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What Are Phobias, and How Are They Treated?

Medically Reviewed by Smitha Bhandari, MD on September 14, 2021

Phobias are irrational and disabling fears. If you have one, you'll do almost anything to avoid what you're afraid of. Someone with a phobia understands that their fear is not logical. Still, if they try to squelch it, it only makes them more anxious.

What Causes Phobias?

Phobias often begin in childhood. Some are responses to traumatic events, like a bite from a dog. Still, most have no obvious cause.

People with a specific phobia have a persistent, irrational fear of particular objects or situations such as:

  • Balloons
  • Bugs
  • Dentists
  • Driving
  • Enclosed spaces (claustrophobia)
  • Germs
  • High places (acrophobia)
  • School
  • Water
  • Snakes
  • Blood
  • Flying
  • Elevators

The fear is usually not of the thing itself, but of some terrible outcome, like falling from an airplane.

Other types of phobias

If you have agoraphobia, you have many fears that have three main themes:

  • Leaving home
  • Being alone
  • A situation where you can't suddenly leave or get help and you feel trapped or helpless

When fear is at its peak, an agoraphobic person may go to almost any lengths to avoid leaving home. Agoraphobia may come about after repeated panic attacks.

If you have social phobia, or social anxiety disorder, you have a persistent, irrational fear of situations in which you may be scrutinized, criticized, or embarrassed by other people. People with it stay away from things like public speaking, parties, and public restrooms. They may even avoid restaurants.

What Symptoms Do Phobias Cause?

At the heart of a phobia, there is anxiety, which can cause:

  • Blushing
  • Faintness
  • Rapid heartbeat
  • Stuttering
  • Sweating
  • Tremors

If you have a phobia that interferes with a normal social or working life, it's time to get treatment. The right kind of therapy can often lessen your anxiety and may diminish or even remove the phobia.

How Are Phobias Treated?

Though some phobias are never completely cured, there are ways your doctor can help you get a handle on your phobias: referring you to a therapist, for example, or prescribing medication. It’s important to seek help and get treatment for phobias. A person whose phobia goes untreated may become withdrawn, depressed, and unable to be in social situations.

How well phobia treatment will work depends partly on the severity of the phobia. Therapy can help many people learn to function effectively. 

Types of therapy

Exposure therapy. Your doctor tries to change how you react to what you're fearful of by gradually exposing you to it. These work well for specific phobias. For example, if you're afraid of dogs, you may start by just thinking about dogs, then looking at a picture of one, and then spending time with a dog in a controlled environment. At each step, you practice relaxing. Once the anxiety is reduced, you’re ready for actual exposure. Relaxation techniques can help at this stage, too. The support of a trusted friend or family member also helps during this process.

For social phobia, your therapist may suggest gradual exposure to social situations, along with role-playing and rehearsal. They’ll teach you methods to reduce the anxiety you feel and encourage you to be less critical of yourself.

With agoraphobia, you move gradually into the places and situations that trigger anxiety. By taking small steps each day -- in the company of a trusted person --  you eventually learn to cope with situations that once caused intense fear. Your therapist will also encourage you to be less critical of yourself.

Cognitive behavioral therapy (CBT). In addition to exposure, you learn new ways to handle what you're afraid of differently. You figure out how to control how you think and feel about it instead of your fear controlling you.

Relaxation techniques, biofeedback, regular deep breathing, and support. These can help you overcome anxiety during treatment. Attending phobia clinics and support groups has also helped many people overcome their fears.

Medications

Your doctor may sometimes decide that medications will help. In the treatment of phobias, medications are used in conjunction with therapy and may not necessarily be a part of initial treatment.
Antidepressants. A class of these drugs called selective serotonin reuptake inhibitors (SSRIs) can be especially helpful in the treatment of social phobia. They include: 

●    Citalopram (Celexa)
●    Escitalopram oxalate (Lexapro)
●    Fluoxetine (Prozac)
●    Paroxetine (Paxil)
●    Sertraline (Zoloft)

Other antidepressants called MAO inhibitors are also effective but require careful monitoring because of interactions with certain other medicines (such as antidepressants, decongestants, or other medicines that can raise blood pressure) or food that contain the amino acid tyramine, which can be found in aged meats and cheeses. 

Beta-blockers. Many musicians, actors, and lecturers reduce their symptoms of stage fright with these drugs known (mostly propranolol). They temporarily relieve physical symptoms of anxiety without causing much drowsiness; at higher doses, they are typically used for high blood pressure but at low doses can block the adrenaline effects that drive the body's response to stress. 

Sedative-hypnotic drugs. Short-term treatment may also include these drugs, which include Valium and Xanax. They can relieve anxiety but may be habit-forming and cause drowsiness. Therefore, they may not be the best choice when long-term symptom control is needed, or when one has to be fully alert and perform certain tasks such as driving or operating machines. 

Anticonvulsant medicines. These medications, such as Neurontin and Lyrica, have been shown in early research studies to have value for several forms of anxiety disorder including social phobia.
It’s important to know that some of these drugs can actually cause anxiety if the dose is increased too quickly or if they are stopped suddenly. It is often best to start with a low dose and slowly increase medication when treating phobias. Also make sure to talk with your doctor about your complete medical history so they can recommend the safest option.

Overcoming phobias takes time. By taking one small step at a time, most people with phobias can reduce their anxiety and, in many cases, move beyond it. Work with a trusted friend or therapist.

WebMD Medical Reference

Sources

SOURCES: 

American Psychiatric Association. 

Waters, R., Phobias: Revealed and Explained, Barron's Educational Series, February 1, 2004.

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