A fear of flying, a fear of spiders, a fear of elevators... these experiences, or phobias, are commonly dismissed as silly, irrational worries to be ignored or as inevitable genetic experiences to be endured. The truth is phobias are a type of anxiety disorder, and they can be effectively treated with exposure therapy, which is a form of cognitive behavioral therapy (CBT). Many people fully and permanently overcome their phobias with the help of short-term CBT. 

Phobias are quite common. Nearly one in ten Americans met criteria for a specific phobia in the last year, and approximately 12.5% of Americans will meet criteria for a specific phobia at some point in their lifetime. Despite how common phobias are, they are poorly understood by many people. In this article, we will explore what phobias are, causes and types of phobias, effective treatment for phobias, and how Aviva Psychology Services can help you overcome phobias. 

What are Phobias?

Phobias are a type of anxiety disorder, and there are actually three types. When most people talk about phobias, they generally are referring to what the Diagnostic and Statistical Manual of Mental Illnesses, or DSM-5, calls Specific Phobia. 

In this condition, a person feels intense fear about a specific object or situation, and that fearful response persists for at least 6 months. For people with Specific Phobia, the feared object or situation is a consistent challenge—it always or almost always provokes intense fear every time it is encountered. 

To be considered a phobic response, the person must experience fear that is out of proportion to the actual danger posed by the situation. Put another way, phobic anxiety is irrational. Feeling fear when an unleashed dog is snarling and advancing on you isn’t a phobic response because this is a genuinely dangerous situation. However, feeling intense fear of all dogs regardless of their behavior or the situation would be considered a phobic response. 

Lastly, for Specific Phobia to be present, a person must either actively avoid the feared object or situation or they endure it with intense anxiety. Both of these coping strategies have negative impacts on our lives. When we choose to cope by avoiding, we often give up a lot of freedom of choice, because the phobia chooses for us. When we choose to cope by white-knuckling our way through situations, we often can’t enjoy our lives fully because we are exhausted by an internal battle with our anxiety. 

Common Types of Phobias 

Phobias can take many forms, as people can develop an intense fear of almost anything. You may have heard some specific terms for certain phobias, such as claustrophobia (the term for fear of enclosed spaces) and arachnophobia (the term for fear of spiders).

In the DSM-5, Specific Phobias are grouped into four common types as well as an “other” category. The categories are as follows:

1. Animal phobias: These can involve the fear of any type of animal, but some animals are more commonly the subject of a phobia. Some especially common types of animal phobia are fear of spiders, insects, and dogs. 
   
   
2. Natural environment phobias: These phobias involve fears of natural phenomena, such as thunderstorms or water, or of certain environments, such as heights. 
   
   
3. Blood-injection-injury phobias: These phobias are sometimes called “medical phobias” and involve experiences like fear of needles, surgeries, or invasive medical procedures. People with these phobias often avoid all or most healthcare. 
   
   
4. Situational phobias: Many different situations can be the focus of a phobia. Some of the most common examples of situational phobias are fear of flying, elevators, or bridges.
   
   
5. Other phobias: The DSM-5 includes this “catch all” category for phobias that do not fit within the other categories. Examples of phobias that fall into this category are fear of vomiting or fear of choking. 

In addition to Specific Phobia, the DSM includes two other types of phobia: social phobia, also called Social Anxiety Disorder, and Agoraphobia. 

In Social Anxiety Disorder (social phobia), people experience intense fear of being watched or evaluated by others and have the specific worry that they will appear foolish or be judged negatively. Just like with Specific Phobia, these individuals feel fear that is out of proportion to the actual threat posed by a social situation. And just like those with a Specific Phobia, they respond to their fear by either avoiding social situations entirely or enduring social situations with extreme discomfort.

People with Agoraphobia experience intense fear of being unable to escape or get help when they feel overwhelmed or incapacitated. For some people with Agoraphobia, they specifically worry about what will happen if they have a panic attack. People with Agoraphobia worry that certain situations—like using public transportation, being in crowded or open spaces, waiting in lines, or being alone in public—will result in overwhelm or incapacitation. As a result of this worry, they either avoid these situations or endure them with great anxiety, just like what occurs with social phobia (Social Anxiety Disorder) and Specific Phobia.

