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.