Effective treatment of phobias involves focusing therapy on both the thinking brain and the emotional midbrain.  Each part of the brain contributes to distress.  Each area of the brain requires different types of interventions.

Unfortunately, most therapists only focus on the thinking brain.  Without the knowledge of how to treat the emotional midbrain, therapy fails to produce significant results.  Phobias fail to get much better.

An anxiety treatment specialist should begin phobia treatment by focusing therapy on the midbrain's contribution to distress.

Phobia Therapy for the Emotional Midbrain

Treating this primitive part of the brain requires a non-cognitive approach.  This is because the limbic system does not work well with language.  However, what does work is a sophisticated form of behavioral therapy.  The behavioral therapy phase of treatment can be divided into four stages:

Counter-Conditioning Past Painful Memory Imprints

This involves identifying negative or painful experiences that directly contribute to the formation of a phobia.

Once identified, each painful memory will be desensitized.  This means providing a special type of therapy that can separate the pain and distress from the memory.

In this procedure, the painful memory is recalled and reviewed.  As you tell the story or view the mental movie of the event, therapeutic interventions are used to create a strong relaxation response.  This is at the exact same time you are recalling and activating a stress response related to the negative memory.  Since you cannot be stressed and relaxed at the same time, if the relaxation response is strong enough, it will override and overwrite the feeling of stress.  In the car crash example, imagine replacing the feeling of fear and distress with such a strong feeling of relaxation that your brain learns to be relaxed when recalling the memory.  When this happens, the alarm is no longer activated.  Your nervous system remains calm.  Reminders of the negative event (car crash example) no longer trigger anxiety.

This is called behavioral counter-conditioning.  It is retraining for the emotional midbrain.  I utilize three innovative therapies to recondition these distressing memories.  They include:

Quick REMAP

EMDR

CBT

The first two of these interventions use elements that have been shown through research to reach and calm the amygdala.  This is part of the secret to retraining this part of the midbrain.

Soothing the Sympathetic Nervous System

What if you could learn to regulate and calm your nervous system when you were in stressful, anxiety-provoking situations?  What if you could do it without medication?  Well, you can!

You can learn some of the same mechanisms used in Quick REMAP and other behavioral therapies to calm your sympathetic nervous system.  This will allow you to turn off the alarm center of your brain.  Then your body will return to a calm and normal state.

My 6-part video series on "Anxiety, Stress and PTSD Treatment" reviews the interventions involved, research supporting them, and how to begin to work with them.

Virtual Reality Exposure Therapy

Now we have successfully desensitized the distress related to past memories that contributed to phobia formation.  You have also learned how to soothe the sympathetic nervous system.

You are now ready to leave the past behind and boldly step into the future.  Here we can leverage the use of video to practice facing your phobic situation.

Here is an example relating to the highway phobia that I have described.  First, I would have the person I am treating ride as a passenger and video parts of the freeway driving that trigger the phobia.

Then, we would review the video over and over in my office.  If any anxiety is triggered, we would work with the tools for calming your nervous system.  With repeated exposure to the video, while calming the body and mind, you begin to retrain the brain further.

Eventually, you should become so comfortable with the videos that they no longer have any triggering effect.

Real-World Exposure Therapy

Now we are ready to do some real-world exposure therapy to complete the treatment.  During this phase, we will create a ladder of increasingly challenging tasks.  Each task would have previously caused a phobic response.  We begin with the least threatening and work our way up the ladder to the most daunting.

Exposure therapy is an essential component of phobia treatment.  Our natural tendency is to avoid things that provoke an anxiety response.  However, in the case of false alarm reflexes, avoidance does not help you get better.  It actually strengthens the fear.

By building a list of low to high-stress exposure activities we can help you free yourself from fear.  The list might look like this for someone who had a fear of driving on overpasses.

Identify a list of overpasses that cause you anxiety.  List the most intense first and the least intense last:

1. The High 5, E. on 635 to N. on US 75 – Stress level 9

2. Bush Turnpike W. to North Dallas Toll Road S. – Stress level 7

3.  I-35 N. to 121 W. – Stress level 6

4.  S. on US 75 to W. on 635 – Stress level 4

Once we have our list, we will begin by climbing the ladder from the least to the most challenging.  Using the tools I will teach you to calm your nervous system, you will get more and more comfortable each time you work with an item on the list.  With enough repetitions, you will no longer be bothered by each situation.

Phobia Therapy for the Thinking Brain

During each phase of treating the midbrain, there is a chance that the thinking brain will jump into the action.  This usually takes place in the form of Automatic Negative Thoughts (ANTs).   ANTs can make phobias worse.

An example of this would be the negative "what if" question.  While practicing driving over high overpasses, you might have this thought.  "What if I pass out and drive off the overpass?"  This type of scary thinking can be completely irrational.  You have probably never passed out from anxiety, no matter how anxious you were.  However, if you have that thought and visualize it vividly enough, your midbrain sets off the alarm.

Here is where cognitive therapy can help challenge or redirect the automatic negative thoughts.  This takes fuel from the fire of anxiety and helps make the behavioral work go more smoothly.

When all of these elements come together, phobias can be conquered and comfort restored.

If you need help to overcome a phobia, call Steve today at 972-997-9955.

Steve Reed is available for an office appointment for your counseling and psychotherapy needs in the Dallas, Fort Worth, DFW metroplex, including Addison, Allen, Arlington, Bedford, Carrollton, Colleyville, Denton, Euless, Flower Mound, Frisco, Garland, Grand Prairie, Grapevine, Highland Park, Hurst, Irving, Keller, Lake Highlands, Lewisville, McKinney, Mesquite, Murphy, Plano, Richardson, Rockwall, Rowlett, South Lake, and University Park. He provides therapy at his office in Richardson, TX.

Treatment is also available via phone or video counseling to people worldwide. 

Steve can also be contacted by email at stevereed@psychotherapy-center.com.