A phobia is an extreme, persistent fear that interferes with normal living. It is not necessarily an irrational fear. Many people have phobias of snakes, spiders, lightning, heights, and other items that really are dangerous. What is irrational is the excessive degree of the fear, leading to panic in the presence of the feared object. In most cases, people with phobias are not so much afraid of the object itself but of their own reactions. They fear that they will have a heart attack or that they will embarrass themselves by trembling or fainting. Consequently, They fear that they will have a heart attack or that they will embarrass themselves by trembling or fainting, Consequently, they do whatever they can to avoid the object that reminds them of it.
According to an extensive study of U.S. adults, about 11% of people suffer a phobia at some time in life, and 5 to 6% have a phobia at any given time. However, phobias vary from mild to extreme, so their apparent prevalence depends on how many marginal cases we include. As with other anxiety disorders, phobias are more common in women than men.
Fear vs. Phobia
It is normal and even helpful to experience fear in dangerous situations. Fear is an adaptive human response. It serves a protective purpose, activating the automatic “fight-or-flight” response. With our bodies and minds alert and ready for action, we are able to respond quickly and protect ourselves. But with phobias the threat is greatly exaggerated or nonexistent. For example, it is only natural to be afraid of a snarling Doberman, but it is irrational to be terrified of a friendly poodle on a leash, as you might be if you have a dog phobia
Difference between normal fear and phobia
Feeling anxious when flying through turbulence or taking off during a storm Not going to your best friend’s island wedding because you’d have to fly there Experiencing butterflies when peering down from the top of a skyscraper or climbing a tall ladder Turning down a great job because it’s on the 10th floor of the office building Getting nervous when you see a pit bull or a Rottweiler
Steering clear of the park because you might see a dog Feeling a little queasy when getting a shot or when your blood is being drawn Avoiding necessary medical treatments or doctor’s checkups because you’re terrified of needles Normal fears in children
Many childhood fears are natural and tend to develop at specific ages. For example, many young children are afraid of the dark and may need a nightlight to sleep. That doesn’t mean they have a phobia. In most cases, they will grow out of this fear as they get older. If your child’s fear is not interfering with his or her daily life or causing him or her a great deal of distress, then there’s little cause for undue concern. However, if the fear is interfering with your child’s social activities, school performance, or sleep, you may want to see a qualified child therapist. Which of my child’s fears are normal?
According to the Child Anxiety Network, the following fears are extremely common and considered normal: 0-2 years – Loud noises, strangers, separation from parents, large objects. 3-6 years – Imaginary things such as ghosts, monsters, the dark, sleeping alone, strange noises. 7-16 years – More realistic fears such as injury, illness, school performance, death, natural disasters. Common types of phobias and fears
There are four general types of phobias and fears: Animal phobias. Examples include fear of snakes, fear of spiders, fear of rodents, and fear of dogs. Natural environment phobias. Examples include fear of heights, fear of storms, fear of water, and fear of the dark. Situational phobias (fears triggered by a specific situation). Examples include fear of enclosed spaces (claustrophobia), fear of flying, fear of driving, fear of tunnels, and fear of bridges. Blood-Injection-Injury phobia. The fear of blood, fear or injury, or a fear of needles or other medical procedures.
Part of the brain which is responsible for fear and phobia.
Part of the brain which responsible for phobia
The amygdala is an “almond shaped” mass of nuclei that is located deep in the brain’s medial temporal lobe. It processes the events associated with fear and is being linked to anxiety disorders and social phobias. The amygdala’s ability to respond to fearful stimuli occurs through the process of fear conditioning. Similar to classical conditioning, the amygdala learns to associate a conditioned stimulus with a negative or avoidant stimulus, creating a conditioned fear response that is often seen in phobic individuals. In this way the amygdala is responsible for not only recognizing ceratin stimuli or cues as
How do phobia subtypes differ from each other? We have already seen one major difference in the case of Judy. Rather than the usual surge of activity in the sympathetic nervous system and increased heart rate and blood pressure, Judy experienced a marked drop in heart rate and blood pressure and fainted as a consequence. Many people who suffer from phobias and experience panic attacks in their feared situation report that they feel like they are going to faint, but they never do because their heart rate and blood pressure are actually increasing.
