Tag Archives: Specific Phobia

What is a Specific Phobia?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

What is

What is a Specific Phobia?
Photo courtesy of Pixabay.

There are lots of things you might be afraid of.

Most Specific Phobias are easy to recognize when you see them. If you have one of these fears you may even wonder how this could get called a mental illness. The key, as far as diagnosing them goes, is that people with a specific phobia are far more afraid of the thing, object, or situation than the real danger might objectively warrant. But if you experience this particular fear there is no such thing as being objective about it.

About twenty-eight to thirty million Americans are believed to suffer from a specific phobia. This number may be low as some people can arrange their life to avoid ever having to experience the thing that scares them. If your job never requires flying that phobia may not come up.

Adults can tell you that this or that scares them. Children usually exhibit their fear through their behavior. The child may cry, scream, have a tantrum, freeze up, or be clingy. For all age groups we expect this very specific fear or phobia to have lasted for a while, customarily six months or more. This particular “thing” almost always triggers the same fear.

The list of things that get diagnosed using the DSM is lengthy and even this list is likely not totally inclusive. See Coding below for the new improved ICD-10 list.

Coding Specific Phobia.

Specific phobia used to all be coded in the DSM-4 as 300.29 now in the DSM-5 with the ICD-10 numbers the “objects” which could be things, animals, or situations, all get classified. Here is the list

F40.218 Animals as in snakes, mice, etc.

F40.228 Nature, storms, water, heights, etc.

F40.230 Medical, blood

F40.231 Medical, injections

F40.232 Medical, other procedures

F40.233 Injuries

F40.248 Situations, enclosed spaces, elevators, planes, etc.

F40.298 Other stuff, choking, vomiting, in children – cartoon characters or loud noises

Yes, it is possible for someone to have more than one specific phobia. If you do, the profession should list all the codes and “objects” that cause you significant anxiety. In clinician jargon, this is “stacking up” or listing multiple diagnoses. Specific phobia also often coexists with other disorders such as Depression, Anxiety, and OCD. There are rules in the DSM to tell clinicians, which disorder to diagnose, when to diagnose several disorders, and when to only diagnose one.

Seventy-five percent of those with Specific Phobia are afraid of more than one thing. The majority of all those with Specific Phobia have 3 or more fears that merit diagnoses. Typically these fears get stronger the closer you get to the thing that triggers your phobia. Just thinking about it can be a trigger. For example, people who need to fly but have a specific phobia of flying will begin to get anxious in the days before the flight every time they think about having to fly.

The treatment of choice for Specific phobias is systematic desensitization.

For some with specific phobia, the symptoms can be every bit as severe as those who experience panic attacks or panic disorder. See the “What is” posts on both of these for more on these topics.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5, some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

com.

Is your Anxiety a disease?

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By David Joel Miller

Anxiety provoking.

Anxiety.
Photo courtesy of Pixabay.com

Some fear is normal, too much is an anxiety disorder.

How can you tell if your fears and anxieties are normal or are they the signs of a more serious mental illness? In everyday language, there is not much difference between fears and anxieties. In technical, mental health terms there are some key differences between fears, anxieties, and the times your anxiety symptoms get out of control and get diagnosed as a mental illness.

Of all the mental illnesses, Anxiety disorders are the most common. In any given year one in five Americans will experience Anxiety so severe it should be diagnosed as an anxiety disorder. Prevalence rates around the world are very similar to the U. S. experience. Anxiety disorders are also the ones most likely to be seen by medical doctors as the symptoms often look like symptoms of physical illnesses.

Fear in the mental health sense is a reaction to a thing or situation that causes an immediate reaction. You see something, something happens and you get that feeling you need to do something now. The standard reactions are to freeze, flee, or fight.

Say you see a poisonous snake and you become very scared. This sounds rational. But if you are afraid to visit a school because they might have pictures of snakes up in the science classroom, that is excessive and should qualify you for some kind of mental health diagnosis. Which diagnosis? We are not there yet.

Anxiety, the mental health type definition, is a feeling of nervousness or uncomfortable about something that may happen in the future. People with anxiety disorders become so afraid that something will or might happen in the future that they have to alter their present to avoid these possibilities.

People commonly report that they have “Panic attacks” or “Anxiety attacks.” If the thing setting off the anxiety attack is something that has a real potential danger then having fear and freezing, fleeing, or fighting might all be reasonable adaptive behaviors. Attacks of a symptom do not always equal a mental illness.

