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).”
Types of Phobias
- Animal (e.g., spiders, insects, dogs)
- Natural environment (e.g., heights, storms, water)
- Blood-injection-injury (e.g., needles, invasive medical procedures)
- Fear of blood
- Fear of injections and transfusions
- Fear of other medical care
- fear of injury
- Situational (airplanes, elevators, enclosed places). The clinical features of this phobia depend on the specific situation, and can be complex. More information on fear of flying and driving phobia can be found on separate pages on this site
- Fear of choking
- Fear of COVID ( This is a new phobia that has emerged characterized by excessive and unreasonable fear of contracting COVID-19. There are obsessional features to this phobia and COVID related agoraphobia can occur as a result)
Treatment
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.
- Exposure Therapy and systematic desensitization
- Cognitive and Behavioral Therapy
- Inference-Based Cognitive and Behavioral Therapy with concepts adapted from the Theory of Constructed Emotion Developed by neuroscientist Lisa Feldman Barrett
- Emotional Regulation Therapy
- Virtual Reality (VR) Ovrcome Virtual Reality (VR) treatment program https://www.ovrcome.io/
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.
Self-Soothing-Emotional Regulation
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 mastered in order for it to be effective in real time.
Steps of Treatment
- General assessment and evaluation
- History of phobia, including start, changes over time, contributing factors
- Assessing, unpacking and mapping the specific phobia(s)
- Presenting the treatment model and different approaches to be used
- Creating a ladder of difficulty for exposures
- CBT psycho-education
- Teaching emotional regulation
- Imaginal Exposures
- Integrating Virtual Reality
- Preparing first exposures
- Progressing up the exposure ladder
- End of treatment and relapse prevention
Links to useful Resources
Becoming a Client
Phone Screening
To understand your specific needs and whether we might be a fit to work together, I offer a free phone screening. I gather initial information about the condition and symptoms for which you are seeking treatment, why you have made this decision now, co-existing conditions, past treatment as well as your motivation and commitment to change. I also I briefly explain the CBT approaches I use, including Inference-Based Cognitive and Behavioral Therapy (I-CBT) The screening is also an opportunity for prospective clients to ask questions and get a sense of who I am and how I work.
One Initial Assessment Session
If the phone screening suggests that there could be a fit, I usually propose one initial assessment session to get more information about your symptoms as well as your relationship and family histories. At the end, I share initial diagnostic impressions along with a sketch of a treatment plan and paths we might take if we agreed to go further.
How to become a client
I offer a free phone screening, to understand your specific needs, and get a snap shot about the condition(s) and symptoms for which you are seeking treatment. We briefly explore why you have made the decision to seek treatment now, possible co-existing conditions as well as your motivation and commitment to change. I briefly explain the CBT approaches I use, including Inference-Based Cognitive and Behavioral Therapy (I-CBT) and answer question you might have
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