TWO PHOBIA TREATMENT METHODS

The first thing I’d like to share on this subject is that phobias, although scary and seemingly gigantic in our minds, are some of the most treatable mental health issues out there. Phobias are a particular form of acute sensitivity to an object, person, or place. This acute sensitivity is not unique to those who have phobias, and is shared by those who suffer from generalized anxiety, obsessive compulsive disorders, trauma, and everyone who habitually engages in avoidance of particular stimuli. What changes is the degree of dysfunction the feared stimuli produces in your day-to-day life. 

For instance until a couple of years ago I was acutely sensitive to social group settings. I feared and avoided them unconsciously, until, on Christmas 2021, despite COVID being a thing of the past, I found myself completely alone, and in physical pain for it (by the way, social isolation brain networks share the same pain networks of physical pain!). I realized in that moment that this was the outcome of a much longer set of choices I had been making without awareness, and I began at once to address the issue with exposure therapy techniques. Beginning that very day, I sought opportunities to expose myself to groups of people in different settings, starting with groups of people where I knew the majority of the members, and where the motive of the gathering was something that appealed to me.

 Within a couple of months, I felt I had overcome my worst hesitations to join groups, and could now join without displeasure, groups of people I didn’t know at all, for motives that were not quite in line with my interests. I used exposure therapy on myself to solve an issue that was foundational to my well-being and would have been a big road-block in my professional life had I not solved it. But phobias, or avoidance mechanisms can also manifest for stimuli that have little to do with our day-to-day lives.

 A friend of mine is afraid of huge ships, but lives in the highlands of Nairobi, which is 1765 mt. above the sea, a fear that is unlikely to ever be of significance to his day-to-day life. Another friend of mine could have a panic attack if exposed to cockroaches: “I am terrified of cockroaches. I have 3 cans of bug spray in my room. One for each hand and an extra can for backup”, but she lives in Copenhagen, and not in Australia, where cockroaches stop the traffic for how big they are! But as I think about this topic, I remember once in Japan a girl from Tokyo came to see me at my farm because I was running a workshop on Non Violent Communication, and in my usual enthusiasm for plants and nature I had showed her the composting system from which I garnered the incredible rich soil from which I grew all my plants. 

The moment I scooped this beautiful, nice smelling soil, she freaked out! …and I freaked out in return! >< . Upon carefully putting back the soil, washing my hands, and standing at some distance from her, I found out she was disgusted by the mere sight of me handling the black rich soil. I had just exposed her to a stimuli that is very rarely present in her day-to-day environment. She had probably only just found out to have a mini-phobia for soil. 

The lesson here is that we can be phobic about things that are not dysfunctional, simply because they do not represent interactions that are foundational to our current lives. If I have a phobia of snakes and live in the city... What's the point of exposing me to snakes? But if my most recent job offer is all about the outdoors, that kind of changes the stakes of my fear…

Cognitive Behavioral Therapy and Virtual Reality Therapy

The most common therapeutic modalities for phobias are Cognitive Behavioural Therapy, and more recently Virtual Reality Therapy. But the foundation of phobia treatment remains the same in either case, and it involves a gradual and systematic exposure to the thing that is feared… rabbit, elevator, person or situation that it may be. 

Exposure in the therapeutic process is tailored to your specific phobia, and your internal and external resources, by which I mean your access to spaces and places where you can feel completely safe and calm. The more of these safe spaces, the more able you are to resource, the stronger your progress.

Having said this, in the treatment of phobia/s, it is not uncommon to discover underlying issues. This can be a blessing or a curse, and much of it depends on the maturity, readiness, and will to change of the client. It can be a blessing in that this may speed up recovery by a large margin. Understanding the event that triggered the phobia, can relieve the phobia like a blown up candle. It can, however, also be a curse, in that if one is not willing to confront the trauma, or maybe one is not in a place to do so, one may also never recover completely despite efforts to make progress. 

When there is an underlying trauma, and the person is not willing to accept the traumatic event, such as childhood sexual abuse, or the sudden loss of a primary care taker, the resolution of one phobia may result in the growth of another. This is because the phobia is just a way for our body and mind to remind us of the unacceptable event that has not been processed. Phobias that are dealt with, but reoccur or change form, are almost a sure sign of a deeper underlying event. In such cases, I will always help you to confront the deeper issues and to stay with you all along this process, creating a safe and soothing environment for you to grow in.

Now for the specifics. The treatment process of a phobia often involves an Assessment, whereby I conduct a thorough questioning to understand the nature of the phobia, its triggers, and the impact it has on your life.  This phase also involves setting up what we call an Exposure Hierarchy. This is a hierarchy of feared situations, starting from the least anxiety-provoking to the most challenging. This hierarchy is then used in the Goal Setting phase, where we collaboratively set specific and achievable goals. Then the real dreaded fun begins! In the Gradual Exposure phase you’ll gradually seek out opportunities to expose yourself to the stimuli you fear, at the level agreed upon.

 Given the appropriate means, and for certain particular phobias, such as fear of heights, open spaces, certain situations or animals, virtual reality scenarios could also be used, but personally I work best with the biggest simulation I know of, reality itself! ; ) I tend to keep my interventions as simple as possible, and I find subtle and gradual increased exposure therapy the most elegant solution. It also works very well, and gives my clients immediate feedback to their system. Exposure therapy takes willingness to expose oneself to something we fear though, systematically, and regularly, and to journal about the experience, so it takes commitment, courage, energy, and it's only worth for things that really matter to our practical lives. 

During this work, we also learn a bunch of techniques to relax. These are techniques that help us in all sorts of situations in life. In fact, people who have successfully conquered a phobia come out of the experience with a very rich set of tools to self-soothe in most situations. The very thing you feared most, has now become the source of your greatest strengths to relax! Isn’t that cool? Long story short, phobias are smaller monsters than they appear to be. Facing the monster gradually and building up self-soothing strategies is the way to go, and what I help my clients with.

Look after your Heart,

Your Shrink in Bansko