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Phobia

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For other uses, see phobia (disambiguation)
A phobia (from Greek: , phobos, "fear"), is an irrational, intense, persistent fear of certain
situations, activities, things, or people. The main symptom of this disorder is the excessive,
unreasonable desire to avoid the feared subject. When the fear is beyond one's control, or if the
fear is interfering with daily life, then a diagnosis under one of the anxiety disorders can be
made. [1]
Phobias (in the clinical meaning of the term) are the most common form of anxiety disorders. An
American study by the National Institute of Mental Health (NIMH) found that between 8.7% and
18.1% of Americans suffer from phobias. [2] Broken down by age and gender, the study found
that phobias were the most common mental illness among women in all age groups and the
second most common illness among men older than 25.

Contents
[hide]

1 Causes

2 The anatomical side of phobias

3 Clinical phobias
o 3.1 Treatments
o 3.2 Non-psychological conditions

4 Non-clinical uses of the term


o 4.1 Terms indicating prejudice or class discrimination

5 See also

6 Notes and references

7 External links

[edit] Causes
It is generally accepted that phobias arise from a combination of external events and internal
predispositions. In a famous experiment, Martin Seligman used classical conditioning to
establish phobias of snakes and flowers. The results of the experiment showed that it took far
fewer shocks to create an adverse response to a picture of a snake than to a picture of a flower,
leading to the conclusion that certain objects may have a genetic predisposition to being
associated with fear[3]. Many specific phobias can be traced back to a specific triggering event,
usually a traumatic experience at an early age. Social phobias and agoraphobia have more
complex causes that are not entirely known at this time. It is believed that heredity, genetics, and
brain chemistry combine with life-experiences to play a major role in the development of anxiety
disorders, phobias and panic attacks.

[edit] The anatomical side of phobias


Phobias are more often than not linked to the amygdala, an area of the brain located behind the
pituitary gland in the limbic system. The amygdala secretes hormones that control fear and
aggression. When the fear or aggression response is initiated, the amygdala releases hormones
into the body to put the human body into an "alert" state, in which they are ready to move, run,
fight, etc.[4] This defensive "alert" state and response is generally referred to in psychology as the
Fight-or-flight response.

[edit] Clinical phobias


Most psychologists and psychiatrists classify most phobias into three categories: [5] [6]

Social phobia, also known as social anxiety disorder - fears involving other people or
social situations such as performance anxiety or fears of embarrassment by scrutiny of
others, such as eating in public. Social phobia may be further subdivided into
o generalized social phobia, and
o specific social phobia, which are cases of anxiety triggered only in specific
situations. [7] The symptoms may extend to psychosomatic manifestation of
physical problems. For example, sufferers of paruresis find it difficult or
impossible to urinate in reduced levels of privacy. That goes beyond mere
preference. If the condition triggers, the person physically cannot empty their
bladder.

Specific phobias - fear of a single specific panic trigger such as spiders, snakes, dogs,
elevators, water, waves, flying, balloons, catching a specific illness, etc.

Agoraphobia - a generalized fear of leaving home or a small familiar 'safe' area, and of
possible panic attacks that might follow.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMIV), social phobia, specific phobia, and agoraphobia are sub-groups of anxiety disorder.
Many of the specific phobias, such as fear of dogs, heights, spiders and so forth, are extensions
of fears that a lot of people have. People with these phobias specifically avoid the entity they
fear.
Phobias vary in severity among individuals. Some individuals can simply avoid the subject of
their fear and suffer only relatively mild anxiety over that fear. Others suffer fully-fledged panic
attacks with all the associated disabling symptoms. Most individuals understand that they are
suffering from an irrational fear, but are powerless to override their initial panic reaction.

[edit] Treatments
Some therapists use virtual reality or imagery exercise to desensitize patients to the feared entity.
These are parts of systematic desensitization therapy.
Cognitive behavioral therapy (CBT) can be beneficial. Cognitive behavioral therapy lets the
patient understand the cycle of negative thought patterns, and ways to change these thought
patterns. CBT may be conducted in a group setting. Gradual desensitisation treatment and CBT
are often successful, provided the patient is willing to endure some discomfort and to make a
continuous effort over a long period of time. [8]
Hypnotherapy coupled with Neuro-linguistic programming can also be used to help remove the
associations that trigger a phobic reaction.
Anti-anxiety or anti-depression medications can be of assistance in many cases. Benzodiazepines
could be prescribed for short-term use.
Emotional Freedom Technique, a psychotherapeutic alternative medicine tool, considered to be
pseudoscience by the mainstream medicine, is allegedly useful.
These treatment options are not mutually exclusive. Often a therapist will suggest multiple
treatments.

[edit] Non-psychological conditions


The word "phobia" may also signify conditions other than fear. For example, although the term
hydrophobia means a fear of water, it may also mean inability to drink water due to an illness, or
may be used to describe a chemical compound which repels water. Likewise, the term

photophobia may be used to define a physical complaint (i.e. aversion to light due to inflamed
eyes or excessively dilated pupils) and does not necessarily indicate a fear of light.

[edit] Non-clinical uses of the term


Main article: -phobIt is possible for an individual to develop a phobia over virtually anything. The name of a phobia
generally contains a Greek word for what the patient fears plus the suffix -phobia. Creating these
terms is something of a word game. Few of these terms are found in medical literature. However,
this does not necessarily make it a non-psychological condition.

