Article: Nidhi Dharod | Edited: Atri Das | Illustration: Dr. Ria Das
"Everything you want is on the other side of fear." - Jack Canfield
Fear of an obvious object like a lion or knife that pose imminent danger to our life is natural. It alerts our danger alarm and helps us make wise and careful decisions during fight or flight response.
Phobia, on the other hand, is an intense, irrational and disproportionate fear of an object, place or situation. The fear and anxiety is more intense than is deemed necessary. People have a tendency to escape the feared object rather than fight it, cocooning oneself and shutting oneself from the rest of the world!
According to American Psychiatry Association (APA), there are three types of phobia:
1) Specific phobia like snakes, heights or flying
2) Social phobia where social interactions cause extreme anxiety and
3) Agoraphobia, fear of places that might cause panic, helplessness or embarrassment
In some cases of phobias, the fear can become so persuasive and overwhelming that the individual will go to extreme lengths to avoid being alone which further affects a lot of their personal relationships. Generally, people with specific phobias recognize that their fear is somewhat excessive or unreasonable although occasionally they might not have this realization. There are a number of treatment approaches whose effectiveness depends on the person, the intensity and the type of phobia.
These are some common symptoms faced by phobic patients when exposed to the phobic object or situation. The same may also occur if the patient thinks about the object. The fear is usually higher if getting away is difficult. As per DSM V, symptoms may include:
➢ Extreme anxiety or fear ➢ Increased heart rate ➢ Nausea ➢ Dizziness ➢ Breathlessness ➢ High blood pressure ➢ The fear or anxiety causes significant distress in various areas of functioning. ➢ Children may express anxiety or fear by crying, tantrums, freezing or clinging.
Extreme anxiety or fear in phobia can lead to panic attacks. Following are some of the symptoms ➢ Rapid speech or inability to speak ➢ Dry mouth ➢ Trembling or shaking ➢ Chest pain ➢ Choking sensation ➢ Fear of dying ➢ Profuse sweating
Symptoms should last for 6 months or more to be diagnosed as phobia.
Onset of phobia is in the early years of childhood but, it is very much possible for a specific phobia to develop at any particular age. This disorder is more prominent among women than men. The following are considered to be the major causes of phobias -
Genetics and Environmental factors: Links are found between an individual’s phobia and related mental health issues of up to the third degree of family members. Phobias can be learnt by seeing a family member react negatively to a phobic object too. People with predisposition to anxiety have greater risk of developing a phobia.
Negative experiences: Experiencing a frightening traumatic event, such as being trapped in an elevator or attacked by an animal, or observing someone go through a traumatic event may trigger the development of a specific phobia. Some phobias are formed due to panic attacks which get associated with the situations.
Neurological factors: Changes in brain functioning also may play a role in developing specific phobias. In a study by Raunch et. Al, Aue et. Al and LeDoux et. Al, participants when exposed to phobic stimuli had an increased activation of the amygdala, visual cortex and cerebellum as compared with non-phobic stimuli. Activity decreased in the auditory cortices, somatosensory cortices and prefrontal cortex. As per McNally inhibited neural associations are responsible for fighting the fear and diminishing it. The activation of the pre-frontal cortex which stores extinction memories is associated with inhibiting learnt fear responses.
Comorbidity: Phobia in elder people may co-occur with other mental health conditions like depression, anxiety or substance abuse.
Treatment for phobia can include therapeutic techniques, medications or a combination of both. Therapy is aimed at reducing fear and anxiety symptoms and helping people manage their reactions to the object or situations they are scared of.
One of the Exposure Techniques include Systematic Desensitization where client talks about his feelings while discussing the phobia. Later, the client is mildly exposed to the phobic object or situation starting with the least anxiety causing situation to the most anxiety causing situation. For e.g. If the client is scared of dogs, the first step would be exposing a picture of dog to them, this is accompanied by relaxation techniques to calm them down. Later moving along the step client would be at a distance of 1km from the dog and gradually the distance is decreased. The last level would be of client holding or playing with a dog with no feelings of anxiety or fear.
Another Exposure technique is Flooding it is not vividly used in clinical settings. It is exactly opposite of Desensitization which includes direct exposure to the phobic object or situation for an extended time with no opportunity of escaping. They gradually learn that the phobia won’t hurt them and is largely irrational.
Cognitive Behavioural Therapy (CBT) is the most commonly used therapeutic treatment for phobia. This therapy focuses on identifying and changing negative thoughts, reactions and irrational beliefs to a phobic object or situation into rational to overcome the phobia.
Medications like Antidepressants which affect serotonin levels in the brain, can result in better moods. Anti-anxiety medications also help calm emotional and physical reactions to fear. Also, treatment procedures involving activating the amygdala many promote the release of GABA which is an inhibitory neurotransmitter.
Concluding with the fact that, there is a thin line of difference between fear and phobia, the former is usually dealt through a flight or flight response while the latter is generally unfounded and has severe impact on a person’s homeostatic mental state.
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