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General Information for Prospective Patients |
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Phobias
Phobias are the most common form of mental disorders. They can be defined as irrational fears about objects or situations. People tend to see these phobias as unreasonable, but feel incapable of giving up the fear, or confronting the situation in a calm fashion. Reasoning with the person as to the foolishness of the fear has no effect.
Phobias can be categorized into three types:
1. Simple, or situational, phobias. These are fears of animals and insects, fears of injuries or injections, or fears of specific situations such as heights, tunnels, flying, or thunderstorms.
2. Social phobias. These are fears of being judged by people, or being seen as foolish. It results in the individual avoiding many social situations which the person believes he or she should otherwise attend.
3. Agoraphobia. This is a somewhat more complicated phobia where the person believes that one will have a panic attack in certain situations that are difficult to escape from, such as open spaces, or tunnels. The individual is more focussed on the danger of having a panic attack, rather than believing the situation is dangerous per se. Phobias can result in an inability to live a profitable or normal existence. For instance, a fear of elevators may prevent a person from taking a particular job, because the company is on a high floor. Or a fear of injections may prevent a person from getting adequate medical attention. A fear of public speaking could stop a person from advancing in one's career. Fear of having a panic attack on the street can prevent a person from leaving home.
Behavioral techniques
Specific behavioral techniques have been developed for eliminating these phobias. Some of these are Systematic Desensitization, Flooding in vivo or in imagination, Modelling, and Exposure and Response Prevention.
The most widely used treatment is Exposure and Response Prevention. This involves a careful, systematic exposure to the fearful situation, with the patient learning to relax and act in a non-defensive way around the phobic event. The patient is guided through a series of situations, learning how to master one's fears in easy situations before being exposed to more fearful ones. The patient sets the speed that the therapy advances, so that the patient never gets too frightened or out of control.
For instance, if a person wished to get rid of a fear of heights, he or she would learn progressive relaxation exercises, and good breathing techniques as a first step to overcoming the fear. Then the person is taught how to use these skills while being exposed to a mildly anxiety-provoking situation, such as the second floor of a building. Only when the anxiety has come down to a very low level would the person be encouraged to go to a higher floor. By this gradual exposure method, most patients can overcome their fears in relatively few sessions.
Phobics who use this method of treatment show a high rate of success, with patients with simple phobias typically taking about 8 to 16 sessions to bring the phobia under control. When dealing with social phobias, treatment tends to be somewhat longer, because the patient often requires social skills training as well as the exposure to the social situations. Agoraphobia also tends to be more difficult to control compared to simple phobias. However, the majority of patients can be helped by these methods.
Using the behavioral methods, patients rarely relapse, Also they tend tend to use these techniques to face their fears in other areas of their lives.
Medication
There are no effective medications to eliminate simple fears. Certain medications can be used to temporarily reduce the anxiety, such as minor tranquilizers. However, these medications do not reduce the fear permanently, and people tend to become dependent on them in order to perform these tasks. Agoraphobia is an exception to this rule in that there are several types of medication that can reduce the frequency and intensity of panics. These include the tricyclics, some of the benzodiazapines and some of the new SSRIs. Unfortunately, the panics tend to return if the medication is discontinued. Some recent studies have shown that a few social phobias may be relieved by medication also. However, the same problem tends to occur if the medication is discontinued.
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