Category Archives: information

Phobic Disorder– An Introduction

Phobic disorder is the name used by the medical and psychiatric professions to highlight the difference between ordinary fear vs phobia symptoms. Your fear must be unreasonable and irrational to be diagnosed as a phobic disorder. It is the most common of all the anxiety disorders, manifesting itself as an out of proportion, conditioned response of persistent fear. It nearly always results in avoidance behaviour.

Whilst this kind of fear disorder is different to panic disorder, people with phobias can also experience panic attacks. Panic attacks and panic symptoms are common with fear of heights phobias, and any phobias involving a fear of being trapped or enclosed, like claustrophobia or agoraphobia. The severity of these physical reactions can impair judgement in extreme cases, leading to an increased risk of harm particularly in the case of heights.

Phobic disorders are classified as either general or specific. The general disorders are agoraphobia and social phobia (also known as social anxiety disorder). All the others are classified as specific phobias, and are triggered by one particular feared stimulus. In these cases the fear has been associated with one specific object or situation. Common types of specific phobias include fear of elevators, heights, flying, speaking and injections. They are often related to animals too, most commonly snakes, spiders and dogs. Specific phobias are the most common, and are sometimes called simple phobias.

I don’t like the word “disorder” because it helps perpetuate the old the mental health system view of phobias as a dysfunction. The sooner we can move on from these stigmas surrounding fears and phobias the better. It implies that something is broken, when in fact in this case it isn’t. A quick look at how the brain works will help explain what I mean, and…

…The Difference Between Fear And Phobias

Whenever you experience something happening in your world, it isn’t the actual event that you experience. What you experience is a ‘representation’ that your brain creates. This representation is based on the information coming in through your senses. In order to create this representation your brain takes all the available information and runs it through three different types of process.

The processes your brain uses are generalisation, deletion and distortion. Your brain then creates the representation that you do experience, as a sequence of steps, presenting the information in a way you can make sense of it. In fact, this is how you make sense of anything. Here are some examples you’re probably familiar with.

  • Generalisation – You can only recognise a chair you’ve never seen before, as a chair, because your brain has “generalised” that something with 4 legs or a base, a horizontal surface at a certain height, and a vertical surface behind it is a chair.
  • Deletion – You can hear your name being mentioned even if their are hundreds of conversations going on around you, by your brain “deleting” the information contained in all that other noise.
  • Distortion – You make a piece of music meaningful and significant by “distorting” it from a series of sounds and connecting them together into a seamless stream of melodic beauty, combined with feelings and images.

Your brain doesn’t always know the best way to use these processes to form a representation when it first encounters something. It forms the best representation it can and then relies on making further modifications by testing it against your experience in the real world.

If it’s working for you, it leaves it alone. But if it notices that some of the generalisations aren’t actually all the same, or that it’s deleting some things that are important, or it’s distorting something in a way that’s not useful, it makes an adjustment.

With more experiences your brain learns more ways to generalise, delete and distort, and the representations become more and more useful. The more ways your brain has to use these processes the more flexibility it has, and the richer your experience of life. In order to do this it has to be able to test the representation in real situations.

Normally this isn’t a problem. But when the representation contains an excessive element of fear, your brain won’t take the risk of getting the experience you need from the real world to change these processes. As far as your brain is concerned there is no difference between fear and phobia. It cannot tell the difference between an irrational fear and a fear of something that really is dangerous. Fear is fear and it doesn’t like gambling with your life to find out whether it’s real or not. This is how anxiety disorders and phobias are formed and maintained.

But if something happens by chance that does allow you to test the representation, and your brain realises that the thing you are frightened of isn’t actually dangerous, it stops the fear. This is what makes the “Face The Fear” exposure therapy treatments like cognitive behaviour therapy work. The trouble is the nature of these methods means the majority of people with phobias don’t want to use them.

Hopefully, you’re starting to understand how natural this all is. It’s a fundamental neurological process, with a structure that your brain is deliberately using; and it’s working perfectly. You can see why we have a problem with the word “disorder” being used to describe phobias. It carries the implication that something is broken and there’s nothing broken at all.

But let’s take a closer look at the word “disorder”. Taken literally, it implies that something is simply happening in the wrong order; and this is far closer to the truth than the people who gave it the name probably intended.

Here’s what I mean. Psychoanalysis and counselling therapies focus on the “root cause”, and trying to change the 3 processes directly. But your brain doesn’t like them being messed with directly, and it keeps them unconscious for a reason. That’s why these treatments have such low success rates when it comes to phobias.

However, these processes are just one side of the equation. The other side is the sequence of steps that your brain outputs to make up the representation you do experience. And like any equation, when you change one side, the other side has to change too.

So if you change, or “re-order”, this sequence of steps, the processes of generalisation, deletion and distortion will also change. And this is the key to collapsing fear without any of the trauma or stress.*

And here’s the best part: It’s how your brain is designed to work.

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Causes of Phobias

When something’s not working as it should be, it’s natural to ask what the circumstances were that led to this development. Phobias are no different. In fact, the more of an impact something has on your life the more urgent the need seems to be to find out information about it.

This is perfectly understandable as the physical symptoms of phobias are extreme by definition. The anxious feelings and panic attacks triggered by the specific feared stimulus can eventually become unbearable. They can begin to affect the general mood and even the mental health of the phobia sufferer. This can lead to depression or obsessive compulsive disorder in some cases, requiring professional medical or psychiatric help.

