Association for Advancement of Behavior Therapy

Fact Sheet on

Phobia

    A phobia can be defined as a fear and/or avoidance of an object, activity, or situation which the individual knows is out of proportion to the actual danger which that object, activity, or situation poses. Phobias are one of the most widespread mental disorders with estimates ranging from 10% to 30% of the population reporting a fear severe enough to disturb some aspect of their functioning.
    According to the DSM-111 (Diagnostic and Statistical Manual, American Psychiatric Association) phobic disorders fall into three types based on the nature of the stimuli which produces the fear.
    1) Simple phobias involve a fear of particular objects or situations such as heights, the dark, moths, or small spaces.
    2) Social phobias involve a fear of being watched or evaluated by others and a belief that the individual will, in some way, appear foolish. This results in avoidance of such situations as eating in front of others, or going to parties or meetings.
    3) Agoraphobia involves a fear of being unable to quickly escape or reach help in the event of sudden incapacitation, commonly a panic attack.
    Specifically, therefore, agoraphobia involves a fear of a wide variety of situations which are believed by the individual to either increase the likelihood of incapacitation or to reduce the chance of reaching help should incapacitation occur. These situations include going to the malls, using public transport, and generally being alone.
    Agoraphobia is broadly found to be the most crippling phobic disorder and simple phobia the least. All phobias can also commonly be associated with chronic anxiety and depression. The age of onset is most commonly in childhood for simple phobias, the late teens for social phobias and the mid-20's for agoraphobia. Phobias in general appear to be more common in females than males although social phobia seems to be fairly evenly divided.

Causes

    The cause of the various phobia disorders is still under considerable dispute. Traditionally, psychologists have believed that phobias are the result of experiencing a traumatic event in the presence of a specific situation or object. For example, being bitten by a dog (conditioning). However, recent research has suggested that this is likely to be the case for only a certain proportion of phobic cases, especially cases of simple phobia and some social phobias such as fear of eating, drinking, or writing in front of others.
    Others ways in which many simple phobias and some social phobias are probably acquired include the passing of false or exaggerated information (e.g. being told dogs are dangerous) or seeing or hearing of someone else being injured or distressed in a particular situation (e.g. seeing someone being bitten by a dog). Some social phobias appear to be worsenings of life-long behaviors and personality factors. In other words, some people who are afraid of going to parties or formal meetings may report that they have always been "basically shy" but only since they took on new responsibilities has this become severe enough to be considered a problem.
    The immediate cause of agoraphobic fear and avoidance involves an unexpected panic attack. This first panic attack is reported to occur "out of the blue." The agoraphobic then begins to fear the occurrence of another such attack and avoids those situations which they believe may cause or worsen any future attack. The reasons why an individual may begin to associate certain situations with panic attacks are not yet known. In addition, the cause of the initial panic attack is only just beginning to be systematically investigated. Some factors which might be responsible for causing the first panic attack include life stressors, earlier experience with loss of control, a tendency to breathe too fast, or fluctuations in brain chemicals.

Treatment

    The basic treatment of choice for the phobic disorders involves what is called graduated exposure to the phobic stimulus. This means that the person is gradually and gently brought into contact with the object or situation which he or she avoids until they " get used to " this stimulus. Repeated investigations have demonstrated the value of exposure-based techniques for all types of phobias.
    For maximum improvement in most cases of social phobia, it also appears to be necessary to teach people to re-evaluate some of their thoughts and beliefs. For example, to learn that "everyone is not watching me" or that "if I say the wrong thing, people will not think I am stupid." Some form of social skills training may also be of value in some circumstances although whether this actually produces new skills or simply increases confidence is not yet known.
    While exposure to external stimuli is of immense value for the avoidance component of agoraphobia, maximum improvement is unlikely to occur without some attempt being made to deal with the unexpected panic attacks. Treatment for panic attacks has traditionally involved the use of medications such as imipramine (e.g. Tofranil) or alprazolarn (Xanax). More recently, psychological techniques are proving to be just as effective. The specific components of psychological treatments for panic attacks which are necessary for treatment effectiveness are yet to be determined, but some possibilities may include teaching people to slow their breathing, teaching people that their symptoms are harmless, and doing gradual exposure to the actual physical symptoms of a panic attack.

    THE ASSOCIATION FOR ADVANCEMENT OF BEHAVIOR THERAPY is a professional, interdisciplinary, nonprofit organization which is concerned with enhancing the human condition through the scientific investigation and application of the principles of human behavior.

    For more information, please contact AABT at 15 West 36th Street, New York, NY 10018. 212-279-7970

    May, 1988