both based in Tullamore. Through Mind Your Self Midlands, they run courses on positive psychology and mindfulness through the year and they write a regular column for the Tullamore Tribune and Midland Tribune. They can be contacted through the Psychological Society of Ireland www.psychologistsociety.ie (Find a Psychologist section) or on their Facebook page, Mind Your Self Midlands
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