When it comes to treatment of phobias, there isn’t a great deal of choice in the NHS, so people sometimes seek medications from their doctor to help alleviate the symptoms. Others turn to alcohol or recreational drugs in an attempt to self medicate against the intense physical reactions.

As the unrelenting fear starts to eat it’s way into your life the first question most phobia sufferers ask is,

“Where do phobias come from?”

When researching the origin of phobias, the fist thing you’ll discover is they usually develop between early childhood and adolescence. Examples of phobias that children can be prone to include: Nyctophobia (fear of the dark), Teratophobia (fear of monsters), Arachnophobia (fear of spiders), Ophidiophobia (fear of snakes), Dentophobia (fear of dentists) and Aichmophobia (fear of needles).

In fact, most young children go through phases of being afraid of these things, but they usually grow out of it. Phobias can develop later, but after the age of 40 it’s rare.

Fear of heights and the complex phobias like agoraphobia and social phobia are unusual in children because their formation is typically more gradual, and normally develops during adolescence.

Phobias are defined as an unrelenting, irrational fear response triggered by exposure to a feared object or situation. The different kinds of phobias all have similar signs and symptoms involving an intense state of anxiety leading to the sufferer avoiding the feared situations.

A quick flick around the internet will demonstrate the understandable obsession with finding out what causes phobias (or any distressing mental disorder for that matter).

So what causes phobias?

The cause of phobias is usually attributed to some external learning experience outside of the control of the phobia sufferer. The logic is easy to understand and goes something like this.

Before “X” Happened I Was Fine…

After “X” Happened I Had A Phobia…

Therefore “X” Must Have Caused The Phobia.

The Traumatic Event – The favourite of psychology and psychotherapy professionals everywhere. A bad experience at the dentist leading to a fear of dentists, being bitten leading to a fear of dogs, a bumpy flight with turbulence and suddenly flying isn’t as fun anymore, an embarrassing 5 minutes in front of the class at school and the thought of public speaking leaves you shaking.

In fact, all the common wisdom tells us any traumatic experience can lead to a phobia. This forms the basis of all the classical conditioning theories. However, our brains are a bit more complex than this. Very few of the phobics I’ve worked with actually got their phobia in this way.

Witnessing Traumatic events. This is where someone observes someone else experiencing a traumatic event, and learns to be frightened from this “witness” position. It doesn’t even have to be real. The number of people seeking treatment for fear of water more than doubled after the release of the film Jaws.

But real events also lead to phobias. It is estimated that the national fear of flying that led to the reduction in air travel and tourism after the terrible events of 9/11 reduced the output of the US economy by 0.75%. 0.75% might not sound like much but it’s the difference between a recovery and a recession.

Cultural Causes (learning from others) – A few years ago there was a lot of debate about phobias being genetic. But it was all founded on the discovery that phobias are more common in women than men and was blown out of all proportion.

The reason that phobias crop up more in some families is because the individuals within that family have learnt to be frightened from other members. Observing the emotional reactions of others is strong evidence of a threat as far as your brain is concerned.

All these experiences may well have been the cause of the fear or anxiety you experienced at the time but, contrary to psychoanalytic theory, they are not the real cause of your phobia developing. After all, not everyone develops a phobia as a result of these experiences. .

If we’re going to find  find the real cause we need to take a look at how your brain works.

Why do people have phobias?

What you experience as reality, isn’t actually reality at all. It’s a representation of reality that your brain has created. Whenever you encounter anything, your brain decides what’s important about it and how it relates to you and everything else in our environment. It then creates the representation that you do experience.

When you experience something for the first time your brain does it’s best to form the most accurate and useful representation it can with it’s limited experience of whatever it is. With further experiences, your brain refines this representation to make it more accurate and more useful.

But if your brain doesn’t get any further experiences it can’t change this initial representation. This is what really causes phobias. If your brain thinks something is dangerous it won’t let you get the further experiences you need. As far as you brain is concerned it wants to keep you out of harm’s way.

This is how you get stuck with the original fear representation – your phobia. And by focusing on the cause of your phobia all you do is keep reinforcing this original representation.

This is why some people grow out of their childhood fears whilst other people seem to carry them with them all their lives. The people who grow out of them have taken their focus off the cause of phobias, and at some point allowed themselves to get other experiences.

Here’s what I mean. If you suddenly find yourself in a river, the reason you are in there is not just that you fell in. The reason you’re in there is also because you haven’t managed to find a way out yet. Focusing on what caused you to fall in will not help you find a way to get out.

The skills and knowledge that will allow you to get out have absolutely nothing to do with whatever lack of skills or knowledge caused you to fall in there in the first place. Finding the a way to get out is obviously far more useful than finding the reason why you fell in.

In much the same way, the external phobia causes listed above will not help you with overcoming the fear. The causes and the effective treatment of phobias are completely different things.

This principle of getting additional experiences is what allows the “Face Your Fear” phobia treatments to work. Cognitive behavioural therapy (cbt), systematic desensitization, and all the exposure methods, rely on this approach. But it isn’t always effective. The trouble is most phobia sufferers are reluctant to use them for obvious reasons.

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