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Treatment for Fears and Phobias

William L. Golden, PhD

Effective treatments are available for fears and phobias. Cognitive-behavior therapy, which is known as CBT, has been found to be highly effective for the treatment of fears and phobias. In CBT you learn to first identify your fears and then reevaluate them. Our thoughts and beliefs affect our feelings. Looking at your fears from a rational perspective can make them less scary.

For example, if you believed you could suffocate from being stuck in an elevator, then you would be afraid to use elevators. You then might avoid going into elevators. If you avoided them repeatedly, you would develop a phobia. We can do reality checks on our fears and worries. Using the fear of suffocating from getting stuck in an elevator as an example, a reality check  could be asking yourself,  "How many people have I heard suffocated from being stuck in an elevator? None." There is plenty of air that gets into elevators, even when they are stuck for long periods of time .

Our actions also affect how we feel. The more we avoid, the more scared we become. Logical thinking helps reduce fear and anxiety. However, by facing our fears we also learn that there is nothing to fear. Our confidence increases as we confront our fears and see that we are safe and can handle the situation. Exposure therapy is a treatment that involves putting yourself in situations where you face your fear.  In CBT, you face your fears one step at a time. You start with the easiest step first and gradually build up to more difficult ones. So in our elevator example, maybe the easiest step would be to just go into an elevator and hold the door open so it doesn't go anywhere.  You don't go onto a harder step until you feel confident about doing the easier step. That usually takes a few repetitions. Initially, we usually feel anxious when confronting our fears. With repetition, the anxiety usually becomes less and less intense. So after a few repetitions, you are ready for the next step, which, in the elevator example, might be going up to the second floor.

The techniques that I have described so far, more or less, are based on common sense. However, most people with phobias require some help with their fears. Exposure therapy is part of CBT. The treatment is structured and systematic. The steps are rank ordered from easier to harder. Care is taken so that there are no big steps. One of the problems in doing exposure therapy on your own is that you may not structure it right. Putting oneself in an extremely anxiety-producing situation can sometimes backfire. If a person gets overwhelmed with anxiety and then withdraws from that situation in a state of panic, that person can become more anxious about reentering that situation in the future. That is why an article such as the present one can only be educational. It is not intended to be treatment or be a replacement for therapy.

In CBT, relaxation techniques are frequently used for the purpose of anxiety reduction. One method of relaxation is to slow your breathing down. Progressive muscle relaxation is a technique for managing tension. You learn to let go of tension, one muscle group at a time. Another relaxation technique is to use a pleasant image.  A popular choice is a beach image, but any place that you feel calm and relaxed is the right one for you. More will be said about relaxation techniques in a future article.

A very important anxiety-reducing approach is cognitive restructuring. Cognitive restructuring involves identifying anxiety-producing thoughts, and replacing them with rational and constructive thoughts. Let's go back to our claustrophobia example. The main fear of most claustrophobic individuals is a fear of being trapped. Many also fear that they will suffocate from a lack of air if they are trapped in an enclosed space such as an elevator. Using cognitive restructuring, we can come up with several coping thoughts that could be used to reduce anxiety:

1) You are safe, even if you are stuck in an elevator. There are airshafts and vents that provide adequate ventilation and enough oxygen.
2) Try pushing buttons. That usually works to get it unstuck. Push the alarm button. Someone will eventually hear it. Eventually you will be rescued.
3) Use your cell phone to call for help.
4) Breathe slow and easy. That will help calm you down..
5) Entertain yourself while you are waiting to be rescued. Use your smart phone to listen to music, or watch a video, or read your emails, or surf the internet, or call friends. You might as well do something entertaining while you are waiting to be rescued. It will help pass the time.

The next step is to get practice at coping with one's fears in a safe learning environment. I find mental rehearsal via imagery to be an excellent method for this purpose. Imagery provides patients with a safe way of practicing their anxiety-reducing techniques while imagining themselves confronting their fears. The exposure is incremental. The CBT therapist has the patient imagine the least anxiety-producing event first and progressively go through the patient's anxiety list, one step at a time. Patients practice using their relaxation techniques and coping thoughts during the imagery.  When the patient is able to imagine taking that step while still feeling relatively calm and in control, the patient is then ready for real-life exposure. Either with the therapist, or independently, the patient  practices in reality what he or she successfully did during imagery.

In this article, my intention was to introduce the reader to some of the basics of CBT in the treatment of fears and phobias. If further information about psychological services, or if professional help is needed, you can utilize the referral service of the Westchester County Psychological Association (WCPA). WCPA is an organization that is committed to furthering the development of psychology as a science and as a profession, in addition to safeguarding the interests of the public.

Disclaimer: Although Dr. Golden is a board member of the Westchester County Psychological Association (WCPA), the views in this article are his and not the views of WCPA.

Statements contained  in the authored articles on the Westchester County Psychological Association (WCPA) website are the personal views of the authors and do not constitute WCPA policy unless so indicated. The information in the articles on the WCPA website is for educational purposes only. The information contained in the articles is not intended for diagnosis, psychological advice or medical advice.  It is not intended to be treatment and is not a replacement for psychotherapy. If you are in need of psychological treatment, you can utilize our clinician database which can be accessed by clicking on the link, "Find a Psychologist." WCPA and its directors and employees are not liable for any damages resulting from the utilization of information contained in articles posted on the WCPA website.

William L. Golden Ph.D. is in private practice in New York City and Briarcliff Manor. He specializes in the treatment of anxiety, phobias, stress-related disorders, habit disorders and depression. He has coauthored several books , Hypnotherapy: A Modern Approach, Psychological Treatment of Cancer Patients and Mind Over Malignancy: Living with Cancer. He is coeditor of Cognitive-Behavioral Approaches to Psychotherapy. He regularly writes articles for professional journals and chapters for books on cognitive-behavior therapy and hypnotherapy.

William Golden's website: http://williamgoldenphd.com/
To view Dr. Golden's referral listing, click here.


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