By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Are you afraid of spiders, snakes or public speaking?
If you are afraid of a particular thing or situation and go to lengths to avoid that thing you may well have a Specific Phobia. Specific Phobia involves the fear that a particular thing is going to harm you. This fear may be irrationally strong even when you have never been harmed this way before and the risk is low.
There are five types of specific phobias, Animal type, Natural environment type, medical type, places, and “other” type. Other type includes diverse things like a fear of choking and a fear of costumed characters. People with a specific phobia, except very young children, know their fear is excessive and is interfering with their life but they will go to great lengths to avoid the thing that scares them and to avoid getting treatment for their phobia.
Animal type refers to the spiders and snakes as well as any number of other creatures great and small that may scare us. Some animals may really be harmful or dangerous but a phobia is not restricted to only those things we should fear but is enlarged to fear all creatures whether they are likely to harm us or not.
Natural environment phobias include heights, weather, and water. The “medical type” includes such things as blood, needles and medical procedures. Place phobia is best known for fear of flying and elevator fear.
A closely related anxiety disorder “Social Phobia” includes things like public speaking and eating in public. In social phobia, the fear is not of being physically injured but a fear of doing something that is embarrassing or uncontrollable.
Both social phobia and specific phobia are treatable. For some people, medication can help to manage symptoms in the short run but over time the symptoms of anxiety may reappear. A specific counseling method called systematic desensitization or exposure therapy is especially helpful for treating specific phobia and a related method works well for fear of public speaking.
If the phobia becomes excessive someone may seek treatment. Here is an example of a treatment episode for a mother; we shall call Ellen, who had a terrible fear of snakes. She was practically pushed in the office door by her husband Bob. Her son and her husband Bob both wanted to go camping and she had refused. While on vacation they had wanted to visit a zoo. Both of these activities might involve snakes and snakes terrified Ellen.
The therapist began by teaching Ellen how to relax using deep breathing and other relaxations techniques. It is impossible to be both frightened and relaxed at the same time. Over the next week, Ellen practiced her relaxation methods every time she became anxious, whether it was about snakes or just day-to-day life.
At the second session, they discussed what things about snakes provoked what level of fear. Could Ellen write the word snake on a piece of paper with only modest fear? Could she say “S-N-A-K-E.?”
For each item on the list, they assigned a number from one to ten. The goal was, to begin with, the “snake’ exposures that were the least frightening and progress to the more threatening ones. Her fear hierarchy might come out something like this.
- Write the word snake on a piece of paper.
- Say snake.
- Talk about snakes.
- Read a word book about snakes.
- Look at pictures in a book about snakes.
- Watch a video about snakes on T. V.
- Visit a local pet store with her son and look at snakes in the cages.
- Touch a snake while the pet shop owner held him.
- Visit the local zoo and look at snakes in the Herpetarium with her son and husband.
- Go on a camping trip where they might encounter a snake.
After developing the “snake fear scale” Ellen practiced her relaxation. She was then able to write down the list of “snake steps” and read them back to the counselor at the second meeting.
By the third session she was reading an article the counselor had brought in about types of snakes and some of the good things snakes can do.
Her efforts to look at pictures in a book took longer, several times she had to stop, do her relaxation exercises and discuss her feelings with her therapist.
Ellen watched the snake video in the counselor’s office, being prompted to do her breathing and relaxation as needed. She was able to take the video home and watch it a second time with her family and reported it went well and she did not have to close her eyes even once.
By the time summer came Ellen reported to the counselor she had completed steps one to nine.
This same sort of method can be used for social phobia. A common fear is public speaking. Many people report they are more afraid of public speaking than death. The old approach to fears and phobias was the “throw them in the deep end and they will sink or swim.” Too many people were traumatized by that approach and never went in the water again.
Turns out that Bob, (Ellen’s husband remember?) was not afraid of snakes, but he was terrified of speaking in public. His company wanted him to make a presentation later in the year at a large convention and Bob was terrified. The counselor worked with Bob for a while on relaxation techniques and then gave Bob some choices.
For those with a fear of speaking there are classes at the local college or adult education and there are clubs whose purpose is to help people overcome their fear of speaking in front of others. Working with a small group of others who are all trying to learn to speak in public can ease the tension. Building up gradually from talking around a table to standing up and speaking to the group and finally to speaking in front of progressively larger audiences can build your confidence.
Bob took the college classes. He was able to complete the class and began speaking to groups his company sent him to speak at. Things were going fine. – Sort of.
Then the counselor got a frantic call from Bob and Ellen. Despite all their efforts and all that progress, Bob was terrified of the speech he needed to give at the convention, he was thinking of quitting his job to avoid it. Ellen had been in the bedroom crying for the last week. She was not going to the convention with Bob, as much as she wanted to be supportive because that meant the camping trip after the convention and her fear of snakes had returned with a vengeance.
Why after all that work had Bob and Ellen had a relapse of Anxiety? We know systematic desensitization works to reduce anxiety.
Stay tuned for a post on what causes an anxiety relapse.
Staying connected with David Joel Miller
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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.