[edit] Terms indicating prejudice or class discrimination


See also: List of anti-ethnic and anti-national terms
A number of terms with the suffix -phobia are primarily understood as negative attitudes towards
certain categories of people or other things, used in an analogy with the medical usage of the
term. Usually these kinds of "phobias" are described as fear, dislike, disapproval, prejudice,
hatred, discrimination, or hostility towards the object of the "phobia". Often this attitude is based
on prejudices and is a particular case of general xenophobia.
Class discrimination is not always considered a phobia in the clinical sense because it is believed
to be only a symptom of other psychological issues, or the result of ignorance, or of political or
social beliefs. In other words, unlike clinical phobias, which are usually qualified with disabling
fear, class discrimination usually has roots in social relations. Below are some examples:

Chemophobia - prejudice against artificial substances in favour of 'natural' substances.

Christianophobia, fear or dislike of Christians or Christianity.

Ephebiphobia - fear or dislike of youth or adolescents

Gynophobia - fear or dislike of women

Homophobia - fear or dislike of homosexuality

Xenophobia - fear or dislike of strangers or the unknown, sometimes used to describe


nationalistic political beliefs and movements. It is also used in fictional work to describe
the fear or dislike of the space aliens.

Fobia
Dari Wikipedia bahasa Indonesia, ensiklopedia bebas

(Dialihkan dari Phobia)


Langsung ke: navigasi, cari
Fobia adalah rasa ketakutan yang berlebihan pada sesuatu hal atau fenomena. Fobia bisa
dikatakan dapat menghambat kehidupan orang yang mengidapnya. Bagi sebagian orang,
perasaan takut seorang pengidap Fobia sulit dimengerti. Itu sebabnya, pengidap tersebut sering
dijadikan bulan bulanan oleh teman sekitarnya. Ada perbedaan "bahasa" antara pengamat fobia
dengan seorang pengidap fobia. Pengamat fobia menggunakan bahasa logika sementara seorang
pengidap fobia biasanya menggunakan bahasa rasa. Bagi pengamat dirasa lucu jika seseorang
berbadan besar, takut dengan hewan kecil seperti kecoak atau tikus. Sementara dibayangan
mental seorang pengidap fobia subjek tersebut menjadi benda yang sangat besar, berwarna,
sangat menjijikkan ataupun menakutkan.
Dalam keadaan normal setiap orang memiliki kemampuan mengendalikan rasa takut. Akan tetapi
bila seseorang terpapar terus menerus dengan subjek Fobia, hal tersebut berpotensi menyebabkan
terjadinya fiksasi. Fiksasi adalah suatu keadaan dimana mental seseorang menjadi terkunci, yang
disebabkan oleh ketidak-mampuan orang yang bersangkutan dalam mengendalikan perasaan
takutnya. Penyebab lain terjadinya fiksasi dapat pula disebabkan oleh suatu keadaan yang sangat
ekstrim seperti trauma bom, terjebak lift dan sebagainya.
Seseorang yang pertumbuhan mentalnya mengalami fiksasi akan memiliki kesulitan emosi
(mental blocks) dikemudian harinya. Hal tersebut dikarenakan orang tersebut tidak memiliki
saluran pelepasan emosi (katarsis) yang tepat. Setiap kali orang tersebut berinteraksi dengan
sumber Fobia secara otomatis akan merasa cemas dan agar "nyaman" maka cara yang paling
mudah dan cepat adalah dengan cara "mundur kembali"/regresi kepada keadaan fiksasi.
Kecemasan yang tidak diatasi seawal mungkin berpotensi menimbulkan akumulasi emosi negatif
yang secara terus menerus ditekan kembali ke bawah sadar (represi). Pola respon negatif tersebut
dapat berkembang terhadap subjek subjek fobia lainnya dan intensitasnya semakin meningkat.
Walaupun terlihat sepele, pola respon tersebut akan dipakai terus menerus untuk merespon
masalah lainnya. Itu sebabnya seseorang penderita fobia menjadi semakin rentan dan semakin
tidak produktif. Fobia merupakan salah satu dari jenis jenis hambatan sukses lainnya.
Beberapa istilah sehubungan dengan fobia :
afrophobia ketakutan akan orang Afrika atau budaya Afrika.
caucasophobia ketakutan akan orang dari ras kaukasus.
hydrophobia ketakutan akan air.
photophobia ketakutan akan cahaya.

antlophobia takut akan banjir.


cenophobia takut akan ruangan yang kosong.
hyperphobia - takut akan ketinggian
Diperoleh dari "http://id.wikipedia.org/wiki/Fobia"

Fighting Phobias,
The Things That Go Bump in the Mind
by Lynne L. Hall
From 50 yards away, you see the animal approaching. Silently it watches you as it slinks ever so
much closer with each padded step. Stay calm, you tell yourself. There's nothing to fear.
But suddenly, panic seizes you in a death grip, squeezing the breath out of you and turning your
knees to Jell-O. Your heart starts slam-dancing inside your chest, your mouth turns to cotton, and
your palms are so sweaty you'd swear they'd sprung a leak. You'd escape this terrifying
confrontation, if only you could make your legs work!
Just what is this wild and dangerous animal making you hyperventilate and turning your legs to
rubber? A man-eating tiger, hungry for a meal? A lioness bent on protecting her cubs? Guess
again. That's Tabby, your neighbor's ordinary house cat, sauntering your way. Ridiculous, right?
How can anyone experience so much fear at the sight of such an innocuous animal? If you're one
of the thousands who suffer from galeophobia--the fear of cats--or any one of hundreds of other
phobias, sheer panic at the appearance of everyday objects, situations or feelings is a regular
occurrence.
Irrational Fears
A phobia is an intense, unrealistic fear of an object, an event, or a feeling. An estimated 18
percent of the U.S. adult population suffers from some kind of phobia, and a person can develop
a phobia of anything--elevators, clocks, mushrooms, closed spaces, open spaces. Exposure to
these trigger the rapid breathing, pounding heartbeat, and sweaty palms of panic.
There are three defined types of phobias:

specific or simple phobias--fear of an object or situation, such as spiders, heights or


flying

social phobias--fear of embarrassment or humiliation in social settings

agoraphobia--fear of being away from a safe place.

