Anxiety and Depression  |  Treatments

Taming the Fear – Understanding and Beating Phobias

BY DR CHAN KEEN LOONG

11 April 2021  |   6 min read

A phobia is an intense and irrational fear of something that, in reality, poses little or no actual danger. This “something” may be a specific object or situation. The response of the individual when faced with the feared object or situation may be out of proportion to the actual threat involved.

According to the Diagnostic and Statistical Manual of Mental Disorders (fourth edition), nearly three per cent of the world’s population suffers from at least one of the 100 most common phobias. Common phobias seen in clinical practice in Singapore are fear of needles or blood-taking (trypanophobia), fear of heights (acrophobia) and fear of enclosed spaces (claustrophobia).

Causes of phobias

Although most cases of phobias develop in childhood, it is possible for a phobia to develop at any age.

Phobias can be caused by a variety of different factors, for example experiencing a traumatic event like being attacked by a dog, or witnessing a traumatic event firsthand such as a car accident. Most of the time, individuals are unable to identify the reason why their phobia developed.

Types of phobias and their signs and symptoms

Phobias may be fall into one of four groups:

  1. Animal-related phobias (e.g. dogs, snakes, spiders)
  2. Natural environment-related phobias (e.g. heights, storms, water)
  3. Medical treatment or issue-related phobias (e.g. fear of seeing blood, fear of needles or injections, fear of going to the dentist)
  4. Situational phobias (e.g. being in an airplane while in flight, crowds, enclosed places)

Difference between phobias and Obsessive Compulsive Disorder (OCD)

A common OCD obsession or compulsion may involve cleanliness, and symptoms may be presented as behaviours directed towards washing or cleaning the part of the body that the person feels is dirty or contaminated. Another common OCD obsession or compulsion may involve a sense of uncertainty and the person involved would engage in behaviour to check if things are missing or whether a task is done correctly, or even redo the task over and over again. In a person with a phobia, the main symptoms are fear or anxiety of facing the phobia and avoidance of the source of the phobia.

When exposed to the source of the fear, the individual may experience a variety of physical and emotional symptoms, such as:

  • Physical symptoms: Difficulty breathing, rapid heartbeat, trembling, sweating, nausea
  • Emotional symptoms: Anxiety, panic or fear; feeling an intense need to escape; fear of losing control or going crazy; feeling powerless to control the fear

The individual may not need to be directly exposed to the source of the phobia to experience the symptoms. Sometimes just anticipating a situation where he or she will need to encounter the feared object or situation will cause the individual to feel distressed.

Individuals who are extremely phobic may experience negative impacts on everyday life including work and social activities. They can be paralysed by extreme fear or anxiety, and will try to avoid the source of fear at all cost. For example, an individual with a phobia of airplanes and flying may not be able to work in jobs that require him or her to travel.

Learn to self-manage phobias

It is helpful for individuals with phobias to learn self-management skills. Here are a few skills that one can practise to manage anxiety when faced with perceived threat or danger.

1. Calming skills

Mild levels of anxiety can be controlled by muscular relaxation and by practising deep and slow breathing.

2. Grounding skills

By focusing your senses on your surroundings and paying attention to the things around you, you can distract yourself from distressing thoughts related to the phobia. Try mindfully taking note of five things you see around you, five sounds you hear around you, and five sensations you feel (e.g. the temperature of the air, movement of the wind, or feeling the contact between your body and the chair you are sitting on).

3. Identifying and challenging irrational thoughts

Individuals with phobias can become conditioned to feel fear after a single negative experience. For example, an individual who had an anxiety attack while travelling on the MRT train may think “If I get on the train again, I will get another anxiety attack”. To challenge this thought, the individual can tell himself or herself, “I have taken the train several times before and never had an anxiety attack. This was just a one-off occurrence”.

Treatment

Some phobias need to be treated more urgently than others. In an urbanised city like Singapore, a phobia of crowds and enclosed places is more likely to be detrimental to a person’s well-being than, say, a snake phobia. Treatment can be by medication or psychotherapy, or a combination of both.

Medications such as sedatives can help individuals relax by reducing the amount of anxiety they feel. Sedatives like benzodiazepines are used with caution because they can cause addiction and should be avoided in those with a history of alcohol or drug dependence.

While medication can help to reduce symptoms of anxiety such as rapid heartbeat, psychological treatments like Cognitive Behavioural Therapy (CBT) or Exposure and Desensitisation are needed to truly overcome the phobia.

During Exposure and Desensitisation, the patient will work with the therapist to come up with a list of scenarios, in increasing severity, that could trigger the phobia. In the presence of the therapist, the patient will be asked to confront their phobia by imagining the scenario and situation on the list, starting with the less intense scenarios. After learning to cope with the scenario, the patient will then slowly progress to the next scenario until he or she is finally able to face the feared object or situation.

CBT involves exposure combined with other techniques to learn ways to view and cope with the feared object or situation differently. By learning alternative beliefs about one’s fears and bodily sensations, it is hoped that the patient develops a sense of mastery and confidence with his or her thoughts and feelings rather than feels overwhelmed by them.

Psychotherapy is highly dependent on the individuals’ motivation to overcome their phobias and willingness to face their fears.

Medication and psychotherapy for the treatment of phobias are available at some polyclinics and at the psychiatric departments of all government restructured hospitals.

The contributor is a Senior Consultant at the Department of Psychological Medicine, Khoo Teck Puat Hospital.