Therefore, those with blood-injury-injection phobias almost always differ in their physiological reaction from people with other types of phobia. The blood-injury-injection phobia runs in families more strongly than any phobic disorder. This is probably because people with this phobia inherit a strong vasovagal response to blood, injury, or the possibility of an injection, all of which cause a drop in blood pressure and a tendency to faint. The phobia develops over the possibility of having this response. The average age of onset for this phobia is approximately 9 years old.
Phobias characterized by fear of public transportation or enclosed places are called situational phobias. Claustrophobia, a fear of small, enclosed places, is situational, as is a phobia of planes. Psychopathologists first thought that situational phobia was similar to PDA. One similarity in these two disorders is age of onset. Both situational phobia and PDA tend to emerge in an individual’s early to mid-20s. The extent to which PDA and situational phobias run in families is also similar, with approximately 30% of first-degree relations having the same or a similar phobia.
But more recent analysis, both descriptive and laboratory based, do not support the similarity as anything more than superficial. The main difference between situational phobia and PDA is that people with situational phobia never experience panic attacks outside the context of their phobic object or situation. Therefore, they can relax when they don’t have to confront their phobic situation. People with panic disorder, in contrast, might experience unexpected, uncued panic attacks at any time.
Natural Environment Phobia
Sometimes very young people develop fears of situation or events occurring in nature. These fears are called natural environment phobias. The major examples are heights, storms, and water. These fears also seem to clusters together: If you fear one situation or event, such as deep water, you are likely to fear another, such as storms. Many of these situations have some anger associated with tem and, therefore, mild to moderate fear can be adaptive. For example, we should be careful in a high place or in deep water. It is entirely possible that we are somewhat prepared to be afraid of these situation, something in our genes makes us sensitive to these situations if any sign of danger is present. In any case, these phobias have a peak age of onset of about 7 years old. They are not phobias if they are only passing fears. They have to be persistent and to interfere substantially with the person’s functioning, leading to avoidance of boat trips or summer vacations in the mountains where there might be a storm.
Fears of animals and insects are called anime phobias. Again, these fears are common but become phobic only f severe interference with functioning occurs. For example, we have seen cases in our clinic in which people with snake or mice phobias are unable to read magazines for fear of unexpectedly coming across a picture of one of these animals. There are many places that these people are unable to go, even if they want to very much, such as to the country to visit someone. The fear experienced by people with animal phobias is different from an ordinary mild revulsion. The age of onset for these phobias, like that of natural environment phobias, peaks around 7 years old.
Separation Anxiety Disorder
All anxiety disorders may occur during childhood, and there is one additional anxiety disorder unique to children. Separation anxiety disorder is characterized by children’s unrealistic and persistent worry that something will happen to their parents or other important people on their life or that something will happen to the children themselves that will separate them from their parents. Children often refuse to go to school or even to leave home, not because they are afraid of school but because they afraid of separating from loved ones. These fears can result in refusing to sleep alone and may be characterized by nightmares involving possible separation and by physical symptoms, distress, and anxiety.
Specific fears occur in a majority of people. The ones most commonly found in the population at large, categorized by Agras, Sylvester, and Oliveau. Not surprisingly, fears of snakes and heights rank near the top. Notice also that the sex ration among common fears is overwhelmingly female with a couple of exceptions. Among these exceptions is fear of heights, for which the sex ration is approximately equal.
Few people who report specific fears qualify as having phobia. But for approximately 12.5% of the population, their fears are at some point in their lives severe enough to be classified as disorders and earn the label “phobia”. These numbers seem to be increasing in younger generation. During a given 1-year period the prevalence is 8.7%. This is high percentage, making specific phobia one of the most common psychological disorders in the United States and around the world. As with common fears, the sex ratio for specific phobias is, at 4:1, overwhelmingly female; this is also consistent around the world.
