Phobias highly treatable, curable
Sarah Crooks
Posted on January 31, 2004

If the idea of clowns, mice, germs or enclosed spaces sends you into panic mode - you're not alone.

According to the National Institute of Mental Health, between 5.1 percent and 12.5 percent of Americans suffer from phobias. But according to Alexandria psychologist Kelley Pears, the actual number is probably higher than lower.

"Technically, there's an infinite number of phobias," Pears explained.

And they all fall into three categories.

"Agoraphobia is one of the most common," Pears said.

Agoraphobia, which can occur with or without panic attacks, is the fear of being alone in a place or situation where it would be difficult to escape or get help if the need arises, says the American Psychiatric Association.

And social phobia, formerly known as social anxiety disorder, is a fear of being watched or humiliated while doing something in front of others. It generally develops after puberty and peaks after age 30.

But the category most often associated with the word is "specific phobia."

According to the Diagnostic and Statistical Manual, Fourth Edition, specific phobia is a "marked and persistent fear that is excessive and unreasonable, cued by the presence or anticipation of a specific object or situation."

That includes everything from a fear of heights or needles to a fear of snakes or spiders.

"Most people are afraid of snakes on some level," Pears said. "If you're sitting in a chair and a snake suddenly crawls out from under it, you're going to experience some type of fear."

The difference between that reaction and a phobia is "excessive and unreasonable" fear.

"If you have a phobia of snakes, even a photograph of a snake, or a snake behind glass at the zoo would cause marked and persistent fear," Pears explained.

Specific phobias can be sorted into five separate categories:


Animal phobias include a fear of snakes, spiders, dogs, rats and the like. These phobias generally begin in childhood.


Natural environment phobias include things such as storms, heights, water and lightening.


Blood-injection-injury phobias are cued by seeing or receiving blood, injections or injuries. According to Pears, this type of phobia tends to run in families.


Situational phobias includes a fear of public transportation, elevators, flying, driving and traveling across bridges or through tunnels.


Other phobias include fears of things like costumed characters and germs

"You can have a phobia to anything," Pears said. "Technically, you could have a phobia to a pillow or a trash can. But those aren't very common."

And while some fears may seem understandable - a fear of germs or heights for instance - others, like the fear of clowns, may seem a bit unfounded until you go back to the source.

"A person can be exposed to an object and when in the presence of that object, something else happens that scares them," Pears said, "so they pair that object with the fear."

Imagine being 5-years-old and having a clown perform at your birthday party. You're watching the clown at the exact moment someone scares you by popping a balloon in your ear.

"In their head, their brain has connected that fear with the clown," Pears said.

Then one day, that fear becomes a problem.

"It crosses the line when ... it starts interfering with their ability to function and do certain things," Pears said. "Once a person realizes this is presenting a problem ... that's when most seek help."

But before receiving a diagnosis, phobia patients must meet several criteria. If they're over 18, the fear must last more than six months.

The person must recognize that the fear is excessive or unreasonable though in children this criteria is sometimes absent. The person must exhibit a tendency to avoid encounters with the object of their phobia or endure those encounters with intense anxiety.

And exposure to phobia objects must cause an immediate anxiety response, such as nausea, increased heart rate, sweating, urge to flee, or inability to flee.

"Most people who have phobias don't seek treatment for it because for the most part, they can avoid that certain thing," Pears said. "The great thing about phobias is that they are highly treatable and curable."

Though some believe the best way to treat a phobia is to bombard the patient with that fear. "For instance, you put the person in an elevator and stay there," Pears said. That technique isn't often used.

Instead, treatment typically involves behavioral systematic desensitization. Therapists first teach the patient a variety of relaxation techniques and then ask them to make a list of all the things of which they are afraid.

"You rank them from most threatening to least threatening," Pears said.

Therapists then take their relaxed patients on a guided imagery tour of fears, starting with the least threatening. Patients imagine getting closer and closer to their fear.

If it's too much to take, the therapist can reverse the tour.

"Once you've mastered the less frightening objects on the list, you move on to the most frightening," Pears said.

In some cases, medication can be used in conjunction with behavioral therapy.

"But medication alone is not going to treat the phobia, just the symptoms," Pears said.

Though it depends on the person and the severity of their phobia, Pears said, patients usually overcome their fear within six or eight sessions.

"There's just a label in their head saying this is threatening when it may not be."