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Phobias

Everyone has fears. Whether it is a fear of spiders or a fear of the dark, there are varying situations, places, feelings, objects or animals that can trigger an unpleasant sensation - an urge to prepare for or completely avoid the perceived danger.

Fear is a completely natural human emotion but, in some people, fears are more pronounced and will manifest as a phobia. A phobia is an overwhelming and debilitating fear that develops when someone has an exaggerated sense of danger about a certain object or situation. They can be incredibly stressful to live with and, in severe cases, can take a toll on a person's health, well-being and overall way of life.

Living with a phobia means people are often in constant anguish about whether they may come into contact with what they are afraid of. However, continually trying to avoid a particular fear is likely to make it seem worse than it really is, and many people will start dreading confronting normal, everyday situations. Treatment for phobias can help to break this negative spiral and can help to get feelings of anxiety under control.

This page will explore phobias in more detail, including the nature of simple and complex phobias, as well as highlighting the benefits of counselling for helping people overcome their fears.

What is a phobia?

A phobia is essentially a type of anxiety disorder - a long-term condition where anxiety is experienced regularly and sufferers feel constantly restless, worried and usually unable to sleep and concentrate properly. They can affect anyone, regardless of age, sex and social background.

There are several different things that people can develop a phobia of, but there tends to be two distinct categories of phobias, specific and complex phobias. These are both concerned with 'avoidance' which is a complication that often develops from a phobia.

Specific phobias 

A specific phobia begins in childhood and is centred on a particular object, animal, situation, or activity - often things that pose no definite threat. Sufferers tend to be aware that their phobia is irrational, but they will still be unable to control it. In most cases, specific phobias will fade as people get older, but sometimes they can be a life-long problem. 

Typical examples of specific phobias include:

  • Animal phobias - an intense fear of dogs, spiders, snakes, rodents, etc.
  • Situational phobias - such as a fear of flying or visiting the dentist.
  • Environmental phobias - fear of heights, deep water, germs etc.
  • Bodily phobias - when people cannot cope with the sight of blood, being around vomit or having injections.
  • Sexual phobias - these include performance anxiety and a fear of getting a sexually transmitted infection (STI). 

Complex phobias

Unlike specific phobias, complex phobias are more likely to develop during adulthood. They are often linked to a deep-rooted fear or anxiety about a particular circumstance or situation and mental health issues such as depression, panic disorder and obsessive compulsive disorder are often linked. The two most common types of complex phobias are social anxiety and agoraphobia.

Social anxiety 

Social anxiety, also known as social phobia or social anxiety disorder is a persistent fear of being around people. You might worry about a social event before, during and after it has happened, or even avoid certain social situations altogether.

Having social phobia can have a huge effect on your life and can make it very difficult to engage in everyday activities such as meeting new people, talking in groups, starting conversations or public speaking. You might worry about social situations because you fear that others will judge you negatively or worry about others noticing that you are anxious - if you start to blush, sweat or stumble over your words.

For me, social anxiety started when I was off work with depression. I felt so lost without my career that I was worried I would have nothing of value to say in a group setting, so I avoided social situations altogether. Along with this fear, I also experienced physical symptoms such as sweating, nausea, and palpitations, but for others, it can lead to full-blown panic attacks.

- Writer Fiona Thomas shares her experience of social phobia and provides some tips on how to network when you have social anxiety.

It may affect your self-confidence and self-esteem and can make you feel extremely isolated. It can make it very difficult to develop and maintain relationships and can interfere with your ability to work and perform everyday tasks such as shopping.

Do you feel overwhelmed in social situations? Psychotherapeutic counsellor Ashlie Smith has six tips to calm your social anxiety.

Agoraphobia

Typically, agoraphobia is thought of as a fear of open spaces, but it is more complex than that. Essentially, agoraphobia is feeling anxious about being in places or situations that it would be difficult or embarrassing to escape from. This is especially the case if a person suffers from panic attacks.

Having agoraphobia can have a big impact on the way you live your life. For individuals living with agoraphobia, simply leaving the house can bring on a sense of panic, while those who do venture out may fear travelling alone and strive to avoid crowded and unfamiliar places.

Agoraphobia can sometimes develop after a panic attack; you may become worried about having another panic attack and may feel your symptoms return when in a similar situation. As a result, you may avoid that place or situation.

