Phobias

What Causes Phobias?

Scientists don’t yet fully understand what causes phobias and other anxiety disorders. However, an individual’s risk for developing a phobia is probably due to a complex interaction of genetic and environmental factors.

Risk factors for specific phobias include:

• Traumatic experience related to the object of a phobia (e.g., being bitten by a dog or having a car accident)
• Exposure to someone, such as a parent, who has a specific phobia, an extreme fear, or anxiety
• Certain personality traits, such as inhibition, sensitivity, or negativity
• Family history of anxiety or other mental illnesses

Are Phobias Hereditary?

People with a family history of anxiety or associated mental disorders have a higher risk of developing specific phobias themselves, suggesting an inherited component to anxiety. However, scientists have not yet identified a single gene definitively associated with anxiety or anxiety disorders. Instead, anxiety is likely the result of a coincidence of multiple genetic and environmental factors.

How Are Phobias Detected?

Specific phobias typically begin in childhood but may emerge at any stage of life. Differentiating between the early signs of a phobia and typical childhood fears is essential for early detection. Normal fears usually go away over time, and they do not significantly impair a child’s daily functioning. Normal childhood fears include:

• Loud noises
• Strangers
• Separation from parents (infants and toddlers)
• Ghosts/monsters
• The dark
• Thunderstorms
• Physical injury or illness
• School performance
• Death

How Are Phobias Diagnosed?

Diagnosis of a specific phobia begins with determining that the patient has a cluster of symptoms that meet the diagnostic criteria for the disorder. A doctor will start with a physical exam to rule out biological problems that may be causing symptoms. After these exams, if the doctor suspects that a phobia or another anxiety disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment to solidify the diagnosis further.

Diagnostic steps may include:

• A physical exam. This exam will be aimed at ruling out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

The results of the psychological assessments will be compared to the diagnostic criteria for specific phobias in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM criteria for specific phobias include:

• A particular object or situation causes fear or anxiety.
• The object almost always causes anxiety.
• The anxiety is out of proportion to the danger posed by the object.
• Fear-inducing situations or objects are avoided or endured under intense distress.
• The fear lasts for six months or more.
• The fear causes significant distress or impairment.
• Another mental illness does not explain the symptoms.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Are Phobias Treated?

A combination of medications and psychotherapy is often used to treat the symptoms of specific phobias.

Medication

Different medications may be used to treat and manage specific phobias. Individual medication plans depend on the patient’s age, responsiveness to treatments, and the severity of their symptoms.

• Benzodiazepines. These anti-anxiety medications work relatively quickly to control symptoms. However, they may lose their effectiveness over time.
• Beta-blockers. These medications are commonly used to treat high blood pressure, but they may be effective at controlling the physical symptoms of phobias.

Psychotherapy

The most common therapeutic approaches used to treat specific phobias include:

• Exposure therapy. This therapy involves gradual, controlled exposure to the object of the phobia. The goal is to help the patient understand and change their fear response to the situation.
• Cognitive-behavioral therapy (CBT). This process focuses on helping the patient identify a pattern of harmful thoughts and construct strategies and solutions for dealing with them.

How Do Phobias Progress?

Untreated specific phobias can have a long-term negative impact. Avoidance of fear-inducing situations can lead to complications, including:

• Depression
• Anxiety
• Relationship problems
• Problems at school or work
• Isolation
• Substance abuse
• Suicide or suicide attempts

How Are Phobias Prevented?

There is no known way to prevent social anxiety disorder. However, children who observe their parent’s phobic reactions are more likely to develop a phobia themselves. Because of this, parents with phobias should get treatment from a mental health professional to reduce the likelihood that their children will develop the disorder.

Phobias Caregiver Tips

Anxiety has many root causes, and it often exists alongside other mental health conditions, a situation called co-morbidity. Phobias usually begin in childhood, while many associated disorders emerge later, making early treatment of phobias a way to potentially prevent the related conditions. Here are a few of the disorders commonly associated with specific phobias:

• Depression and specific phobias are common comorbid mental disorders.
• Alcoholism and substance abuse are commonly comorbid with specific phobias.
• People with specific phobias may have other anxiety disorders as well.
• Obsessive-compulsive disorder (OCD) and phobias are often associated with one another.
• Post-traumatic stress disorder (PTSD) shares many symptoms with other anxiety disorders, including specific phobias.

