Positive Health Online

It is estimated that up to 16 million people in the UK are suffering with anxiety disorders. One in three people will suffer panic attacks at some stage in their lives, and one in ten suffers with a disabling anxiety disorder. Statistics reveal that the three most common triggers for panic attacks are phobias of open spaces (agoraphobia), spiders (arachnophobia) and social situations. Less common triggers are the number 13 (triskaidekaphobia), the wind (ancraophobia), clouds (nephophobia) and even knees (genophobia). It is impossible to quantify the exact number of phobias or sufferers; however, there are over 400 phobias that are documented as being 'common'. As there are so many recognized phobias, is it possible that you might be suffering from one?

What is a Phobia?

It is important to understand that experiencing fear and anxiety is not necessarily the same as suffering from a phobia. Most people have fears and anxieties in some form or another, but this does not mean that we are all suffering from a phobia.

A phobia is an extreme reaction to fear triggered by a stimulus. Some phobias are triggered by a range of stimuli (known as general phobias) while others require only a single stimulus (known as specific phobias). Whatever the cause, the reaction is one of extreme panic - an automatic and irrational response. This often leads the sufferer to avoid certain situations and/or objects.

Phobias can therefore often have a profound and devastating effect on one's quality of life, limiting choices and affecting decisions.

There are four characteristics of a phobia that can help distinguish it from normal fears and anxieties:

1. If you are suffering from a phobia, the reaction to your trigger is persistent. For a specific phobia this means that each time the stimulus is encountered an extreme reaction of fear is experienced. For a more general phobia, four or more attacks could be experienced in a four-week period;

2. The phobic response is unreasonable. In some circumstances a feeling of panic is a normal and healthy response that is crucial to our survival and safety. For example, feeling fear when a car approaches rapidly as we cross the road enables us to move out of the way of impeding danger. However, it would be unreasonable to suffer severe anxiety whenever you saw a stationary vehicle, whether or not it posed an immediate danger;

3. Phobia sufferers tend to go out of their way to avoid exposure to their feared stimulus. In certain situations this will not have an impact on the sufferer's life. For example, someone with a snake phobia living in England would not have to change their life dramatically in order to avoid snakes. They would certainly avoid going on a safari holiday in Africa, however;

4. A phobia is disabling. Severe phobic sufferers are usually prevented from living a 'normal' life as a result of the symptoms they experience.

Apart from the four characteristics of a phobia, the physical symptoms suffered are also more extreme than in the case of normal fear and anxiety.

Symptoms of Phobia

Phobia sufferers experience severe panic attacks and heightened anxiety when exposed to their stimulus. Common physical symptoms experienced are a racing heart, sweaty palms, trembling/shaking limbs, feelings of faintness or dizziness, skin reactions and nausea.

These symptoms are due to the biochemical changes that take place in the body, and are an automatic response of the nervous system in a time of stress. These become a problem when the mind attaches feelings of anxiety to something that is otherwise harmless in the everyday environment, with the effect that the nervous system mistakenly learns this as being the 'correct' response whenever the stimulus is present. Continual experience of these symptoms combined with the inability to control them and with the knowledge that it is irrational can lead to loss of self-confidence and self-esteem, further compounding an individual's suffering.

The symptoms alone are sufficient to demonstrate that having a phobia is not a pleasant or liberating feeling that one would voluntarily choose to experience. So, if phobias are not a matter of choice, how are they acquired?

How We Acquire Phobias

Research with newly born and young infants has shown that there are only two phobias that we are born with - the fear of falling (not to be confused with the fear of heights), and the fear of sudden, loud noises. All other fears are learned responses, developed at some stage in one's life. There are five ways in which it is recognized that we can acquire a phobia, as discussed below.

1. Traumatic Experiences

Either a single traumatic event or an accumulation of negative and distressing events can reinforce one another and lead to the development of severe anxiety. This anxiety is then attached to something that is present in the environment at the time of the trauma.

For example, when Melissa was three years old she was watching her mother wash the dishes when a mouse ran across her mother's foot and made her mother scream. The sudden scream gave Melissa a shock, which she associated with the sound of the tap which was running at the time, rather than the mouse. This experience led to the development of a fear of running water. The past trauma may be consciously remembered or, as is often the case, may be repressed and outside conscious awareness.

2. Transference

In some situations, family members or friends often suffer from a similar phobia. This is because the response to a stimulus becomes the learned and normal response to that stimulus. One sufferer, Kim, was scared of the dark, and through conversation it came out that her mother was also scared of the dark and had to sleep with the light on. Kim had grown up unconsciously learning that darkness was something to be feared and avoided.

