Phobias: Fear On Steroids
From spiders and snakes to flying and germs, phobias can be debilitating.
The diagnostic criteria for phobias, according to the DSM-V, includes a marked fear or anxiety of a specific object or situation. But how can you distinguish between being really scared and phobic? There are several ways, according to Megan Hughes-Feltenberger, PhD, assistant professor of Clinical Psychology in Psychiatry at Weill Cornell Medicine, New York-Presbyterian Hospital—Westchester Division. “The level of distress must be clinically significant or it must cause impairment,” she says. “Clinically significant distress could be getting so anxious that you are having panic attacks in the presence of the trigger. Impairment could be doing poorly in school or work, or it could be making decisions—like moving out of a house that has mice—that demonstrate how much the phobia is impacting your day-to-day life. Someone with a fear of vomiting might restrict the types of foods that they eat, or refuse to go to bars—where they think they’ll encounter vomit.”
Phobias can be caused by a traumatic event, but, according to Hughes-Feltenberger, most people with phobias can’t remember the reason their phobia started. Others, she says, develop phobias by observational learning (seeing someone else be afraid of a situation) or “informational transmission, such as being warned of a danger by others or something in the news.”
Treating phobias can be tricky. “Medications have not been particularly helpful for phobias,” Hughes-Feltenberger says. “They can treat the symptoms—for example, taking a benzo to get on a plane—but will not make the phobia go away.”
Instead, behavioral treatments are preferred. Cognitive Behavioral Therapy (CBT) focuses on identifying thoughts (overestimating dangers, magnifying predicted negative outcomes), feelings (such as anxiety), and behaviors (avoidance) associated with how the person responds to the phobic object. In CBT, a therapist will “work on decatastrophizing the thoughts, then preparing to expose a person to their feared stimulus in small steps,” says Hughes-Feltenberger. “You create a hierarchy of your fear. If you are afraid of mice, you might start with pictures of mice, then videos of mice, then mice in a room nearby, then mice in a cage in a room with you, et cetera.” The goal is to have a person stay in the situation without avoiding the trigger until his or her anxiety decreases. Then it’s on to the next step. For more on phobias and how to treat them, please visit www.westchestermagazine.com/phobias.
Where to Find Help
There are many wonderful mental-health professionals in the county, including a number (too many to list here) who specialize in anxiety and phobias. There are also local centers and organizations that specialize in treatment of phobias. Here are a few.
The Anxiety & Phobia Treatment Center at White Plains Hospital (914-681-1038; phobia-anxiety.org) has been helping people with phobias and other anxiety disorders for 45 years. All of the center’s counselors are graduates of the center’s Phobia Counselor Certification Program, and many have personally experienced phobias and other anxiety disorders. The center offers a variety of workshops, groups, and courses, including ongoing weekly support groups; one-on-one therapy sessions; and specific programs for health anxiety, fear of flying, OCD, public speaking and social anxiety, and more.
Columbia University Clinic for Anxiety and Related Disorders (CUCARD) (White Plains, 914-631-4618; columbiapsychiatry.org/clinicalservices/cucard-westchester) This clinic specializes in accelerated outpatient care for children, adolescents, and young adults whose lives are severely impaired by obsessive-compulsive disorder (OCD), anxiety, tic disorders, and trichotillomania.
National Institute for Mental Health
Hotline for Acute Phobia Attacks; 800-647-2642
Anxiety Disorders Association of America (301-231-9350; www.adaa.org)