What is a phobia?
Phobia comes from the Greek word φόβος meaning “disgust,” “fear” or “mortal fear.” In ancient Greek mythology, “Phobos” (Phobos) was the twin brother of Deimos (Deimos), the personification of violence, terror.
In popular literature, it is customary to designate specific phobias using the Greek name of the object of fear, adding the suffix “-phobia” to it. In this case, the very word “phobia” may not necessarily be involved in the designation of a mental disorder. For example, “hydrophobia” is an old name for rabies, as water aversion is one of the symptoms of this disease (a specific water phobia is called “aquaphobia”). The word “hydrophobe” is a chemical term meaning a compound that repels water. Likewise, the term photophobia is used as a diagnosis of sore eyes characterized by aversion to light. Among the non-medical suffixes “-phobia” are words such as chemophobia (Chemophobia) – a negative attitude and distrust towards chemistry and synthetic chemicals. Xenophobia (Xenophobia) – hostility towards strangers or foreigners, also used to describe nationalist beliefs and movements. Homophobia (Homophobia) – negative attitude towards homosexuals, lesbians, bi-, and transsexuals (LGBT). As a rule, the non-medical use of the word “phobia” is associated with an attempt to endow the subject with such qualities and properties as fear, dislike, disapproval, hatred and other variants of a negative predisposition towards the object of “phobia”.
In medicine, phobia is a type of anxiety disorder defined as a state of fear. These states last more than six months and are characterized by the fact that the patient is constantly trying to avoid rapprochement with objects of phobia (there are usually several of them). In the end, it all ends with an acute attack. For example, if they see blood or a wound, such a patient may faint.
All phobias are usually divided into three groups:
The first group is fear of objects and phenomena of a biological nature. These can be animals, natural phenomena, blood, etc. The most common ones are fear of spiders or snakes. These phobias are usually called specific (specific phobias), and about 6-8% of the population in the West and 2-4% of people in Asia, Africa and Latin America suffer from them per year. Specific phobias are treated exclusively with exposure therapy, since medication is powerless in such cases. The essence of exposure therapy is that a person encounters the source of his anxiety until he masters the ability to overcome it.
The second group includes people who were unable to survive the negative experience of any interaction. These people are afraid of a repetition of the situation (for example, judgment from others). This behavior is called social phobia and affects about 7% of the population in the United States and 0.5-2.5% in the rest of the world.
The third group includes fears generated by open space where it is impossible to hide, and this trend is usually called agoraphobia (from Agora – an area full of people). This type of phobia affects 1.7% of people around the world, and women are twice as likely as men.
Both social anxiety and agorophobia are usually neutralized by pharmaceuticals: antidepressants, benzodiazepines, or beta-blockers.
Here is what the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, DSM-V writes about the categories of anxiety disorders.
- Specific phobias– a fear of certain objects or social situations, which instantly leads to a feeling of anxiety, and sometimes to a panic attack. Specific phobia is divided into five subgroups: animal type, type of natural processes of the natural environment, situational type, “blood-injection-wound” and others. A specific phobia is a pronounced and deeply rooted fear that manifests itself excessively in moments of waiting or being directly next to a phobic object or situation; specific phobias can lead to loss of control, panic, or fainting if they find themselves in close proximity to the subject of phobic terror.
- Agoraphobia– generalized fear of being out of the house or any other “safety zone”, which entails possible panic attacks, which can also be caused by various specific phobias, such as open space, social embarrassment (social agoraphobia), fear of infection (fear of contamination – fear of microbes). Agoraphobia can be complicated by obsessive-compulsive disorder or PTSD (post-traumatic stress disorder) if the trauma occurs outside the home. If specific phobias are determined by the connection with objects or situations, then social phobias are an expression of social fear and people’s opinion. The DSM (Diagnostic and Statistical Manual of Mental Disorders) divides specific phobias into five subtypes: animals, natural environment, blood-injection-injury, situational types, etc. Among children, phobias related to animals, the natural environment (darkness) and blood-injection-wound develop between the ages of 7 and 9 and are part of normal development. In addition, specific phobias prevail in children from 10 to 13 years old.
- Social phobia,also known as social anxiety disorder, refers to the fear of a situation in which a person is afraid of being judged by society. According to diagnostic criteria, in contrast to specific phobias, social phobias include fear of public places and situations that lead to feelings of embarrassment or humiliation.
All phobias vary in severity. Some patients can simply avoid the object of their fear and experience relatively mild anxiety, while others experience full-scale panic with all the ensuing adverse symptoms. Most patients are aware of the irrationality of their fear, which, nevertheless, cannot be overcome. They complain of dizziness, loss of bowel and bladder control, rapid breathing, pain and shortness of breath.
