Phobia and its treatment

ByDr./ Hala Salah

Lecturer of psychiatry

PHOBIA

Defined as irrational fear that produce conscious avoidance of the feared subject, activity, or situation.

Either the presence or the anticipation of the phobic entity elicits severe distress in the affected person who usually recognize that the reaction is excessive.

Phobias are divided into two main categories:

Specific phobias:. Strong persistent fear of an object or situation These include

-situational type: (e.g. enclosed spaces ,elevators, airplanes)

- Animal type: particularly spiders, snakes.

-Natural environment type (e.g. heights, storms, water ) .

-Blood-injection-injury type -Other type: flying, germs, illness, death.

Social phobia Strong persistent fear of situation in

which embarrassment can occur .

Social phobia involves a combination of: - Excessive self-consciousness, - Fear of public humiliation in common social situations, - Fear of negative evaluation by others.

-Feeling of overwhelming anxiety.-Feeling an intense need to escape-Difficulty breathing

- Racing or pounding heart- Chest pain or tightness

-Feeling dizzy or lightheaded-Hot or cold flashes; tingling sensations-Sweating

The avoidance , anxious anticipation,

or the distress may interfere significantly with the person’s normal routines, occupational, academic functioning or social activities.

ETIOLOGY--- Specific phobia

Behavioral1-Pairing of a specific object or

situation with emotions of fear.

2-Modeling :- observing the reaction in another e.g. parents.

3-Information transfer which the person is taught to be danger.

GENETIC At least one of the first degree relative has specific phobia of the same type

AETIOLOGY--- Social phobia

: Behavioral inhibition during childhoodParents are less caring , more rejecting , more protecting

Genetics:First degree relatives have three times more incidence than control’ relatives

Neurochemical factors

-Increase release of epinephrine and norepinephrine.

-Increase sensitivity to normal level of adrenergic stimulation.

-Dopaminergic dysfunction.

Selective serotonin reuptake inhibitors (SSRIs)

Benzodiazepines

Beta Blockers

Through repeated experiences facing your fear, you’ll begin to realize that the worst isn’t going to happen; you’re not going to die or “lose it”.

With each exposure, you’ll feel more confident and in control. The phobia begins to lose its power.

Make a listBuild your fear ladderWork your fear up the ladderPractice

Step 1: Look at pictures of dogs.Step 2: Watch a video with dogs in it.Step 3: Look at a dog through a window.Step 4: Stand across the street from a dog

on a leash.Step 5: Stand 10 feet away from a dog on

a leash.

Step 6: Stand 5 feet away from a dog on a leash.

Step 7: Stand beside a dog on a leash.Step 8: Pet a small dog that someone is

holding.Step 9: Pet a larger dog on a leash.Step 10: Pet a larger dog off leash.

A simple deep breathing relaxation exercise!!!!!

Once the patient is comfortable with this deep breathing technique, he can start to use it when he is facing his phobia or in other stressful situations

The patient tends to:1- overestimate how bad it will be if

he is exposed to the situation he fears.

2- At the same time, he underestimates his ability to cope.

A-Telling the future

I will definitely suffocate when the elevator doors close.”

“That pit bull lunged at me. All dogs are dangerous.”

“The person next to me coughed. May be it’s the swine flu. I’m going to get very sick!”

Is there any evidence that contradicts this thought?

“I see many people using the elevator and it has never broken down.”

“I have never actually been in an elevator that has broken down.”

Could you do anything to resolve this situation if it does occur?

“I guess I could press the alarm button or use the telephone to call for assistance.”

Are you making a thinking error?“Yes. I’m fortune telling, as I have no

evidence to suggest that the elevator will break down.”

What would you say to a friend who has this fear?

“I would probably say that the chances of it happening are very slim.

Thank you