How Are Phobias Treated?
What is a phobia, an excessive fear of an object or situation? What types are there, and how are phobias worked on in therapy?
Treating Phobias: Cognitive Behavioural Therapy
A phobia is an unrealistic or excessive fear of an object or situation. For a fear to be diagnosed as a phobia, the excessive anxiety triggered by the stimulus must disrupt daily functioning and/or cause significant distress. We often come across examples such as a fear of cats, heights or flying, both in the therapy room and in everyday life.
Because people have usually suffered from a phobia for a long time, they find it hard to believe that treatment is possible. In fact, phobias are anxiety disorders with a very high treatment success rate. Many studies have found that 80–90% of people who come for treatment with cognitive behavioural therapy see their phobia resolve by the tenth session. In cognitive behavioural therapy, a structured treatment method, the aim is to break the link between the feared stimulus and the anxiety experienced. This is done by identifying irrational thought patterns and replacing them with new, more functional and realistic thoughts. An example makes this clearer. For someone with a fear of cats, a cat passing by, rubbing against their leg or appearing in front of them on the street is seen as a “disaster”. In treatment, cognitive restructuring is used to replace this unrealistic, unhelpful thought with a more realistic and functional alternative. For example, the new thought might be: “A cat could cross my path anywhere and at any time; that doesn't mean it will hurt me.”
What actually keeps a phobia going is that the person constantly avoids the feared object or situation and so never gets to face it. This lack of confrontation sends the message that the “disaster scenario” is true. As a result, the phobia continues. In systematic desensitization, a method used in cognitive behavioural therapy, the client and therapist draw up an anxiety hierarchy for the phobia together. The person then faces their phobia step by step, moving from the situation that causes the least anxiety to the one that causes the most. These confrontations are reinforced with in-session practice and exercises between sessions. In this way the person sees through experience that the “disaster scenario” is not true; they learn by living it.
So with a treatment plan built around the person's expectations and therapy goals, phobias can be worked on very successfully in cognitive behavioural therapy. To break out of the circle of a phobia, the first and most important step for people with phobias is to stop avoiding and come to therapy.
