Therapy for Phobias
Mild phobias are extremely common, as I discovered recently when talking to a group of friends - out of six people all of us had something we would go out of our way to avoid because of fear, including heights, trains, cats and cows! When phobias become more intense they can lead to strong fear reactions such as panic attacks, and become extremely limiting. For example, someone who is extremely fearful of spiders will start to avoid any situation where a spider might be encountered - since spiders can turn up almost anywhere this could mean avoiding going out, avoiding friends houses, shops, going in the garden, certain rooms in the house, and so on.
Left untreated phobias tend to get worse rather than improve. However they can be treated relatively easily and quickly by means of a technique called graduated exposure. This is based on the principle that if we face the fear and stay with it long enough, the fear will automatically reduce of its own accord.
The fear response is a natural biological mechanism that protects us from danger, but the effects only last for a relatively short time. If we can deliberately stay in the fear-provoking situation our bodies will naturally habituate, and the fear will decline. If this is practised repeatedly, using the exposure technique, eventually our body learns not to fear the situation - the fear has been extinguished.
Normally we do not do this - we use a safety behaviour such as avoiding the situation, or doing something else to make us feel better. The problem with the safety behaviour is that it prevents habituation occurring, so we never overcome the fear. The top diagram shows this - after encountering the feared situation anxiety is triggered and rises rapidly, and we use our safety behaviour to counteract this. Each time the situation is encountered the pattern repeats.
The middle diagram shows what happens whe we stop doing the safety behaviour - the anxiety remains for longer at first, but eventually it will reduce as the body adapts to the situation. Unlike the upper diagram, there is permanent learning here, so with repeated exposure the fear is gradually extinguished (bottom diagram).
If you do suffer from a limiting fear or phobia I am not saying you have to confront your worst nightmare all at once - this is where the graduated part comes in. You start by dealing with something you can manage (strong enough to create the fear response, but not so strong that it overwhelms you), and having mastered that gradually work up to the more difficult situations