About phobias
Phobias are excessive, intense or irrational fears of certain objects or situations that result in avoidance or extreme distress.
Although these objects or situations pose little or no danger, some people experience such great fear or anxiety that it becomes a phobia and interferes with everyday life.
Experiencing phobias can be overwhelming, frightening and isolating. People may feel bewildered by their emotions when confronted with their phobias but feel powerless to control them.
Phobias fall into three main groups:
Specific phobias
- Animal type – Fear of specific animals or insects, e.g. dogs, cats, or spiders (arachnophobia), are common. If you are phobic of dogs, you will feel extremely anxious anywhere near a dog and want to get away from it quickly. You will avoid dogs if at all possible. This happens even though you may realise that your fear is unreasonable. Once you leave the situation, the fear will go away, but you may experience a comedown and “emotional hangover” as your body recovers from the intense feelings.
- Natural/environmental type - Fear of nature, weather or environmental events, e.g. thunder and lightning, water, storms.
- Situational type - Fears triggered by specific situations, e.g. being in lifts, aeroplanes, high places, enclosed spaces.
- Blood-injection-injury type - Most people don’t like being injured or having injections, but some people are so phobic they feel extremely anxious just hearing about injuries, needles, operations or blood. They avoid reading or talking about these subjects. They find it hard to visit a friend in hospital. They may avoid going to the dentist. The sight of blood might make them panic or faint. Away from these subjects and situations, they feel quite okay.
- Other - Fears triggered by objects or situations that don’t fit the above categories, e.g. dolls, clowns, vomiting.
Social phobia
While almost anyone would be anxious if they had to give a talk to an audience of 100 people, people with social phobia fear everyday social situations and interactions with people. People with social phobia are especially afraid people will think badly of them, judge them, criticise them or treat them unkindly because of the way they act or appear. They might fear being seen to shake, sweat or blush, or appear nervous or incapable. Sometimes this is a fear of only one activity, such as eating in public, writing in public, or using a public toilet. For some, it includes most social situations and interactions with people. Some level of social anxiety is common in the teenage years, and social phobia usually starts during this time. Social phobia, if untreated, can be ongoing, with varying levels of severity.
Agoraphobia
People with agoraphobia feel an intense fear of situations or public places from which it might be difficult or embarrassing to escape, or where help might not be available. Most people with agoraphobia also have panic attacks − sudden severe attacks of anxiety, during which they fear that something dreadful is going to affect their physical or mental health.
People fear having these attacks and avoid places where they might have them, such as shops and other public places, cars or other forms of transport. They also fear being away from safety or help in case something goes wrong. They feel safest at home or in the company of someone they trust. Agoraphobia tends to vary from day to day, and people with it don’t necessarily panic every time they leave home or go into a previously feared situation.
People with agoraphobia may have anxiety or depression at other times, and they may sleep poorly.
Helplines
Who gets phobias?
Phobias are one of the more common anxiety disorders and can be experienced by people of any age, gender, culture, and socioeconomic status. Many types of phobias are common across cultures, but other phobias vary from country to country and are culture-specific. For example, in Northern Australia, crocodile phobia is common because of the higher crocodile population.
Conversely, in New Zealand, some people have a phobia about snakes, even though we don’t have them in the wild here.
What causes phobias?
Often there is no obvious cause for a phobia. Phobias do run in families. If someone in your family has a specific phobia or anxiety, you are more likely to develop it too. This could be due to tendencies inherited through genetics or as a result of learning from observing a family member’s phobic or anxious response.
Some specific phobias start after a frightening experience or a panic attack related to a specific object or situation. For example, being attacked by a dog can lead to a phobia of dogs, and having a panic attack in public can lead to agoraphobia. However, many people with phobias have not had a negative experience with the feared object. It is thought that hearing about negative experiences can lead to the development of a specific phobia; for example, hearing about plane crashes can lead to a phobia of flying.
Agoraphobia and social phobia are more common in people who are anxious or nervous by nature. Some people with social phobia are generally shy, but some are not and only have problems in certain social situations. Specific phobias happen just as often in people who are not otherwise anxious.
It's important to remember that it’s not your fault if you are experiencing anxiety or a phobia.
Symptoms
Signs to look for (symptoms)
The way you experience a phobia is unique to you. Symptoms will range from mild anxiety or concern through to a full-blown panic attack when confronted with the object, creature or situation you’re most concerned about.
The types of panic symptoms you experience could include:
- shaking or trembling
- sweating
- choking feelings
- racing or pounding heart
- chest pain or tightness
- nausea, stomach pain or diarrhoea
- hot and cold feelings
- shortness of breath or feeling smothered
- dizziness or light-headedness
- tingling or numbness, often in the fingers
- feeling cut off from reality
- fainting (this symptom is unique to blood-injection-injury phobia, although people experiencing other phobias often fear it will happen to them).
Through all of this, you may feel you need to escape before you lose control. You may also know that you are overreacting but feel powerless to control your reactions.
People with phobias can develop other problems. These can include other anxiety disorders, depression or substance-use disorders (alcohol or other drugs). For that reason, if you suspect you or a loved one is experiencing a phobia, it’s important to see your doctor or a mental health professional and talk to them about what you are going through.
Treatment options
Without treatment, phobias can last for years or for life, but most people with phobias make a good recovery once they seek help. Even if you continue to have episodes, you can still experience recovery and live a happy and worthwhile life.