3. Avoidance

Avoiding a particular situation or object can lead to a fear or anxiety being attached to it. Often in life we fear or worry about doing something, but when we do it we discover that the experience was less traumatic than anticipated. People with phobias normally avoid the feared situation and, as a consequence, never experience the feeling of relief afterwards.

This avoidance strategy serves to maintain and reinforce the phobia, creating a destructive cycle which can lead eventually to a fear of the fear.

4. Severe Stress and Anxiety

Stress in one area of life can unconsciously be transferred to another area of one's life and create what therapists refer to as a 'secondary gain'. Here, a fear develops around a stimulus that would not normally cause the sufferer anxiety, replacing the real and unavoidable cause of the stress or worry. One sufferer, Sean, had a fear of heights which developed when he started a new job on the twelfth floor of an office block. During therapy it was discovered that he was very unhappy and distressed in his work, and the phobia had been acquired unconsciously in order to avoid going to work.

5. Association

Some of us have very vivid imaginations, which for most of the time is not a negative thing. However, there are times when it is possible to let one's imagination run wild. It is very easy to create a fear based on the premise: 'it could happen to me'. This is all too common in today's media-led society where constant and repetitive exposure is given to certain events or 'newsworthy' items. For instance, it would be possible to develop a fear of flying as a result of hearing numerous stories of people dying from deep vein thrombosis after air travel.

Whatever the cause of a particular phobia, it then develops into a continuous cycle. The initial negative experience leads to the expectation that exposure to the particular stimulus again will result in another negative experience. This can then prompt the sufferer to avoid particular situations, resulting in a persistent and irrational fear of the stimulus.

Having understood how a phobia may have been acquired, and the characteristics that distinguish it from a 'normal' fear or anxiety, how does one go about curing it?

Treatment Choices

There are many different methods of treatment available, which can make choosing the right treatment a daunting prospect. Some possibilities are as follows.

Cognitive Behaviour Therapy

This involves teaching sufferers strategies to cope with their fears and the ability to look at them from a more rational viewpoint. One major exponent of this treatment method is the support group 'No Panic'. Its team of 85 people takes over 25,000 calls a year to its helpline requesting treatment. The speed of treatment using cognitive behavioural therapy differs from individual to individual, as there are many factors that can impact on progress. As a guideline, sufferers start noticing a reduction in their anxiety in about 3-6 months. The overall success rate if the treatment is completed is around 85%.

Systematic Desensitization Behaviour Therapy

Sufferers are introduced to their fear in very small steps, building up slowly to face the feared stimulus. For example, a sufferer afraid of snakes, would initially be shown photographs of a snake, then perhaps a film, then be taken to see a snake in a tank and gradually moving closer to it. Eventually the point is reached where they can hold the snake. Again, with this method progress can be slow as a psychological adjustment needs to be made at each stage before moving on to the next level of fear-provoking stimuli.

Flooding

This is the opposite of desensitization therapy in that sufferers are exposed to the highest level of their feared stimuli. For example, someone with a fear of heights might be made to climb up a crane. For many people this is a rather traumatic method of treatment, and can lead to their phobias being increased. For some, it deals with the problem of avoidance and can lead to a discovery that their perception of the fear is unwarranted.

Psychoanalysis

This has evolved through the Freudian approach to therapy and involves discussing and analysing the fear. This method of treatment can also be slow to achieve results. In some circumstances, talking about a phobia and trying to understand it can reinforce the phobia by forcing the sufferer to focus on it too much. As a phobia is an irrational response, trying to make sense of it and understand it is often a very difficult task.

Hypnosis

From my experience, one of the most successful ways to treat phobias is through the use of hypnosis. Hypnosis is a form of deep mental and physical relaxation in which awareness of the senses becomes heightened, and memory is often enhanced. While in this state of deep relaxation, one remains in control and aware of everything that is going on around but is more able to access inner resources, memories and emotions that are typically not available through the conscious mind. The ability to access the connection between the conscious and unconscious mind enables the cause of problems to be identified and treated, in contrast with some other therapies which treat the symptoms alone.