Causes of phobias
There is a version that irrational fear can develop in three ways (Rachman). The first is the classical conditioned reflex, acquired according to the Pavlov model. For example, a person receives an electric shock in a certain room; in addition to the fear of electric shock, he may have a fear of the room itself. The second way is the acquisition of a substitute fear (Vicarious fear acquisition), when defensive behavior is formed not from personal experience, but through observation. For example, when a child sees an expression of fear towards an animal on the part of a parent, he too may become afraid of it. This reaction is also seen among other primates, whose young learn to fear snakes by observing their parents’ fear. Although observational learning is considered to be effective in developing correct behaviors,
Phobia is diagnosed not by reaction to an object or situation, but by the factor of its avoidance by the patient and by symptoms of deterioration in physical condition, up to disabilities. With acrophobia, a disruption in professional activity can reach the point that a person refuses to do his job because of a high office floor, or rejects his participation in an event if it is held in a recreation park.
Physical processes of a phobia
Research by Critchley and others has shown that under the lateral fissure in the cerebral cortex is an islet that is part of the limbic system that is involved in the expression of emotions. It detects and interprets threats. In any case, observations have shown that there is a correlation between the increased activity of this area of the cerebral cortex and the feeling of anxiety. In the manifestation of phobia and fear, the anterior parts of the cingulate gyrus and the medial prefrontal cortex are also involved. They are responsible for reacting to danger. The ventromedial prefrontal cortex controls the amygdala’s responses to alarms and fearful memories. More specifically, the medial prefrontal cortex plays an active role in the disappearance of fear and is responsible for long-term remission. Stimulation of this area, accordingly, lowers the response to irrational fear, so its work may be to inhibit the activity of the amygdala to serve the impulses of danger. The hippocamus plays an important role in the formation of the corresponding memories. When a person experiences fear, the hippocampus receives impulses from the amygdala, which allows him to connect the feeling of fear with smells or sounds. The ability of the amygdala, deep in the medial temporal lobe of the brain, to respond to anxiety impulses is key to the irrational horror process. It is she who causes the secretion of hormones that affect fear and aggression. When they appear, the amygdala releases hormones into the body in order to bring a person into a state of “combat readiness”, preparing a person to move, run, fight, etc. This protective “cheerful” state is referred to in psychology as a “fight-or-flight response”. The process of receiving a stimulus, interpreting it, and releasing certain hormones into the blood is called the Hypothalamic-Pituitary-Adrenal Axis (HPA). Small cell neurosecretory neurons (the parvocellular neurosecretory neurons) of the hypothalamus secrete corticotropin, which in turn releases the hormone CRH, which is directed to the anterior pituitary gland. In the latter, the adrenocorticotropic hormone (ACTH) is released, which ultimately stimulates the release its interpretation and the release of certain hormones into the blood is called the Hypothalamic-Pituitary-Adrenal Axis (HPA). Small cell neurosecretory neurons (the parvocellular neurosecretory neurons) of the hypothalamus secrete corticotropin, which in turn releases the hormone CRH, which is directed to the anterior pituitary gland. In the latter, the adrenocorticotropic hormone (ACTH) is released, which ultimately stimulates the release its interpretation and the release of certain hormones into the blood is called the Hypothalamic-Pituitary-Adrenal Axis (HPA). Small cell neurosecretory neurons (the parvocellular neurosecretory neurons) of the hypothalamus secrete corticotropin, which in turn releases the hormone CRH, which is directed to the anterior pituitary gland. In the latter, the adrenocorticotropic hormone (ACTH) is released, which ultimately stimulates the release cortisol . Glucocorticoid receptors in the hippocampus control the amount of cortisol in the blood and, through negative feedback, can signal the hypothalamus to stop releasing the CRH hormone. In other words, if the amygdala is responsible for activating the HPA circuitry, then the hippocampus is responsible for suppressing it. As in the situation with the conditioned reflex, the amygdala “learns” to associate the conditioned signal with the negative or “avoidance”, thus creating the image of horror, which is often noted in people with phobias. In fact, the amygdala is responsible not only for recognizing the danger signal, but also for creating its image in memory.
According to the DSM-IV-TR Guidelines, a diagnosis cannot be made if phobic stimuli, be they an object or a public situation, are absent from a person’s everyday life. An example of such a situation would be a patient who is afraid of mice, but lives in an area where they are not. Although the thought of mice makes you feel unwell, it does not occur with them, hence the disorder is imaginary. Anxiety increases as you approach the subject of the phobia. For example, when a person approaches a snake, the level of ophidiophobia increases. Phobia treatments are varied. Some include systematic desensitization, others include progressive relaxation, virtual reality, modeling, still others, medications, and others.hypnotherapy.
