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The Truth About Phobias

Phobias may be irrational but they are real medical conditions that can be treated.

Nature or Nurture? continued...

But this theory doesn't come close to explaining most phobias.

"Why," McNally asks, "would we have an evolutionary fear of spiders if the vast majority are not poisonous to humans?" His answer? "Spiders and snakes move quickly and unpredictably. They are highly discrepant from human form. It may not be so much that we are biologically prepared to fear spiders because they threatened our early ancestors but that certain things related to spiders happen to elicit fear."

Certain things trip wires in our brains. As we get older, most of us outgrow these fears. Some of us don't. And some of us apparently have extraordinarily sensitive fear alarms.

Which is why, in the future, McNally says, phobias may be referred to as a kind of "fear circuitry disorder."

Not everyone who is scared by a spider or who feels anxious in a crowded elevator or airplane has a phobia. Phobias are learned behaviors. And while they can't be unlearned, it's possible to override them with new learning.

Treatment for Phobias

"The goal of treatment is not to disconnect the fear but to overcome it with new learning that overrides the underlying fear," McNally says. The technique is called exposure therapy. Here's how it works:

Evaluation: A professional therapist first assesses a patient and asks what he or she is afraid of, and what has happened in the past that may contribute to these fears.

Feedback: The therapist conducts a detailed assessment and offers a treatment plan.

Fear hierarchy: The therapist creates a list of fearful situations, increasing in order of intensity.

Exposure: The patient is exposed to the feared situations -- starting with the least scary. Patients learn that panic decreases after a few minutes.

Building: The patient moves up the list to confront increasingly difficult situations.

Take, for example, a person with a snake phobia who decides to try exposure therapy. Barbara Olasov Rothbaum, PhD, director of the Trauma and Anxiety Recovery Program at Atlanta's Emory University, starts with pictures of snakes. Then she and her patient handle rubber snakes. Then they go to the zoo. Then comes the ultimate test.

"We have a photo taken with a snake around the patient's neck -- with the patient not experiencing any anxiety," says Ross. "In the future, when that person starts to get scared, the picture serves as a reminder."

Does treatment work forever? Not without constant practice, Rothbaum says. "It's like losing weight. You have to stick with diet and exercise to stay thin."

And Wolicki? With exposure therapy, her world slowly is getting larger.

"I got over some of my phobias," she says. "Now I can get into an elevator and not think it is going to stall and I am going to die. And I can take the subway. I am still a little hesitant, but I can do that."

Published August 16, 2006.

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