Most people will feel some degree of anxiety and discomfort when they anticipate a painful or life-threatening experience, such as getting an injection, or when faced with potential danger, such as being confronted by an angry, barking dog.
People with a specific phobia, however, have developed an extreme fear of a particular object, activity or situation which is out of proportion with the actual level of threat posed. People with specific phobia will actively avoid the feared object or situation and experience a high level of anxiety if it is encountered.
Common phobias include:
- animal related phobias (e.g., snakes, spiders, dogs)
- phobias relating to the natural environment (e.g., storms, water)
- blood, injection, and injury phobias (e.g., needles, medical procedures)
- situational phobias (e.g., elevators, aeroplanes, tunnels).
Specific phobias usually develop during childhood, and they are twice as likely to be diagnosed in women compared to men. Many people with a specific phobia experience multiple phobias over their lifetime.
Symptoms
Specific phobia is characterised by:
- an intense fear or anxiety related to a specific object, activity or situation which is out of proportion with the degree of danger actually posed.
- active efforts to avoid the feared object, activity, or situation (e.g., always taking the stairs to avoid going in an elevator).
A diagnosis of specific phobia is made when these symptoms are present for six months or longer and cause the person significant distress, or interfere with important aspects of the person’s life, such their work or relationships.
Causes
While many phobias have no obvious cause, several factors have been linked to the development of a specific phobia. These include:
- Direct learning: Many phobias (especially those related to animals, injections, and enclosed spaces) occur following a negative or previous traumatic experience, for example, a person may develop a phobia of dogs after being bitten by a dog.
- Indirect learning: A person may become fearful of a particular object or situation after observing another person’s fearful response to that same object or situation, for example a child observing how their parent is fearful of and avoids flying.
- Genetic factors: People with a family history of animal phobias, situational phobias, and blood, injection, and injury phobias have a higher chance of developing the phobia than those without a family history.
Once a specific phobia has developed, a person’s fear can continue due to a number of behavioural and cognitive factors. These include:
- Unhelpful thoughts: Unhelpful thoughts such as overestimating the chance of harm or incorrect beliefs about the consequences of confronting a feared object/situation are also thought to contribute to the continued experience of a phobia.
- Avoidance: Avoidance is a common behavioural reaction to a specific phobia as it allows people to avoid feelings of fear and anxiety. However, avoidance prevents opportunities to learn to challenge fearful beliefs and develop effective coping skills to manage anxiety. As a result, the specific phobia is maintained and not overcome.
Treatment
Exposure therapy
Exposure therapy has the most research evidence as an effective treatment for specific phobias. In exposure therapy, the person is supported to gradually and over time face the feared object or situation without engaging in any avoidance or escape behaviours. By encouraging people to face their fears, it is thought that exposure therapy teaches a person that feelings of anxiety decrease naturally over time and that the feared consequences of the phobic object or situation are unlikely to occur.
The most effective form of exposure therapy is in vivo exposure. In vivo exposure is typically conducted in a controlled real-world environment and involves directly confronting the person’s fear through a series of activities which provoke increasing levels of fear and anxiety. For example, a person with a phobia of dogs may first decide to approach a dog on a leash, then proceed to pat a dog on the head, then allow a dog to lick his/her hand, and eventually go to a dog park. A person usually undergoes exposure therapy until the most anxiety-provoking situation has been successfully mastered. In extreme cases, exposure therapy may start with indirect exposure to the feared object or situation, such as looking at a photo or watching a video of a dog.
Cognitive therapy
Cognitive therapy involves helping the person to identify and challenge unhelpful thoughts. In the treatment of phobias, cognitive therapy looks to:
- identify the person’s automatic thoughts of the feared object or situation (for example, “All dogs will bite me”)
- determine the difference between the automatic thoughts and the real world, and
- replace the automatic thoughts with alternative thoughts (such as “most dogs don’t bite, some dogs may bite if provoked, and dangerous dogs will growl and lunge before biting”).
Cognitive therapy might be used alone or together with exposure therapy, such as looking for evidence of automatic and alternative thoughts when observing or interacting with dogs.
Seeking help
Seeing a Psychologist
If a specific phobia is affecting your day-to-day life, a psychologist may be able to help. Psychologists are highly trained and qualified professionals skilled in helping people with a range of mental health and wellbeing concerns, including anxiety and phobias.
There are a few ways you can access a psychologist. You can:
- use the Australia-wide Find a Psychologist service or call 1800 333 497
- ask your GP or another health professional to refer you.
If you are referred to a psychologist by your GP, you might be able to get a Medicare rebate that may assist you in meeting the costs of treatment. You may also be able to receive psychology services via telehealth so you don’t need to travel to see a psychologist. Ask your psychologist or GP for details.
Additional resources
Head to Health
The Federal Government’s website linking the public to reputable and evidence-based digital mental health services.
www.headtohealth.gov.au
beyondblue
Provides information on anxiety, depression, and related disorders
www.beyondblue.org.au
headspace
Australia’s National Youth Mental Health Foundation, providing assistance for individuals aged 12-25
www.headspace.org.au
Lifeline
A 24-hour counselling, suicide prevention and mental health support service
Telephone: 13 11 14
www.lifeline.org.au
References
- American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
- Boehnlein, J., Altegoer, L., Muck, N. K., Roesmann, K., Redlich, R., Dannlowski, U., & Leehr, E. J. (2020). Factors influencing the success of exposure therapy for specific phobia: A systematic review. Neuroscience & Biobehavioral Reviews, 108, 796-820. https://doi.org/10.1016/j.neubiorev.2019.12.009
- Eaton, W. W., Bienvenu, O. J., & Miloyan, B. (2018). Specific phobias. The Lancet Psychiatry, 5(8), 678-686. https://doi.org/10.1016/S2215-0366(18)30169-X
- Kaczkurkin, A. N., & Foa, E. B. (2022). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in Clinical Neuroscience, 17, 337-346. https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin
- Mobach, L., Oar, E., & Hudson, J. L. (2020). Exposure therapy for specific phobias in children and adolescents. In T.S. Peris, E.A. Storch, & J.F. McGuire (Eds.), Exposure Therapy for Children with Anxiety and OCD: Clinician’s Guide to Integrated Treatment. (pp. 165-191). Academic Press. https://doi.org/10.1016/B978-0-12-815915-6.00008-1
- Pittig, A., Treanor, M., LeBeau, R. T., & Craske, M. G. (2018). The role of associative fear and avoidance learning in anxiety disorders: Gaps and directions for future research. Neuroscience & Biobehavioral Reviews, 88, 117-140. https://doi.org/10.1016/j.neubiorev.2018.03.015
- World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/
- Zinbarg, R. E., Williams, A. L., & Mineka, S. (2022). A current learning theory approach to the etiology and course of anxiety and related disorders. Annual Review of Clinical Psychology, 18, 233-258. https://doi.org/10.1146/annurev-clinpsy-072220-021010