No one knows for sure how phobias develop. Often, there is no explanation for the fear. In many
cases, though, a person can readily identify an event or trauma--such as being chased by a dog-that triggered the phobia. What puzzles experts is why some people who experience such an
event develop a phobia and others do not. Many psychologists believe the cause lies in a
combination of genetic predisposition mixed with environmental and social causes.
Phobic disorders are classified as part of the group of anxiety disorders, which includes panic
disorder, post-traumatic stress disorder, and obsessive-compulsive disorder. Several drugs
regulated by the Food and Drug Administration are now being used to treat phobias and other
anxiety disorders.
Dogs, Snakes, Dentists . . .
A person can develop a specific phobia of anything, but in most cases the phobia is shared by
many and has a name. Animal phobias--cynophobia (dogs), equinophobia (horses), zoophobia
(all animals)--are common. So are arachnophobia (spiders) and ophidiophobia (snakes). And, of
course, there's the fear of flying (pterygophobia), heights (acrophobia), and confined spaces
(claustrophobia).
"One of the most common phobias is the fear of dentists [odontiatophobia]," says Sheryl
Jackson, Ph.D., a clinical psychologist and associate professor at the University of Alabama at
Birmingham. "People who suffer with this phobia will literally let their teeth rot out because they
are afraid to go to a dentist."
Jackson says that most specific phobias do not cause a serious disruption in a person's life, and,
consequently, sufferers do not seek professional help. Instead, they find ways to avoid whatever
it is that triggers their panic, or they simply endure the distress felt when they encounter it. Some
may also consult their physicians, requesting medication to help them through a situation, such
as an unavoidable plane trip for someone who is phobic about flying.
Drugs prescribed for these short-term situations include benzodiazepine anti-anxiety agents.
These medications include two approved for treating anxiety disorders: Xanax (alprazolam) and
Valium (diazepam). Beta blockers such as Inderal (propranolol) and Tenormin (atenolol),
approved for controlling high blood pressure and some heart problems, have been acknowledged,
partly on the basis of controlled trials, to be helpful in certain situations in which anxiety
interferes with performance, such as public speaking.
Some phobias cause significant problems that require long-term professional help. "People
usually seek treatment when their phobia interferes in their lives--the person who turns down
promotions because he knows public speaking will be required, someone who must travel
frequently but who is afraid of flying, or a woman who wants to have children but who has a fear
of pain or blood. These are the people who seek long-term treatment," says Jackson.

While anti-anxiety medication sometimes may be used initially, systematic desensitization may
also be an effective initial approach. Jackson explains that this nondrug treatment works on the
theory that the more a person is exposed to the object of his phobia, the less fear that object
generates.
First, the patient and therapist establish a hierarchy of feared situations, from the least to the most
feared. For someone who fears elevators, for example, stepping onto the elevator causes a certain
level of anxiety; going up one flight causes another level of anxiety. With each additional flight
the anxiety increases until it becomes intolerable.
Therapy begins with the patient and therapist practicing the least fearful event, riding out the
anxiety until the physiological symptoms subside. This step is repeated until the anxiety level is
acceptable. Then the person progresses to the next step in the hierarchy. Each successive step is
repeated until the physical reactions and anxious mood decrease to the point where the person
can step onto an elevator and ride to the top floor without panicking.
Everyone's Looking at Me!
Social phobia is a complex disorder, characterized by the fear of being criticized or humiliated in
social situations. There are two types of social phobias: circumscribed, which relates to a specific
situation such as "stage fright," and generalized social phobia, which involves fear of a variety of
social situations.
People suffering from social phobia fear the scrutiny of others. They tend to be highly sensitive
to criticism, and often interpret the actions of others in social gatherings as an attempt to
humiliate them. They are afraid to enter into conversations for fear of saying something foolish,
and may agonize for hours or days later over things they did say.
"I always believed that everybody else knew the secret to enjoying themselves in social
situations, that I was the only one who was so afraid," says Lorraine from Birmingham, Ala.,
who asked that her last name not be used. "For a long time, I avoided as many situations as
possible, even talking on the telephone. After a while, the loneliness and boredom would
overwhelm me, and I would try again. I wanted to have fun, but I never really enjoyed myself
because of the anxiety I felt. I always believed that others were looking at me and judging me."
Many people with social phobia are so sensitive to the scrutiny of others that they avoid eating or
drinking in public, using public restrooms, or signing a check in the presence of another. Social
phobia may often be associated with depression or alcohol abuse.
Neurotransmitter-receptor abnormalities in the brain are suspected to play a part in the
development of social phobias. Neurotransmitters are substances such as norepinephrine,
dopamine and serotonin that are released in the brain. The substance then either excites or
inhibits a target cell. Disorders in the physiology of these neurotransmitters are thought to be the
cause of a variety of psychiatric illnesses.

