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.
A 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 to overcome their fears.
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What are phobias?
A phobia is essentially a type of anxiety disorder - a long-term condition where anxiety is experienced on a regular basis and sufferers feel constantly restless, worried and usually unable to sleep and concentrate properly. They have been found to be more common in women than men, and according to the Mental Health Foundation, 22 in 1,000 women are affected compared with 13 in 1,000 men in Britain.
There are several different things that people can develop a phobia of, but there tends to be two distinct categories of phobias. These are both concerned with 'avoidance' which is a complication that often develops from a phobia.
A specific phobia begins in childhood and is centered 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 visiting the dentist or flying.
- Environmental phobias - 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).
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 agoraphobia and social phobia.
Agoraphobia is a fear of being in public places where escape may be difficult - a condition that usually develops in the late 20s. 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. A big concern for many agoraphobics is not having control over a situation and being unable to escape should they come into contact with something that triggers their anxiety. This is especially the case if a person suffers from panic attacks.
Agoraphobia is linked to panic disorder, and the majority of sufferers have a history of panic attacks. Moments of intense fear, panic and loss of control that characterise a panic attack may occur due to being in certain situations, so this is what often drives people to start avoiding public open spaces. 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.
Alternatively some people with agoraphobia will not have panic disorder, and in these cases their phobia tends to be the result of a combination of issues such as 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.
People with social phobia (social anxiety disorder) experience a persistent fear of being around people and therefore will aim to avoid social situations. Their condition is essentially an intense form of shyness in which everyday activities such as shopping, eating out, going to the cinema and speaking on the phone can bring on overwhelming feelings of panic and anxiety. Like agoraphobia, social phobia is typically more common in women than men, and will start around adolescence. It is also likely to make everyday living difficult and many sufferers will experience panic attacks.
Signs of social phobia are often evident at a young age. Children with social anxiety disorder are likely to cry a lot and have persistent tantrums, while some will be worried about going to school and may freeze or clam up in social situations. Low self-esteem and having trouble making eye contact are further indications that a child may have a social phobia, and some may resort to drug and alcohol abuse as they get older to help them deal with their anxiety.
Causes of social anxiety disorder are unknown, but there is a strong link with mental health issues such as depression, panic disorder and post-traumatic stress disorder. According to Anxiety UK, certain types of parenting may also influence the development of social phobias in children. One study showed that people with the disorder tend to have parents who:
- are not affectionate enough
- are overprotective
- exaggerate the danger of approaching strangers
- constantly criticise them
- over-emphasise the importance of looking good and having manners.
Symptoms of phobias
As briefly aforementioned, 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.
Causes of 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. They may pick up on their parent's behaviours after repeated observations of their anxious responses when they come into contact with certain people, situations or objects. 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, a child who gets trapped in a confined space is more likely to develop a fear of small spaces (claustrophobia) in the future. Sometimes a child can be inadvertently faced with frightening information - or a strict instruction to stay away from someone/something - and could easily grow up to become scared about confronting such people or situations. For example, if a trusted adult repeatedly warns the child about something, such as keeping away from dogs in the street, this can develop into a deep-rooted fear.
Treatment 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.
Counselling for phobias
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. 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 in order 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's 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 fulfillment.
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.
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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Tim LeBon (MA (Oxon), UKCP, BABCP accredited)12th November, 2017
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Anthea Hollingworth Psychotherapist and Counsellor MSc. MBACP (Accred)31st May, 2017
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