While some anxiety disorders are brief most, to get diagnosed, need to be more than temporary conditions. The criteria for many anxiety disorders it’s that you must have had this anxiety for six months or more. Of course, during that time period, your anxiety may have episodes of getting stronger, and other times it may be less troublesome. If it has interfered with your life for 6 months or more you most likely have an anxiety disorder.

Not every case of nervousness or anxiety is the result of having an anxiety disorder. Someone who is depressed and has difficulty doing things they used to do is likely to become anxious. We include that kind of anxiety as part of the depression. Same thing when someone with a psychotic disorder becomes fearful and think people are watching them. That paranoia is part of the psychosis and does not get a separate diagnosis of an anxiety disorder.

What makes this fear diagnosable is when it begins to interfere with or change your behavior or upset you. If you can’t leave the house or work because of your anxiety, that is probably a diagnosable anxiety disorder. If your extreme fearfulness, anxiety, or hyper reactiveness start affecting your relationships, that is a probable diagnosis.

There are a number of different types of anxiety disorders depending on what is causing your fear or anxiety. Further complicating this picture is that many people who have anxiety disorders have more than one kind. Having multiple anxiety disorders is considered very common.

Since people with anxiety disorders have by definition “excessive” fear or anxiety it takes an outside observer, usually a therapist to evaluate the risk and see if this person’s fear is reasonable given their situation and their life experiences.

Most anxiety disorders start in childhood, often before the end of middle school. Over time and untreated anxiety disorders get worse. The stats say two of every three people with anxiety disorders are women. I believe this is partly cultural. Boys and men are taught to approach what they fear. Attack it. Women are supposed to get away. This results in anxious men becoming more violent or using a substance to cover up their anxiety and as a result, they get a behavioral or substance use diagnosis.

Physical sensations may be symptoms of anxiety.

Different people experience anxiety differently. Anxiety symptoms are frequently physical and many people interpret their anxiety symptoms as a physical illness.

If you experience an anxiety attack you may feel dizzy or light-headed. You may feel disoriented, have difficulty breathing or swallowing. The heart may race, you might sweat or tremble all over.  Despite the feeling you want to run your legs could become rubbery or jelly-like.

Some people experience gastrointestinal symptoms, constipation, diarrhea, nausea or feeling like you may vomit. Sleep disturbances, mind racing, and confused thoughts can result in Anxiety disorders getting confused with Bipolar Disorder and other mental illnesses.

Here is the most recent list of recognized Anxiety Disorders. These are necessarily brief, general descriptions of the disorders in plain language. For the specific criteria consult the relevant edition of the DSM.  For more on each separate disorder look for the articles I have written on specific disorders. I plan to write more of these posts on specific anxiety disorders in the future.

You will find the link to other articles on anxiety below.

Separation Anxiety Disorder.

This disorder customarily starts early in life. The child is afraid to leave or be away from a caregiver. They may think that something bad will happen to them or the caregiver if they are separated. We used to think of this mostly as a disorder of children and that they should “grow out of it.” We are starting to think that you can have this at any point in your life and that many clingy needy adults had this and or an attachment disorder since childhood.

Selective Mutism.

Someone who speaks normally at home but is afraid to or refuses to speak when in public or around strangers fits the description of Selective Mutism. The criteria for this disorder does not imply that the child is being poorly behaved but just that they are so afraid they can’t speak around strangers. The result is poor grades or school failure. As they get older this may lessen but again there are adults who just avoid speaking around strangers as much as possible.

Specific Phobia.

Spiders and snakes, blood, heights, or flying can all be objects of a specific phobia. With Specific Phobia we can point to things or situations that are the cause of the anxiety. People with specific phobias often had fears of several things or situations and may have other anxiety disorders as well.

Social Anxiety Disorder (Social Phobia).

In this disorder, the anxious person is afraid of social situations where others may watch them, evaluate them, or otherwise form an opinion about them. The fear here is about doing something “wrong” or being judged. This is about having your peers think poorly of you, what you wear, or how you do things. In severe cases, people avoid eating in public or going to social gatherings.

Panic Disorder.

Panic disorder involves many of the physical symptoms we talked about above. The person having a panic attack may have shortness of breath or chest pain and think they are having a heart attack. Having had one attack people become afraid to leave the house for fear they will have another and not be able to get help in time.