Causes of Phobias

When we have difficult experiences, it is human nature for us to ask why. As such, many people who experience phobias are eager to understand the causes of phobias. Research in this area is ongoing. So far, research indicates that phobias likely have both genetic and environmental causes, that some people with phobias have only one of these factors present, and that many people have a combination of these factors present. 

When it comes to genetic causes, research is limited and ongoing. However, research so far suggests that there are genetic factors that predispose people to developing phobias. This means we can “inherit” being at higher risk of developing a phobia, but our genetics do not guarantee that we will or won’t develop one during our lifetime. Some research suggests that certain types of phobias, like animal-related and blood-injury-injection phobias, have a higher genetic influence than others.

Regarding environmental causes of phobia, research tells us that some people develop phobias after an especially frightening or even traumatic experience. For example, someone might develop a phobia of dogs after being attacked by a dog or develop a phobia of bridges after a car accident that involved a bridge or similar environment. However, many people develop a phobia without an identifiable experience that was the “origin” of the specific fear. 

It is important to note that sometimes people develop other types of disorders after a frightening or traumatic experience, such as posttraumatic stress disorder or obsessive-compulsive disorder. These conditions could develop instead of a phobia or coexist with a phobia. Aviva Psychology Services offers treatment for these conditions, too, and you can read more about PTSD here and read more about OCD treatment here. 

Treatments for Phobias

Phobias are highly disruptive, but they are also highly treatable. Broadly speaking, the treatment of choice for phobias is cognitive behavioral therapy (CBT). CBT is a broad category of therapy, and there are well-researched, highly-effective forms of CBT for many different mental health conditions. All forms of CBT involve helping people understand the connection between their thoughts, emotions, and actions.

The most evidence-based form of CBT for phobias involves a technique called exposure therapy. In this type of treatment, a therapist guides a client through a process of strategically and gradually facing fears until the phobia is overcome. This process is very much like training to run a marathon—no one starts by running 26 miles on the first day! Instead, the training process is customized to each runner, builds gradually on their baseline, and eventually builds to the point that they can run the full race.

Similarly, exposure therapy is highly customized to each type of phobia and each unique person who experiences a phobia. For example, someone with a Specific Phobia of dogs may start by looking at cartoon drawings of dogs until the cartoons no longer provoke anxiety, then progress to looking at photographs, then videos, and over time slowly get to the point where they can comfortably be around and even interact with dogs. However, someone who experiences emetophobia, or fear of vomiting, might be doing very different exposure exercises, such as spinning in circles to help overcome the anxiety triggered by nausea-like symptoms. 

Types of exposure therapy are also used for the other two types of phobias introduced in this article. Social Anxiety Disorder (social phobia) involves similar gradual exposure to overcome social fears, but also includes working to challenge unhelpful beliefs that are common with social anxiety. Agoraphobia, too, uses gradual exposure to overcome fears, but adds additional therapy to address panic attacks, as they are a very common part of Agoraphobia. 

No two courses of exposure therapy for phobia look exactly the same, but they all involve taking a specific, gradual approach to facing fear with the goal of decreasing anxiety while increasing personal freedom. For many people, exposure therapy is a fairly short-term treatment, requiring on average 3-4 months of weekly sessions. 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. In fact, for many people, once the course of exposure therapy is completed, the phobia never returns. 

Getting Started In Therapy

Starting any kind of therapy may feel intimidating, and beginning therapy to face an intense fear like a phobia may seem especially so. While treatment of phobias requires courage and involves some discomfort, therapy provides a safe, structured way to approach and overcome our phobias and fears. 

At Aviva Psychology Services, treatment for phobias will emphasize evidence-based therapeutic strategies and be guided by client needs, preferences, goals, and readiness. 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:

1. American Psychological Association. (2017). What is exposure therapy? American Psychological Association. Retrieved from: https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy 
   
   
2. ‌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.
   
   
3. Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php
   
   
4. John Hopkins Medicine. (2019). Phobias. John Hopkins Medicine; John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/phobias 
   
   
5. National Institute of Mental Health. (2020). Specific Phobia. https://www.nimh.nih.gov/health/statistics/specific-phobia
   
   
6. 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.
   
   
7. 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. 
   
   
8. Wall, D. (2021, March 10). Phobias | Fact Sheet. ABCT - Association for Behavioral and Cognitive Therapies. https://www.abct.org/fact-sheets/phobias/