Physical symptoms

People with phobias often have panic attacks. These can be very frightening and distressing. The symptoms often occur suddenly and without warning.

As well as overwhelming feelings of anxiety, a panic attack can cause physical symptoms, such as:

• sweating
• trembling
• hot flushes or chills
• shortness of breath or difficulty breathing
• a choking sensation
• rapid heartbeat (tachycardia)
• pain or tightness in the chest
• a sensation of butterflies in the stomach
• nausea
• headaches and dizziness
• feeling faint
• numbness or pins and needles
• dry mouth
• a need to go to the toilet
• ringing in your ears
• confusion or disorientation

Psychological symptoms

In severe cases, you may also experience psychological symptoms, such as:

• fear of losing control
• fear of fainting
• feelings of dread
• fear of dying

Specific phobia is characterised by:

• an intense fear or anxiety related to a specific object, activity or situation which is out of proportion with the degree of danger actually posed
• active efforts to avoid the feared object, activity or situation (e.g., taking the stairs to avoid going in an elevator).^1,2

A diagnosis of specific phobia is made when these symptoms are present for six months or longer and cause the person significant distress, or interfere with important aspects of the person’s life, such their work or relationships.^1,2

Common phobias include:

• animal related phobias (e.g., snakes, spiders, dogs)
• phobias relating to the natural environment (e.g., storms, water)
• blood, injection, and injury phobias (e.g., needles, medical procedures)
• situational phobias (e.g., elevators, aeroplanes, tunnels).^1,2

Specific phobias usually develop during childhood and they are twice as likely to be diagnosed in women compared to men. Over 75 per cent of people with a specific phobia experience multiple phobias over their lifetime.³

Exposure therapy

Exposure therapy is considered the most effective treatment for specific phobias.⁹ In exposure therapy, the person confronts the feared object or situation without engaging in any avoidance or escape behaviours. By encouraging people to face their fears, it is thought that exposure therapy teaches a person that feelings of anxiety decrease naturally over time and that the feared consequences of the phobic object or situation are unlikely to occur.⁶

The most effective form of exposure therapy is in vivo exposure.⁹ In vivo exposure is typically conducted in a controlled environment and involves directly confronting the person’s fear through a series of activities which provoke increasing levels of fear and anxiety. For example, a person with a phobia of dogs may first decide to approach a dog on a leash, then proceed to pat a dog on the head, then allow a dog to lick his/her hand, and eventually go to a dog park. A person usually undergoes exposure therapy until the most anxiety-provoking situation has been successfully mastered.^6,10

Cognitive therapy

Cognitive therapy involves helping the person to identify and challenge unhelpful thoughts. This technique might be used alone or in conjunction with exposure therapy.^9,11

Face your fear slowly

Exposure is one of the most effective ways to overcome fears. You want to start by facing your fear in a controlled and safe way. Some people choose to do this in therapy or with the help of a trusted friend or family member. Create specific steps to become acclimated with the object or situation you feel anxiety about. For example, suppose you had a phobia about dogs; you could follow the following steps:

• Look at a picture of a dog.
• Have a friend bring a dog over and keep it outside your window, so you can see it but are separated from it.
• Have your friend open the door but keep the dog outside.
• Stand about 20 feet away from the dog, slowly closing the distance until you can stand next to the dog.
• Touch and pet the dog – the dog may need to be on a leash first, then off the leash.

Practice and work with each step until you feel comfortable. This may take some time, you may need to repeat the step several times before you reduce your fears. Be patient with yourself, this process takes time, patience and practice.

Practice relaxation techniques

You may want to do deep breathing exercises every day. This not only helps reduce overall anxiety but gives you a way to calm yourself down in particularly anxious   situations. When you do these exercises on a daily basis, this type of breathing becomes automatic and you can take deep breaths whenever feeling nervous to help calm down.

Change thought processes

This can be difficult but is essential to overcoming anxiety. Many times, when faced with a difficult situation, you exaggerate the negative aspects or worry about the outcome, making you even more nervous. Instead of thinking, “The dog walking toward me is going to bite me,” tell yourself, “I can walk past this dog.” As you pay attention to how you talk to yourself and begin to change your thoughts, you may notice a significant reduction in your anxiety.