There are a number of different approaches and techniques that can be employed by a hypnotherapist to treat phobias:

* Visualization and mental rehearsal can be used quickly and effectively to desensitize a sufferer to a particular phobia. Just like any skill or habit, the more it is practised the easier it becomes, until eventually it is an automatic response. As many professional sportspeople and athletes will tell you, mental rehearsal is often more important than the physical practice - the same goes for the phobic sufferer;

* Dissociation is a valuable technique that is often used in conjunction with this in order to separate oneself, mentally and emotionally, from the feared object or situation. This then enables the individual to create new and positive mental responses to that stimulus;

* Regression is another tool that may be used, to return to the time when the phobia was first experienced. This helps to pinpoint the situation that created the anxiety and identifies the visual images and internal dialogue that led to the continued experience of fear;

* A mixture of neuro-linguistic programming (NLP) techniques, reframing and cognitive behavioural therapy can be used to modify and then eliminate the negative response to the experience of the trauma;

* Self-hypnosis is also an excellent skill that phobic sufferers can be taught to use to generate feelings of calmness and relaxation within themselves, enabling them to reduce any anxiety swiftly. This gives them a sense of control over their response, which increases their confidence;

* Post-hypnotic suggestions can be given, which help to guide behaviour and emotional responses in a more positive direction, and boost feelings of confidence and well-being.

Hypnotherapy is recognized by the National Phobia Society as a successful treatment that has eliminated phobias for hundreds of its members, so much so that they have an in-house team of hypnotherapists.

Case Study 1

Katy has been afraid of heights for as long as she can remember. She can’t walk across Waterloo Bridge for fear of being sick – she has to catch the bus. She can’t look out of her 3rd storey flat window without having an attack of the shakes. She even has difficulty descending a flight of stairs without feeling dizzy and having an anxiety attack. She encounters these situations every day, and, through years of practice, has adapted her life in a way that limits her exposure to these and other fear-provoking stimuli.

 

Katy’s first session involved discussing her fear of heights, where it became clear that Katy was completely unaware of life without this fear. To her it seemed to have been a fear she had  been born with. She had little hope of ever getting rid of it, and was nervous about the process of hypnotherapy. The first session of hypnosis centred on educating Katy about what to expect and how hypnosis worked. The session primarily involved relaxation in order to allow Katy to feel comfortable with hypnosis.

A week later I saw Katy again, who was enthusiastic about having more hypnotherapy and had reported feeling calmer and more confident during the preceding week. Katy was keen to explore from where this fear of heights came so we regressed her to the first time she experienced this fear. Katy went back to when she was a toddler and was being swung around in the air by her uncle. His grip slipped and she fell to the ground, and although not hurt, she was very upset and shaken. When I emerged Katy, she laughed at how silly and insignificant that experience was to her now. She could not believe that it was that memory which had been creating all of her unnecessary fears. The key to Katy’s problem was understanding what had created her phobia. Once she understood this, she was able consciously and unconsciously to understand that it did not serve a purpose in her life and was therefore able to move on. Katy has subsequently enjoyed a ride on the London Eye, and is no longer afraid of heights.

Case Study2

James 43 had a fear of public speaking. Just knowing he would have to make a presentation would give him a cold sweat, make him feel physically ill, cause sleepless nights, and affect his concentration. James managed to live successfully with his fear through avoidance as he had a colleague to whom he was able to delegate presentations. When I met James he was in a state of turmoil, having been offered a promotion, his dream job, except for one aspect – the requirement to present monthly sales seminars.

 

In the first session, we talked about what was behind his fear. We used NLP to explore what the anxiety that caused the fear felt like, where it began, and ended, how it moved within his body. By identifying this, we were able to change the feeling created by the fear and instantly reduce the feelings of overwhelming anxiety. This was combined with teaching James relaxation techniques so that he could calm himself down when he felt his fear growing out of control, and we reinforced this with post-hypnotic suggestions.

By the 3rd session James reported feeling calmer and relaxed, but still did not feel confident with speaking in front of a group. Through discussion we were able to identify positive experiences in the past in which James had confidently and succesfully spoken in front of people in social situations. This discovery enabled James to consciously create a bridge between numerous positive experiences in the past, and something he always thought was impossible for him to do. We built on this through mental rehearsal and positive visualisation both in and out of hypnosis.

By the end of the 5th session James felt confident to face his fear. In fact through the post-hypnotic suggestions, positive visualisation and mental rehearsal he felt he already had! 5 months later James loves his new role, and is excited by recent developments in his career even though they have further expanded the need for presentation and public speaking.

Further Information

If you are finding that an excessive fear or phobia is negatively affecting your life and you would like to eliminate this, there are various support groups offering help. For more information contact:

* No Panic; Tel: 0808 808 0545; ceo@no-panic.co.uk; www.no-panic.co.uk
* National Phobia Society; Tel: 0870 7700 456; natphob.soc@good.co.uk; www.phobics-society.org.uk
* The Hypnotherapy Association; Tel: 01702 340 077; bhaadmin@lineone.net; www.thehypnotherapyassociation.org