“Do not be afraid.”
For millions of people, this simple statement is much easier said than done. Their lives are dominated by a fear of encountering a specific object, circumstance, or idea that evokes tremendous anxiety and uneasiness. By definition, a phobia is an extreme or irrational fear that significantly impacts an individual’s functioning or causes significant distress. As distinguished from other types of anxiety or a reasonable fear, a phobia is defined in a few specific ways. One, it is associated with an intense, emotional reaction almost every time a specific circumstance or object is encountered. Two, someone with a phobia will go to great means to avoid the impetus for their fear even if it results in significant inconvenience or hardship. Finally, the degree of the fear itself is disproportionate to the actual danger that exists.
Let’s use the example of someone who has a phobia of spiders. A person with this condition would likely experience an intense sense of anxiety (e.g., racing thoughts, increased heart rate, difficulty breathing, leaving the scene quickly) not only in seeing a spider in real life, but even potentially in seeing one on a screen. He or she might avoid public spaces that would seem to be most conducive to spiders being present, such as grassy and wooded areas, even if it resulted in more limited social engagements and/or activities. Although certain spider bites can be harmful, it is likely that all spiders would be seen through a “catastrophic lens” and the true risk of a dangerous encounter would be inflated substantially.
The rates and types of phobias differ dramatically although there are a few primary types. Specific phobias are those in which individuals have an extreme fear of a specific experience (e.g., getting a shot, seeing blood, being in an elevator), animal, or environmental feature (e.g., storms, heights). Social phobia (or social anxiety disorder) is characterized by an intense fear of being scrutinized by others, or being seen “in a negative light” in social situations. People with a social phobia worry that they will be humiliated and ultimately rejected by others for how they appear and what they do (e.g., making a mistake while speaking in front of others). On the contrary, agoraphobia is characterized by intense anxiety about being in public places due to worries about an inability to escape a situation before panic-attack symptoms ensue, or before harm or discomfort occurs (e.g., a person faints). Agoraphobia is somewhat contrasted from social phobia in that in that individuals who struggle with the latter are typically much more focused on negative evaluation by others, and may often feel less anxiety in situations where they perceive being largely “anonymous.”
Treatment of phobias largely focuses on the process of systematic desensitization through the use of multiple cognitive-behavioral techniques. There are three main components to treatment. First, individuals are taught methods of calming, such as diaphragmatic breathing, progressive muscle relaxation, and visual imagery. The primary purpose of these techniques is to develop means of easing tension and facilitating greater calmness that is incompatible with the physiological fear response that people feel when experiencing a phobia. The second component involves creating a fear hierarchy, which is a list of graded fears that are associated with the phobia (e.g., from 1 to 100 denoting least to most intense). For example, if a person is afraid of public speaking, they might list watching someone speak on television as a 10, sitting in the audience as a 20, sitting on stage while someone speaks as a 50, introducing a keynote speaker as a 70, and presenting on a specific topic as a 100). The third component utilizes the hierarchy as a means of providing “gradual exposure without response prevention.” In other words, the person starts with one of the least unpleasant circumstances (e.g., watching a speech on television) and then performs this act while utilizing the behavioral calming techniques indicated prior and other cognitive strategies (e.g., reframing the situation in a more realistic, positive way). Once the person is able to get their anxiety level within a reasonable range, then they move to a more anxiety-provoking task; eventually, they are able to manage the phobic situation or object without intense fear or immediate avoidance.
Rarely, though, is this process linear, but may require a person to step back to an easier task if anxiety increases unexpectedly even after seemingly dealing with a more difficult challenge. But the key to effective treatment is that avoidance altogether (which is desired the most, but helps the least) is not allowed, and that gradual exposure is repeatedly employed (with the use of calming techniques) until a phobia becomes simply a manageable fear. Although treatments typically (and are most effective) using in vivo exposure (i.e., exposure to a real object or event), there are times when in vitro exposure (i.e., exposure to imagined situations) can be helpful. But regardless, phobias require an individual to tolerate a certain amount of discomfort in order to, well, become more comfortable in the end.
For so many people, phobias are not just a source of fear, but also shame. Although kids maybe somewhat less inclined to hide phobias, many people perceive that phobias are a sign of weakness or compromised intellect. Yet the reality is that they strike people of all dispositions, circumstances, and means; some struggling with phobias have had a traumatic experience that precipitated a longstanding fear, but I find that many simply had an unpleasant (but not overly harmful) experience that provoked an initial avoidance that ballooned into an intense fear. If you have ever been scared by a menacing dog, it is easy to see how avoiding dogs altogether might be the safest and simplest response.
Yet midst an understandable sense of embarrassment and shame, there is an emerging body of research that suggests a hugely important point: we may be most responsible for shame that we feel. For starters, a couple of terms must be defined. Public stigma is characterized as “the degree to which the general public holds negative views and discriminates against a specific group [in this case, those with a phobia or other psychological difficulties].” Personal stigma captures “how one actually would view and treat others themselves.” That being said, research cited previously uncovered a number of interesting results. It was found that perceived public stigma was rated at a significantly higher level than personal stigma. On the topic of personal stigma, 93% indicated “disagreement” that they themselves would view someone with mental health difficulties (such as a phobia) negatively while 0.8% “agreed” they would have a negative view of such individuals. 9 out of 10 raters indicated that those with mental health issues should not feel embarrassed, worry about their reputation, or see themselves as weak or think less of themselves in this situation.
Now, there are some potential confounding factors beyond the scope of this article that may have moderated or mediated these effects. However, there is compelling evidence to suggest that embarrassment or shame that a person feels related to phobias (or any other psychological difficulty) is more a product of our self-appraisal than what others actually convey to us. Although in some ways this might be a frustrating message, I would like to regard it as a hopeful one. Because as a psychologist, I have repeatedly found that when people reach out in authentic, transparent, humble ways regarding their struggles, they are surprised at how much more accepting (and less judgmental) others are in understanding and receiving them in their admission of vulnerability.
Not everyone struggles with a phobia, although many more people do than you or I will ever know. But all of us struggle with fears, and we would all do ourselves and each other a great service if we would strive to acknowledge where the fear lies and go in search of the most effective response. In many ways, FDR was right when he said the following:
So, first of all, let me assert my firm belief that the only thing we have to fear is fear itself—nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.
Don’t forget. He uttered this phrase in the middle of the Great Depression, a time when people had much to fear. Yet he recognized what psychological research has come to show; that is, only when retreat is turned to advance do our fears begin to subside.