Remember, phobias and anxiety have taken years to take hold of you and may take years to overcome. Continue to practice these techniques, every day. Keep a notebook of your progress, that way when you are feeling overwhelmed or frustrated, you can look back to see how far you have come.

For anxieties, phobias and fears that are stopping you from fully participating in your life, talk with your doctor, psychiatrist or psychologist. Some people find it helpful to utilise other treatment methods, such as medication, as they work on the techniques to overcome their fears and phobias.

Talk with your doctor or health professional to find out if this would be a good option for you.

Exposure therapy

Exposure therapy is considered the most effective treatment for specific phobias.⁹ In exposure therapy, the person confronts the feared object or situation without engaging in any avoidance or escape behaviours. By encouraging people to face their fears, it is thought that exposure therapy teaches a person that feelings of anxiety decrease naturally over time and that the feared consequences of the phobic object or situation are unlikely to occur.⁶

The most effective form of exposure therapy is in vivo exposure.⁹ In vivo exposure is typically conducted in a controlled environment and involves directly confronting the person’s fear through a series of activities which provoke increasing levels of fear and anxiety. For example, a person with a phobia of dogs may first decide to approach a dog on a leash, then proceed to pat a dog on the head, then allow a dog to lick his/her hand, and eventually go to a dog park. A person usually undergoes exposure therapy until the most anxiety-provoking situation has been successfully mastered.^6,10

Cognitive therapy

Cognitive therapy involves helping the person to identify and challenge unhelpful thoughts. This technique might be used alone or in conjunction with exposure therapy.^9,11

1. American Psychiatric Association. (2013).Diagnostic and Statistical Manual of Mental Disorders(5th ed.). Washington DC: Author.
2. World Health Organization. (2008).ICD-10: International Statistical Classification of Diseases and Related Health Problems (10th Rev.). New York, NY: Author.
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4. Van Houtem, C. M. H. H., Laine, M. L., Boomsma, D. I., Ligthart, L., van Wijk, A. J., & De Jongh, A. (2013). A review and meta-analysis of the heritability of specific phobia subtypes and corresponding fears.Journal of Anxiety Disorders, 27(4), 379-388. doi: http://dx.doi.org/10.1016/j.janxdis.2013.04.007
5. Hofmann, S. G., Alpers, G. W., & Pauli, P. (2008). Phenomenology of panic and phobic disorders. In M. M. Antony & M. B. Stein (Eds.),Oxford handbook of anxiety and related disorders(pp. 34-46). New York, NY: Oxford University Press,.
6. Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2011).Exposure therapy for anxiety: Principles and practice. New York, NY: Guilford Press.
7. Hood, H. K., & Antony, M. M. (2012). Evidence-based assessment and treatment of specific phobias in adults. In T. E. Davis III, T. H. Ollendick & L-G. Öst (Eds.),Intensive one-session treatment of specific phobias(pp. 19-42). New York, NY: Springer Science + Business Media.
8. McCabe, R. E., Ashbaugh, A. R., & Antony, M. M. (2010). Specific and social phobia. In M. M. Antony & D. H. Barlow (Eds.),Handbook of assessment and treatment planning for psychological disorders(2nd ed., pp. 186-223). New York, NY: Guilford Press.
9. Wolitzky-Taylor, K. B., Horowitz, J. D., Powers, M. B., & Telch, M. J. (2008). Psychological approaches in the treatment of specific phobias: A meta-analysis.Clinical Psychology Review, 28(6), 1021-1037. doi: http://dx.doi.org/10.1016/j.cpr.2008.02.007
10. Cisler, J., Lohr, J., Sawchuk, C., & Olatunji, B. (2010). Specific Phobia. In J. C Thomas & M. Hersen (Eds.),Handbook of Clinical Psychology Competencies(pp. 697-722). New York: Springer
11. Choy, Y., Fyer, A. J., & Lipsitz, J. D. (2007). Treatment of specific phobia in adults.Clinical Psychology Review, 27(3), 266-286. doi: http://dx.doi.org/10.1016/j.cpr.2006.10.002
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