Is your life feeling limited by an intense fear of certain situations or experiences? Is a fear costing you things you value, like time with family or job opportunities or accessing health care? You may be experiencing a phobia. 

Common phobias that interfere with everyday life are a fear of flying, fear of enclosed spaces like elevators, fear of bridges or other heights, fear of needles or dentistry appointments, or a fear of specific animals, like dogs or spiders. 

Know this: you are not alone! 

Psychological research shows that as many as 1 in 10 Americans have struggled with a phobia within the last year, and about 12.5% of Americans experience a phobia at some point in their lifetime. 

Phobias are not silly, minor worries. They can be profoundly impactful and make daily life a challenge to navigate. For example, fear of flying may make it difficult to attend important family or work events. A fear of heights may mean devoting excessive amounts of time to planning travel routes so you can avoid bridges or roads with “scenic overlooks” that frighten you. 

The reality is phobias are a type of anxiety disorder. Like other anxiety disorders, they can be treated via psychotherapy. Research indicates that the most effective therapy for phobias is called Exposure Therapy, a form of cognitive behavioral therapy (CBT). 

In this article, we will explore what to expect in Exposure Therapy. To learn more about phobias in general, please see this previous Aviva article about phobias. 

What Are Phobias?

Phobias are a type of anxiety disorder, and the Diagnostic and Statistical Manual of Mental Illnesses, or DSM-5, uses the term Specific Phobia. To meet diagnostic criteria for a Specific Phobia, there are are several criteria:

1. A person feels intense fear about a specific object (e.g., needles, dogs) or situation (e.g., heights, enclosed spaces)
   
   
2. The fear is a persistent experience– the feared object or situation always or almost always provokes intense fear every time it’s encountered 
   
   
3. The fear is out of proportion to the actual danger posed (e.g., the anxiety is irrational and not a reasonable response to real danger)
   
   
4. The persistent, intense fear lasts for at least 6 months
   
   
5. The person actively avoids the feared object or situation or they endure it with intense anxiety 

In addition to Specific Phobia, there are two other types of phobia listed in the DSM. 

1. Agoraphobia involves intense fear of being unable to escape or get help when overwhelmed or incapacitated. Panic attacks are commonly part of the presentation of Agoraphobia. You can read more about Agoraphobia in this Aviva blog article.
   
   
2. Social Phobia, which is also called Social Anxiety Disorder, involves intense fear of being watched or evaluated by others, with particular worry that they will appear foolish or judged negatively. You can read more about Social Phobia in this Aviva blog article.
   
   

However, it is important to note that not all intense fears are phobias.

For example, sometimes people develop intense, specific fears after a traumatic experience, and their fear and avoidance may be more accurately described as PTSD. You can read more about PTSD here, and you can also read about what to expect in evidence-based PTSD treatment here.

Additionally, people experience intense fears and engage in compulsions to try to escape the anxiety or prevent feared outcomes. When this occurs, it is possible that Obsessive-Compulsive Disorder is present. You can read more about OCD and OCD treatment here. 

Given intense fear and avoidance is part of many different psychological conditions, it’s important to meet with a trained psychologist for a full diagnostic assessment. You can pursue assessment and treatment at Aviva Psychology Services by filling out the Request an Appointment form.

How Are Phobias Treated?

Phobias are incredibly difficult to live with. In addition to resulting in intense experiences of fear, they often disrupt our daily lives by interfering with our ability to live the way we value. Fortunately, they are also highly treatable. 

Psychological research tells us that the most effective way to treat phobias is a type of therapy called cognitive behavioral therapy (CBT). CBT is an “umbrella term” that refers to an approach to therapy that helps people understand the connection between emotions, thoughts, and actions. This understanding is then leveraged in therapy to help clients create the changes they are seeking. CBT is considered a highly researched, well-established, very effective form of therapy for many different conditions, and there are many specific types of CBT designed to treat specific psychological concerns. 

The most evidence-based form of CBT for treating phobias is called Exposure Therapy. Exposure Therapy works by training your brain to respond differently to the triggers of your phobia. People with phobias have learned “trigger = danger.” However, that’s not true with phobias, and so exposure therapy gives our brain practice facing the fear in slow, gradual, safe ways to that our brain can learn that the danger isn’t real, that anxiety decreases over time, and that we can handle much more than we first thought.

What to Expect in Exposure Therapy

Exposure Therapy looks slightly different for each person who engages in it. After all, every human is a unique person with their own specific symptoms, goals, histories, needs, preferences, and values. The best therapy is tailored to fit you personally. However, there are some core components of Exposure Therapy that you can expect if you seek treatment at Aviva Psychology Services. 

1. Psychodiagnostic Evaluation: The first step is to conduct a thorough biopsychosocial assessment to understand your symptoms, goals, history, and important details about your life, like your social supports and current coping skills. This takes place over the first few sessions with your psychologist via a semi-structured interview.
   
   
2. Diagnosis: One of the goals of the psychodiagnostic evaluation is to arrive at a diagnosis based on your specific symptoms. The diagnosis is important because different types of anxiety disorders and different types of phobias require different treatment plans.
   
   
3. Treatment Planning: This is a collaborative process that allows the psychologist and client to continue to build rapport while exploring which treatments appear most appropriate for the client’s diagnosis, goals, needs, and preferences. Sometimes this stage involves exploring our values and reasons for seeking therapy to enhance our motivation for the hard work of Exposure Therapy.
   