Phobia therapy
Desansibilization is a cognitive behavioral therapy (CBT), induced from the outside, or as they say in science, cognitive behavioral therapy, which is aimed at working out thoughts and judgments that paralyze a person under the pressure of feelings experienced by him. The goal of this type of therapy is to recognize the irrationality of your fear. CBT is done both individually and in group sessions. Gradual desensitization works well (90%) if the patient is willing to experience some discomfort. There are many CBT programs for children to reduce negative thinking, increase problem-solving ability, and more.
Desensitization by means of correction of perception with the help of eyeball movements has been shown to be effective in relieving phobic symptoms caused by trauma, for example, after a dog bite.
Long-term exposure is a volitional meeting of the patient with the object of his fear for a long time and is used by psychiatrists to treat severe forms of phobia. This method is applicable when the patient is able to overcome his fear.
Systematic desensitization is the process of getting used to a phobia. The patient encounters the source of his fear for a long time, until the discomfort ceases to be unbearable for him. The key to this type of therapy is controlled exposure of the stimulus.
The patient’s humor and self-irony during the implementation of desensitization can act as an independent method of overcoming the disease. “What’s funny is not dangerous” – usually this type of treatment is structured as a sequence of healing acts, which are designed to arouse laughter in relation to the phobic object.
Progressive muscle relaxation. These techniques are used in situations where the patient is not ready for desensitization procedures. Progressive muscle relaxation helps patients “before” and “during” the encounter with the phobic object.
Participant modeling is a technique used with children and adolescents. It lies in the fact that the therapist offers the patient a model of behavior when he is overcome by fear. This motivates patients to exercise, which strengthens wellness behaviors. As in systematic desensitization, here the patient is accustomed to the presence of phobic objects, but the therapist is involved in the procedure, who sees everything and promptly suggests options for action, thus simulating the patient’s positive behavior.
Virtual reality therapy is an effective type of therapy based on systematic desensitization, but using not real, but playful realities that cannot exist in life. The advantage of this therapy is that the patient is in control of the scenario of what is happening, he is also better able to transfer phobic scenes (in real life, they could be unbearable). In addition, VR therapy is closer to the field than simple imagination.
Drug treatment for phobias
In certain cases of phobias, fear is suppressed by antidepressants such as MAOIs and SSRIs. These drugs act on serotonin, which affects mood. Another type of medication prescribed for phobias is sedatives. For example, benzodiazepines, which help the patient to relax by reducing anxiety, but are dangerous with long-term use. If benzodiazepine treatment is accompanied by self-destructive behaviors (for example, alcohol abuse), then the patient gets used to them and becomes addicted. The third type of pharmaceutical used in the treatment of phobias is beta blockers. They are designed to stop the stimulation of the affect of adrenaline in the human body (sweating, tachycardia, pressure surges, tremors and palpitations). Usually, beta blockers are used to relieve the experience.
Hypnotherapy
Hypnotherapy is the procedure for editing the acquired reflexes of a person (phobias and other psychosomatic diseases) by immersing him in a controlled “waking dream” (or “subconscious wakefulness”). Almost all methods and techniques for reducing emotional susceptibility (desensitization) aimed at overcoming phobic anxiety contain elements of hypnotherapy, but hypnotherapy itself is possible only when the patient is immersed in a deep hypnotic trance. Being a natural human ability to extreme over-concentration, this state finds expression in deep emotional relaxation, in which the patient’s repressed memories – psychotrauma are revealed, obtained, as a rule, in infancy. During a hypnotherapy session, they present themselves as the roots of acquired reflexes that make the patient suffer, and therefore are subject to sanitation through rethinking. To do this, the patient must act under the guidance of a hypnotherapist in order to once again experience the traumatic event, and gain new impressions designed to replace the old, negative. The memory renewed in this way deprives the outdated reflex of the power source, and the phobia disappears by itself.
Phobia spread statistics
Phobia is a common form of anxiety disorder that affects a particular gender and age. An American study by the National Institute of Mental Health (NIMH) found that phobias affect 8.7% to 18.1% of Americans, making it the most common mental illness among women of all ages and the second most common among men over 25. In children and adolescents, specific phobias cover from 4% to 10%, social phobias – from 1% to 3%. A Swedish study also showed that women are more susceptible to the disease than men (26.5% in women and 12.4% in men). One specific phobia in Sweden accounts for 21.2% in women and 10.9% in adult men. 5.4% of women and 1.5% of men are carriers of multiple phobias.