Agoraphobia.

Agoraphobia translates as “fear of the marketplace” mostly this involves crowded situations. Fear of buses, standing in lines, crowded places, stores, and similar situations. In severe cases, the person becomes unable to leave the house to go shopping and either needs someone to go with them or just go at times the store will be very empty.

Generalized Anxiety Disorder.

This involves being over-anxious all the time. A person with Generalized Anxiety Disorder is anxious all the time about most anything. There may be real-life causes for this anxiety, like living through a war or being assaulted or harmed. The professional has to look carefully to separate this from PTSD or other Trauma and Stressor-related disorders.

There are also diagnoses for anxiety problems caused by drugs, medications, medical conditions, or other factors.

For more on Anxiety, treatments for anxiety and related issues see:

counselorssoapbox.com Anxiety Post list.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Systematic desensitization – conquering fear.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Anxiety provoking.

Fear and Anxiety.
Photo courtesy of Pixabay.com

Anxiety can be a stubborn foe.

It is tempting to avoid the things you fear and to find ways to numb those unpleasant feelings. Some people use alcohol or sleeping pills other people use avoidance. But eventually, you have to face that fear or be taken prisoner by your fear.

You can’t get over something you don’t face. Sometimes the only way out of a burning building is through the door that is on fire. To begin with, we won’t ask you to walk through the flames, just to look at the door and see how your fear that it might be on fire on the other side is keeping you a prisoner in that room.

Systematic desensitization reduces the impact of fears.

One way of domesticating the anxiety monster is a technique called systematic desensitization. This is an especially effective technique for taming fears or anxiety when those anxieties are a fear of one very specific thing.

Some of these item fears are so specific we name them Specific Phobias. Meaning you are deathly afraid of one particular thing even if you are never around that thing.

Some of these specific phobias are so terrifying to the people with that particular specific phobia that I can’t even write the word out or they would stop reading. So let’s start with an exaggerated and somewhat humors example of how this specific desensitization could work.

Say there is this person that is deathly afraid of crackers. (The little packaged edible kind.)

If you know who I am talking about here please do not let on. That person’s family laughed at him.  But try as he would he just could not bear to eat at a table where there were crackers. Eventually, this got so bad that I – I mean he – could not eat with his family when they were having soup for fear there would be crackers present.

This fear became progressively worse. Soon eating out was impossible because there might be crackers all around. Eventually, even commercials for crackers or the mention of the word might provoke a panic attack. Something needed to be done.

The cure for cracker or saltine phobia? Systematic desensitization.

So off to the therapist this sufferer from cracker phobia went. Here are the steps in recovery from cracker phobia.

First, you need to be willing to talk about this fear and develop a scale of fear. Something like if we just talk about that fear I – I mean he – had by referring to this as the fear of “You know what.” That would be a 1 on the fear scale.

Actually using the name “Cracker” that scored a two. To see a picture of some crackers in a magazine that would rate a fear factor of 4. Entering at a restaurant where there might or might not be crackers present, that was a 5. Seeing actual crackers, that would be a 6, and witnessing someone eat one that would rank an 8. To have to physically touch a cracker that would rank a 9. To personally eat a cracker that would rate a 10.

Now having developed our scale we would begin to work our way up the scale all the while with the therapist reassuring the client.

Along the way, the therapist might teach the client some relaxation techniques, deep breathing, and so on. The theory here is that you can’t really feel two contradictory feelings at the same time. The more you concentrate on your relaxation the more likely you are for the fear, or anxiety if you prefer, to subside.

So over time, the exposure to the dreaded crackers becomes more and more frequent and closer, all the while practicing the relaxation skills.

At the end of treatment, the goal would be for the client to actually open a package of crackers and to eat one while the counselor watched.

Now neither I nor anyone I know has really suffered from a cracker phobia. This cracker fear has been a long time joke in the family. But I hope this has demonstrated how a counselor could help a client overcome a specific phobia that may sound funny to the client’s family and friends but has been causing the client some very real distress.

What are some of the specific phobias that this method is known to work on? Well the number one fear in America, more severe than the fear of death, is the fear of public speaking. Also up there on the list are phobias to snakes and spiders.

Fear of snakes is no big thing for most city dwellers, but if you needed to live and work outdoors this could be a trial. If you worked at the zoo in the reptile house, a fear of snakes could cost you your job.

