Written by Regine Galanti
While most individuals display some anxiety when facing certain situations, such as spiders, insects, driving, heights, or closed spaces, among others, most of these fears are relatively benign and don’t affect an individual’s functioning. Many people, however, do suffer from these seemingly benign fears: The boy who avoids going to camp because he might see a spider, the woman who walks up 15 flights of steps to avoid the elevator, or the man who takes public transportation (despite having a car and driver license) in order to avoid driving over a bridge. These examples are just some of the ways that specific phobias manifest – almost any specific fear that causes an intense reaction that is disproportionate to the actual level of threat and interferes with an individual’s daily functioning, meets criteria for specific phobia, and is worthy of treatment. Everyone knows someone who suffers from a specific phobia, as these are some of the most prevalent mental health problems, affecting 1 in 8 people over the course of a lifetime.
That was the bad news. Here’s the good news: Exposure Therapy – a variant of Cognitive Behavior Therapy (CBT) – is a remarkably effective and relatively low-cost treatment for these types of phobias. In fact, intensive or even single-session exposure therapy treatments can be completed in as little as a single day, and provide long-lasting effects in reducing fear.
Phobic responses involve three parts: (1) A physiological fear response (the fight or flight response), (2) Cognitive appraisals (“this fear is dangerous”), and (3) Behaviors such as avoiding or escaping the feared situation. Take, Sally, for example, who is afraid of riding in elevators. When standing in front of an elevator, Sally notices muscle tension, and her hands begin to shake (the physiological response). She thinks to herself, “that machine is a deathtrap, it can’t be safe,” (cognitive response) and she decides that the best course of action is to take the stairs (behavioral avoidance).
Exposure therapy for specific phobias helps individuals by targeting all three parts of this phobic response. In particular, exposure therapy helps people recognize the role of their avoidance in maintaining their anxiety. Because Sally takes the stairs, she never actually gets to experience what happens if she did go in an elevator, and she therefore never gets to learn new information that would change her cognitions and physiology. It’s true that the elevator might get stuck, or plunge 20 feet, but the much more likely scenario is that the elevator rises as planned and Sally finds out that the catastrophic event she predicts will not happen. By riding the elevator, repeatedly, Sally also learns that her physiological response to fear is a “false alarm,” telling her something is wrong, when that is not true. Sally therefore learns that she can tolerate her physical symptoms, even though they are uncomfortable. By facing her fear rather than avoiding it, Sally’s fear response eventually decreases.
This type of approach, which involves confronting the feared stimulus in real life, is called in vivo exposure. As noted above, exposure therapy is highly effective for specific phobias, and can sometimes be completed start-to-finish in one session. Yet, many people live their whole lives in fear of something that they could overcome in a single day!