Treatment, Therapy, Relief
DFW, Dallas, Plano, Richardson TX
By Steve Reed, LPC, LMSW, LMFT
What are Phobias?
Phobias are irrational and perhaps extreme fears of situations or things that present no clear or present danger. A phobia can also be a fear of any situation that presents such a low risk profile that few people worry about it.
Phobias can interfere with work, social and family responsibilities. This is a common reason people seek therapy to find relief from the distress of phobic reactions.
Phobias effect about 4% to 5% of the U.S. population. Although this percentage may sound low, it still means a very large number of people suffer each year from fears and phobias. In Australia, it is estimated that over 2 million people will suffer from some form of anxiety, including specific phobias.
Fears and Phobias
A person can develop a fear or phobia in relation to almost anything under certain circumstances. However, there are a number of phobias that are very common. Some of these can be very disruptive to people's lives. Many of the people that I treat in the DFW area are dealing with one or more of the following:
If you develop a fear of driving your life will either be very inconvenienced or you will suffer a lot of distress. This is largely due to the fact that if you want to travel in the Dallas, Plano, Allen, Frisco, McKinney, Garland, or Richardson TX area, you will have to drive. There is not a very good public transportation system in the DFW area, so driving is the main choice. Driving can be a big problem if you are suffering from:
Fear of Overpasses
Fear of Highway Driving
Fear of Flying | Airplane Phobia
I work with a lot of business travelers who have developed a fear of flying. This can really get in the way of one's career and adds an unnecessary level of stress to the normal challenges of high performing business professionals.
Fear of Public Speaking
This is another phobia that can be a work-related obstacle to business professionals. If your work requires that you present to groups or even small work teams, then a speaking phobia can become overwhelming.
Fear of Heights
If you work in a tall office building or have to be in high structures, then a fear of heights can be a constant source of anxiety. This is what confronts many working people daily. Although you can easily avoid riding in hot air balloons, it may be more difficult to avoid the windows of your 10th floor office.
By Steve Reed at the Psychotherapy Center
Elevator phobias can interfere with work for many people. I have had clients who would walk up 10 flights of stairs to avoid an elevator. The feeling of being trapped or confined can become so overwhelming that people have even quit a perfectly good job to avoid dealing with an elevator on a daily basis.
There are many other phobias. Fear of insects (a bug phobia), animal phobias, needle phobias, agoraphobia, claustrophobia, and social phobia are some of the more common problems that people suffer. I have treated many people who have emetophobia, a fear of throwing up, or vomiting.
Research from the Ohio State University has shown that the greater a person's fear, the more they distort the level of threat associated with their fear.¹ This can magnify the intensity of a phobia and increase the degree to which it disrupts one's life.
Needle phobias can lead to the avoidance of needed medical care. The fear of doctors or treatment centers, latrophobia, can lead to serious medical issues. Social phobias can contaminate the pleasure associated with normal social functions. Emetophobia can dramatically affect eating and social situations. Phobias can adversely affect one's life both in terms of function and quality.
Phobia symptoms can be experienced as rather mild anxiety or they can be extreme, overwhelming, and turn into a panic attack. I typically find that the people I treat will suffer from several of among 35 or more typical phobia and anxiety symptoms. Here is a list of some of the most common physical symptoms of distress associated with phobias:
- Heart racing
- Shaking or trembling
- Difficulty breathing
- Tightness in the chest
- Butterflies in the stomach
- Dizzy or light headed
- Hot feeling
What Phobias Have in Common
What phobias have in common can be viewed within the context of two categories related to the brain's involvement.
The emotional midbrain or limbic system governs the fight-or-flight reflex. It is the part of the brain that serves as its alarm system. When we experience an overwhelming, high emotional impact event it can affect this part of the brain. If the stress intensity level is high enough, a primitive part of the midbrain, the amygdala, gets imprinted.
In a frightening or overwhelming moment, the amygdala encodes sensory data about the experience. It records all of the visual, auditory, kinesthetic (sensory), and olfactory data that is present.
Because the midbrain is not smart like the cortex (the thinking brain), it cannot determine what is really a threat. So what does it do? It codes everything as equally threatening.
Here is an example. You were in an auto accident on the highway. You crashed into the guard rail. Even if you were not seriously injured, you could have been so shaken by the experience that your midbrain perceives a threat. If it perceives a threat, then it will try to protect you from experiencing the same threat in the future. It does this by coding everything about the event as dangerous.
In this case, the midbrain might conclude that highways are the problem or fast driving is the problem. If a teenager, driving in a distracted state, caused the car crash, then this too would be coded as dangerous.
Unfortunately, only one of the three conditions cited above was actually responsible for the accident. However, your midbrain would rather be safe than sorry. So, it also codes highways and fast driving as equally dangerous. It does so even if these are benign conditions.
Now your amygdala has been conditioned to associate danger with all three of these elements. Any reminder of them in the future will set off the alarm. When the alarm center goes off, your sympathetic nervous system is activated. You begin to experience the physical symptoms of fight-or-flight. You have the symptoms of distress associated with phobias.
This is your brain trying to protect you from a recurrence of the highway accident. It is trying to protect you by keeping you from driving on highways and in fast traffic. Even though the intentions are good, it is, in fact, making a mistake. However, it does not care. It only cares about you surviving. Even if it is at the expense of you not being able to drive to work on the highway.
To keep this midbrain alarm system from firing off false alarm reactions, the midbrain needs to be retrained. In the last section, we will look at how this can be accomplished.
Thinking Brain Involvement
The cortex (thinking part of the brain) can also become involved in the activation of phobic responses. Where the midbrain is too primitive to work with language, the cortex is just the opposite. The thinking brain is so sophisticated that it can create vivid stories and imagery. The problem here is that the poor dumb midbrain cannot tell the difference between what is actually happening and what the cortex vividly imagines. If the imagery is negative enough, the amygdala thinks it is real. It then sets off the fight-or-flight alarm.
If you were starting to dread getting on the freeway and vividly imagined having a panic attack while driving, the midbrain would react. It would believe that it was going to happen. To protect you, it sets off the alarm. Then you begin to feel panicky.
How ironic, the only way the midbrain can save you from anxiety is to make you anxious enough that you will not drive on freeways.
The same applies to whatever phobia you have. This pattern is common to all phobias. It does not matter whether it is related to driving, flying, public speaking, heights, elevators, bugs, animals, water, or anything else. The good news, however, is that the mechanism of formation and activation of phobic responses are all the same. Therefore, we can use the same systematic approach to treat any phobia.
Phobia Treatment, Therapy, Relief
By Steve Reed at the Psychotherapy Center
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:
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 email@example.com.
1. Vasey, M. W., Vilensky, M. R., Heath, J. H., Harbaugh, C. N., Buffington, A. G., & Fazio, R. H. (2012). It Was as Big as My Head, I Swear! Biased Spider Size Estimation in Spider Phobia. Journal of Anxiety Disorders, 26(1), 20–24. http://doi.org/10.1016/j.janxdis.2011.08.009