We all get scared. We all experience fear.
But not all that we fear and gets scared with develops into what we call “Phobia”.
What is Phobia?
Phobias are defined as extreme or irrational fears, often persistent, that compel sufferers to avoid the object or situation to which their fear is connected (Fleming, 2017).
The Diagnostic and Statistical Manual of Mental Disorders – fifth edition (DSM-V) categorized it under the Anxiety Disorders and follows a name “Specific Phobia” (300.29).
A specific phobia relates to a particular stimulus that causes fear, anxiety or avoidance and results in intense distress for the sufferer (Fleming, 2017).The criteria remained unchanged from its fourth revision (DSM-IV).
The criteria are as follows:
- The individual suffers from a persistent fear that is either unreasonable or excessive, caused by the presence or anticipation of a specific object or situation.
- Exposure to the stimulus usually results in an anxiety response, often taking the form of a panic attack in adults, or a tantrum, clinging, crying or freezing in children.
- The sufferer recognizes that their fear is disproportionate to the perceived threat or danger (not always present in children).
- Individuals take steps to avoid the object or situation they fear, or endure such experiences with intense distress or anxiety.
- The phobic reaction, anticipation or avoidance interferes with the individual’s normal routine and relationships, or causes significant distress.
- The phobia has persisted for a period of time, usually six months or longer.
- The symptoms cannot be attributed to another mental condition, such as obsessive-compulsive disorder or post-traumatic stress disorder.
Specific Types of Phobia (DSM-V):
- Animal Type
- Natural Environment Type (Ex: heights, storms, water)
- Blood-Injection-Injury Type
Situational Type (Ex: airplanes, elevators, enclosed places)
- Other Type (Ex: phobic avoidance of situations that may lead to choking, vomiting, or contracting an illness; in children, avoidance of loud sounds or costumed characters)
Causes of Specific Phobia
The antecedents that trigger the development of specific phobia could be various. Dr. Kevin Fleming (2017) cited in his article discussing about specific phobia and its probable causes:
Traumatic experiences – Individuals who have a traumatic experience in childhood may begin to make associations with related situations or objects in adulthood. For example, someone who is bitten by a dog at a young age may develop a fear of dogs in later life.
Learned behavior – The family environment may be a cause of specific phobias – being around relatives who have particular fears, or deal with anxiety in a certain way, is thought to influence children and may contribute to the onset of phobias.
Genetics – Some individuals may be genetically predisposed to having an anxious personality, making them more prone to phobias.
Fear response – Having a panic attack or other pronounced response to fear or panic in a certain situation can lead to feelings of embarrassment or fear of a repeat episode, which over time may develop into a phobia.
Ongoing stress – Over the long term, stress can result in feelings of anxiety, depression and inability to cope in certain situations, which may progress into a phobia.
Living with phobia magnifies a seemingly non-threatening situation, object, animal etc and turns it into something big to make someone trembles at his/her knees and causes certain dysfunction in a person’s daily living.
There are numerous interventions that could help alleviate the symptoms of specific phobia such as Cognitive Behavioral Therapy (CBT), Exposure Therapy, Relaxation Techniques, Hypnotherapy, Mindfulness, and Medications.
The following case presentation is based on a real client who has lived with a specific phobia from childhood called “Pediophobia” otherwise known as,”Fear of Dolls”.
Exposure Therapy was applied as the main intervention to help the client overcome the irrational fear of dolls.
Client “JC” (male) was 25 years old during the time when the therapy program was applied to his case. He described himself as a generally sociable and a happy person. He is also a type of person who is easily scared and startled when surprised.
He doesn’t have any recollection of traumatic events associated with dolls when he was a kid. He also doesn’t have any family member who has anxiety disorder.
All that he knows was when he was young they have a doll named “Jay-R”. He recalled that he felt like this doll is going to blink, talk and move whenever he looks at it. He emphasized how the eyes of dolls are so scary for him. Most especially, the porcelain ones.
Whenever he sees dolls, he would just immediately close his eyes, screech, feels paralyzed yet there’s a strong desire for him to run away from it, develops rapid heartbeat, nausea, and would beg to tears for the doll to be taken away from his path even if it is far away from him.