Negative social experiences, such as being rejected by peers or suffering some type of
embarrassment in public, and poor social skills also seem to be factors, and social phobia may be
related to low self-esteem, lack of assertiveness, and feelings of inferiority.
Treatment can include cognitive-behavior therapy and medications, though no drug is approved
specifically for social phobia. In addition to the anti-anxiety drugs and beta-blockers,
medications may include the monoamine oxidase (MAO) inhibitor antidepressants Nardil
(phenelzine) and Parnate (tranylcypromine), and serotonin specific reuptake inhibitors (SSRIs)
such as Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), and Luvox (fluvoxamine). Of
the latter four drugs, Prozac, Zoloft and Paxil are approved for depression; Prozac, Paxil, Luvox,
and Zoloft are approved for obsessive-compulsive disorder; and Paxil is approved for panic
disorder.
Chris Sletten, Ph.D., a clinical psychologist and behavioral medicine specialist at the Mayo
Clinic, says the use of SSRIs with behavior therapy is becoming more popular in the treatment of
social phobia. Because there are fewer side effects associated with these drugs and a very low
addiction potential, practitioners are more comfortable prescribing them. Plus, the antidepressant
action of these drugs is helpful in treating patients who suffer from depression in addition to
social phobia, he says.
"My therapist prescribed Prozac, and it has been an absolute godsend for me," Lorraine says.
"After only a couple of months taking it, those voices in my head, the ones that always assured
me that everyone was judging me--and finding me lacking--just seemed to shut up. I didn't feel
high or drugged in any way. I felt like I always thought a "normal" person would feel. It's not a
complete cure, of course. I still feel anxiety in social situations. But I don't avoid them as much.
In fact, I actually pick up the phone now and ask friends to dinner, and I can relax enough to
have fun. It's a whole new life for me."
The Wide Open Spaces
Agoraphobia comes from Greek, meaning literally "fear of the marketplace," but it usually is
defined as a fear of open spaces. Sletten says it stems more from the fear of being someplace
where you will not be able to escape. It is closely identified with panic disorder, and in many
cases, agoraphobia is directly related to the fear of experiencing a panic attack in public.
A person with panic disorder suffers sudden bouts of panic for no apparent reason. These attacks
can occur anywhere at any time. One minute everything is fine, the next the person is engulfed
by a feeling of terror. The heart races, breathing comes in gasps, and the entire body trembles.
The attack may last only minutes, but its memory is etched indelibly in the brain, and the
anticipation of another causes almost as much terror as the attack itself.
People who suffer agoraphobia avoid places and situations where they feel escape would be
difficult in case an attack occurs. This could be anywhere--the grocery store, a shopping mall, the
office. As the fear of an attack increases, the agoraphobic's world narrows to only a few places
where he or she feels safe. In the most severe cases, this is limited to the home.

Agoraphobia is the most disabling of all the phobias, and treatment is difficult because there are
so many associated fears--the fear of crowds, of elevators, of traffic. As with social phobias,
treatment involves behavioral therapy combined with anti-anxiety or antidepressant medications,
or both. Paxil has received FDA approval for use in treating panic disorders with or without
agoraphobia, and at press time, Zoloft was being considered for this additional use.
"The most important thing for people with phobias to remember," says Sletten, "is that phobic
disorders do respond well to treatment. It's not something they have to continue to suffer with."
Lynne L. Hall is a writer in Birmingham, Ala.

Figuring out phobia


Researchers are using neuroimaging techniques to delve into the neurobiological
underpinnings of phobias, with a view to improving treatments.
BY LEA WINERMAN
Monitor Staff
Print version: page 96

More than 10 million adults in the United States suffer from some sort of phobia, according
to the National Institute of Mental Health. These exaggerated fears--whether of spiders,
needles (see page 100), snakes, heights, social situations (see page 92) or even public
spaces (see page 94)--can become so all-consuming that they interfere with daily life.
The good news is that over the past several decades, psychologists and other researchers
have developed some effective behavioral and pharmacological treatments for phobia, as
well as technological interventions.
Now researchers are taking the next step, says psychologist and phobia researcher Arne
hman, PhD, of the clinical neuroscience department at the Karolinska Institute in Sweden.
They are using neuroimaging techniques like positron-emission tomography (PET) and
functional magnetic resonance imaging (fMRI) to understand the brain circuitry that
underlies phobia and what happens in the brain during treatment.
They're finding that the amygdala--a small, almond-shaped structure in the middle of the
brain's temporal lobes--is a key player, and that malfunctions of the amygdala and
associated brain structures may give rise to many phobias. Still, researchers have yet to
work out the details of how this happens.
"As soon as we know more about what is happening in the brain, then we can fine-tune
treatment," hman says.
The biology of fear