For a long time, we thought that most specific phobias began with an unusual traumatic event. For example, if you were bitten by a dog, you would develop a phobia of dogs. We now know this is not always the case. This is not to say that traumatic conditioning experiences do not result in subsequent phobic behavior. Almost every person with a choking phobia had some kind of a choking experience. An individual with Claustrophobia who recently came to our clinic reported being trapped in an elevator for an extraordinarily long period.
These are examples of phobias acquired by direct experience, where real danger or pain results in an alarm response. This is one way of developing a phobia, and there are at least there others: experiencing a false alarm in a specific situation, observing someone else experience severe fear or under the right conditions, being told about danger. Many initially have an unexpected panic attack in a specific situation, related, perhaps, to current life stress. A phobia of that situation may then develop.
Munjack studied people with specific phobias of driving. He noted that about 50% of the people could remember when their phobia started had experience such as a car accident. The others had nothing terrible happen to them while they were driving, but they had experienced an unexpected panic attack during which they felt they were driving was not impaired, and their catastrophic thoughts were simply part of the panic attack. We also learn fears vicariously. Seeing someone else have a traumatic experience or endure intense fear may be enough to instill a phobia in the watcher. Remember, we noted earlier that emotions are contagious. If someone you are with is either happy or fearful, you will probably feel a tinge of happiness or fear also. Ost describes how a severe dental fear developed in this way. An adolescent boy sat in the waiting room at the school dentist’s office part
Although the development of phobias is relatively complex, the treatment is fairly straightforward. Almost everyone agrees that specific phobias require structured and consistent exposure-based exercises. Nevertheless, most patients who expose themselves gradually to what they fear must be under therapeutic supervision. Individuals who attempt to do too much too soon and end up escaping the situation, which may strengthen the phobia. In addition, if they fear having another unexpected panic attack in this situation, It is helpful to direct therapy at panic attacks in the manner described for panic disorder. For separation anxiety, parent are often included to help structure the exercises and work with parental reaction to childhood anxiety.
Finally, in cases of blood-injury-injection phobia, where fainting is a real possibility, graduated exposure-based exercises must be done in specific ways. Individuals must tense various muscle groups during exposure exercises to keep their blood pressure sufficiently high to complete the practice. New development make it possible to treat many specific phobias, including blood phobia, in a single, daylong session. Basically, the therapist spends most of the day with the individual, working through exposure exercises with the phobia object or situation. The patient then practices approaching the phobic situation at home, checking in occassionally with the therapist
Social anxiety disorder, also known as social phobia, involves intense fear of certain social situations—especially situations that are unfamiliar or in which you feel you’ll be watched or evaluated by others. These social situations may be so frightening that you get anxious just thinking about them or go to great lengths to avoid them. Underlying social anxiety disorder or social phobia is the fear of being scrutinized, judged, or embarrassed in public.
You may be afraid that people will think badly of you or that you won’t measure up in comparison to others. And even though you probably realize that your fears of being judged are at least somewhat irrational and overblown, you still can’t help feeling anxious. While it may seem like there’s nothing you can do about the symptoms of social anxiety disorder or social phobia, in reality, there are many things that can help. It starts with understanding the problem. Common social phobia / social anxiety disorder triggers
Although it may feel like you’re the only one with this problem, social anxiety or social phobia is actually quite common. Many people struggle with these fears. But the situations that trigger the symptoms of social anxiety disorder can be different. Some people experience anxiety in most social and performance situations, a condition known asgeneralized social anxiety disorder. For other people with social phobia, anxiety is connected with specific social situations, such as speaking to strangers, eating at restaurants, or going to parties. The most common specific social phobia is fear of public speaking or performing in front of an audience. Triggers for social anxiety disorder (social phobia)
Signs and symptoms of social anxiety disorder / social phobia Just because you occasionally get nervous in social situations doesn’t mean you have social anxiety disorder or social phobia. Many people are shy or self-conscious—at least from time to time—yet it doesn’t get in the way of their everyday functioning. Social anxiety disorder, on the other hand, does interfere with your normal routine and causes tremendous distress. For example, it’s perfectly normal to get the jitters before giving a speech. But if you have social anxiety disorder or social phobia, you might worry for weeks ahead of time, call in sick to get out of it, or start shaking so bad during the speech that you can hardly speak.
