Specific phobia is a consistent, intense or severe fear of a “specific object or situation” that continues for 6 months or more. In phobias the degree of fear experienced is “out of proportion to whatever possible danger posed by the specific object”. The closer one is to the phobic object/situation the great the fear, and intensity of reactions can range from moderate to intense, overwhelming symptoms of panic. Usually, the phobic object or situation presents no objective danger whatsoever. Yet, these are avoided if possible or “endured with intense fear” to a degree that can cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

To meet criteria it is important that symptoms NOT be the product of another condition, such as the type of “fear, anxiety, and avoidance” caused by “panic-like symptoms (as in agoraphobia), or those related to obsessions (as in obsessive-compulsive disorder), “reminders of traumatic events, separation from home or attachment figures or social situations (as in social anxiety disorder).”

I treat phobias using a combination of method that include: desensitization through progressive exposures to the phobic situation together with Cognitive and Behavioral Therapy (CBT) emotional regulation strategies, that include selected principles from adapted from the Theory of Constructed Emotion, developed by Harvard Neuroscientist, Lisa Feldman-Barrett.

Regardless of the modality, it is important to “unpack’” the specific origins and components of how the phobic fear is constructed that are unique to the person.This is important to create the relevant hierarchy of steps for progressive exposure and desensitization. Often there are irrational beliefs about the situation or object that need to be discovered and reframed. It is important to have a de-castrophized, reality-based path to travel when desensitizing.

For example, a phobia of elevators could be driven by fear of a life-threatening accident; or there could be a fear of suffocation in the elevator. The cognitive strategies and even the way exposures are organized would vary depending on what exactly is feared in a given situation. Thorough interviewing is the only way to reveal the specificity of meaning necessary to design a treatment plan tailored to the person’s needs.

Calming strategies, such as breathing retraining, recalled relaxation and mindfulness training are also components the treatment of phobias. Dialing down “anxious reactivity” improves one's ability to tolerate extreme distress of exposure. It important to first practice and master these strategies in a non-threatening environment. In basketball you develop your shot and dribble in practice. Once skill is achieved, then you move on to a game situation. Self-soothing is also a skill that must be first developed in separate learning space. Once mastered it can used fluidly when facing challenging phobia

Here is a graphic model of the phobia treatment process