Phobias Brain Science

Scientists believe that anxiety symptoms come from activity in the parts of the brain that control emotions and our reactions to them. These parts of the brain are collectively called the limbic system. The limbic system is associated with anxiety in several ways:

• The amygdala, the part of the brain responsible for detecting threats, may be hyperactive and may misidentify causes for fear or worry when none exist.
• An overactive amygdala may persistently cause the hypothalamus to trigger the hormonal response that produces the physical symptoms of phobias.
• Communication between the amygdala and the prefrontal cortex (PFC) may be impaired. The PFC is responsible for triggering a rational response to threats, and it may not be able to do so when it is unable to communicate with the amygdala effectively.

Phobias Research

Title: Bringing Exposure Therapy to Real-Life Context With Augmented Reality-Dogs (ARET)-Dogs

Stage: Not Yet Recruiting

Principal investigator: Arash Javanbakht, MD

Wayne State University

Detroit, MI 

In this patented project, U.S. Patent No. 10,839,707, the investigators will develop an augmented reality exposure therapy method for cynophobia, also known as dog phobia, to test in the clinic. The platform will include software that allows the clinician (psychiatrist/therapist) to position virtual objects in the real environment of the patient with the above-mentioned phobia while the patient is wearing the augmented reality (AR) device. Then the clinician will lead the patient through steps of exposure therapy to the feared object. The investigators will then measure the impact of treatment and compare it to before-treatment measures of fear of the phobic object.

Exposure therapy is the most evidence-based treatment for specific phobias, social phobia, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). The core principle is the patient’s exposure to the feared objects/situations guided by a clinician. For example, in cynophobia, the patient is exposed to pictures of dogs printed or on a computer screen – or, if available, a view of a real dog in the office. Gradually, the patient tolerates viewing/approaching the dog from a closer distance, and fear response extinguishes. Thus, the clinician has a crucial role in signaling safety to the patient, as well as providing support and coaching. However, this treatment is limited by multiple factors: 1) limited access to feared objects/situations in the clinic, 2) even when feared objects are available, they are not diverse (e.g., different types, sizes, and colors of dogs), which limits the generalization of safety learning, 3) when available, the clinician has very limited control over behaviors of the feared object, 4) safety learning is limited to the clinic office context, and contextualization of safety learning to real-life experiences is left to the patient to do alone, which often does not happen. This is specifically important in conditions such as PTSD, where there is cumulative evidence for impaired contextualization as a key neurobiological underpinning. 5) Lack of geographical access to experts in exposure therapy, especially for PTSD, in rural areas.

Title: Using Immersive Virtual Reality to Treat Pediatric Anxiety

Stage: Recruiting

Principal investigator: Joseph F. McGuire, PhD

Johns Hopkins University School of Medicine

Baltimore, MD 

Anxiety is a common and impairing problem for children. The principal treatment for pediatric anxiety involves facing a child’s fears in a stepwise approach through a therapeutic exercise called exposures. While exposures are effective, some feared situations cannot be confronted in a clinician’s office (e.g., heights, public speaking, storms). This poses a logistical challenge in treatment that: (1) takes time away from patient care, (2) leads clinicians to rely on imagined exposures, and/or (3) requires families to complete exposures outside of the therapy visits. This creates a burden for clinicians and families and impedes treatment success. Immersive virtual reality (VR) presents an innovative solution that allows children to face fears without leaving the clinician’s office. While VR has been used to distract children during painful medical procedures, it has not been well examined as a primary treatment for pediatric anxiety. This study proposes to examine the effectiveness and acceptability of using immersive VR exposures to treat children and adolescents with specific phobias.

Title: Use of Safety Behaviors in Exposure Therapy for Arachnophobia

Stage: Recruiting

Contact: Cynthia Lancaster, PhD

University of Nevada, Reno

Reno, NV

This study examines the impact of safety behaviors (i.e., unnecessary protective actions) on exposure therapy outcomes for spider phobia. Researchers will compare exposure therapy with (a) no safety behaviors, (b) safety behaviors that faded toward the end of treatment, and (c) unfaded safety behaviors.

Some studies suggest that safety behaviors might undermine the efficacy of exposure therapy (Powers et al., 2010). In contrast, other studies suggest there is no difference in exposure therapy outcomes whether or not safety behaviors are used (Deacon et al., 2010). Mixed findings could be explained by the safety behaviors’ parameters, such as whether they are used throughout the full course of therapy or faded toward the end of therapy. This will be the first study to directly compare the impact of faded and unfaded safety behaviors on exposure therapy outcomes. Specifically, researchers will randomize participants with a fear of spiders to receive exposure therapy (a) without safety behavior use, (b) with faded safety behavior use, and (c) with un-faded safety behavior use. Researchers will compare each condition’s impact on fear reduction and the tolerability/acceptability of treatment.