Understanding your phobia is an important step in overcoming or learning how to live with it. The majority of people who suffer from phobias find relief from their symptoms when treated with therapy, medications and education, or a combination of these.
Psychoeducation (providing education)
Education can be extremely important to help you, your family/whānau and your supporters to understand phobias and help in the recovery. Your doctor or mental health professional will give you information about the disorder, suggest different ways to handle it, and discuss any complications which may occur.
There are also numerous self-help books available which some find to be a useful first stage in getting help. They can teach you about some of the ways of dealing with your phobia, and they can also get you used to reading about or discussing problems that you have previously kept completely to yourself. They are generally written by medical experts, drawing on the experience of people who have phobias.
You may also find that reading books written by other people with phobias makes you feel less alone and helps break down the stigma attached to phobias.
Talking therapies
These are non-medical treatments that address your emotional needs such as your thinking, behaviour, relationships and environment. This involves talking with a trained professional who uses clinically researched techniques, to assess and help you understand what has happened, and to help you make positive changes in your life.
Cognitive-behavioural therapy (CBT) is the first line of treatment for phobias and has been shown in research to be effective for many people. CBT is a psychological therapy that largely focuses on helping you overcome unhelpful beliefs and behaviours, as well as providing practical ways to deal with the anxiety that results from your phobia.
An essential part of CBT treatment for any phobia is gradual exposure to your fears (known as systematic desensitisation or exposure therapy). This works by gradually increasing the level of exposure to your fear, in both imagination and real-life settings, which allows you to gain control over your phobia. As the treatment progresses, you should begin to feel less anxious about your phobia.
In the last decade, research has been looking at the effect of using technology, such as virtual reality, to assist in the exposure to feared objects/situations in phobias. In virtual reality exposure therapy, an individual with a phobia experiences the fear situation in a fully artificial setting simulated by a computer program through a headset. Evidence so far suggests that this is an effective and well-tolerated treatment for a range of specific phobias among adults.
People with social phobias may benefit from specific training in social skills or assertiveness techniques, in addition to the exposure-based treatment described above. These may be taught either individually by a therapist or counsellor or in a group.
Each person’s experience of having a phobia is unique, and a particular therapy may not be right for you, even if it has worked for many others. Try different types of therapy, or new therapists, until you find what works best for you.
Looking after yourself
Medication
Medication is not usually recommended for treating phobias. Medication may be prescribed when CBT with exposure is not available or feasible, when there has been a limited response to CBT, or when someone does not engage with CBT. For most people, medication on its own is less effective than CBT on its own.
If you are prescribed medication you are entitled to know:
- the names of the medicines
- what symptoms they are supposed to treat
- how long it will be before they take effect
- how long you will have to take them for and what their side effects are (short and long term)
- what the process of stopping taking them could look like.
You should be told about risks and side effects of any medication and receive clear instructions about how you should take them and what precautions are necessary.
If you are pregnant or breastfeeding, seek advice from your GP before taking any medication.
Important strategies that support recovery
If your fear is great, you may need to have some professional help to do this. But you can do a lot for yourself.
If you are aware that you have a phobia and feel that you are able to confront it, then the best strategy is to face the object or situation as often as possible. If you have recovered from a phobia, it is good to keep in practice at being in a situation you used to fear. For example, if you know you are quite anxious about meeting new people, do not avoid doing this. If you take every opportunity to meet new people your confidence will grow.
Complementary therapies
The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it.
Certain complementary therapies may enhance your life and help you to maintain wellbeing, although they alone are not treatments for phobia. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.
Physical health
It is also really important to look after your physical wellbeing. Make sure you get an annual check-up with your doctor, and do what you can to reduce stress, get enough sleep, eat a balanced diet and exercise. Being in good physical health will also help your mental health.
Peer support groups
Peer support means people who have been through similar experiences coming together to support each other. A support group provides an opportunity to share your journey with people who have been through something similar.
Other strategies that help include:
- Make sure you go out often if you have mild agoraphobia and have some anxieties about leaving home because of panic or feeling unsafe. Ask family/whānau and friends to keep you company if this helps. Explain your experience to them. If they know that you might have to wait for a panic attack to pass, or even to go home, this can help you feel less pressured or embarrassed.
- Practise relaxation techniques. If you are anxious much of the time (in addition to having a phobia), relaxation can be helpful. If you already have some way of relaxing, do this regularly. If you need to, learn a relaxation technique such as breathing exercises, which are good if you over-breathe (hyperventilate). Find something to do with your family/whānau or friends that is relaxing and enjoyable. Phobias usually affect only one part of your life. Keep up all your other activities, especially those you enjoy.
- Limit alcohol and other drugs. These are not good ways of relaxing to overcome a phobia. You’ll probably feel more anxious afterwards, and you risk becoming addicted. Many people without social phobia feel a bit more relaxed socially with a few drinks, but if you are unable to socialise without drinking, you are at risk of becoming dependent on alcohol.
- Notice your reactions to caffeine and nicotine, as these have the potential to increase anxiety. If you have agoraphobia and panic, you may be sensitive to these substances.
Thanks to Natasha de Faria, clinical psychologist, and members of the Thriving Madly peer support network in Christchurch for reviewing this content. Date last reviewed: September, 2022.
Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.