Emotional symptoms of social anxiety disorder / social phobia Excessive self-consciousness and anxiety in everyday social situations Intense worry for days, weeks, or even months before an upcoming social situation Extreme fear of being watched or judged by others, especially people you don’t know Fear that you’ll act in ways that that will embarrass or humiliate yourself Fear that others will notice that you’re nervous
Physical symptoms of social anxiety disorder / social phobia Red face, or blushing
Shortness of breath
Upset stomach, nausea (i.e. butterflies)
Trembling or shaking (including shaky voice)
Racing heart or tightness in chest
Sweating or hot flashes
Feeling dizzy or faint
Behavioral symptoms of social anxiety disorder / social phobia Avoiding social situations to a degree that limits your activities or disrupts your life Staying quiet or hiding in the background in order to escape notice and embarrassment A need to always bring a buddy along with you wherever you go Drinking before social situations in order to soothe your nerves Social anxiety disorder / social phobia in children
There’s nothing abnormal about a child being shy, but children with social anxiety disorder or social phobia experience extreme distress over everyday activities and situations such as playing with other kids, reading in class, speaking to adults, taking tests, or performing in front of others. Often, children with social phobia don’t want to go to school. Social anxiety disorder treatment #1: Challenge negative thoughts Social anxiety sufferers have negative thoughts and beliefs that contribute to their anxiety. If you have social anxiety disorder, or social phobia, you may find yourself overwhelmed by thoughts like: “I know I’ll end up looking like a fool.”
“My voice will start shaking and I’ll humiliate myself.” “People will think I’m stupid.”
“I won’t have anything to say. I’ll seem boring.”
Challenging these negative thoughts, either through therapy or on your own, is one effective way to reduce the symptoms of social anxiety disorder. The first step is to identify the automatic negative thoughts that underlie your fear of social situations. For example, if you‘re worried about an upcoming work presentation, the underlying negative thought might be: “I’m going to blow it. Everyone will think I’m completely incompetent.” The next step is to analyze and challenge them. It helps to ask yourself questions about the negative thoughts: “Do I know for sure that I’m going to blow the presentation?” or “Even if I’m nervous, will people necessarily think I’m
incompetent?” Through this logical evaluation of your negative thoughts, you can gradually replace them with more realistic and positive ways of looking at social situations that trigger your anxiety. Unhelpful thinking styles involved in social phobia
In particular, ask yourself if you’re engaging in any of the following unhelpful thinking styles: Mind reading – Assuming you know what other people are thinking, and that they see you in the same negative way that you see yourself. Fortune telling – Predicting the future, usually while assuming the worst will happen. You just “know” that things will go horribly, so you’re already anxious before you’re even in the situation. Catastrophizing – Blowing things out of proportion. If people notice that you’re nervous, it will be “awful,” “terrible,” or “disastrous.” Personalizing – Assuming that people are focusing on you in a negative way or that what’s going on with other people has to do with you. How can I stop thinking that everyone is looking at me?
In order to reduce self-focus, pay attention to what is happening around you, rather than monitoring yourself or focusing on symptoms of anxiety in your body: Look at other people and the surroundings.
Really listen to what is being said (not to your own negative thoughts). Don’t take all the responsibility for keeping conversations going—silence is okay, other people will contribute. Adapted from: Moodjuice
Social anxiety disorder treatment #2: Learn to control your breath Many changes happen in your body when you become anxious. One of the first changes is that you begin to breathe quickly. Overbreathing throws off the balance of oxygen and carbon dioxide in your body—leading to more physical symptoms of anxiety, such as dizziness, a feeling of suffocation, increased heart rate, and muscle tension.
Learning to slow your breathing down can help you bring your physical symptoms of anxiety back under control. Practicing the following breathing exercise will help you stay calm when you’re the center of attention. A breathing exercise to help you keep your calm in social situations Sit comfortably with your back straight and your shoulders relaxed. Put one hand on your chest and the other on your stomach. Inhale slowly and deeply through your nose for four seconds. The hand on your stomach should rise, while the hand on your chest should move very little. Hold the breath for two seconds.
