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Facing Our Fears: Why it Works

Everyone fears something. In fact, it is estimated that more than 19 million Americans suffer from specific phobia. But the things that we fear and the extent to which we fear them can vary greatly from person to person. While one person might overcome a fear of spiders during their childhood years, another might grapple with touching or even being near the creepy crawly arthropods long into adulthood.

In his role as the associate director at the Center for the Treatment and Study of Anxiety, David A. Yusko, Psy.D., sees dozens of patients living with a variety of debilitating phobias. Some phobias are seemingly more rational than others but according to Yusko, many, if not all of them can be cured with Cognitive Behavioral Therapy (CBT).

CBT is an umbrella term used to reference a suite of psychotherapy treatments. The essential, binding idea behind CBTs is that they focus on addressing present-oriented problems by changing the way people think, behave and feel.

“We really think of it as a triangle… A is affect or how you feel, B is behavior or how you act, and C is cognition or how you think; and these are all interconnected with one another,” Yusko explains.

“So if you are feeling sad, that leads you to maybe think your life is not going so well, which leads to certain behaviors like sleeping more or isolating yourself, which ultimately makes you feel sadder; you can see the interconnected cycle there.”

Phobias, too, are maintained by this cycle.

One of the most puzzling things about phobias is that they tend to be almost completely irrational. Whether a phobia developed during a past experience or was fostered through hand-me-down tales from others’ experiences, people with phobias tend to feel like they are in danger even though there is no real threat involved.

Take, for instance, trypophobia, an intense, irrational fear of irregular patterns or clusters of bumps or holes: a phobia that is not recognized in psychiatry's Diagnostic and Statistical Manual of Mental Disorders. Surely small holes pose little threat to one’s well-being, but that hasn’t stopped hundreds of thousands of people from taking to the internet to share their experiences of shivering and writhing in disgust and anxiety at the sight of an image of a lotus pod. Researchers published the first study of trypophobia just under four years ago in 2013, and found that “although sufferers are not conscious of the association, the phobia arises in part because the inducing stimuli share basic visual characteristics with dangerous organisms, characteristics that are low level and easily computed, and therefore facilitate a rapid non-conscious response.” In other words, people who experience trypophobia associate the images that they fear with animals or plants that they view as dangerous and the fear of that organism then makes them also fear the image that resembles it.

Regardless of the type of phobia, behavioral therapists who use CBT to treat phobias believe that intervention at the cognitive and/or behavioral level will ultimately change the way a person feels, thereby eradicating the original fear. Intervention methods, however, may vary from practitioner to practitioner.

For Yusko, it’s all about tackling the fear head-on through different levels of exposure. His intervention technique involves creating a hierarchy of items for a patient to confront in an effort to get them to understand that they’re not actually in danger.

One of the more common phobias Yusko sees patients for is arachnophobia, or a fear of spiders. For a patient with arachnophobia, for example, he might start by exposing them to pictures of spiders, then move up to a cartoon video of spiders, then have them watch the movie “Arachnophobia,” and then maybe take them to a pet store and have them stand near the spider cages. The exposure process would continue up the thermometer scale until the fear is ultimately conquered.

Recent studies indicate that specific phobias are most effectively and efficiently treated with exposure-based treatments like CBT.

“Slowly, they work their way up to harder and harder things to confront, and at each level they are learning more and more about what’s dangerous and what’s not,” Yusko said.

“So the exposure leads to learning and it also leads to something we call habituation, which indicates that the more time you spend with something that’s not actually dangerous, your body stops producing that fear response.”

Now imagine, for a moment, treating a less common but more complex phobia, like emetophobia (a fear of vomit) with CBT.

Exposure therapy for emetophobia may require both the patient and the practitioner to spend hours looking at photos and videos of vomit — a gut-wrenching experience that Yusko has endured on more than one occasion to help a patient overcome the fear. “The best resources for exposure therapy, by the way, are Google images and YouTube,” Yusko added.

Considering situations involving food poising or the unintentional digestion of an object, one could see how conquering a fear of induced vomiting could be a matter of life or death. Other phobias that lead sufferers to avoid medical treatment — like iatrophobia, the fear of doctors, or trypanophobia, the fear of needles and injections — too can pose a very real threat to one’s livelihood.

As Yusko explained, the world can begin to feel a lot smaller and much more limited when a phobia prevents a person from moving toward a life dream or goal such as wanting to get pregnant but struggling with a fear of doctors or needles, or needing to travel for work or to visit family who live far away but being stricken by a fear of flying.

“These types of events start to warrant treatment,” Yusko said. “When a phobia reaches that critical interference level, it’s time for treatment, and phobias tend to be really responsive to CBT.”

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