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| Phobias
A phobia is an exaggerated, unrealistic fear of a specific situation, activity, or object. If you search the web you can find lists of hundreds of phobias:
- fear of flying
- fear of spiders
- fear of being tickled
- fear of enclosed spaces
- fear of elevators
- fear of clowns, etc.
Are all unrealistic fears phobias, however? The answer is no. If something is to be called a phobia, it must involve an unrealistic fear that is of sufficient intensity to truly affect the quality of the individual’s life. Many people, for example, have an unrealistic fear of spiders. They could not, for example, let a daddy longlegs crawl along their cheek, despite knowing that the spider can’t harm them. These people do not have arachnaphobia. Someone with true arachnaphobia would be unable to enter a room if the person had seen that there was a spider somewhere in the room, and perhaps would be unable to leave their bedroom if they saw a spider hanging down from just outside the bedroom door.
How do phobias develop? In some cases, at least, there is a clear learning and conditioning element to the development of a phobia involving both classical and operant conditioning. Consider, for example, the case of someone with a fear of going into a shopping mall. Phobias like this often start with a panic attack . For some reason, this individual begins to feel anxious at a mall, and the anxiety escalates quickly into a full-blown panic attack. The experience is extremely aversive, involving the anxiety itself along with the humiliation of being seen having a panic attack in a public place. The individual deals with the situation by leaving the mall, and it is only at that time that the anxiety diminishes.
Let’s analyze what has happened in terms of classical and operant conditioning .
First, through classical conditioning, the anxiety response has become associated with features of the situation in which the panic attack occurred (the shopping mall). Second, through operant conditioning, the individual has taught herself (with the reward of anxiety reduction) to cope with the anxiety of being in a mall by escaping from the situation. Notice, however, that this coping mechanism, although successful in reducing the anxiety, is maladaptive in the long run because it may lead to an inability to go to shopping malls in the future.
Indeed, the next time this individual thinks about going to a mall, she may reflect on what happened before and start to become anxious about the possibility of having another panic attack! This fear of feeling anxious will, of course, increase the chances that she will feel anxious. And if she does start to feel anxious next time she enters a mall (as a result of both the fear of becoming anxious and the conditioning of anxiety to the situation), she is likely to cope with that anxiety in the way she did before-by escaping the situation, and avoiding that situation in the future.
Agoraphobia. Among the most serious of phobias is agoraphobia, a fear of being away from a safe place. Many individuals who suffer from agoraphobia never leave their homes. It is a disorder that is more common than most people realize (for the obvious reason that you are unlikely to meet such a person unless you go to that person’s home). In the agoraphobia video segment, take note of the woman’s description of how her phobia developed, of the degree to which the quality of her life has been diminished by the phobia, and of the fact that although she realizes that her fear is irrational, she is nonetheless incapable of coping with the fear through any means other than staying at home. |
Treatment of Phobias
The most successful treatments for phobias involve the use of two behavioral techniques designed to address the operant and classical conditioning tied to developing many phobias.
Methods to reduce anxiety. One element of these treatments, therefore, involves teaching the individual methods of coping with their anxiety other than simply escaping from the situation. This may utilize something as simple as focusing one’s thoughts on breathing as a way to distract attention away from thinking about the situation’s anxiety-inducing elements. Whatever the method, the process of teaching the individual a way to reduce anxiety has two positive effects. First, the individual now has something else to use (other than escaping from the situation) when attempting to cope with the phobia-related anxiety. Second, the anticipation of anxiety will likely be reduced if the individual is confident that she has a method of dealing successfully with the anxiety.
Methods to extinguish the association. The other element of the treatments involves extinguishing the classically conditioned association between anxiety and the feared situation. The problem here is that, in order to extinguish the conditioning, the individual must experience the situation without experiencing intense anxiety. Two methods have been developed to achieve this goal:
- Systematic desensitization. This method involves approaching the feared situation in small steps. For example, if you are afraid to fly, the first treatment session may involve simply talking about flying. The next session may involve going to the airport and walking around. The next session may involve watching a plane take off. Finally, the individual actually takes a flight. The key to this technique is that at each step along the way, the individual should be able to handle the situation without feeling extreme anxiety, and that success should set the stage for the next step, and so on.
- Flooding. Flooding is also designed to permit the individual to experience the feared situation without feeling intense anxiety, but it accomplishes that goal in a very different manner. Flooding basically involves confronting your fears-entering the situation that you fear and staying there until you calm down. Flooding is used by psychologists who treat phobias, but many people essentially use flooding on their own to try to control their fears. For example, in the “flooding” video segment, you will see a case of a man with a blood phobia who, as a way of trying to control his phobia, works as a special effects artist specializing in creating bloody-looking scenes in movies.
Obssesive Compulsive Disorders
Phobias, panic disorder, and generalized anxiety disorder occur approximately twice as often in women as in men. In contrast, OCD rates are the same in males and females. OCD also does not have the learning and conditioning element that is found in the development of many phobias and other anxiety disorders. Instead, OCD is generally considered to be a true neurological disorder, resulting from some kind of abnormality in neurotransmitter levels or some feature of functioning in certain parts of the brain.
Treatment for OCD
Until recently, OCD had proven to be a particularly difficult disorder to treat successfully. The past fifteen years, however, have seen a revolution in the treatment of OCD through the use of medications originally used to treat depression. Although not everyone with OCD is helped by the medications (hoarders seem to be the most difficult kind of OCD patients to treat successfully), many OCD patients find that the severity of their symptoms declines dramatically when they take antidepressant medication. These drugs do not, however, cure the disorder. If the patients go off the medications, the symptoms typically return. As a result, the patients continue to take maintenance dosages of the medications on a daily basis for the remainder of their lives. |
