Anxiety: ​​Phobias and Treatment Approaches

A phobia is not just a simple fear. It is an excessive, abnormal, irrational fear that is not in proportion to the event or object encountered. People often go to great lengths to avoid their specific triggers: They may feel a need to escape when exposed or they may have physical symptoms when exposed to the trigger, for example, tachycardia (rapid heartbeat), nausea, dizziness, or a feeling of syncope (passing out). Things can be so bad that they can be debilitating. Reactions like this are typically considered true phobias when they have been going on for six months or more.

Understanding anxiety, phobias, and treatment approaches can shed light on the intensity of those reactions and what to do about them, from therapy to medical treatment to lifestyle changes. Rest assured, many options can help provide relief.

To better understand anxiety, phobias, and treatment approaches, it’s helpful to look at how these intense fears develop, what symptoms they involve, and which options—from therapy to lifestyle changes—can offer lasting relief.

The symptoms of phobias are very much like the symptoms listed for anxiety. These symptoms can run on a spectrum from mild to severe.

What Causes Phobias?

Several things can cause a person to develop a phobia. Factors that may contribute include: genetics, a bad experience in the past with the phobic object; learning fear about the object through media; altered neuron function: An impulse takes the wrong path in the brain and lands in the amygdala or fear center, setting off a fear response. Sometimes these paths can be changed through neuroplasticity (read more about this process in the section about generalized anxiety).

Trying to Escape From a Phobia

The following is a discussion about various phobias.

Agoraphobia - This is not considered a specific phobia. It is a dread of going to certain places (often with a fear that you will be unable to leave and/or that no one will be able to help) and avoidance of feared places. It can sometimes trigger panic attacks. Common situations include a fear of leaving home, a fear of open spaces or bridges, a fear of public transit, a fear of enclosed spaces, being in a crowd or waiting in line, or being outside of the home alone. It can be minor or it can be very disabling. To be “officially” diagnosed with this, according to the DSM-5, symptoms must have persisted for six or more months.

Specific Phobias

Specific phobias, just as the name implies, are those phobias focused on a specific object or situation.

There are numerous phobias – things you would never consider as Phobias. Some are quite common and some are not. The site on Positive Psychology has a great list of more than 100 interesting phobias.

There are four groups of specific phobias (remember, these are extreme responses):

Situational

• Aerophobia (fear of flying)

• Claustrophobia (fear of being in an enclosed space)

• Amaxophobia (fear of driving a car)

• Gephyrophobia (fear of bridges)

Environmental

• Acrophobia (fear of heights)

• Astraphobia (fear of storms)

Blood injection-injury

• Hemophobia (fear of blood)

• Trypanophobia (fear of needles and injections)

Animal

• Ophidiophobia: (fear of snakes)

• Arachnophobia (fear of spiders)

Other

• Dentophobia (fear of dentists)

• Phonophobia (a persistent, abnormal, and unwarranted fear of sound)

• Mysophobia (extreme fear of germs)

• Nosophobia (fear of getting a disease)

• Masklophobia (also Maskaphobia) - (fear of masked characters – i.e. clowns)

• Iatrophobia (fear of seeing medical providers or medical procedures). Is this why a lot of men avoid coming to the doctor until they are on their deathbed or is it a distrust? If you are very sick, see a healthcare provider (take someone with you).​

• Gerascophobia - Fear of growing old. I suspect that there is some validity to this as the body and mind start to slow down.

High Blood Pressure Phobia - I have seen this quite a bit in the clinic I work in. I have had patients come in who are being treated for blood pressure problems (usually older people). I increase their medication or change it if there is a problem, and tell them to check their blood pressure at home. They go home and check it, then call back with an even higher reading. Then, in two hours, they check it again with a little bit of a higher reading, and they keep doing this. It is a vicious cycle - the more they worry about their blood pressure, the higher it goes up. I just have to talk to them and tell them to take their meds, calm down, do a relaxation exercise like deep breathing, don't check the blood pressure for several hours, and, after all that, everything usually works out fine

Treatment of Phobias

If phobias are severe or bothersome, a person should seek treatment or, at least,, consult with a counselor. There are some very successful treatments for phobias.

