What do you fear? Some people might have to think long and hard for an answer, while some answer ‘clowns!’ And there are the plucky ones who answer ‘nothing!’ but secretly have nightmares about heights. But what lines must ‘fear’ cross, to be considered ‘phobia’? Fear is feeling threatened by a certain stimulus; an object, organism, or situation. However, phobias are self-acknowledged, irrational fears of stimuli. People facing that type of anxiety disorder, experience extreme distress in response to the stimulus. In this essay, I will be examining specific phobias; (the most common type of phobias that people face), how they come about, and possible treatments for them.
Specific phobias are divided into 5 categories; animal phobias, blood-injection-injury phobias, situational phobias (e.g. finding themselves in closed spaces), natural environment phobias (e.g. phobia of heights), and others (for the types of phobias that weren’t already included).
Phobias can drastically affect occupational and social functioning, among other things, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) by the American Psychiatric Association (2013). The symptoms that fit the description of phobias listed under the DSM-V include; having a significant fear/anxiety about a specific stimulus last for six months or more, having the stimulus almost always provoking responses of immediate fear or anxiety, and stimulus being avoided or endured with intense fear or anxiety. The fear and anxiety felt must also be disproportionate, in comparison to the legitimate threat of the stimulus. Lastly, it is only considered a phobia if the symptoms cannot be described better by another disorder.
Psychologists have several theories about specific phobias. One is the theory of biological preparedness by Seligman (1971). It claims that we are biologically vulnerable to developing certain specific phobias because of the potentially dangerous nature of the feared stimulus. This theory explains phobias through an evolutionary lens; it believes that the vulnerabilities we have toward certain phobias (e.g. phobia of snakes) is our way of adaptation, to avoid life-threatening stimuli.
There are biological ways to counter phobias; through medication. Certain medications, such as antidepressants, are able to assist people to control the immediate anxiety response that occurs, whenever they are faced with a feared stimulus. An example is Prozac; a Serotonin-Specific Re-uptake Inhibitor (SSRI). Serotonin, a neurotransmitter that affects cognition and how we process information (Spoont, 1992), helps us regulate our emotions and reactions to different stimuli. SSRIs block the presynaptic re-uptake of serotonin, increasing the levels of serotonin available.
Phobias can also be developed and maintained psychologically, as explained by Mowrer’s (1947) two-factor theory of avoidance. It reasons that phobias develop and are maintained through classical and operant conditioning. Classical conditioning is essentially a neutral stimulus (an object, situation, etc.) getting paired with an unconditioned, usually aversive stimulus, in order to cue an unconditioned response, (e.g. fear of the stimulus). The fear of the neutral stimulus becomes a conditioned response, if repeated enough. Watson and Raynor (1920) proved this, in their experiment with Little Albert, an 11-month-old, who wasn’t initially scared of the toys they presented him. Every time he reached for a white mouse (neutral stimulus), they hit a metal bar with a hammer, right behind his head (an unconditioned stimulus). Albert cried in fear (an unconditioned response). Each time he tried to reach for the white mouse, they struck the bar, (conditioned stimulus), and he coiled away in fear (a conditioned response.) Specific phobias can therefore be the result of a psychologically traumatic event, but what causes it to continue on, is the next factor.
The second part of this explanation involves operant conditioning, a process that positive/negative associate actions and consequences and whether they’re reinforced or punished. For example, if I had a phobia of snakes, I would avoid them at all costs. This is an example of negative reinforcement; negative because I wish to avoid the stimulus (snakes), reinforcement because I make an active effort to change my behavior in order to avoid the feared stimulus.
There is a psychological treatment to address specific phobias; systematic desensitization via exposure therapy (ET). ET is a form of cognitive behavioral therapy that targets the lack of rationale behind certain phobias. The patient provides a hierarchy of scenarios that involve them facing the feared stimulus, at different levels of intensity. Together with a professional, they work through the scenarios of facing the stimulus, in a controlled environment; one where the patient is capable of seeing how irrationally disproportionate their fear is to the specific stimulus presented. In a study that combined the results of different studies, “ten studies directly compared one or more exposure treatments to a non-exposure treatment. As predicted, exposure treatment led to significantly greater improvement.” (K.B. Wolitzky-Taylor et al, 2008)
This treatment is advantageous because of its high generalisability. This treatment allows each patient to personally tailor their treatment to what they are comfortable with, at their own pace. It doesn’t force them to face their fears all at once, as, for example, flooding does. However, some disadvantages are that; it’s a long process. Exposure therapy sessions can go on for weeks, usually lasting 3-4 hours per session. This could mean high dropout rates because patients get weary of facing the phobic stimulus.
Specific phobias can also be developed via observation. According to Bandura’s (1977) social learning theory (SLT), phobias can be learned based on individuals observing others fear a certain stimulus. People affect the way someone perceives their surroundings; certain things leave them vulnerable to developing certain phobias. In a laboratory experiment, Mineka et al (1984) observed that monkeys born in captivity didn’t fear snakes the way that the wild-born monkeys did. Their hypothesis was that “observational conditioning of snake fear in rhesus monkeys” (Mineka ea, 1984) would occur for the wild-born ones. The monkeys learned to fear snakes based on, to put simply, ’monkey sees, monkey do. The experiment proved that the SLT accounts for the way certain specific phobias being learned.
Phobias can be treated socially as well. Treatments like CBT administered in the form of group therapy have been proven to show satisfactory results (Gelernter et al.,1991). In that form of group therapy, the patients happened to have social phobia, so they were exposed to social situations, Vivo exposure assignments, and associated restructuring (Turk, Heimberg,& Hope, 2001). This could be applicable to patients with specific phobia, e.g. if patients were to discuss their fear of rabbits together.
It’s advantageous because this treatment has high usefulness; some people can take comfort in the fact of knowing that they aren’t facing the phobia, or the treatment of the phobia, on their own. However, it’s difficult to standardize the procedure of group therapy, which causes it to have low reliability. It. Individuals might not get the attention they require, but there’s no way to examine it. With minimal controls, it’s difficult to replicate and repeat to review the effectiveness.
Conclusively, the development and maintenance of specific phobias can depend on a variety of different factors, just like the effectiveness of the different types of treatments administered.