Phobias (irrational fears of objects or situations) are common. Some phobias have relatively small effects. For instance, a phobia of mice in a person living in an upper-class urban area might lead to only occasional distress and avoidance. However, phobias can be deadly. For instance, a fear of doctors or of injections can lead to missing essential treatment. A woman recently wrote to me and told me about a young relative who never would go near doctors or hospitals. The young woman had serious asthma and obtained moderately effective drugs over the counter. The woman bought a new dog, to which she was somewhat allergic. She developed a cold. The over-the-counter drugs did not work well under the circumstances, and she stopped breathing while at home alone. She then received emergency medical care, but it was too late to save her.
Dental phobia can also prove deadly because organisms that grow unrestrained in the gums can spread to the heart and kill a person. A person with water phobia who unexpectedly goes into a body of water may panic and drown quickly. Individuals who drive long distances rather than flying, because they fear flying, increase their chances of dying in a travel accident — because flying on a commercial airliner is safer than driving the same distance.
The main evolutionary purpose of fear is to reduce the risk of harm. With phobias, the risk of harm can go up, sometimes way up.
I was glad to hear, after the broadcast of the Insight show on phobias, that a mental health help line was receiving many calls about where to go for phobia treatment. I myself have received calls from individuals who want treatment for a phobia. Taking any action to overcome a phobia can help a person eliminate life limitations and, in some cases, serious dangers.
Who do you know who has a phobia? Has the person tried to beat the phobia? Has the person tried the most successful method according to research, gradual exposure treatment provided by a professional?
John Malouff, PhD, JD, Assoc Prof of Psychology
I’m working with a young man who has an intellectual disability. He has a phobia of birds. It is life threatening as he runs when he sees them and will run out Into traffic. He has also run from a moving vehicle when birds get too close. I ran a desensitization program with him and also taught him coping skills. He was doing very well then experienced spontaneous recovery. I believe his behavior is also reinforced by social attention. It’s a challenging case.
Hello Fay. Interesting man. Determining the trigger for the relapse could be important in preventing future relapses. It sounds as if the man needs more exposure trials. Can you take him to the place that has injured birds in a huge enclosure? To the zoo? I like the idea of trying to eliminate reinforcement for fear behaviors. The Insight show I was on had a woman with bird phobia. One of my students last year helped someone overcome a bird phobia. Here in Australia, it is common for magpies to attack humans in Sept/Oct, but in Florida the birds are rather tame, as I remember them. I’d like to hear how you go with this client.
When you wrote this article, I was working with a phobia client (16) who had always hated vomiting around her, and one week ago, had almost vomited on food, and “instantly developed a phobia about swallowing”. She and her mum had seen the show (I haven’t), and I was able to “leverage” their experience of the show, as a series of examples of phobia recovery. The girl hadn’t eaten for a week (literally, only water, almost fainting, and was one step from needing medical intervention, in my opinion) and left looking forward to a milkshake and a big serve of chicken … second session, one step back, but on smoothies, then a telephone reported relapse. Unfortunately, with expectations of instant help in one or two sessions, I haven’t been able to see her again, so I hope she is going OK.
I’ve come to think of one model for phobias, useful with clients, is that a phobic response is way up one end of an anxiety spectrum; very specific, very focused: and quite realistic if there is a tiger in the room, or a large chasm opening up under your feet. All we have to do is adjust the response …
Hi MS. We need clients to show up in order to help them. I have not dealt with a client who has a swallowing phobia. I might try thicker and thicker liquids in session, followed by tiny bites of solids — if the fear hierarchy went like that.
HiJM. You are so right, we do need clients to show up to help them. I wonder if you might write a post on client expectations in the “click-buy now” world that surrounds us, and if there has been change over time with regard to seeking, attending and continuing therapy.
Client non-adherence, including not returning and not doing assignments, is a major problem in psychotherapy and in other types of health care. I don’t know of any evidence that the problem is getting worse, but I understand how a cultural emphasis on instant gratification could lead to more adherence problems. Cooperation, conscientiousness, and persistence in clients are important to psychotherapy success, but not many clients have high levels of these characteristics. So our work is not easy. That’s why we get paid big money!