While some of the treatments (below) for general anxiety can be used for phobias there are also some very specific, often successful treatments available, quite different from those used to treat general anxiety. Many of them involve exposure therapy, which involves in-person (in vivo) confrontation with the feared object or systematic desensitization, which desensitizes people through confrontation with fearful images and thoughts. The exposure sessions can be done several times in one-hour sessions or through one long session. Many times these are done in conjunction with SSRIs and SNRIs and beta-blockers (sometimes used to help symptoms-like a rapid heart rate while public speaking).

Social anxiety, while similar to a phobia, is no longer considered a "phobia." Because it is fairly common, there is a section dedicated to social anxiety.

Anxiety: ​​Phobias and Treatment Approaches:

Treatments and Approaches Are Often Similar to Those of Generalized Anxiety

There are a lot of different approaches to improve anxiety, which is good because not everyone will respond to one approach, and not everyone will like the same approach. In serious cases, medication along with therapy is the best way to go but, again, not all people care for one or the other.

General Approaches to Anxiety

• First of all, you want to try to attack this early, especially if it is increasing

• Acknowledging your feelings

• Staying present in the moment

• Relaxation exercises, mentioned many times in the above discussion, play a big role in reducing feelings of stress and anxiety:  

           -Deep breathing exercises

           -Progressive muscle relaxation techniques

           -Mindfulness (which reportedly helps the fronto-limbic/amygdala areas)

        areas of the brain - as evidenced by MRIs),

• Meditation

• Yoga

• Read self-help books

• Social support - Engage with Family, friends, or groups

      (even online)

• A healthy diet and exercise may be involved in

       developing greater neuroplastic patterns so that you can "re-form" your anxious thoughts

• Journaling

• Do things you enjoy

• Avoid alcohol and drugs (these are often a means of self-medication that are used by those who do not want to deal with therapy or other medications for mental health, but they eventually have harmful physical and neurological effects)

• Get enough sleep

• Get Counseling. Sometimes we get into a rut, and our brain keeps circulating the same anxious messages. Counseling helps you "retrain" your brain to learn other patterns and to see things from a different perspective. Some of these approaches include

            CBT  - Cognitive behavioral therapy                                                                                  DBT - Dialectical Behavioral Therapy

            ERT - Emotion Regulatory Therapy

• EMDR - This is an unusual treatment that often helps. It is reported to help decrease activity in the amygdala (especially for trauma, but it does help with phobias).

Over-the-Counter Treatment of Anxiety

There are no over-the-counter commercial treatments for anxiety except possibly an antihistamine, which will help make a person possibly more relaxed and tired.

• Benadryl/diphenhydramine as directed over the counter

Considered Alternative and Herbal Approaches to Anxiety

• L-Theanine

• ​Lemon balm

• ​Valerian

• Magnesium

• Kava kava

• CBD or medical marijuana

• Vitamins -  Band D and Omega 3s

• Aromatherapy (especially lavender, chamomile, and others)

Prescriptive Treatments for Anxiety

• Barbiturates and benzodiazepines increase GABA (these work very well for episodic moments of great anxiety, but both are potentially very addictive and should not be used on an ongoing basis)

• SSRIs - Selective serotonin reuptake inhibitors.  (common: Celexa/citalopram, Lexapro/escitalopram, Prozac/fluoxetine, Luvox/fluvoxamine, Paxil/paroxetine, Zoloft/sertraline, Trintellix/vortioxetine)These increase the availability of serotonin neurotransmitters for use in the brain. These work by enhancing cortical (thinking) processes (assists well with therapies) and possibly by decreasing excitation in the amygdala (emotion center).

• SNRIs - Serotonin-norepinephrine reuptake inhibitors - (common: Effexor /venlafaxine, Cymbalta/duloxetine, and Pristiq/desvenlafaxine. These medications help decrease activity in the amygdala.

• Other Antianxiety Medications- Remeron/mirtazapine is used off-label for anxiety (not FDA approved for this problem). This medication causes greater production of serotonin in the brain. Buspar/buspirone increases serotonin and decreases dopamine (an excitatory neurotransmitter in the amygdala).

There are many medications and many approaches that can help with anxiety. If your phobias are making your life too uncomfortable, if they are causing unhappiness or making it hard to function, talk to someone to see if there might be something you can do to help yourself.