However, this is not always the case for everyone suffering from agoraphobia. For some, their phobia tends to be the result of a combination of issues such as an illness, a previous traumatic experience, or a genetic link. Sufferers are also very likely to show signs of low self-esteem and may feel unable to cope alone. Although the severity of agoraphobia will vary considerably between individuals, ultimately, all sufferers will experience the same physical, cognitive and behavioural symptoms when they find themselves in a situation where they feel uncomfortable.

What are the symptoms of phobias? 

The symptoms of phobias tend to be very similar to those experienced during a panic attack. These include shortness of breath, heart palpitations, dizziness, trembling and sweating, and, in severe cases, sufferers may also feel an intense fear of dying and fear of losing control.

Due to the varying nature of phobias, not everyone will experience the same symptoms - and while, for some, the symptoms are mild, others will have full-blown attacks. Furthermore, some people with phobias will only have symptoms when they encounter the situation or object that they are afraid of. Others, however, will feel anxious and panicky just thinking about their phobia.

See our page on panic disorder for a full list of symptoms.

What causes phobias?

Phobias can develop at any stage in life, and although there is no known cause it is thought that they are triggered by a combination of factors. One theory is that phobias can be 'learnt'. Research suggests that children are more likely to develop a phobia if members of their family - particularly their parents - have phobias. 

Children may pick up on their parent's behaviour after repeated observations of their anxious responses when they come into contact with certain people, situations or objects. Alternatively, genetic links have also been identified. It is thought that some people are born with a tendency to be more anxious than others, although the extent to which a phobia is inherited is uncertain.

Other causes of phobias include early stressful and traumatic experiences, which can leave people afraid of certain objects or places that remind them of these unpleasant events. For example, after Sophie was in a car accident, she developed a fear of driving. She shares the realities of living with a phobia:

Whilst I managed to drive around my local area, I still avoided dual carriageways and felt anxious and tearful before I got in the car. I constantly felt that other cars were going to pull out in front of me. I suffered with bad dreams about the car accident and kept getting flashbacks of the accident every time I got in a car - even as a passenger.

What treatments are available for phobias? 

Generally, with any form of anxiety, the earlier help is sought the better - as avoidance behaviour often makes the problem more complex and disruptive to an individual’s life. When behaviour is affected (for example if a person cannot meet with friends or take up employment because of their anxieties), professional support is normally required.

While treatment for simple phobias tends to be in itself relatively simple - often involving self-care to be carried out at home in the form of gradual exposure to a certain phobia - treating complex phobias can take longer and often involves more work. Talking therapies used in counselling are strongly recommended for treating complex phobias.

Counselling for phobias

Cognitive behavioural therapy is one of the most commonly used approaches, as it helps individuals to reconsider their way of processing situations whilst enabling them to find ways to deal with their anxieties more constructively. Cognitive behavioural therapists will also encourage clients to explore some of the complex underlying causes of their anxiety to help them better understand it and see it in a more realistic light.

Group therapy and attending self-help groups are also considered beneficial for helping people to overcome their phobias. These group settings can help to keep people motivated during and after therapy, and there is great relief and support that can be found in sharing your problems with others who understand what you are going through. All counselling treatments for phobias are essentially a gradual and controlled way of decreasing anxiety and helping people to develop new patterns of thinking and behaviour that promote well-being and life fulfilment.

In some cases, treatment for phobias may involve a combination of medication with counselling. The three main types of medicine that are prescribed to treat anxiety issues including phobias are antidepressants, beta-blockers and tranquillisers. Drug treatments that act on levels of serotonin in the brain may also be an option.

Hypnotherapy

Many people who have phobias find hypnotherapy helpful for relieving their symptoms. Visit Hypnotherapy Directory to find out more about how hypnotherapy works to treat phobias.


What should I be looking for in a counsellor or psychotherapist?

Whilst there are currently no official rules and regulations in position to stipulate what level of training and experience a counsellor dealing with phobias should have, we do recommend that you check your therapist is experienced in the area for which you are seeking help.

In regards to psychological treatment NHS Choices suggest cognitive behavioural therapy (CBT) and/or desensitisation to help overcome the phobia.

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