Phobia Treatment

Causes of Phobia

Before we dive into treatments for phobias, let's first look at this disorder.

While many people are scared of objects or events, phobias take them to another level. When someone has a phobia, they refuse to enter a situation where they could interact with their phobia. Sometimes, even thinking about it can give them anxiety.

There is not one specific cause of phobias. Stressful events, social anxiety, or abuse can all impact the development of a phobia. Existing mental health disorders can be a precursor to the development of a phobia, but they do not have to be.

Phobias: Behavioural Approach

According to the behavioural approach, phobias can be learned through individual experiences. Mowrer's (1960) two-process model explains this idea, suggesting that phobias are learned through association (classical conditioning).

Classical conditioning develops phobias when an anxiety-provoking stimulus is associated with an unpleasant or negative emotion, as this causes the phobic person to associate their anxiety with the stimulus.

The two-process model also suggests that phobias are maintained through reward and punishment (operant conditioning). Phobias are maintained as the conditioned stimulus evokes strong fear, and the person retains this fear by avoiding the feared object.

Social Phobia Disorder Treatment

Social phobia is the irrational fear of being judged. This phobia typically causes anxiety in social situations because the person is scared they will embarrass themselves or be perceived negatively. Due to this, people with social phobia avoid social situations.

Let's now look at social phobia disorder treatment. Since social phobia stems from the anxiety of being around others in social settings, treatment starts working on that anxiety.

Fig. 1. Someone with a social phobia would not speak in front of a crowd.

The first treatment commonly used for someone with social phobia is psychotherapy. Psychotherapy is a way for someone with social phobia to talk to a therapist about their struggles. By talking with a professional, people can learn about their triggers and ways to calm their anxiety.

Additionally, they can work with their therapist to develop new ways to approach social situations that do not induce a panic attack.

The specific type of psychotherapy recommended for most mental health disorders is cognitive-behavioural therapy, also known as CBT. CBT helps the patient understand the cognitive and behavioural maladaptive ways they respond to situations and how changing those responses can help them.

If CBT alone does not help alleviate the phobia symptoms, some medications can be prescribed to help in conjunction with psychotherapy.

Phobia Treatment: Exposure Therapy

One type of treatment for phobias is exposure therapy. Exposure therapy is a behavioural therapy in which the patient is exposed to the stimulus they are afraid of. It is important to note that the patient is in a completely safe environment while taking part in exposure therapy.

Exposure therapy works when patients know they are in a completely safe environment. If the space is not safe, it could cause someone's phobia to worsen.

A type of exposure therapy is systematic desensitisation.

Phobia Treatment: Systematic Desensitisation (Vivo/SD)

Wolpe (1950) was the first person to propose systematic desensitisation. This technique uses classical conditioning to replace the patient's phobia with a new response reaction, unlearning the phobia.

Systematic desensitisation is mainly driven by the idea that two opposite emotions cannot coexist, such as anxiety and calmness.

The patient gets gradually exposed to their phobia through a fear hierarchy. The hierarchy goes from 1 to 10, with each number increasing in potential fear. When exposed, relaxation techniques are practised to break down a patient's negative association with the feared object, gradually replacing it with a positive association of calmness.

Virtual Reality Exposure Therapy (VRET)

Virtual reality exposure therapy (VRET) uses the principle of systematic desensitisation but in a virtual setting.

During the therapy, the patient uses a virtual reality headset that immerses them in their phobic stimulus with sensory cues such as navigating their way through and moving their hands in the air.

The therapist has a computer monitor showing what the patient is seeing.

Fig. 2. VRET therapy uses a headset as a tool when conducting systematic desensitisation.

Phobia Treatment: Flooding

Flooding is a type of exposure therapy that may take only one session.

During this treatment, the patient is directly exposed to their phobic stimulus.

The patient initially experiences a surge of anxiety due to direct exposure. Still, they will give in to exhaustion and realise the phobic object caused no physical harm to them.

Naturally, humans cannot sustain a state of anxiety for a long period, so longer periods of exposure can help unlearn the fear by forming a new association with the feared object, such as calm instead of anxiety.

Behavioural Treatments for Phobias: Evaluation

Now that we've reviewed some of the behavioural phobia treatments. Let's look at the advantages and disadvantages of those treatments.

Exposure therapy is an effective way to treat phobias. Research shows that the systematic desensitisation method is effective 75% of the time when treating various phobias (McGrath et al. 1990).

VRET can be a safe alternative to exposure therapy, systematic desensitisation, and flooding since it is virtual. Despite its convenience, the necessary equipment is expensive, making it inaccessible to all therapists.

Flooding, despite sounding radical, can be extremely effective in terms of treatment and cost. Flooding is a one-time treatment and can save the patient money. However, flooding may compromise the mental health of the patient and cause trauma. It can sometimes strengthen the phobia rather than reduce it, as some might end up quitting in the middle of the treatment reinforcing their behaviour by avoiding the stimulus.

Biological Treatment for Phobias

Along with behavioural and psychotherapy approaches to treatment, there are also medicinal options. Sometimes therapy is not successful on its own, but when combined with medicine, it can be extremely effective.

The biological treatments for phobias involve prescribing patients medication to help them relax and slow down the effects of anxiety. However, medications for phobias are seldom used as a stand-alone treatment for phobias.

Instead, they are always combined with other treatment methods, such as behavioural or cognitive therapy. Biomedical therapy is mostly the last resort for most phobia cases.

Two kinds of medicines are prescribed as a phobia treatment to patients: benzodiazepine tranquillisers and antidepressants.

Benzodiazepine tranquillisers are considered a sedative drug. One of the main aims of these sedative drugs, such as Xanax, is to reduce the severe effects of anxiety. They are known to increase GABA levels, an inhibitory neurotransmitter. These are minor-category tranquillisers used in small doses as adjusted by professionals.

Antidepressants or selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat anxiety disorders, panic disorders, and depression.

Lower levels of serotonin are related to underlying depression and anxiety. Some SSRIs, such as Prozac, block the reuptake or serotonin absorption in the synapse, allowing more serotonin prevalence.