All phobias are anxiety disorders, lumped in the same class as post-traumatic stress
disorder and panic disorder, among others. And anxiety disorders are, fundamentally, based
on fear.
"What we know about the neurocircuitry and brain basis of fear originally comes from
animal research," says psychiatrist Scott Rauch, MD, of Harvard Medical School. Indeed,
more than 30 years of research has examined the neurological underpinnings of fear in
laboratory rats.
The workhorse paradigm has been the fear conditioning/fear extinction model, Rauch
explains. In this model, researchers condition rats to fear a neutral stimulus, like a
particular tone, by pairing it with something aversive, like an electric shock. Then, later, the
researchers can "extinguish" this fear by repeatedly playing the tone without the
accompanying shock. The researchers can use electrodes to record electrophysiological
activity in the rats' brains during the fear conditioning or extinction process.
"Using this paradigm, in the past 25 years we've been able to pinpoint pretty precisely
where to look for fear in the brain," says New York University psychologist Joseph LeDoux,
PhD, a pioneer of this type of research.
What they've pinpointed is the amygdala. LeDoux and others have found that there is a
double pathway leading to and from the amygdala. One path leads directly from a
frightening sensory stimulus--like the sight of a snake or the sound of a loud crash--to the
amygdala in just a few thousandths of a second. A second, slower pathway travels first to
the higher cortex before reaching the amygdala.
"The shorter pathway is fast but imprecise," LeDoux explains. "If a bomb goes off, you
might not quickly be able to evaluate any of the perceptual qualities of the sound, but the
intensity is enough to trigger the amygdala. If you knew a lot about bombs, then through
the cortex pathway you could evaluate the danger, but it will take longer."
The fast pathway, then, is the brain's early warning system, explains LeDoux, and leads to
physical manifestations of fear like a racing heart and sweaty palms. The second pathway
can override the first, and either lead to conscious feelings of fear or no fear. Studies like
these have led researchers to believe that phobias and other anxiety disorders are caused
by some type of dysfunction in the amygdala and related brain areas.
Moving to humans
The detail and scale of what researchers have learned from animal experiments is
extraordinary, according to Rauch. "But the disadvantage is that you have to extrapolate
from what you've learned to humans, and particularly to humans with anxiety disorders," he
says.
So about a decade ago, researchers began to try to examine the analogous processes in
people, using brain-imaging technology such as PET and fMRI.

What they've found has already led to a greater understanding of many anxiety disorders,
particularly obsessive-compulsive disorder and post-traumatic stress disorder.
Fewer studies have focused on phobias, Rauch says: "The data there are a little less
developed, and the results less cohesive." The first studies, from the early and mid 1990s,
were symptom-provocation studies: Researchers would show, say, a snake-phobic person a
snake or a picture of a snake, and then use PET scans to examine the brain's reaction.
"Heuristically, it was appealing to believe that these phobic disorders would be related to
abnormalities in the fast-track through the amygdala," Rauch says. But in fact the earliest
studies--like a 1995 study by Rauch in the Archives of General Psychiatry (Vol. 52, No. 1,
pages 2028)--didn't find any evidence of amygdala activation, although some cortical
areas that communicate with the amygdala were active.
As measurement and experimental techniques have developed over the past decade,
though, the findings have developed as well. For example, fMRI works more quickly than do
PET scans, so researchers can examine the brain's reaction to stimuli in a narrower time
scale, Rauch explains. In a 2003 study from Neuroscience Letters (Vol. 348, No. 1, pages
2932), for example, psychologist Wolfgang Miltner, PhD, and his colleagues at Friedrich
Schiller University in Germany used fMRI to examine spider phobics as they viewed pictures
of spiders, snakes and mushrooms. This time the researchers found that the amygdala was
more active in the spider phobics than in control participants.
Other researchers have found that "masking" the phobia stimulus, so that participants see it
but are not consciously aware of it, produces interesting results. In a 2004 study in Emotion
(Vol. 4, No. 4, pages 340353), hman and his colleagues flashed 16 snake and spider
phobics with pictures of a snake and a spider, each followed by a neutral picture. The
presentation was so fast that the participants were not consciously aware that they had
seen the snake or spider. Next, the researchers waited long enough for the participants to
consciously register the feared stimuli before presenting the neutral ones.
The researchers found that when the timing did not allow conscious awareness, the
amygdala responded to both the phobic and fear-relevant stimuli (fear-relevant stimuli were
snake pictures for spider phobics, and vice versa). But when the timing did allow awareness,
the amygdala responded only to the phobic stimuli. This suggests, hman says, that the
amygdala responds immediately to anything that might be threatening, but that with more
time to process other areas of the brain suppress the amygdala's initial response.
Finally, some researchers have begun to look particularly at what happens in the brain
during and after phobia treatment. Psychologists Tomas Furmark, PhD, Mats Fredrikson,
PhD, and their colleagues at Uppsala University in Sweden used PET scans to examine the
brain activity of 18 people with social phobia as the people spoke in front of a group. Then,
one-third of the participants received nine weeks of cognitive-behavioral therapy, one-third
received the selective serotonin reuptake inhibitor Citalopram and one-third received no
treatment. The researchers tested the patients again, using the same public speaking task,
at nine weeks and again after one year. They found that the activation in the amygdala and

related cortical areas at nine weeks could predict which people's symptoms would improve
after one year.
Though all of these findings are shaping researchers' understanding of the parts of the brain
that give rise to phobia, the picture is far from complete.
"This is a critical area of research for the future," says Rauch.