So whatever your fear or specific phobia there are treatments to help you turn that anxiety or fear control back down to a manageable setting.

Similar to systematic desensitization, at least in my book, is the use of exposure and response prevention. People with Obsessive-Compulsive Disorder (OCD) develop rituals or routines that they feel the need to perform to reduce the anxiety. If we can expose the person to the thing that they fear and prevent the ritual, then over time the fear diminishes. Combine some relaxation techniques with the exposure and response prevention and you move close to the systematic desensitization approach.

Best wishes on taming those pesky excessive anxiety and fear monsters.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Fear, anxiety or phobia?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Fear.

Fear.
Photo courtesy of Pixabay.com

Is it fear, anxiety or have you developed a phobia?

The textbooks tell us there is a difference between Fear and Anxiety. The researchers use some specific criteria to differentiate the two. In our own lives, even without looking it up in the dictionary, we know if we are anxious or in fear. Like so many other words, fear and anxiety may have different meanings to different people.

Fear is about a sense of specific danger. We are afraid of a person with a gun or an animal chasing us. We might also be afraid of a relationship like marriage or an act like public speaking.

Anxiety, on the other hand, is a heightened sense of awareness, a being on alert looking out for danger. New situations, places known to contain dangerous items or risky relationships, can provoke anxiety because of the uncertainty.

Some authors suggest that fear is or should be about a real danger; though in practice many of the fears people are most worried about hold a small risk of harm.

One other distinction between fear and anxiety is that fear is largely about the future while anxiety is about the present. Anxiety is about not knowing.

Specific Phobia is a mental health diagnosis involving excessive anxiety when exposed to a feared object or situation. This used to be called Simple Phobia. This excess anxiety begins interfering in the person’s life to the extent of disrupting relationships, keeping them from school or work or making them personally unhappy.

Both anxiety and fear are survival mechanisms.  Fear tells us to avoid things that are known to be harmful. Anxiety is about being extra careful when in new, novel situations or at times of increased danger. Anxiety is often free-floating and attaches to any and all events that are not expected.

Fear becomes a problem when it is attached to things with a low likelihood of happening and this fear keeps you from doing things you need to do. When that fear becomes debilitating and prevents having a job, family, or friends, then it has gone out of control.

Fear is commonly learned as a result of three factors, personal experience, watching others, and verbal accounts.

A child who climbs on the roof of the house and falls, breaking a limb, may forever after be afraid of heights. People who grew up in homes where violence was a standard part of life may be afraid of relationships or commitment to a long-term relationship.

You do not have to experience the event personally. If you witness someone being injured or killed you will have an increased fear of whatever caused that injury or death. Social learning theory tells us that humans have a phenomenal ability to learn from the experiences of others.

Those experiences of others do not even need to be real to create fear in us. Children told often enough about the boogeyman become frightened of the dark. People of all ages can develop intense fears from watching events unfold on television. As parents discover, the young child may be unable to tell the difference between reality and fantasy and may become fearful of things they saw in fictional movies.

There is a long list of common fears below. This list is far from complete and is not in any particular order. The fear involved often greatly exceeds the risk of something happening but as anyone who has a specific fear (phobia) will tell you real or not that fear can cause great suffering.

Fear of Public Speaking or performing in public.

Public speaking is reported to be the most common fear exceeding even the fear of death. The principle concern here is that the larger the group the more likely you are to say something that alienates someone or causes them to judge you negativity.

This is especially crippling for people whose occupation requires them to appear in front of the public.

Fear of Snakes or Spiders.

The majority of snakes and spiders are not poisonous to humans. Still, this is no comfort if you are bitten and die. Being afraid of particular creatures helped people who lived in rural areas survive.

If your fear reaches a point that you can’t leave the house, it has gotten way out of hand.

Fear of Flying.

Despite plenty of statistics to show that flying in a plane is safer than driving a car on the freeway people are still afraid of flying. There are two reasons I believe for this heightened fear of flying.

In driving, we are largely able to maintain the illusion that we are in control. In flying there is no question that our lives are in the hands of a person we have probably never met.

Plane crashes are spectacular and widely publicized. We see extensive media coverage of these events. This heightened awareness results in an increased perception that flying is dangerous.

Fear of Failure.

