On the last track, we discussed depression co-occurring with anxiety disorder. We took a look at primary depression; primary anxiety disorder; and when both depression and anxiety disorder are primary.
On this track, we will examine three types of phobias which result in anxiety: simple phobias; blood-injury phobias; and illness phobias
#1 Simple Phobia
The first phobia is simple phobia. Clients with simple or specific phobias focus their fear to one object in particular. These types of phobias are the most common and most famous of the phobias. Objects of fear include flying, spiders, even vegetables. Animal phobias usually are the result of a negative encounter with the specific animal in childhood. Most often, children outgrow their phobias, but those who do not recover tend to be female.
In general, those clients with simple phobias do not seek treatment nor announce their fear unless it is encountered with the object. They remain emotionally balanced in all other circumstances. When such an encounter does occur, the client could begin to feel any number of symptoms related to anxiety such as shortness of breath, clammy hands, or dizziness. During such situations, many phobic clients will leave the room until they are assured that the object has been removed. Kari, a 24 year old client of mine, had a fear of spiders, a common animal phobia.
Kari described to me the lengths she would go to in order to avoid the object of her fear, “My fear is that a spider will get on me. Generally, it’s not much of a problem since I know where spiders hang out and stay away from those places. I am more uncomfortable in warm weather when there are more spiders. Recently we bought a piece of land in the country where we plan to build our home. It’s covered with tall grass and I just can’t go there because I’m afraid I’ll run into a spider web or a spider.
"I also tend to avoid dark places where I’d have trouble seeing spiders and places I think they might be lurking, such as curtains. The other day was one of the worst experiences I have ever had. I was in the bathroom and a spider was in the doorway. I couldn’t get out of the bathroom and started shaking, crying and screaming at the spider. I was stuck there for about 10 to 15 minutes until my husband came home and killed the spider.”
As you can see, Kari’s new situation at home has caused her to come into contact with her phobia. With exposure treatment, Kari could learn to overcome her fear.
Technique: Exposure Therapy
To help Kari overcome her fear of spiders, I found “Exposure Therapy” helpful. This involves slowly and gradually exposing the client to the object of his or her fear. This will cause the client to force themselves to cope with their fear when they encounter it instead of giving in to the urge to run away. When exposing a client to a phobia, I use the following helpful tips:
- Arrange the expected phobic situations into groups according to the amount of distress that the client anticipates in his or her particular case. For example, Kari’s distress would be:
- Being on the other side of a room from a caged spider - fairly easy
- Being in the same room with an uncaged spider - hard
- Sitting at a table with a spider on it - very hard
- Letting a spider crawl on an arm - almost impossible
- Choose an easy situation, enter it, and encourage the client to force him or herself to remain there until his or her anxiety dampens down. It is most important that the client does not run away too soon.
- Repeat exposure to the easy situation—the phobic reaction should now be less unpleasant.
- Select a more difficult situation and repeat the procedure outlined in steps 1 and 2.
- Carry on this process with progressively more difficult situations.
By the end of her six week exposure therapy, Kari had allowed herself to hold a small daddy long-legs spider without extreme anxiety. Think of your phobic client. Could he or she benefit from Exposure Therapy?
#2 Blood-Injury Phobias
The second type of phobia is blood-injury phobias. This type of phobia involves a severe reaction to the sight of blood, injury, or injury to one’s own person. Clients with blood-injury phobias may faint when they encounter the sight of blood or even talk of blood or injury to others. The fainting is a result of the stimulation of the vagus nerve. This slows the heart down so severely that not enough blood reaches the brain if the client is sitting or standing.
If the client falls down or lies down before he or she faints, consciousness is rapidly regained because the heart will pump enough blood to the brain if it is not having to work against the force of gravity. Patrick was a 32 year old client of mine who had a phobia of needles, specifically, being stuck with a needle.
He described his own encounters with his phobia, “I’m afraid to have blood tests because every time they put a needle in my arm I faint. This is the dumbest thing because I am not afraid of anything else I can recognize. The only times I haven’t fainted are when I’ve told the person about my problem and they had me lie down before they put the needle in my arm.” Just like Kari, I treated Patrick with exposure therapy. Over the course of four sessions, he was exposed to blood drawing in a hospital blood-drawing station.
First, I asked him to lie on a couch to lessen the chance of fainting and watch other patients having their blood drawn. Then a needle and a syringe were brought close to his arm. His pulse was monitored and as long as it did not slow, the needle was brought closer. During the second session, blood was actually drawn with him lying flat on his back and not looking at the needle. His heart rate did not slow and he didn’t faint but he still wanted to be able to have drawn in a sitting position.
During the third and fourth sessions, he progressed steadily to a full sitting position and direct observation of the blood drawing procedure. As you can see, as with Kari, exposure to the phobic object will slowly reduce a client’s fear of the object.
#3 Illness Phobia
In addition to simple phobias and blood-injury phobias, the third type of phobia is an illness phobia. Clients who suffer from this phobia have a constant and severe fear of contracting, suffering from, and ultimately dying of such diseases as cancer, heart disease, or any other illness. These fears soon cause the client to request endless check-ups and examinations, sometimes with multiple physicians.
These types of phobics differ from hypochondriacs because phobics focus their fear onto one specific illness while hypochondriacs fear a multitude of diseases. Hilene was a 48 year old illness phobic client of mine who focused her fears on cancer.
Hilene stated, “Somehow, I’ve got the idea that if I get near people who have cancer, I’ll get it. This leads me to avoid hospitals, nursing homes, friends who I know have cancer and especially doctors. I’ve never followed any particular rituals to disinfect myself or anything like that and I don’t wash any more than anyone else in my family. I just try to avoid situations. It’s so bad, I won’t even go to a funeral of someone who has died of cancer.”
As you can see, there is no real rationality to Hilene’s fears. Through subsequent education of the disease and exposure sessions, Hilene’s fear of cancer soon lessened.
On this track we presented three types of phobias which result in anxiety. These were simple phobias; blood-injury phobias; and illness phobias.
On the next track, we will examine the three substances that panic disorder clients misuse most commonly: caffeine; illicit drugs; and alcohol.
What are three types of phobias?
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