Exhale slowly through your mouth for six seconds, pushing out as much air as you can. The hand on your stomach should move in as you exhale, but your other hand should move very little. Continue to breathe in through your nose and out through your mouth. Focus on keeping a slow and steady breathing pattern of 4-in, 2-hold, and 6-out. Relaxation techniques for anxiety relief
In addition to deep breathing exercises, regular practice of relaxation techniques such as meditation, yoga, and progressive muscle relaxation will also help you get control over the physical symptoms of anxiety. For step-by-step advice on getting started, see Relaxation Techniques for Stress Relief: Finding the Relaxation Exercises that Work for You. Social anxiety disorder treatment #3: Face your fears
One of the most helpful things you can do to overcome social anxiety disorder, or social phobia, is to face the social situations you fear rather than avoid them. Avoidance keeps social anxiety disorder going. Avoidance leads to more problems
While avoiding nerve-wracking situations may help you feel better in the short term, it prevents you from becoming more comfortable in social situations and learning how to cope. In fact, the more you avoid a feared social situation, the more frightening it becomes. Avoidance may also prevent you from doing things you’d like to do or reaching certain goals. For example, a fear of speaking up may prevent you from sharing your ideas at work, standing out in the classroom, or making new friends. Challenging social anxiety one step at a time
While it may seem impossible to overcome a feared social situation, you can do it by taking it one small step at a time. The key is to start with a situation that you can handle and gradually work your way up to more challenging situations, building your confidence and coping skills as you move up the “anxiety ladder.” For example, if socializing with strangers makes you anxious, you might start by accompanying an outgoing friend to a party. Once you’re comfortable with that step, you might try introducing yourself to one new person, and so on. Working your way up the social phobia “anxiety ladder”
Don’t try to face your biggest fear right away. It’s never a good idea to move too fast, take on too much, or force things. This will backfire and reinforce your anxiety. Be patient. Overcoming social anxiety takes time and practice. It’s a gradual step-by-step progress. Use the skills you’ve learned to stay calm, such as focusing on your breathing and challenging negative assumptions. Social anxiety disorder treatment #4: Build better relationships Actively seeking out and joining supportive social environments is another effective way of tackling and overcoming social anxiety disorder or social phobia. The following suggestions are good ways to start interacting with others in positive ways: Take a social skills class or an assertiveness training class.
These classes are often offered at local adult education centers or community colleges. Volunteer doing something you enjoy, such as walking dogs in a shelter, or stuffing envelopes for a campaign — anything that will give you an activity to focus on while you are also engaging with a small number of like-minded people. Work on your communication skills. Good relationships depend on clear, emotionally-intelligent communication. If you find that you have trouble connecting to others, learning the basic skills of emotional intelligence can help. Social anxiety disorder treatment #5: Change your lifestyle
While lifestyle changes alone aren’t enough to overcome social phobia or social anxiety disorder, they can support your overall treatment progress. The following lifestyle tips will help you reduce your overall anxiety levels and set the stage for successful treatment: Avoid or limit caffeine. Coffee, tea, caffeinated soda, energy drinks, and chocolate act as stimulants that increase anxiety symptoms. Drink only in moderation. You may be tempted to drink before a party or other social situation in order to calm your nerves, but alcohol increases your risk of having an anxiety attack. Quit smoking. Nicotine is a powerful stimulant. Smoking leads to higher, not lower, levels of anxiety. Get adequate sleep. When you’re sleep deprived, you’re more vulnerable to anxiety. Being well rested will help you stay calm in social situations.
When self-help for social anxiety / social phobia isn’t enough The best treatment approach for social anxiety disorder varies from person to person. You may find that self-help strategies are enough to ease your social anxiety symptoms. But if you’ve tried the techniques above and you’re still struggling with disabling anxiety, you may need professional help as well. Therapy for social anxiety disorder / social phobia
Of all the professional treatments available, cognitive-behavioral therapy (CBT) has been shown to work the best for treating social anxiety disorder, or social phobia. Cognitive-behavioral therapy is based on the premise that what you think affects how you feel, and your feelings affect your behavior. So if you change the way you think about social situations that give you anxiety, you’ll feel and function better.
