Cognitive-Behavioral Therapy for Phobias

Phobias – the basics

Phobias, such as agoraphobia and social phobia, are fears of specific objects or of situations, events, or activities that cause phobia sufferers to avoid them or engage in them with trepidation. The elements of a phobia are anxious thoughts  – such as apprehension, rumination, and obsession – and avoidant behavior.  Phobias are emotionally painful and interfere with people’s ability to function. Thus, fear of flying, driving, freeway driving, elevators, and dental treatment, as well as of public speaking and injections are all phobias, all very much treatable. Discover how cognitive-behavioral therapy can help overcome phobias.

General situational phobias, such as agoraphobia, claustrophobia, and acrophobia, involve anxious feelings triggered in situations with physical or environmental elements in common, like heights and wide open or confined spaces. People who suffer from agoraphobia, the most widespread of the general situational phobias, feel unnerving, “pre-panic-attack” sensations and anxieties when they perceive themselves to be cut off from exits, sources of safety, or when alone. Claustrophobics react similarly in situations that appear physically confining or crowded, such as elevators, stairwells, cramped aisles, or crowded cafes, as do acrophobics when they feel trapped on high, apparently precarious places like bridges or rooftops.

Fear of flying belongs in this category because it has elements of acrophobia, claustrophobia, and agoraphobia – fear of the vastness of the open sky – as well as “fear of fear” or anxiety sensitivity – the fear of arousal-related bodily sensations and emergent anxiety symptoms like irregular breathing, heart palpitations, trembling, and flushing that are associated with the onset of panic.

Social Anxiety Disorder (Social Phobia)

People with Social Anxiety Disorder are very sensitive to situations where they are expected to interact or perform, fearing that they will be ridiculed or humiliated. It often begins with childhood shyness but, unless treated, may continue through adulthood. Dating anxiety and fear of public speaking are very common forms of social anxiety.

Social anxiety disorder is very treatable. Until the 1990s, many people were unaware or reluctant to seek treatment, both because of the perceived stigma of being too uncomfortable to be sociable and reluctance to attract attention by seeking out treatment.  Social anxiety disorder sufferers need not grapple with it alone.  Treatment is now widely available (see “Helpful Resources”, below), and  cognitive-behavioral therapy can help a great deal.

People’s uneasiness during episodes of social anxiety is often much complicated by “sticky thinking” – hard to control bursts or consuming clouds of repetitive negative thinking (sometimes referred to as “falling down the rabbit hole”).  In this website, I’ll discuss the role of sticking thinking in anxiety. “Selfing” is frequently an aspect of sticky thinking – thinking negatively about “me, myself, and I”, as, for example, in thinking “What if I make a fool of myself?” or “They’ll think I’m a complete imposter,” or “nobody will want to talk to me”. It’s easy to imagine how fear of embarrassment and giving a bad impression would be intensified by getting whipped together with negative, sticky thinking.

Specific Phobias

Specific Phobias are anxious reactions to specific objects like snakes, spiders,  or bugs, and singular situations like thunderstorms or blood tests or injections. They are often based on universal human fears that linger after childhood. Many specific phobias are treatable without medication and often respond pretty quickly to focused behavior therapy.

Freeway phobia and emetophobia are relatively new additions to the specific phobia category. Emetophobia – the disproportionate fear of vomiting or being the presence of someone vomiting – affects 11-16 million Americans, particularly mothers of young children; but people have only recently begun to seek out treatment for this eminently treatable disorder.

Freeway phobia – fear of loss of control or coming to harm while driving on freeways has massively increased in the U.S. over the past 40 years as a consequence of a 350% increase in the number of vehicles on the freeways, speed limits raised from 55 up to 65 or 70 mph, and greatly intensified congestion on many urban freeways.  I estimate that well over 10,000 motorists on L.A. freeways during rush hour are suffering from freeway phobia. Many dozens of clients whom I’ve treated have succeeded in greatly improving or overcoming freeway phobia.

Helpful Resources

Anxiety and Depression Disorders Association of America (ADAA) – For over 35 years, the flagship organization for people with anxiety to turn to for professional help, self-help, and a wealth of resources and for clinicians to learn the latest and most effective treatments for anxiety and depression.  The ADAA is a principle forum where psychological and psychiatric scientists disseminate the latest theories and anxiety research information  –

Association for Behavioral and Cognitive Therapy (ABCT) – One of the world’s foremost organizations of behavioral and cognitive scientists, researchers, and clinicians.  Go here for the very latest scientific information on cognitive-behavioral  therapy (CBT), anxiety, and other emotional disorders.

International OCD Foundation (IOCDF) is a not-for-profit organization composed of people with obsessive compulsive disorder (OCD) and related disorders, their families, friends, professionals and other concerned individuals whose mission o is to help individuals with OCD live full, productive lives. Their aim is to increase access to effective treatment, end the stigma associated with mental health issues, and foster a community for those affected by OCD and the professionals who treat them.”

National Institute of Mental Health (NIMH) – Tap the U.S. government’s vast wealth of information about mental health.  The NIMH commissions and underwrites much of our research into the nature and treatment of emotional and cognitive disorders.

National Social Anxiety Center (NSAC) – The National Social Anxiety Center (NSAC) is a national association established with the intent of making the highest quality, evidence-based psychotherapy services to treat social anxiety available to those in need through research, collaboration, dissemination to other therapists, and education to the public.

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