AllPsych Journal

Phobias: Causes and Treatments


Erin Gersley
November 17, 2001

Phobia (FO-bee-ah): a persistent irrational fear of an object, situation, or activity that the person feels
compelled to avoid. (Wood 689) And that is only the start of it. Phobias can interfere with your ability to
work, socialize, and go about a daily routine (American). People who have phobias are often so
overwhelmed by their anxiety that they avoid the feared objects or situations (NIMH). For most people,
the simple pleasures of life are striped from them. Symptoms of a phobia include the following:

Feeling of panic, dread, horror, or terror

Recognition that the fear goes beyond normal boundaries and the actual threat of danger

Reactions that are automatic and uncontrollable, practically taking over the persons thoughts

Rapid heartbeat, shortness of breath, trembling, and an overwhelming desire to flee the
situation all the physical reactions associated with extreme fear

Extreme measures taken to avoid the feared object or situation (American)

There are three classes of phobias: agoraphobia, social phobia, and specific phobia (Wood 521).
Agoraphobics have an intense fear of being in a situation from which immediate escape is not possible or
in which help would not be available if the person should become overwhelmed by anxiety or experience
a panic attack or panic-like symptoms (Wood 521). Agoraphobia is the most disabling of all phobias, and

treatment is difficult because there are so many associated fears (Hall). Specific phobia is a catchall
category for any phobias other than agoraphobia and social phobias (Wood 522). There are four
categories of specific phobias: situational phobia, fear of natural environment, animal phobia, and bloodinjection-injury phobia (Wood 522). Between these four categories are more than 350 different types of
specific phobias. They range all the way from cathisophobia-fear of sitting to something as severe as
arachnophobia-fear of spiders. For people with social phobia, however, the fear is extremely intrusive and
can disrupt normal life, interfering with work or social relationships in varying degrees of severity (NIMH).
Approximately 4 to 5% of the U.S. population has one or more clinically significant phobias in a giving
year (NIMH). Specific phobias affect an estimated 6.3 million adult Americans and are twice as common
in women as in men (About). The average age of onset for social phobia is between 15 and 20 years of
age, although it can begin in childhood (NIMH). Childhood phobias usually disappear before adulthood.
However, those that persist into adulthood rarely go away without treatment (American).
Many psychologists believe the cause lies in a combination of genetic predisposition mixed with
environmental and social causes (Hall). Some believe that neurotransmitter-receptor abnormalities in the
brain are suspected to play a part in the development of social phobias (Hall). Neurotransmitters are
substances such as norepinephrine, dopamine, and serotonin that are released in the brain (Hall).
Disorders in the physiology of these neurotransmitters are thought to be the cause of a variety of
psychiatric illnesses (Hall). It has also been demonstrated that identical twins may develop that same
type of phobia, even when they were reared separately soon after birth, and educated in different places
(Masci). It may by also true that human beings are biologically prone to acquire fear of certain noxious
animals or situations, such as rats, poisonous animals, animals with disgusting appearance, such as
frogs, slugs or cockroaches, etc.(Masci) But phobias are not always destined in our genes.
In a classical experiment, the American psychologist Marting Seligman associated an aversive stimulation
(a small electric shock) to certain pictures (Masci). Two to four shocks were enough to establish a phobia
to pictures of spiders or snakes, while a much larger series of shocks was needed to cause phobia to
pictures of flowers, for example (Masci). One possible explanation is that those fears where originally
important for the survival of the human species thousands of years ago and that they lie dormant inside
our brains, just waiting to be awaken at any time (Masci). Another reason for the development of phobias
is that we often associate danger to things and situations that we cannot prevent or control, such as
lightning strikes during a storm, or the attack of a dangerous animal (Masci). In this sense, patients who
have clinically-established panic disorder, often end developing phobia to their own crisis, because the
feel totally helpless in controlling it (Masci). In consequence, they start avoiding going to or staying in
places or situations where they might become publicly embarrassed or unable to escape, due to the onset
of the crisis (Masci).
Traumatic events often trigger the development of specific phobias, which are slightly more prevalent in
women than men (NIMH). Negative social experiences, such as being rejected be peers or suffering
some type of embarrassment in public, and poor social skills also seem to be factors, and social phobia
may be related to low self-esteem, lack of assertiveness, and feeling of inferiority (Hall). Many people
with social phobia are so sensitive to the scrutiny of others that they avoid eating or drinking in public,
using public restrooms, or signing a check in the presence of another (Hall). Social phobia may often be
associated with depression or alcohol abuse (Hall).
Finally, there is also the social component or cultural influences on phobia (Masci). For example, there is

