How to Best Treat a Phobia?
Quick Overview
Phobia Treatments
Commonly Treated Phobias
Quick Overview
Naturally, all therapeutic approaches to treat a phobia have the same goal and seek to help relieve or completely eradicate someone’s phobic fear. However, the approaches used differ from treatment to treatment. Some treatments like CBT focus more on the thoughts as a means of changing the phobic behaviour. However, most aim to treat the phobia by disrupting or altering the psychological processes that trigger fear below the awareness. There are two main forms of exposure used to treat a phobia:
- In vitro – imagined exposure to the phobic stimulus.
- In vivo – actual exposure to the phobic stimulus.
There are also ways of limiting exposure in vitro where a client is asked to imagine a traumatising event or memory. As phobia memories are emotionally charged and can be distressing for a sufferer to visualise, a therapist may ask a client to access these traumatic memories in different ways:
- Associated – first-person view so to speak. As if the client were there again experiencing it as it happened. Directly reliving a traumatic phobia event in this was carries with it the risk of triggering the associated anxiety. In extreme cases, this could lead to an undesired abreaction
- Disassociated – this is a very practical way of shielding a client from the anxiety that is normally associated with a phobia memory. Seeing the memory from a third-person view. That is, the client seeing themselves from the outside as the memory plays out
- Doubly disassociated – this adds another layer to an already disassociated memory. As such, it offers a great deal of emotional shielding so that experiencing what would normally be an uncomfortable memory, can be done is a relaxed manner. When using this method, a client would be asked to view themselves watching the memory and not the actual memory itself.
Hypnotherapy/NLP
This is probably too broad a category as different hypnotherapists utilise different approaches. Although a bit old fashioned now, some hypnotherapist may be preoccupied with the root cause of the phobia and use regression as a way of taking their client back to a time it all began. This is not something I’ll ever use to treat a phobia. Firstly, the process will likely be uncomfortable for the client and secondly, it’s not at all important to establish when the phobia initially began. Although we do revisit phobia events that have happened, I take a far more solution-focused, forward thinking approach to treat a phobia.
Also, it’s important to acknowledge that hypnosis on its own is not a treatment. It is one of several tools that come together to form effective phobia treatment. It’s far more comfortable for a client to be relaxed during the session especially when treating a phobia. Hypnotic techniques provide a perfect way to help someone unwind naturally. The use of hypnosis combined with NLP and Solution Focused Brief Therapy (SFBT) techniques is how I treat phobias.
Everything is in vitro and utilises the skilful use of associated and dissociated imagery. This ensures the session is comfortable but also helps maximise the effectiveness of the techniques. For example, I might use dissociation or double disassociation when dealing with difficult memories and use association when working on positive visualisation.
Highly charged phobic memories aren’t processed in the same way as less threatening ones. They tend not to fade in the same way and are kept ‘on hand’ as reference if you like within the subconscious mind. The subconscious mind can trigger the fight or flight response when it perceives a match in your environment. Broadly speaking, the phobia treatment works on the premise that, when calm, the brain can assimilate these memories into a new non-threatening context within the mind.
Cognitive Behavioural Therapy
CBT advocates that changing the way a person thinks about something will change the way they behave and for the most part that’s true. However, when it comes to phobia treatment, we know the response is triggered below the awareness and not governed by conscious thought. Furthermore, as the fight or flight response is so important to survival, the subconscious, that sounds the alarm, has the ability to ‘hijack’ the intellect in an instant. This happens before any cognition or reasoning can occur.
CBT, as standard, often involves thinking of a phobia event or stimulus from an associated perspective and as mentioned earlier this can be distressing for someone with a phobia. For this reason, it seems, there is now an offshoot of CBT named TF (trauma-focused) CBT that utilises dissociation techniques.
Eye movement desensitisation realignment (EMDR)
EMDR therapy has had successes as a phobia treatment and is used by various health authorities. It follows an eight-phase plan and bilateral simulation is a core element in EMDR. Once a phobia memory is targeted, the therapist uses external stimuli to facilitate bilateral stimulation. Most commonly, this means that while the client thinks about distressing memories and feelings, the client will track the therapist’s hand with their eyes as the hand moves through the client’s field of vision. It is thought through that this gives the mind an opportunity to process the memory. Therefore, this method still means the client will be exposed to thinking from an associative perspective about the event or memory that may be uncomfortable.
Emotional freedom technique: (EFT)
Energy Psychology, Emotional Freedom Technique or Tapping
This has been popularised by therapist Roger Callahan and involves tapping along a series of points of the body and repeating phrases that relate to the phobic memories in some way. The theory is the emotional intensity is diffused and the associated traumas allowed to melt away. Any successes may seem mystical to the practitioners and clients but it would seem instead that the tapping is a form of dissociation as it diverts attention from the client as they access a phobia event or stimulus in the mind. This could lead to the memory being recontextualised as non-threatening.
Exposure Therapy
Exposure therapy is probably the oldest form of phobia treatment and has helped people overcome their fears. Exposure therapy does not disassociate a client from the phobia stimulus. This more direct approach is therefore not for the faint of heart. A fair amount of courage is required for someone with a severe phobia to put themselves through a course of exposure therapy. It’s phobia treatment through confrontation if you like. The ‘exposure’ can be achieved in various ways and now includes a modern approach that uses Virtual Reality (VR) to expose clients.
Direct Exposure (in vivo)
As the name suggests, this is about direct physical exposure to the phobia stimulus. Examples would include, in the case of arachnophobia, working up to hold a spider. A client with social phobia may be asked to do public speaking.
Imagined Exposure (in vito)
This is very much imagining the feared object/situation/activity from an associated view. The idea is by recalling and describing a traumatic event in detail this will somehow reduce any feeling of fear linked to it.
Virtual Reality Exposure Therapy (VRET)
An immersive form or exposure within a computer-generated environment that includes the stimulus or phobia trigger.
Commonly Treated Phobias