Cognitive-behavioral therapy for social phobia typically involves: Learning how to control the physical symptoms of anxiety through relaxation techniques and breathing exercises. Challenging negative, unhelpful thoughts that trigger and fuel social anxiety, replacing them with more balanced views. Facing the social situations you fear in a gradual, systematic way, rather than avoiding them. While you can learn and practice these exercises on your own, if you’ve had trouble with self-help, you may benefit from the extra support and guidance a therapist brings. Group therapy for social anxiety disorder / social phobia
Other cognitive-behavioral techniques for social anxiety disorder include role-playing and social skills training, often as part of a therapy group. Group therapy for social anxiety disorder uses acting, videotaping and observing, mock interviews, and other exercises to work on situations that make you anxious in the real world. As you practice and prepare for situations you’re afraid of, you will become more and more comfortable and confident in your social abilities, and your anxiety will lessen. Medication for social anxiety disorder / social phobia
Medication is sometimes used to relieve the symptoms of social anxiety, but it’s not a cure for social anxiety disorder or social phobia. If you stop taking medication, your symptoms will probably return full force. Medication is considered most helpful when used in addition to therapy and other self-help techniques that address the root cause of social anxiety disorder. Three types of medication are used in the treatment of social anxiety disorder / social phobia: Beta blockers – Beta blockers are used for relieving performance anxiety. They work by blocking the flow of adrenaline that occurs when you’re anxious.
While beta blockers don’t affect the emotional symptoms of anxiety, they can control physical symptoms such as shaking hands or voice, sweating, and rapid heartbeat. Antidepressants – Antidepressants can be helpful when social anxiety disorder is severe and debilitating. Three specific antidepressants—Paxil, Effexor, and Zoloft—have been approved by the U.S. Food and Drug Administration for the treatment of social phobia. Benzodiazepines – Benzodiazepines are fast-acting anti-anxiety medications. However, they are sedating and addictive, so they are typically prescribed only when other medications for social phobia have not worked.
Symptoms of social phobia
Excessive self-consciousness and anxiety in everyday social situations Intense worry for days, weeks, or even months before an upcoming social situation Extreme fear of being watched or judged by others, especially people you don’t know Fear that you’ll act in ways that that will embarrass or humiliate yourself Fear that others will notice that you’re nervous
Red face, or blushing
Shortness of breath
Upset stomach, nausea (i.e. butterflies)
Trembling or shaking (including shaky voice)
Racing heart or tightness in chest
Sweating or hot flashes
Feeling dizzy or faint
Is a marked fear and avoidance of being alone or isolated in open and public places from which escape might be difficult or embarrassing. This phobia is accompanied by avoidance behaviors that may eventually interfere with normal activities. It can become so debilitating that it prevents the individual from going into any open space, traveling in airplanes or through tunnels, or being in crowds. People with a severe case may decide never to leave their home, fearing that they will lose control, panic, or cause a scene in a public place. Agoraphobia is often brought on by stress, particularly interpersonal stress. It is far more common in women than in men, and it is often accompanied by other disorders.
This disorder brings about hyperventilation, extreme tension, and even cognitive disorganization. Agoraphobics feel weak and dizzy when they have an attack and often suffer from severe panic attacks. Panic attacks are characterized as acute anxiety, accompanied by sharp increases in autonomic nervous system arousal, that is not triggered by a specific event; persons who experience such attacks often avoid the situations that are associated with them, thus perpetuating the agoraphobia.
Agoraphobia is complicated, incapacitating , and extraordinarily difficult to treat. According to freud and other psychoanalysts, traumatic childhood experiences may cause people to avoid particular objects, events, and situations that produce anxiety. Freudians speculate that as young children, agoraphobics may have feared abandonment by a cold or nonnurturing mother and the fear has generalized to a fear of abandonment or helplessness. Most researchers today find Freudian explanations of phobic behavior unconvincing. As an alternative, modern learning theory suggests that agoraphobia may develop because people avoid situations they have found painful or embarrassing. Failed coping strategies and low self-esteem have been implicated. Despite much research, no simple cause for the disorder has been found.
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