a kind of phobia called taijin kyofusho, which occurs only in Japan (Masci). In contrast to what happens in
the social phobias (when the patient is afraid of being humiliated or loathed by other persons), taijin
kyofusho is the fear of offending other persons by an excess of modesty or showing respect! (Masci). The
patient is afraid that his social behavior or an imaginary physical defect might offend or embarrass other
people (Masci). Fortunately effective relief can be gained through either behavior therapy or medication
(American).
One of the most successful treatments is behavior therapy. In behavior therapy, one meets with a trained
therapist and confronts the feared object or situation in a carefully planned, gradual way and learns to
control the physical reactions of fear (American). The behaviorists involved in classical conditioning
techniques believe that the response of phobic fear is a reflex acquired to non-dangerous stimuli
(Phobia). The normal fear to a dangerous stimulus, such as a poisonous snake, has unfortunately been
generalized over to non-poisonous ones as well (Phobia). If the person were to be exposed to the nondangerous stimulus time after time without any harm being experienced, the phobic response would
gradually extinguish itself (Phobia). In other words, one would have to come across ONLY non-poisonous
snakes for a prolonged period of time for such extinction to occur (Phobia). This is not likely to occur
naturally, so behavior therapy sets up phobic treatment involving exposure to the phobic stimulus in a
safe and controlled setting (Phobia). Foa and Kozak call this exposure treatment, so called because the
patient is exposed to the phobic stimulus as part of the therapeutic process (Phobia).
One simple form of exposure treatment is that of flooding, where the person is immersed in the fear reflex
until the fear itself fades away (Phobia). The key is keeping the patients in the feared situation long
enough that they can see that none of the dreaded consequences they fear actually come to pass (Wood
548). Some patients cannot handle flooding in any form, so an alternative classical conditioning
technique is used called counter-conditioning (Phobia). In this form, one is trained to substitute a
relaxation response for the fear response in the presence of the phobic stimulus (Phobia). This counterconditioning is most often used in a systematic way to very gradually introduce the feared stimulus in a
step-by-step fashion known as systematic desensitization, first used by Joseph Wolpe (Phobia).
In desensitization, three steps are involved:
1. Training the patient to physically relax
2. Establish an anxiety hierarchy of the stimuli involved
3. Counter-conditioning relaxation as a response to each feared stimulus beginning first with
the least anxiety provoking stimulus and moving then to the next least anxiety provoking
stimulus until all of the items listed in the anxiety hierarchy have been dealt with
successfully (Phobia).
Also, systematic desensitization can be paired with modeling, and application suggested by social
learning theorists (Phobia). In modeling, the patient observes others (the model(s)) in the presence of
the phobic stimulus who are responding with relaxation rather that fear (Phobia). In this way, the patient
is encouraged to imitate the model(s) and thereby relieve their phobia (Phobia). However relaxation
therapy is not the only treatment used in curing phobias.
Hypnosis can also set you free of fears and phobias. In mild cases, where a person recognizes the
triggers but would like help controlling their reaction, posthypnotic suggestions can help them control their

breathing, slow their heart rate, and achieve a relaxed state of mind (Wizell). This permits them to deal
with the problem in a calm and rational manner (Wizell). More severe cases are often the result of a
traumatic childhood event (Wizell). Most of the time the event can no longer be recalled by the conscious
mind, but is still retained in the subconscious (Wizell). In these cases, the Hypnotherapist will often apply
age regression (Wizell). Age regression is one of the most powerful tool available to the Hypnotherapist
(Wizell). With it s/he can guide the person back in time, and help them reexamine the event that initially
triggered the fear from an objective point of view (Wizell). Once the cause is revealed, the fear of losing
control is eliminated (Wizell).
Medications are also used to control the panic experience during a phobic situation as well as the anxiety
aroused by anticipation of that situation and are the treatment of first choice for social phobia and
agoraphobia (American). Drugs prescribed for these short-term situations include benzodiazepine antianxiety agents (Hall). These include two approved for treating anxiety disorders: Xanax (alrazolam) and
Valium (diazepam) (Hall). Beta-blockers such as Inderal (propranolol) and Tenormin (atenolol), approved
for controlling high blood pressure and some heart problems, have been acknowledged, partly on the
basis of controlled trails, to be helpful in certain situations in which anxiety interferes with performance,
such as public speaking (Hall).
In addition to the anti-anxiety drugs and beta-blockers, medications may include the monamine oxidase
(MAO) inhibitor antidepressants Nardil (phenelzine) and Parnate (tranylcypromine), and serotonin specific
reuptake inhibitors (SSRIs) such as Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), and Luvox
(fluvoxamine) (Hall). Because there are fewer side effects associated with these drugs and a very low
addiction potential, practitioners are more comfortable prescribing them (Hall). Plus, the antidepressant
action of these drugs is helpful is treating patients who suffer from depression in addition to social phobia
(Hall).
Newer antidepressants are being specifically designed to target mechanisms that elevate serotonin and
other neurotransmitters in the brain; some showing promise for anxiety are venlafaxine (Effexor) and
nefazodone (Serzone). (Well-Connected) The antidepressant drugs known as tricyclic antidepressants
(TCA) have also been effective in treating panic and obsessive-compulsive disorders (Well-Connected).
The most common TCA used for the treatment of panic disorder is imipramine (Tofranil, Janimine); it is
also effective in treating agoraphobia (Well-Connected). But with proper treatment, the vast majority of
phobia patients can completely overcome their fears and be symptom free for years, if not for life
(American).

Work Cited
About.com
Specific Phobias. http://seniorhealth.about.com/library/men/bl_anxiety6.htm?iam=savvy&terms=
%2Bphobia
American Psychiatric Association.
Hall, Lynne L.

Phobias . http:www.psych.org/public_info/eating.cfm

Fighting Phobias, The Things That Go Bump in the Mind.

http://www.fda.gov/fdac/features/1997/297_bump.html
Masci, MD Cyro.
Phobia: When Fear is a Disease.
http:www.edub.org.br/cm/n05/doencas/fobias_i.htm
NIMH (National Institute of Mental Health)
.Anxiety Disorders: Quick Facts
http://www.nimh.nih.gov/Anxiety/anxiety/phobia/phqfax.htm
Phobia List

.Treatment for Phobias. http://www.phobialist.com/treat.html

Well-Connected .How is Anxiety Disorder Diagnosed and Treated


.http://my.webmd.com/content/article/1680.5027
Wizell, Victoria. Hypnosis can set you free of fears and phobias.
http://www.hyptalk.com/Articles/Fears/htm.
Wood, Samuel E. & Ellen Green Wood. The World of Psychology: 3rd Edition.
Viacom, 1999

Needham Heights:

