- Hey, everybody, happy Monday.
Now because Halloween is coming, and many of you have asked
about these diagnoses, today I'm going to talk
about phobias, what are they, why are they so upsetting
and, most importantly, how can we overcome them.
First, let's talk about how phobias are diagnosed.
In the DSM, the "Diagnostic and Statistical Manual
"of Mental Disorders", all phobias fall
under the diagnosis of specific phobia.
Now, in order to be diagnosed with specific phobia,
we must meet the following criteria:
Number one, we have to show a marked fear or anxiety
about a specific object or situation, such as flying,
heights, animals, receiving an injection or seeing blood.
Now they call these objects or situations, phobic stimulus,
and, when it says marked fear or anxiety,
what that term really means is that the reaction
we have to the phobic stimulus is intense or severe.
Now the second criteria is the phobic object or situation
almost always provokes immediate fear or anxiety.
Now I know this one is pretty obvious
because the term, phobia, is defined as an extreme
or irrational fear of, or aversion to, something.
So, of course, we're going to be immediately scared
or have anxiety about something.
But just keep this in mind because the fear or anxiety
usually doesn't happen hours or days later,
or anything like that.
Or, let's say you're afraid of driving over bridges.
It wouldn't be stressful or upsetting to you
only one out of every five times or so
that you drive over a bridge.
That wouldn't be sufficient
in order to be diagnosed with specific phobia.
And criteria number three, the phobic object or situation
is avoided or endured with intense fear or anxiety.
And, in my experience, it's usually avoided as much
as possible because it's so uncomfortable to be around.
And I've had patients avoid the doctor for years
because they're afraid of needles and, only when forced,
or if there's no other way to avoid it, do they go.
But they hate it and can sometimes
even have panic attacks as a result.
The fourth criteria is that the fear or anxiety
is out of proportion to the actual danger
posed by the specific object or situation,
and to the sociocultural context.
Now, the actual degree or fear of anxiety
may vary from person to person and situation to situation.
It can be anything like anticipatory anxiety
all the way up to full-blown panic attacks.
And this can be due to the length of time
we have to be around the stimulus,
or maybe how many other people are around us,
or, if it's just a particularly difficult situation,
like let's say we're afraid of needles,
and the nurse couldn't find a vein
and just keeps having to stick us with it over and over.
That can be really hard.
And also the fear and anxiety
can be expressed differently in children versus adults.
And that's really important to know,
especially when you're a clinician diagnosing,
or if you're a parent and wanting to make sure
that your child is properly diagnosed.
In children, the fear and anxiety may be expressed
by crying, tantrums, freezing or clinging.
So just keep that in mind.
But this criteria is that the fear, anxiety or avoidance
is persistent, typically lasting for six months or more.
So this isn't something that's just come up
for just a couple of days or weeks.
It has to be around pretty persistently for six months.
And the sixth criteria is that the fear, anxiety
or avoidance causes clinically significant distress
or impairment in social, occupational
or other important areas of functioning.
And this is part of every diagnosis.
It has to make it hard for us
to do what we need to do each and every day.
Otherwise, our ability to do
what we need to do isn't impaired.
And we always focus on the impairment
when it comes to diagnoses.
So, notice your ability to function at work, school
and in your social life, as well as at home.
And the seventh and final criteria,
which is also part of almost every diagnosis,
is that the disturbance is not better explained
by symptoms of another mental disorder.
We just want to make sure that it's actually this
that's causing the impairment, and not something else.
And I also found it interesting that the DSM
stated that it's common for people
to have multiple specific phobias,
and that the average person with this diagnosis
has three specific objects or situations that they fear.
Also, approximately 75% of people with specific phobia
fear more than one situation or object.
So, if you have one phobia, chances are you have another.
Which I guess makes sense.
If phobias are anxiety driven, we all know
how anxiety can only get worse the more we avoid things.
They can move into other parts of our life.
And so, it's almost as if,
by giving in to these fears and anxieties,
we're proving them to be true and making it worse.
Oh, and one more thing that I found really interesting.
Because phobias cause us to be scared and can push us
into fight or flight, the part of the brain
that they know is involved in phobias is our amygdala
and the related structures around it.
Because, if you don't know, our amygdala
is what's responsible for our fight, flight or freeze.
So, of course, phobias would trigger that.
Okay, now let's get into the good stuff,
the treatment options.
And the first option that is researched and supported
is exposure therapy.
Now I know even the name of this treatment
scares some people, but the truth is that your therapist
isn't going to force you to immediately face your fears.
They're going to work with you, to build up your calming
and soothing resources, then put together a hierarchy
of fears so they know what's most upsetting to you
and what's tolerable.
And, then, they're going to work with you
to move up that hierarchy, using your resources
to help calm you back down all along the way.
And the goal of exposure therapy
is to change your response to the phobia stimulus,
by slowly and gradually exposing you to it.
But, as always, in therapy you get to set the pace,
and make sure you let them know
if it's ever too much or too fast.
Next, there is cognitive behavioral therapy,
otherwise known as CBT.
Now the goal of CBT is to better understand your thoughts
and feelings about the phobia stimulus
and work with you to change any of those unfounded beliefs,
things such as, if I drive over a bridge,
it's going to collapse and I'm going to die.
CBT also utilizes some exposure techniques to prove to you
that the unfounded or faulty belief you had
is in fact not true.
And, just like exposure therapy, this works
because exposing you to an anxiety-provoking thing
and then showing you that nothing terrible happened,
and you can still calm yourself down,
helps you slowly fight back against that belief
and get rid of the phobia for good.
It's like we're proving to our brain that there really
isn't anything to be feared with that particular stimuli.
Now the final treatment option is medication
and, like I've talked about in the past,
if you aren't even able to participate in therapy
because it's too overwhelming or stressful,
you may want to try medication for a short time
so that you can overcome some of your symptoms
and actually benefit from therapy.
And there are three types of medications
that have been shown to be effective
when it comes to specific phobias.
And those are SSRIs or SNRIs because, if you didn't know,
they can be used to help with anxiety symptoms.
And so, of course, if they can lower our anxiety,
then maybe we can participate more in therapy.
The second is beta blockers because they block
the stimulating effects of adrenaline,
which your body may be producing
when you feel anxious, overwhelmed or scared.
And these can be symptoms like heart racing,
feeling shaky, sweaty palms, things like that.
Adrenaline can even raise our blood pressure
and all sorts of things.
So, but the beta blockers will just bring that down,
help us not feel so panicked.
And the third medication option is sedatives,
and these are things like benzodiazepines.
Now benzos can be very calming and definitely take the edge
off of any anxious or on-edge feelings that you may have,
but, if you have any history of addiction,
please take these with caution and let your doctor know.
And, of course, ask any questions about side effects
or any worries you have about medication
when you see your doctor,
before you start taking the medication.
And, overall, I just want you to know
that phobias are very common,
but they can be overcome with the right treatment.
And I hope you found this information helpful.
Thank you so much for watching,
and I will see you next time, bye.
(pleasant music)