A phobia is strong fear or dread of a thing or event, which is out of proportion to the reality of the situation. The most effective treatment is cognitive behavioural therapy. Antidepressant medication also helps in many cases.
What are the symptoms of phobia?
If you come near to, or into contact with, the feared situation you become anxious or distressed. In addition you may also have one or more unpleasant physical symptoms. These can be, for example:
- A fast heart rate.
- The sensation of having a 'thumping heart' (palpitations).
- Feeling sick (nausea).
- Shaking (tremor).
- Dry mouth.
- Chest pain.
- A 'knot in the stomach'.
- Fast breathing.
The physical symptoms are partly caused by the brain which sends lots of messages down nerves to various parts of the body when you are anxious. In addition, you release stress hormones - such as adrenaline (epinephrine) - into the bloodstream when you are anxious. These can also act on the heart, muscles and other parts of the body to cause symptoms.
You may even become anxious by just thinking of the feared situation. You end up avoiding the feared situation as much as possible, which can restrict your life and cause distress.
There are different types of phobia
Social anxiety disorder
This is also known as social phobia and it is possibly the most common phobia. With social anxiety disorder you become very anxious about what other people may think of you, or how they may judge you. Therefore, you fear meeting people, or 'performing' in front of other people, especially strangers. You fear that you will act in an embarrassing or humiliating way and that other people will think that you are stupid, inadequate, weak, foolish, crazy, etc. You avoid such situations as much as possible. See the separate leaflet called Social Anxiety Disorder for more details.
This too is common. Many people think that agoraphobia means a fear of public places and open spaces. But this is just part of it. If you have agoraphobia you tend to have a number of fears of various places and situations. For example, you may have a fear of:
- Entering shops, crowds and public places.
- Travelling in trains, buses, or planes.
- Being on a bridge or in a lift.
- Being in a cinema, restaurant, etc, where there is no easy exit.
But they all stem from one underlying fear. That is, a fear of being in a place where help will not be available, or where you feel it may be difficult to escape to a safe place (usually to your home). When you are in a feared place you become anxious and distressed and have an intense desire to get out. Therefore, to avoid this anxiety many people with agoraphobia stay inside their home for most or all of the time. See the separate leaflet called Agoraphobia for more details.
Other specific phobias
There are many other phobias of a specific thing or situation - for example:
- Fear of confined spaces or of being trapped (claustrophobia).
- Fear of certain animals.
- Fear of injections or needles.
- Fear of vomiting.
- Fear of being alone.
- Fear of choking.
- Fear of the dentist.
- Fear of flying.
However, there are many others, some quite rare.
What is the treatment for phobias?
Cognitive and behavioural therapies
These therapies help you to change certain ways that you think, feel and behave. They are useful treatments for various mental health problems, including phobias.
- Cognitive therapy is based on the idea that certain ways of thinking can trigger, or fuel, certain mental health problems such as anxiety, depression and phobias. The therapist helps you to understand your current thought patterns. In particular, to identify any harmful, unhelpful and false ideas or attitudes which you have that can make you anxious. The aim is then to change your ways of thinking to avoid these ideas. Also, to help your thought patterns to be more realistic and helpful.
- Behavioural therapy aims to change any behaviours which are harmful or not helpful. For example, with phobias your response to the feared object (anxiety and avoidance) is not helpful. The therapist helps you to change this. Various techniques are used, depending on the condition and circumstances. For example, for agoraphobia the therapist will usually help you to face up to feared situations, a little bit at a time. A first step may be to go for a very short walk from your home with the therapist who gives support and advice. Over time, a longer walk may be possible, then a walk to the shops, then a trip on a bus, etc. The therapist may teach you how to control anxiety when you face up to the feared situations and places. For example, by using deep breathing exercises. This technique of behavioural therapy is called exposure therapy where you are exposed more and more to feared situations and learn how to cope.
- Cognitive behavioural therapy (CBT) is a mixture of the two where you may benefit from changing both your thoughts and your behaviours.
CBT is usually done in weekly sessions of about 50 minutes each, for several weeks. You have to take an active part and are given homework between sessions. For example, you may be asked to keep a diary of your thoughts which occur when you become anxious.
Note: unlike other forms of talking treatments (psychotherapy), CBT does not look into the events of the past. CBT aims to deal with your current thought processes and/or behaviours, and helps to change them where appropriate.
CBT usually works well to treat most phobias but does not suit everyone. However, it may not be available on the NHS in all areas. See the separate leaflet called Cognitive Behavioural Therapy (CBT) for more details.
These are commonly used to treat depression. However, they also help to reduce the symptoms of phobias (particularly agoraphobia and social phobia), even if you are not depressed. They work by interfering with brain chemicals (neurotransmitters) such as serotonin which may be involved in causing anxiety symptoms.
- Antidepressants do not work straightaway. It takes two to four weeks before their effect builds up and anxiety is helped. A common problem is that some people stop the medicine after a week or so, as they feel that it is doing no good, and it is too early to tell if the medication is working.
- Antidepressants are not tranquillisers and are not usually addictive.
- There are several types of antidepressants, each with various pros and cons and they differ in their possible side-effects. However, selective serotonin reuptake inhibitor (SSRI) antidepressants are the ones most commonly used for anxiety and phobic disorders. Examples of SSRIs are escitalopram and sertraline.
Note: after first starting an antidepressant, in some people anxiety symptoms can become worse for a few days before they start to improve. Your doctor or practice nurse will want to keep a check on you in the first weeks of treatment to see how you manage.
A combination of CBT and an SSRI antidepressant may work better in some cases than either treatment alone.
Benzodiazepines such as diazepam are sometimes called minor tranquilisers but they can have serious side-effects. They often work well in the short term to ease symptoms of anxiety. The problem is they are addictive and can lose their effect if you take them for more than a few weeks. They may also make you drowsy. Therefore, they are not a useful long-term treatment for phobias. A short course, or even a single dose, may be prescribed for a phobia which occurs rarely; however, there is no evidence to support this practice. Referral for CBT or a fear of flying course (organised by most airlines) is more effective.
Further reading and references
Social anxiety disorder: recognition assessment and treatment; NICE Clinical Guideline (May 2013)