|Phobias are distressing
and common disorders in which someone has a powerful fear of a
situation or object. Common phobias include fears of animals,
birds, heights, crowds or social events. People with a phobia
may acknowledge that their fear is out of proportion to the true
danger or threat, but they cannot control or explain it.
If someone does not take steps to overcome a phobia, it can last
for years and be very disabling. It can cause considerable disruption
to their daily lives - and those of their families.
|Most people have no symptoms
until they are faced with their feared situation or object. When
they are confronted by this, they have severe symptoms of anxiety.
These can be so unpleasant that the person takes elaborate steps
to avoid coming into contact with their feared object. Symptoms
of the anxiety include:
- fast breathing (hyperventilation)
- being aware of a fast heart beat (palpitations)
- choking sensations
- flushes, sweating and feeling faint
In severe cases, these symptoms can occur even when the person
is thinking about being close to the feared object or simply seeing
a picture of it.
|We do not know what causes
phobias. Psychologists who have studied phobias have suggested
that they develop from an unpleasant experience in childhood involving
the feared object. The unpleasant situation is stored in the person's
memory, bringing on the fear again when the memory is triggered.
For some people, the onset of a phobia may be triggered by a stressful
life event, such as bereavement.
|Types of phobias
These are fears of specific situations such as being close to
animals or birds, fear of heights, lifts or other closed spaces
(claustrophobia), needles, flying or the sight of blood. These
phobias are more common in women, and they often begin in childhood,
in some cases after an associated traumatic experience.
People who suffer from these phobias rarely have any other psychiatric
or psychological problems.
Agoraphobia often starts in late adolescence and early adulthood.
Strictly speaking, it means a fear of open spaces. In reality
it is often used to refer to a fear of crowded places. People
with agoraphobia often experience anxiety, panic and depression.
Agoraphobia can be particularly disabling, as many people who
suffer from it become completely housebound.
Social phobia occurs when there is an excessive fear of intimate
social situations, such as small groups of people at parties.
This is different to the fear of contact with crowds of people,
as with agoraphobia.
People with social phobia have no confidence with people they
do not know, and fear that strangers are being overtly critical
of them. They may also fear that they will behave in an embarrassing
way, such as blushing or shaking in public.
In some cases, social phobia may lead to excessive drinking, as
some people with social phobia feel they need a drink to steady
their nerves before any social event. Some people with this disorder
have a particular fear of eating in public, or of any encounters
with the opposite sex. This may lead to people having very lonely
lives, as they try to avoid any social situation outside their
|Self help for phobias
|The personal motivation
to expose oneself to the feared object and to tolerate the anxiety
is the most important ingredient of treatment. Some people find
that they can do this on their own, perhaps with the help of books
and other support, including that from friends and family.
|If self-help techniques
do not help, a person with a phobia should talk to their doctor,
who may recommend a range of therapies.
Cognitive behavioural therapy
The best treatment for phobia is a psychological treatment called
cognitive behavioural therapy. The cognitive element addresses
the thoughts about the phobia, while the behavioural part focuses
on exposing the person to their feared object or situation, and
changing specific actions.
The cognitive aspect teaches people to understand the thinking
patterns that contribute to their symptoms and to change their
thoughts so that symptoms are less likely to occur.
For example, when the anxiety associated with phobia begins, and
the person feels dizzy, they may automatically become alarmed
and start thinking 'I'm dying'. He or she learns to replace this
with a more realistic thought such as 'It's just dizziness and
I'm going to be OK'. Other typical thoughts that may be experienced
during exposure such as 'I'm unsafe' are also challenged.
An example of the part of cognitive behavioural therapy that focuses
on behaviour, rather than thoughts, is exposure therapy, outlined
Exposure therapy involves starting to confront the fear and stopping
to avoid it. When exposed to the feared object or situation, the
person is taught to tolerate their high levels of anxiety. After
30 minutes or so, anxiety levels naturally fall. The body cannot
keep up this highly-aroused state when there is no logical reason
to be frightened. People learn to conquer their fears by gradually
learning that no catastrophe befalls them during exposure. The
degree of exposure is increased gradually.
For example, for someone with a bird phobia, this would start
with looking at photographs of birds. This would move on to handling
feathers, to going to areas such as a duck pond and feeding the
ducks or eventually even helping to clean out a friend's birdcage
and handling the bird in the process.
It may be helpful for a friend or relative to get involved in
the treatment. If a professional is involved, a friend could attend
some of the sessions or help with 'homework' or practice exposure.
|Other types of therapy
Counselling is sometimes also called supportive psychotherapy.
Some people find it useful to discuss how they have altered their
lifestyle to cope with a phobia, and the adjustments they have
made to avoid the feared situation. However, unless the person
actually starts confronting the situation, counselling alone is
unlikely to change things.
Discussing the impact of a phobia may be enough to help some people
make the decision to change themselves, perhaps with the help
of a friend or family member. Many people, however, still need
the help of a professional trained to treat phobias.
There are exercises to reduce symptoms of anxiety. Relaxation
training includes breathing exercises and muscular relaxation.
For some people, it can be a useful addition before a behavioural
therapy programme by providing skills that help reduce anxiety
when exposed to the feared object. However, relaxation training
alone is not enough to treat a phobia.
Hypnosis has been tried but with no scientifically proven effect.
|Drugs are rarely used to
treat phobias, though if the person has an associated condition,
like depression, this may be treated with medication. Some doctors
may prescribe medicines called benzodiazepines (such as Valium)
to ease symptoms in the initial stages of a psychological programme.
Other drugs, called beta-blockers, are sometimes used to reduce
anxiety and have also been used together with psychological treatment
programmes. Drug treatment alone, however, is not enough.
|Hong Kong Mood Disorders
Center (The Chinese University of HK)
Hotline : (852) 2833 0838 - 8
Mental Health Association of Hong Kong
St. John's Counselling Service
Address : 7D, On Hing Building., 1-9, On Hing Terrace, Central,
Tel : (852) 2525 7207/8
Fax : (852) 2524 2777
Email : firstname.lastname@example.org
The American Psychiatric Association
National Phobics Society
|Healthwise (Health Information Resource
Tel : (852) 2849 2400
Fax : (852) 2849 2900
Email : email@example.com
Homepage : http://www.healthwise.org.hk/
This leaflet is for information only. For a detailed
opinion or personal advice, please consult with your own