   
4. Building An Exposure Hierarchy: Assuming the treatment plan concludes that Exposure Therapy is appropriate, you and your therapist will build an exposure hierarchy. This involves brainstorming different ways to face your specific fear to create a list of exercises of varying intensity. For example, for a person with a phobia of dogs, an easier challenge might be looking at cartoon depictions of dogs, a medium challenge might involve watching videos of real, barking dogs, and a hard challenge might be watching dogs play at the dog park.
   
   
5.  Systematic Desensitization: In this active phase of therapy, your psychologist will guide you through a gradual, strategic process of facing fears, starting with less intense exposure exercises and slowly progressing to more challenging ones. Throughout this process, your psychologist will also provide relaxation strategies and emotional processing so that you can leave sessions feeling grounded and increasingly confident in your ability to overcome your phobia. Over time, challenges that once felt significant will feel familiar and less distressing as your body learns that your phobia is not truly a sign of danger and that you can handle much more than you once believed.
   
   
6. Relapse Prevention: Many people can overcome phobias entirely and permanently via Exposure Therapy. To get great results that last, Exposure Therapy also involves your psychologist teaching you strategies to maintain your gains, just like a personal trainer teaches you ways to stay in shape over time. 

Is Exposure Therapy Safe?

For clients who have healthy coping skills for managing distress, Exposure Therapy is safe. For clients who don't arrive with those skills, therapy can focus on teaching those first before progressing to Exposure Therapy. 

However, while Exposure Therapy is effective and safe, it is very uncomfortable! Facing a fear isn't easy, especially when you must do so week after week, and especially since the phobia will make your brain tell you that you're in danger, even if parts of you know that isn't really true.

Having realistic expectations of therapy is helpful. Success in Exposure Therapy begins with expected and acknowledging that there will be discomfort and strong urges to avoid. You will feel challenged and encouraged to go (repeatedly and for extended periods of time) outside of your comfort zone. This part of the process, which is challenging but worthwhile for the freedom it can bring to your daily life.

How Long Does Phobia Treatment Take?

Exposure Therapy is a fairly short-term treatment. The intake process and treatment planning process often requires about one month of weekly appointments. After that, the active Exposure Therapy process requires 3-4 months of weekly appointments on average.

Those who are consistent with their at-home exposure assignments tend to recover more quickly, experience more dramatic improvement, and to have more long-lasting results. Your psychologist will typically provide weekly at-home exercises to practice between appointments. 

Getting Started In Therapy

Facing your fears is hard, uncomfortable work, but it can also be incredibly freeing to overcome a phobia and no longer have it control your life. Even considering Exposure Therapy is an act of bravery—and the first step in recovery! 

Remember, while Exposure Therapy is uncomfortable, it is strongly supported by research evidence that tells us it is safe and effective for many people. At this time, it is even considered the “gold standard” therapy for treating phobias. Your psychologist will provide you with support, structure, and a sense of safety along the way. And remember: you don’t have to start your therapy journey with Exposure Therapy. Many clients prefer to work on other issues first, deepen their trust and relationship with their therapist, and start Exposure Therapy once that stability is achieved. 

Psychologists at Aviva are trained to help you develop a customized treatment plan that allows you to overcome your fears and reclaim your freedom from phobias. You can get connected with a psychologist who has expertise in overcoming phobias by filling out the Request an Appointment form.

Selected References and Additional Reading:

• American Psychological Association. (2017). What is exposure therapy? American Psychological Association. Retrieved from: https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy
  
  
• ‌C.M.H.H. Van Houtem, M.L. Laine, D.I. Boomsma, L. Ligthart, A.J. van Wijk, A. De Jongh, A review and meta-analysis of the heritability of specific phobia subtypes and corresponding fears, Journal of Anxiety Disorders, Volume 27, Issue 4, 2013, Pages 379-388, ISSN 0887-6185, https://doi.org/10.1016/j.janxdis.2013.04.007.
  
  
• Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php
  
  
• John Hopkins Medicine. (2019). Phobias. John Hopkins Medicine; John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/phobias
  
  
• National Institute of Mental Health. (2020). Specific Phobia. https://www.nimh.nih.gov/health/statistics/specific-phobia
  
  
• Sawyers C, Ollendick T, Brotman MA, Pine DS, Leibenluft E, Carney DM, Roberson-Nay R, Hettema JM. The genetic and environmental structure of fear and anxiety in juvenile twins. Am J Med Genet B Neuropsychiatr Genet. 2019 Apr;180(3):204-212. doi: 10.1002/ajmg.b.32714. Epub 2019 Feb 1. PMID: 30708402; PMCID: PMC6414251.
  
  
• Villafuerte S, Burmeister M. Untangling genetic networks of panic, phobia, fear and anxiety. Genome Biol. 2003;4(8):224. doi: 10.1186/gb-2003-4-8-224. Epub 2003 Jul 28. PMID: 12914652; PMCID: PMC193636.
  
  
• Wall, D. (2021, March 10). Phobias | Fact Sheet. ABCT - Association for Behavioral and Cognitive Therapies. https://www.abct.org/fact-sheets/phobias/