Exposure therapy was offered to “JC” to help him come out strong from his phobia. Exposure therapy is classified as a Behavioral Therapy. The person undergoes various phases where the behavior is modified through systematic desensitization as the person gets exposed with the feared stimulus.
There are 3 phases included in his exposure therapy program. But, before the first phase began, he was taught to do relaxation techniques called the progressive muscle relaxation and deep breathing so that he could apply this when he encounters strikingly high anxiety levels as he gets to face his feared stimulus. In this way, he can manage his own anxiety by calming himself down. He was also oriented to rate the aroused anxiety level from 0-10 (0 = no anxiety and 10= strikingly high anxiety level) as the feared stimulus gets presented and after intervention was applied to it to know if there are changes in the anxiety level of the client. Attained positive behavior were always given differential reinforcement through verbal praises and physical gestures such as giving a tap on the back, high-five or even a hug. Worksheets were given to the client as a follow-up tasks every after session so as the effect will carry on and be generalized even outside the therapy.
The first phase was the “Imaginal Exposure.” This kind of technique is helpful most especially if the exact stimulus paired with a traumatic event is no longer available to be utilized. In this phase, the client was asked to close his eyes and imagine to go back in time when he first encountered the doll “JAY-R.” He was directed through various steps as he was asked to do certain actions such as going inside the room where the doll is, walking near the doll and touching it. Each of the step were rated by “JC” as to how much anxiety is building up in him. He was asked to stay in the moment together with the feared object and asked to stay on a thought about what dolls really are – which is they are just inanimate, non-threatening toys for children. This was done so as the magnitude of the feared object will be deemed insignificant to help the client break irrational thoughts. Concept of Hypnotherapy was also applied before he was asked to open his eyes and go back in reality.
The second phase was establishing “Fear Hierarchy.” This is the phase where pictures and videos of dolls where presented to the client. The hierarchy starts with images that were less anxiety-provoking towards the client such as showing a seemingly cartoony image of a doll going to his most feared ones – porcelain dolls’ pictures and lastly, a video of dolls. The client was asked to stay with the image, for him to not close his eyes as the therapist assured the safety of the environment and of the client himself. Cognitive restructuring through dispute was also done by asking questions to the client such as, “Are the dolls really moving?”, “Are they going to attack you?” etc. The client was asked to verbally answer the questions to stimulate rationalization. Each picture was asked to be rated by the client from 0-10 based on how much anxiety was aroused by it. Stimulus that were on the high anxiety arousal rate was utilized for further exposure until his anxiety level decreases.
The third phase of the exposure therapy done to the client was the “In-Vivo Exposure.” This was the most anxiety provoking of all the phases because the client is now faced with the actual feared object. The client was first oriented about the last phase before entering the room with dolls. The client was guided inside the room and as he saw the dolls, he bursted in tears and trembled. He started to close his eyes and uttered, “They are looking at me!” The therapist did extinction of this behavior so as not to reinforce it rather, he was guided and encouraged to open his eyes and to look at the dolls from a distant and was assured that he is in a safe place. Once again, cognitive restructuring assisted through dispute was utilized by asking questions to the client to negate irrational thoughts. When the client successfully did it and reported to have had a decreased anxiety level, he was asked to come near the dolls and sit with them on the sofa. The anxiety level of the client shoots up once again and he started to cry and felt nauseous than ever. The therapist sat along the dolls to demonstrate how non-threatening they are. After a while, he decided to open his eyes and slowly touched the dolls. Reinforcement was instantly given to the client through praise and encouragement. He even started to carry the dolls one by one. After being able to do this, he said that he felt dizzy and passed out for a few minutes.
When he was awaken, he started to look and touch the dolls instantaneously as if his passing out seemed to be like a reset of his system. He reported that his anxiety level has zeroed out gradually. He even asked for his picture to be taken with the dolls hanging around him – something that he wouldn’t do within the bounds of his phobia.
We discover wider rooms in our potentials when fear is kicked out. We realize that thriving and not just merely surviving is possible even when vulnerability to fear is present. Even if phobia is beyond fear, the person itself is still beyond phobia. It all starts with a conscious decision that we are able to overcome what our minds conceive as our limits.