Overcoming phobias and fears with EMDR

Many people don’t like going to the dentist, experiencing feelings of discomfort before an appointment and relief once it’s over. But if you feel high levels of anxiety or fear about going to the dentist – perhaps to the point where you are unable to make or attend an appointment – and this fear is out of proportion to any actual risk posed by a dental procedure, it may be that you have a phobia of dentists.

The same could apply to a fear of flying, injections, speaking in public or dogs. If the fear feels out of proportion and leads you to avoid these situations or experiences altogether, it may have reached the level of a phobia.

How can phobias develop?

Phobias can be extremely distressing and life-limiting, impacting relationships, socialising, work and your ability to enjoy your environment. There are well-established behaviour-based techniques, including CBT and exposure therapy, designed to help people overcome a range of phobias.

There is also growing evidence (Doering et al., 2013; De Jongh, 2016) that eye movement desensitisation and reprocessing (EMDR) may help people where an underlying traumatic or distressing memory is contributing to the phobia. There is even an EMDR protocol for specific fears and phobias, the Phobia Protocol, developed by Ad de Jongh, a Dutch dentist who later trained as a clinical psychologist and EMDR therapist and who wrote his doctoral thesis about fear of dentists (De Jongh, 2016).

If the phobia has developed in the absence of an underlying traumatic memory, other approaches, such as CBT and exposure therapy, may also be considered. This article explores how EMDR can be used to help people recover from phobias.

There are many ways a phobia can develop. This might include going through a traumatic experience related to the phobia, witnessing or hearing about a similar experience happening to someone else, or being told that certain activities are dangerous. Such experiences can lodge in the memory and be difficult to shift.

These experiences might generate negative or unhelpful thoughts about the dangers of certain activities and what could happen if you engage in them. For example, a scary, turbulent flight at a young age, when you thought the plane was going to crash, might resurface years later whenever you think about flying, leaving you fearful that the same thing could happen again.

Similarly, an experience of speaking up in class, being criticised by a teacher and laughed at by other children might contribute to a later fear of public speaking or giving presentations at work. Even hearing about someone else’s distressing experience, such as a friend having a difficult tooth removal, could contribute to a fear developing.

These experiences can have such an impact because of how traumatic memories may be processed in the brain. Sometimes, a traumatic experience can be so overwhelming that your sensory response to what happened – the thoughts, feelings and physical sensations – can feel as though it becomes stuck in the brain’s “alarm system”, involving the amygdala, rather than being fully processed and stored as a memory in the brain’s library, the Hippocampus.

This matters because the hippocampus plays an important role in understanding time, place and context, so when a memory has been processed, you know that it is a memory and, difficult as it was, it is now over, and you don’t have to relive it. The amygdala, the brain’s alarm or survival system, can respond differently, so if something happens to remind the brain of a distressing experience, even years later, it can feel as though the event is happening again, making you think and feel the same way you did before.

Put another way, it’s as if one part of your brain knows what year it is, that you are the age you are, that none of the flights you have been on has actually crashed, and that air travel is very safe. In another part of your brain, it feels like you are still on the flight you took when you were twelve; it’s a stormy night, the plane is being buffeted by turbulence, and you are scared it will crash. Whenever you think about going anywhere by plane, this younger part wakes up. You feel frightened and are convinced the next plane you board will crash.

How can EMDR help with phobias?

EMDR treatment of phobias typically begins with discovering the early experiences which may be the origin of the phobia and then processing these memories to take the power out of them.

EMDR uses bilateral stimulation, which may help facilitate the flow of information around the brain. This means that the knowledge that you are, in fact, safe – that you have never been on a plane that crashed and are extremely unlikely ever to be – can reach the part of your brain that still feels in danger and still feels as though you are twelve years old and on a scary flight. This can help update that part of your experience and bring it into the present.

Bilateral stimulation usually takes the form of eye movements, though tapping, sounds and other forms are also used. Your therapist may ask you to think about the worst moment of the event: what you can see, the negative thoughts you have about yourself in that moment, your emotions and where you feel them in your body. They may then ask you to follow their fingers with your eyes as they move them from left to right in front of you, and simply notice what happens.

The procedure will be repeated until the image has faded, the negative thoughts have been replaced by more positive ones, the emotion has lessened, and your body feels relaxed.

By directing your attention from left to right while thinking of the target memory, both sides of the brain are engaged, which may help with the processing of information. One way of understanding this is that it can help the traumatic experience move from your alarm system/amygdala towards the library/hippocampus, which, as noted, understands time and place. Once the memory is there, your brain can recognise that the event, scary as it was, is over and you are now safe.

This disrupts the connection in your brain between flying on a plane in general and one specific experience of flying on a plane, so you can think about flying without the fear from the original flight. Once this has been achieved (and there may be several flights or aspects of flights which need to be processed), you can move on with your therapist to thinking about the next time you have to fly.

Your therapist might ask you to play in your mind the film of your next journey, leaving home, travelling to the airport, going through security, getting on the plane, taking off, flying and landing, using bilateral stimulation again to work through any anxiety which might come up, until you are able to visualise the whole trip without any anxiety.

Techniques to help you manage anxiety

An EMDR therapist will also teach you techniques to help you feel calmer when anxious, including breathing, grounding, and safe space exercises, as well as techniques to help disrupt worried or anxious thoughts. For example, this might include counting backwards in threes from one hundred and fifty, which you can use between sessions if feeling overwhelmed or anxious.

You might also look at some educational material around the safety of air travel or statistics on fatal attacks by dogs in the UK, again perhaps in combination with BLS to support the part of you that knows that flying on a plane or going to the dentist is actually very safe, which can come as a great relief.

You might also look at some educational material around the safety of air travel or statistics on fatal attacks by dogs in the UK, for example, perhaps in combination with EMDR. This can support the part of you that knows that flying on a plane or going to the dentist is actually very safe, which can come as a great relief.

When to seek support for a phobia

If your phobia is limiting your ability to enjoy life fully, it may be time to speak with a therapist. Perhaps you can't get on a plane to go on holiday without being overwhelmed with anxiety, have to pull out of presentations at work or can't make an appointment with a dentist.

If you think there is or might be a traumatic experience in your past which contributes to the phobia, then it may be helpful to speak with an EMDR therapist to explore the roots of the issue and what might be possible. If the causes of the phobia are less clear, then consulting a CBT therapist and considering exposure therapy may also be helpful.

The most important thing is to remember that many phobias are treatable and that you don't have to just accept the limitations your phobia places on your life.

References

De Jongh, A. 2016. EMDR Therapy for Specific Fears & Phobias: The Phobia Protocol. In: Luber, M. ed: EMDR Therapy: Scripted Protocols & Summary Sheets. Springer. New York. 

Doering, S., Ohlmeier, M. C., de Jongh, A., Hofmann, A. & Bisping, V. (2013). Efficacy of a trauma-focused treatment approach for dental phobia: a randomized clinical trial. European Journal of Oral Sciences, 121(6), 584–593.