What are Phobias and How Can Exposure Therapy Help?
Everyone knows the feeling: that pit in your stomach, a racing heart, or the overwhelming urge to run when faced with something scary, even when you know it's not truly as dangerous as it feels.
While many of us might feel a pang of fear when encountering spiders, heights, or public speaking, which can cause experiences of discomfort and a desire to avoid the situation, we can usually push through these feelings. However, for some, these fears can become far more intense and debilitating, developing into a form of anxiety disorder that we call phobias.
In this post we are going to break down what is a phobia, how phobias develop, how phobias are sustained and what you can start doing right now to start overcoming them.
Phobia vs Fear
What is a phobia and how does that differ from fear?
A phobia is much more than just disliking something or feeling a bit nervous. It's a strong, ongoing, and often unreasonable fear of a specific thing or situation. This fear tells your body that something terrible is about to happen, causing feelings of panic, dread, and a powerful urge to escape the situation or get away from the feared scenario.
When people feel this much anxiety, they naturally try to avoid what scares them. They do this to feel safer and stop the panic from happening.
Some common phobias that we treat at our clinic include agoraphobia (fearing places or situations that might cause panic and feelings of being trapped) trypanophobia (extreme fear of needles and medical procedures involving needles) and fear of flying.
Many of us can understand feeling uneasy about air travel – being squeezed into a plane, dealing with delays, cancellations, and worrying about luggage. We've also had news stories about planes crashing when experiencing bad turbulence and wondered if we are going to experience a similar fate.
However, for someone with a flying phobia, the experience is much more upsetting and serious. They might even have panic attacks, which can feel a lot like having a heart attack if you've never had one.
To avoid this frightening experience and the embarrassment of such intense anxiety, the person will avoid getting on a plane. This can stop them from enjoying important activities, job opportunities, or relationships that matter to them. The long story short is that their phobia is having a negative impact on their functioning and life; this is important as this is a requirement to meet the criteria for a phobia diagnosis.
Unfortunately, engaging in avoidance doesn't just lead to less experiences, it also strengthens the belief that the thing the person is fearful of is indeed a grave threat; this because the person is acting as if they are in danger and prevented the fear from being actualized because they avoided getting on the plane. This creates a feedback loop that is difficult to break where avoidance feels like it equals safety; when in fact avoidance equals sustaining the phobia.
How do Phobias Develop?
Phobias, like all human behaviours, are believed to stem from a mix of our genes, our environment, and what we learn. Simply put, if someone is naturally more prone to anxiety and has certain experiences in life, they might be more likely to develop a phobia.
Consider a child who becomes afraid of dogs after a bad encounter at a park. The dog corners the child, who gets scared. The parent steps in and, because of this encounter, becomes more protective of the child around dogs. As a result, the child feels more anxious around dogs and avoids them. Each time they avoid a dog, their anxiety lessons and they experience relief.
In this scenario, the protective parent even encourages the child to avoid dogs because they are also scared, worrying about what might have happened if they hadn't intervened and wanting to spare the child any distress by forcing them to interact with a dog.
As the child works hard to avoid all dogs to feel safe, they do not learn that most dogs are friendly, or that they can manage their fear without avoiding them. Instead, as their avoidance increases, so does their fear of dogs and their distress when they encounter them. Each time they avoid, it tells their anxiety that dogs are dangerous and should be avoided.
This cycle becomes stronger and more ingrained each time it's repeated. In some cases, phobias can lead to a pattern of avoidance that slowly shrinks a person's world, stopping them from doing healthy activities, enjoying hobbies, or even just going about their daily routines.
Overcoming Fears: The Transformative Power of Exposure Therapy
As we often tell our clients, avoidance is the problem with most anxiety conditions and phobias tend to best illustrate this. So what is the solution? Exposure.
The fundamental principle behind exposure therapy is simple yet highly effective: to break the cycle of fear and avoidance, we must expose the person to what they are fearful of so that they can learn to overcome it. By gradually and systematically confronting the feared object or situation, you begin to discover that your anxieties are often exaggerated, or in many cases, entirely unfounded. It's about teaching your brain, through direct experience, that what it perceives as dangerous is actually safe. The great thing about exposure is that it has been consistently proven to work.
Types of Exposure Therapy
There are different ways to approach exposure therapy and we have provided a description of the two most common ones.
Flooding: If you've ever seen a show like Fear Factor, you'll get the idea of "flooding" therapy. This method involves facing your fear directly, for a longer period of time, and often very intensely. The idea is that your body's "fight or flight" response can only stay active for so long before it naturally calms down. We call this "habituation", your body gets used to the situation, and when nothing bad happens, your mind learns there's no need to be scared. While it can work for some, it's very intense and can make people stop treatment because it feels too overwhelming. We totally understand why! If we were afraid of heights and were told the cure was bungee jumping, we'd find that to be a tough sell.
Systematic Desensitization (also known as Graduated Exposure): This is generally the preferred approach, and very much the type of exposure therapy that we provide at our clinic. It involves a carefully planned, step-by-step process of gradual exposure. It's like climbing a ladder one rung at a time, rather than trying to jump to the top. In this approach, you learn to:
Tune in to your anxiety: Tools like a "Fear Thermometer" or what we call a Subjective Units of Distress Scale (SUDS) to help you rate your anxiety level from 0 to 100. These are simple tools to give you a concrete way to track your progress and to better understand your reactions as you work to overcome your fear.
Build a "Fear Hierarchy": This is where you, with guidance, create a list of steps, from the least anxiety-provoking to the most, related to your fear. For someone with a fear of dogs, the first step might be looking at a picture of a puppy, then watching a video of a dog, then being in the same room as a dog behind a fence, and so on, until the ultimate goal (e.g., petting a dog) is reached. Each step is small and manageable.
Learn and use relaxation skills: Before and during exposure, you learn practical techniques like deep breathing, guided imagery, or progressive muscle relaxation. These skills are your tools to manage rising anxiety, helping your body stay calm even as you face your fears.
Through systematic desensitization, you are guided through each step of your fear hierarchy. If you feel overwhelmed, you can pause and use your relaxation skills. This collaborative process is empowering; you're not just a passive recipient of therapy, but an active participant in designing your own path to freedom, celebrating each small victory along the way.
If jumping into therapy isn’t where you are at, there are some good guides that you can check out online on Systematic Desensitization that you might want to check out. Including one from the University of Michigan.
Facing Your Fears for a Fuller, Freer Life
No matter if your fear is public speaking, dogs, or social situations that keep you isolated from others, learning about phobias and how exposure therapy works can truly change your life. It's about getting back the parts of your life that fear has taken away. By bravely and slowly facing what you're afraid of, you can start to question those deep-seeded, often untrue beliefs that are holding you back. You can also learn to overcome and better manage your anxiety, while learning strategies other than avoidance. It's a journey, but your fears can be overcome one step at a time. With the guidance of therapy, especially evidence-based approaches like exposure, you can learn to face your fears gradually, build resilience, and develop practical tools to manage anxiety. Change takes courage and consistency, but it is absolutely possible. If you’re ready to start your journey toward a fuller, freer life, reach out today to book a free 15-minute consultation.
