Phobias

Learn about specific phobias mental health professionals deal with ...

phobias

Sometimes riding an elevator in a skyscraper makes people queasy, or even driving through a long tunnel, or over a bridge that spans a large body of water. And no one particularly enjoys getting an injection, or seeing someone bleeding from an injury. These are normal sensations that everyone experiences at one time or another.

But specific fears taken to an extreme, those that cause severe distress and avoidance behaviors, are given a name in Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV): specific phobias. The DSM-IV is the manual used by doctors, therapists, and counselors to diagnose mental health disorders.

This manual categorizes phobias under anxiety disorders, but it makes a distinction between phobias and the other anxiety disorders, which include obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder (PD), social anxiety, and generalized anxiety disorder (GAD).

Phobias are markedly different from these other anxiety disorders (see Anxiety Disorders), and are defined according to various criteria.

Criteria Defining Phobias

  • Excessive, persistent, unreasonable fear, triggered or cued by the presence or anticipation of an object or situation. Examples include flying, heights, blood, injections, insects such as spiders, animals such as dogs, lightning, high places, elevators, etc.
  • Exposure to the specific object or situation causes heightened anxiety – immediately – that can turn into a panic attack.
  • Adults recognize the irrationality of the fear, but cannot stop it. (Children may not be able to distinguish between rational and irrational fears.)
  • Individuals completely avoid the objects or situations causing the distress.
  • The avoidance of the situation or object significantly affects the ability for the individuals to live fully functioning, normal lives. Careers, relationships, social activities, and educational plans can be impacted in negative ways.
  • For children under the age of 18, the extreme fear must last at least six months.
  • The fear or phobia and its avoidance is not accounted for by any other anxiety disorder classified as anxiety, such as OCD, PTSD, PD, GAD, social anxiety, separation anxiety disorder, or agoraphobia (see Agoraphobia) with or without panic disorder (see Panic Disorder).

The reason that phobias are irrational is that the level of fear and anxiety caused by the situation or item is completely out of proportion to its real or actual threat. This fear keeps individuals from living a fully functioning life. For example, someone might not accept a job in a skyscraper because of a fear of heights, or elevator phobia. Or someone might refuse to take a job in a location that required the daily crossing of a bridge. Someone’s job that requires frequent air travel eventually quits if a flying phobia makes these trips too uncomfortable.

Some phobias are easier to avoid and not interfere with normal daily functioning, such as the fear of spiders. However, it could become problematic if an individual refuses to enter any public places for fear of seeing a spider or other insect.

Simply thinking about a spider (or other phobic item) can cause a panic attack for those with a specific phobia.

These phobias usually appear unexpectedly, and can occur at any developmental stage, and according to the National Institute of Mental Health, approximately 19.2 million Americans have the disorder. It is a disorder that affects more women than men.

Researchers and scientists are still trying to determine what causes specific phobias. Some studies have linked trauma in the individual’s past to developing a phobia, others suggest that genetics play a significant role. As with other anxiety disorders, most professionals believe that a combination of genetics, brain chemistry, and environment all contribute to developing this disorder.

And, like other disorders, left untreated, specific phobias can lead to other mental health disorders. Social isolation, loneliness, depression, and substance abuse are all possible complications developing from untreated specific phobias.

Treatment for specific phobia usually takes the form of cognitive behavioral therapy (see Cognitive Behavioral Therapy), which helps individuals learn new ways to think about the object or situation causing fear. (see Anxiety Treatments and Anxiety Counseling.)

Exposure therapy is another intervention commonly used by therapists to desensitize feared objects or situations. (see article on Overcoming Panic Attacks) Mental health professionals might also prescribe medications that have shown to be effective for treating phobias.

If you desire to help individuals cope with and manage a specific phobia, or any of the other anxiety disorders, consider a career as a mental health counselor or therapist. Most states require a master’s degree in mental health counseling to treat individuals as a mental health professional.

Most states also require a license to practice, requiring the taking of a state exam. Other requirements for licensing or additional certification depends on the mental health counseling specialty and work setting.

For more information on working in field of Mental Health Counseling, request information from schools offering degree programs in mental health counseling or a related counseling field.

A Snakey Way to Research Phobias

In order to research brain areas activated while displaying the emotions of fear and courage, researchers at the Weizmann Institute of Science in Rehovot, Israel, recruited individuals with a fear of snakes to participate in a unique – if not daunting – research study.

Lead researcher Yadin Dudai and colleagues rigged a conveyer belt to move a large corn snake attached to the top of a box with Velcro. "It's not a poisonous snake," Dudai reported in a June 2010 article on the experiment in Neuron.

But for those scared of snakes, whether or not it’s poisonous doesn’t matter. These individuals still have a snake phobia.

Each participant lay in a functional magnetic resonance imaging (fMRI) scanner that situated the writhing snake behind his or her head, which could be seen through an attached mirror. They could push a button to bring the snake 11 centimeters closer or move the snake 11 centimeters away.

The fMRI scanner displayed images of the brain that were activated as participants made decisions to move the snake closer – an act of courage - or push it further away. The pushing away represented the emotion of fear.

When acting with courage, a frontal brain region called the subgenual anterior cingulate cortex, or sgACC, lit up. But when the snake was pushed away, this area didn’t light up or become activated.

Dudai and his team hypothesized that the sgACC brain region could possibly direct the body to ignore or disregard fear. In other words, stimulating this area of the brain could help those with phobias to overcome their fears.

The Israeli researchers also noticed that sweating decreased when this “courageous” brain area was activated.

While researchers note that more research needs to take place to prove Dudai’s hypothesis, this new study sheds new light on phobias, helping those with a fear of snakes shed or dispose of this fear. It could also generalize to other phobias if in fact the sgACC controls the emotion of courage in overcoming all fears or phobias.