LetsTalkFactsAbout
Phobias
Copyright2005AmericanPsychiatricAssociation
Fearisthenormalresponsetoagenuinedanger.Withphobias,thefeariseitherirrationalor
excessive.Itisan
abnormallyfearfulresponsetoadangerthatisimaginedorisirrationallyexaggerated.People
candevelopphobic
reactionstoanimals(e.g.,spiders),activities(e.g.,flying),orsocialsituations(e.g.,eatingin
publicorsimplybeingin
apublicenvironment).
Phobiasaffectpeopleofallages,fromallwalksoflife,andineverypartofthecountry.The
AmericanPsychiatric
InstituteforResearchandEducation(APIRE)hasreportedthatinanygivenyear,7.8%of
Americanadultshave
phobias.Theyarethemostcommonpsychiatricillnessamongwomenofallagesandarethe
secondmostcommon
illnessamongmenolderthan25.

Symptoms

Phobiasareemotionalandphysicalreactionstofearedobjectsorsituations.Symptomsofa
phobiaincludethe
following:
Feelingsofpanic,dread,horror,orterror

Recognitionthatthefeargoesbeyondnormalboundariesandtheactualthreatofdanger
Reactionsthatareautomaticanduncontrollable,practicallytakingoverthepersonsthoughts
Rapidheartbeat,shortnessofbreath,trembling,andanoverwhelmingdesiretofleethe
situation
allthephysicalreactionsassociatedwithextremefear
Extrememeasurestakentoavoidthefearedobjectorsituation

CategoriesofPhobias

Phobiasaredividedintocategoriesaccordingtothecauseofthereactionandavoidance.
AGORAPHOBIA
Agoraphobiaisthefearofbeingaloneinanyplaceorsituationwhereitseemsescapewouldbe
difficultorhelp
unavailableshouldtheneedarise.
Peoplewithagoraphobiamayavoidbeingonbridges,busystreetsorincrowdedstores.Some
peoplewith
agoraphobiabecomesodisabledtheyliterallywillnotleavetheirhomes.Iftheydo,itisonly
withgreatdistressor
whenaccompaniedbyafriendorfamilymember.
Twothirdsofthosewithagoraphobiaarewomen.Symptomsusuallydevelopbetweenlate
adolescenceandmid
30s.Theonsetmaybesuddenorgradual.
Mostpeoplewithagoraphobiadevelopthedisorderafterfirstsufferingfromoneormore
spontaneouspanic
attacksfeelingsofintense,overwhelmingterroraccompaniedbysymptomssuchassweating,
shortnessofbreath,
orfaintness.Theseattacksseemtooccurrandomlyandwithoutwarning,makingitimpossible
forapersonto
predictwhatsituationwilltriggersuchareaction.
Page 2

LetsTalkFactsAbout
Phobias
Copyright2005AmericanPsychiatricAssociation
Theunpredictabilityofthepanicattackstrainsindividualstoanticipatefuturepanicattacks
and,therefore,tofear
anysituationinwhichanattackmayoccur.Asaresult,theyavoidgoingintoanyplaceor
situationwhereprevious
panicattackshaveoccurred.
SOCIALPHOBIA
Apersonwithsocialphobiafearsbeingwatchedorhumiliatedwhiledoingsomethinginfront
ofothers.The
activityisoftenasmundaneassigningapersonalcheckoreatingameal.Themostcommon
socialphobiaisthe

fearofspeakinginpublic.Manypeoplehaveageneralizedformofsocialphobia,inwhichthey
fearandavoid
interpersonalinteractions.Thismakesitdifficultforthemtogotoworkorschoolortosocialize
atall.
Socialphobiasgenerallydevelopafterpubertyand,withouttreatment,canbelifelong.
SPECIFICPHOBIA
Asthenameimplies,peoplewithaspecificphobiagenerallyhaveanirrationalfearofspecific
objectsorsituations.
Thedisabilitycausedbythisphobiacanbesevereifthefearedobjectorsituationisacommon
one.
Themostcommonspecificphobiainthegeneralpopulationisfearofanimalsparticularly
dogs,snakes,insects,
andmice.Otherspecificphobiasarefearofclosedspaces(claustrophobia)andfearofheights
(acrophobia).
Mostsimplephobiasdevelopduringchildhoodandeventuallydisappear.Thosethatpersistinto
adulthoodrarelygo
awaywithouttreatment.

Treatment

Anyphobiathatinterfereswithdailylivingandcreatesextremedisabilityshouldbetreated.
Withpropertreatment,
thevastmajorityofphobiapatientscancompletelyovercometheirfearsandbesymptomfree
foryears,ifnotfor
life.Effectivereliefcanusuallybegainedthrougheithercognitivebehaviortherapy,medication,
oracombination
ofboth.
COGNITIVEBEHAVIORTHERAPY
Inbehaviortherapy,onemeetswithatrainedtherapistandconfrontsthefearedobjector
situationinacarefully
planned,gradualwayandlearnstocontrolthementalandphysicalreactionsoffear.By
confrontingratherthan
fleeingtheobjectoffear,thepersonbecomesaccustomedtoitandcanlosetheterror,horror,
panic,anddreadhe
orsheoncefelt.
MEDICATIONS
Medicationsareusedtocontrolthepanicexperiencedduringaphobicsituation,aswellasthe
anxietycausedby
anticipationofthatsituationandareoftenusedtotreatsocialphobiaandagoraphobia.