Specific Phobia
TREATMENT
COGNITIVE BEHAVIOURAL THERAPY (CBT)
Cognitive behavioural therapy (CBT) is the most widely
used treatment for specific phobias. The outcome of this therapy
is that the person changes the way they think and behave about their
fear/phobia.
Cognitive therapy
Cognitive therapy seeks to change fearful beliefs
about the phobia, a process that requires identifying fear generating
thoughts, feelings and perceptions and reconstructing these cognitions.
Reconstruction involves challenging the fearful cognitions often
by asking, “what is the evidence for such thoughts, beliefs
or perceptions?” In the absence of evidence, a more rational
and healthy set of cognitions is established. The outcome of such
therapy is the anxiety or panic no longer occurs to that which was
once a fear/phobia.
Behavioural therapy
Behavioural therapy aims to minimise the anxiety/panic sensations
and overcome phobic avoidance through exposure therapy.
Techniques for minimising anxiety
Strategies to minimise anxiety symptoms include:
- Progressive muscle relaxation
- Diaphragm breathing
Exposure therapy techniques
a. Systematic imagined desensitisation
This approach
requires the individual in a relaxed state to visualize features
of the phobia. Initially, a hierarchy is established from the
least threatening to the most threatening aspects of the phobia.
Visualization commences with the least threatening aspect. The
science behind
this strategy is that when
visualising the scene in a relaxed state, the conditioned anxiety
becomes unlearnt and a more relaxed response to the phobic situation
is acquired.
b. In-vivo exposure (active exposure)
In-vivo exposure involves exposing the sufferer in a graded way
to their fear/phobia. At first, a hierarchy of concerns about the
phobia is established commencing from the most feared to the less
feared aspects. Exposure then occurs, first to the less feared aspect
until no anxiety is experienced, followed by exposure to the next
feared aspect in the hierarchy. In time, less anxiety occurs in
the phobic situation, a phenomenon known as habituation.
c. Virtual reality
This therapy, a recent innovation, involves exposure to the feared
situation via technology (photographs
or video film), which creates the
phobic situation that is feared similar to that
experienced in reality. CBT is undertaken
while the sufferer
is in this state of virtual reality.
Applied tension therapy
When those
with blood injury phobia are exposed to their phobic concern, an
initial increase in blood pressure and acceleration in heart rate
occurs. This is followed by a rapid drop in blood pressure and a
decrease in heart rate to below resting levels, actions that collectively
may result in a faint. To prevent a faint, applied tension techniques
are taught that includes tensing of gross body muscles, thinking
of distressing thoughts or inflicting mild pain.
DRUG ASSISTED TREATMENT
Pharmacotherapy is less commonly used in the treatment
of specific phobia, however, for
some whose condition is severe the simultaneous use of pharmacotherapy and cognitive behavioural
therapy is effective. The most widely used drugs in the treatment
of specific phobias are those used for treating panic attacks.
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