Fear of failure is especially troubling for those who were raised in a home where success was everything and failure was interpreted as you were defective. If you have to always be perfect to be worthwhile any failure is catastrophic.

Other common fears include intimacy, marriage, heights, water, clowns, death, terrorist attacks, and violence.

Some of these have clear reasons for causing fear and others are likely learned from experiences and tales we were told.

If fear is impacting your life and the fear you feel is beyond the real risk of danger there is help available. Several therapies, as well as medication, have been shown to be effective in reducing the impact fear has on your life. Systematic desensitization is known to be effective in conquering many of these fears.

Have you been troubled by Fear, Anxiety, or a Specific Phobia and are you willing to do something about those fears?

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

Relapse on anxiety, depression or another mental illness?

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Urge Surfing Prevents Relapses.

Urge Surfing Prevents Relapses.
Photo courtesy of Pixabay.com

Can you relapse on anxiety, depression, or another mental illness?

Relapse is a concept that has been borrowed from substance abuse treatment. It is easy to think in terms of an alcoholic drinking again as a relapse, but do people with a mental illness relapse? What would a relapse for anxiety or depression look like and what can we do to prevent a mental health relapse?

We are starting to view mental health and wellness as a continuum so people can move from well to less well to unwell and back again. In that respect, a mental health relapse seems to make sense.

A lot of people experience a mental illness at least once in their lifetime. Estimate run from 25% in any one year to 50% at some point in a lifetime. For an Anxiety Disorder, the estimates run from 10% to 20% and may even be higher than that when we consider the increase in PTSD.

In a previous post, we talked about Bob and Ellen who were treated for anxiety disorders, social phobia and specific phobia using systematic desensitization sometimes called exposure therapy. This is a proven effective treatment for specific phobia. As we last saw Bob and Ellen, after getting better they had both relapsed and were having symptoms of anxiety again. This is not surprising.

From one-third to two-thirds of everyone treated for anxiety disorders relapses, despite the fact that we know why this happens and how to prevent it.

Anxiety is fear-based.

It shrinks when approached. We tend to avoid scary things but the more you avoid them the harder they become to face the next time. Once people complete treatment they tend to stop thinking about the thing they feared. Over time the gains they made fade away. Substance abuse treatment tries to avoid this problem by encouraging people to continue with self-help groups to maintain the growth that has happened. Self-help groups for emotional issues are much harder to find.

Treatment for fear in the office does not equal less fear out in the backyard.

A recovery skill needs to be practiced in many settings so that it is usable at any time or place. Fear is worse in new novel situations. Learning, to be useful, needs to “generalize” into many settings. People who are in treatment for an anxiety disorder need to practice their skills in as many situations as possible.

Many people use medication to reduce or manage symptoms.

As soon as the symptoms are reduced they discontinue the medication. Discontinuing medication too soon is likely to result in relapse.

If there is an actual injury fear is more likely to return.

Getting treated for irrational fear is likely to stick but if you were in an accident you have good reason to be afraid of the same thing happening again. You should expect to use extra caution in dangerous situations if you have been injured in the past. Anxiety is meant to keep you safe. The goal is to manage the anxiety not to completely eliminate it.

If nothing else happens fear tends to return with time.

Treatment for anxiety needs occasional “boosters” to prevent its return.

Other emotional issues increase the risk of a return of anxiety.

An untreated depression greatly increases the risk of a relapse of anxiety, so does substance abuse. If you have multiple problems, anxiety, and depression or anxiety, and substance abuse you need to be working on all the issues at the same time. Leave on issue untreated and the risk of relapse for the others increases.

Continue to work on your recovery to prevent a relapse of anxiety, depression, or another mental illness.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

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Anxiety – fears and phobias can be treated.

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By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Fear

Get rid of fear.
Photo courtesy of Pixabay.com

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 relaxation 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.

  1. Write the word snake on a piece of paper.
  2. Say snake.
  3. Talk about snakes.
  4. Read a word book about snakes.
  5. Look at pictures in a book about snakes.
  6. Watch a video about snakes on T. V.
  7. Visit a local pet store with her son and look at snakes in the cages.
  8. Touch a snake while the pet shop owner held him.
  9. Visit the local zoo and look at snakes in the Herpetarium with her son and husband.
  10. 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 into 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

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

For these and my upcoming books; please visit my Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

For videos, see: Counselorssoapbox YouTube Video Channel

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