Category: Phobias

Overcoming Specific Phobias with Exposure Therapy

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!

I touched a creepy, big, fuzzy, nasty, spider and . . .

Written by Hadar Naftalovich

For as long as I can remember, I have been scared of spiders. Especially the big ones. In my head, tarantulas are really scary and very very venomous. They can sense fear. It was obvious to me, that if a tarantula ever landed on me, it would have a feast on my inner freak-out and bite down. Now, back up a moment. What if my pre conceived notion of tarantulas is wrong and they’re not so venomous? (Spoiler: they’re not. (Tarantula Bite Guidelines)) Well, I was prepared for that too. The spider would for sure bite me, and while any one else would be okay, I myself am allergic, and would need to go to the ER anyway.

This fear I had was not only related to tarantulas. It spread to all other types of creepy-critters, but especially smaller spiders. I was so afraid of facing the big ones, that I would even avoid the little ones. I’d make excuses not to go to picnics, and leave my friends if they wanted to study outside.

Turns out that tarantulas are quite docile. While working at the Center for Anxiety, I was given the opportunity to face my fears as part of a session we hosted. We were bringing a Spider-guy in and he was bringing spiders with him. Participants would be given the chance to let one crawl up their arms and toward their heads. I was also given a chance to back out. I didn’t.

So, with much preparation, I let one crawl over my hand. I felt the fear and crawly sensations even after the spiders last hair left my hand. But there was no ER, not even a rash.

What I learned from this exercise is that something good happens when you stop avoiding something you fear and finally face it. One might argue that even someone who is not phobic of spiders would not want to hold a tarantula, and so what does it prove to go out of your way to be scared? We don’t need (or want) to face something terrifying if we can avoid it.

The answer to that has to do with you. Take a moment to think, on a smaller scale, about the things in your life that you avoid like I avoid spiders. Exercising? Studying? Paying bills? We all have them. Things that we avoid every week, or even every day. I’ve made a list of those things I avoid and I’ve started to approach them. I went for a run. I began studying more seriously for the GRE. I finally tried out a new water-color technique I had come across.

Consequently, I began to feel more accomplished and in control. The exercise has made me realize how many things in my day I do because I have to, or as a reaction to what is going on around me. Even though not all these tasks are pleasant, when I complete them I feel proud that I set a challenge for myself and met it.

Sometimes we avoid things, even though they’re good for us. Do something you’ve been dreading. Practice distress, and you might feel better!