What phobias feel like

20 October 2018

Interview with

Olivia Remes, Cambridge University

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Phobias can cause a great deal of distress and disruption to people's lives. So what is it like to have a phobia, and what can be done to treat them? Student doctor Isabelle Cochrane asked mental health expert Olivia Remes from Cambridge University...

Olivia - A phobia is this exaggerated fear response that you have when you are encountering a situation or an object or even an animal. Basically a response to a situation which provokes a lot of fear which is out of the ordinary. A lot of times you know that your response is exaggerated and irrational but you can't control this fear, it is awful. You are consumed by anxiety and your trying to do everything you can to get away from this object or the situation which is provoking this fear.

Isabelle - So with a spider phobia then for example what happens to someone if they see a nice big fat hairy juicy spider sat around on their desk?

Olivia - That is their worst nightmare. They all get a sudden spike of anxiety. They might feel dizzy nauseous, they might start sweating if they have to endure that spider if there is no way of getting out and even just thinking of a spider or just looking at pictures of spiders that can also induce anxiety in those people.

Isabelle - For someone who has such an intense reaction against the spider, is this necessarily because they had a negative experience with the spider in the past?

Olivia - There are many causes which could come into play and research still hasn't unravelled all of the causes. They may have had a horrible experience with a spider or been involved in some kind of trauma in which a spider’s also played a role and this manifested in arachnophobia which is a fear of spiders later on, so this could very well be a factor. Or sometimes you develop a phobia because you see one of your parents having the same phobia or because of your genes, you are more predisposed to have a little bit more anxiety than other people and to have this fear of objects or places.

Also a triggering event for one person may not necessarily be a triggering event for somebody else. And this is also where personality comes into play. So for example there is a personality factor called neuroticism. You tend to be a little bit more anxious than other people. You are more likely to have low mood than others generally and are also more likely to develop phobias.

Isabelle - Where do we draw that line between a normal fearand a disorder?

Olivia - When the fear becomes abnormal and exaggerated and when it becomes disorder, you start avoiding places because you don't want to encounter that situation or that object, if it impacts your day in such a serious and negative way. That's when normal becomes abnormal and it becomes a disorder.

Isabelle -  For somebody whose fear is impacting their life in that very severe way, what kind of treatments that are out there?

Olivia - The treatments that are available include medication. But your doctor will be able to advise you on that and which medication is ready for you, if you do need it. Also there is cognitive behavioral therapy or talk therapy. Essentially you are seeing a counselor or a therapist and they are trying to, in a way, replace the maladaptive thought pattern with ways of thinking that are more beneficial for you. So for example for people with social phobia, when you're afraid to talk to other people to make contact with other people, often when they have conversations with others afterwards they'll start ruminating about what they said. “Did I say the right thing” or “I shouldn't have said that” and they beat themselves up over it. So one technique of cognitive behavioral therapy for these people is to wait to worry. Instead of worrying about how you performed at that social event then and there, you postpone it and the reason that this is so effective is that our thoughts actually decay, if we don't feed them with energy. So you might realize then when you come to your worry period what you were initially so worried about is and is bothersome anymore.

Another very effective technique is facing your fears. You start small and then you build your way up. One example is if you have a fear of dogs. So your therapist might first get you to just think about dogs. The next thing that you might do is looking at pictures of dogs because this gets you slowly adapted to a dog again. As you’re trying to face your fear you see and your brain senses that you know, yes you are feeling anxious, but you can still cope with that. So your body is able to handle bigger challenges, like actually seeing a dog in real life, so that may be the next thing they might ask you to do.

Isabelle - And for people who do seek treatment, do we have any idea how many of this people can expect to get better? Will they stay better?

Olivia - It really depends on the person and how effective the treatment is for each individual. A lot of times actually people don’t seek treatment which is a problem. Sometimes people can get better and not have anymore symptoms but then the disorder can come back. Sometimes if you have an anxiety disorder, especially if its starting when you are young then that’s when it tends to be more chronic and if you have one disorder then that can increase your risk for a second.

What treatment helps you do is to just become a bit more positive and to manage those things which are so distressing for you and to be able to lead a better life.

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