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Phobia Treatment Options

An overview of traditional and complimentary / alternative methods for phobia treatment

Table of Contents

Introduction
This Isn't Happening! Denial or Avoidance
Strength in Numbers - Support Groups
Seeking Help From A Practitioner
Traditional Western Approaches

Psychotherapy
Psychoanalysis
Cognitive-Behavioral Therapy (CBT)
Behavioral Therapy
Medication
Complementary / Alternative Treatment Options

Energy Psychology
Neuro-Linguistic Programming
Hypnotherapy
EMDR

Self-Support Techniques

Conclusion and Recommendations

Introduction
Not all phobias are severe enough to seriously impede the overall happiness of quality of our life. But many phobias can and do exactly that. There are many ways to deal with a phobia, and some treatment methods are much more effective than others.

Which treatment option will work best for you?

Every individual is different. It depends on your personality, motivation, severity of your symptoms, how much time you have, and how much money you have budgeted to spend.

Here are a few of the common approaches for phobia treatment:

  1. Denial / Avoidance
  2. Support Groups
  3. Traditional Western (psychotherapy and medication)
  4. Complementary (or Alternative) Methods
  5. Self Care

If you or someone you know and love suffer from a phobia, what are your best options for treatment? This article will explore the various options, their advantages and disadvantages, and help you to decide for yourself which of them may be the best choice for you.

This Isn't Happening! Denial or Avoidance
Denial and avoidance are common methods for coping with phobias, or other problems we may face in life. By denying that a problem is there, people mistakenly believe that it will go away on it's own. However, life rarely works like that. Typically the problem will only get worse, and the stress that results from being in denial can begin to create additional problems on top of the phobia itself.

Many people with a phobia will initially simply avoid the situation or objects that cause the symptoms. For example, if you have a fear of elevators, and work on the 4th floor of an office building, you may take the stairs, and tell your coworkers that you do so for the exercise.

Or you might look for a job that is located only on the ground floor of a building. You would take special care to never be in a situation where you had to use an elevator. This may not be a big deal, but certain phobias can be very problematic to avoid, and can become a huge hassle and stress factor in your life, and in the lives of those around you.

Strength in Numbers - Support Groups
Joining a support group can be another method to cope with a phobia. If you are in a large city, there may be a live group of people that meet on a regular basis. If you have Internet access, you can find forums and newsgroups that offer support for just about every kind of phobia that you can imagine. If you can't find one, you can start one yourself.

Benefits of Support Groups
Support groups can be helpful because at the very least you learn that you're not alone! It is not uncommon for someone with a phobia to also experience feelings of sadness, intense isolation, or even depression. Knowing that there are others like you who have experienced the same phobia and related problems can provide a sense of comfort. You can find a lot of compassion and understanding from a support group. People can share stories about how the phobia has affected their life, and also about various treatment methods.

Potential Problems With Support Groups
Support groups can become quite a community. The potential downside that I see with support groups is that it is possible for people to fulfill their need for connection and understanding to such a strong degree, that it becomes more important than their need to be rid of the phobia or problem.

Many people who suffer severe symptoms from a phobia do not talk about it. They feel embarrassed, and it is not uncommon for someone with a phobia to feel very lonely and isolated, and think that they are somehow unique in having this phobia. Imagine after years of not only suffering from the phobia - but suffering from the isolation - they find an entire group of people with their exact same problem!

What may happen is that the group can create what is called a "secondary gain." Secondary gain is any "covert advantage that is not directly related to the professed desired outcome." So the person is not consciously aware of this secondary gain, but it nonetheless motivates their behavior, often in a self-destructive way.

Common examples of secondary gain "are increased care, sympathy, and pity that one receives" What can happen, then, is that the benefit of having the secondary gain becomes stronger than the need to be rid of the phobia, even though it is causing problems. If someone with strong secondary gain of being in a support group were to get rid of their phobia, they could lose all of their new friends and support. The patient can see the situation as black and white - either I have this phobia with all my friends, or I get rid of the phobia and lose all my friends. This is where treatment such as cognitive therapy or NLP can be helpful because it can show people other (healthy) ways to get the benefits of secondary gain AND be rid of their phobia.

I have personally traded emails with people who have started large online support forums who tenaciously defended their belief that their phobia was unique and that there was no cure! They were not even open to the possibility of trying a new method or of letting me introduce anything new to the group. I even offered free help - which was turned down.

I don't want to knock all support groups, because, like I mentioned, they can be helpful initially, but keep in mind your purpose. If you want to get rid of your phobia, you'll need to take the next step and use other methods. And remember, that every benefit you have from secondary gain, can also be created in a healthy way elsewhere in your life.

Seeking Help From A Practitioner
If your phobia has been persistent and is causing problems with your day to day life, it may be best to seeking help from someone who has been trained. Professional help can be divided into two categories:

  1. Traditional Western approaches, and
  2. Complementary / Alternative approaches.

The biggest potential challenge with either approach is finding a practitioner who is competent at helping clients produce the results. Whether someone is a licensed health care practitioner, or is a lay-person with a brochure offering an alternative treatment, does not necessarily mean that they can help you.

Ask about their training and their success rates. Ask around in your community to find out about the practitioner's reputation and ask to talk with previous clients about their experience. Make sure that your practitioner has a solid history of helping people create the results that they want.

Traditional Western Approaches
Traditional approaches for treating a phobia generally include two specific types: psychotherapy (talk therapy) and prescribing medication. Not all traditional therapists will prescribe (or are qualified to prescribe) medications to treat phobias. There are various forms of psychotherapy available.

If you choose the route of traditional treatment for your phobia, the doctor will spend time taking your case history, evaluating your symptoms, and making a diagnosis.

Treatment options can vary, depending upon what you are diagnosed with. Phobias, (except for Social Phobia) are typically diagnosed as Generalized Anxiety Disorder.

If you have been treated previously, the doctor will want to know specific details about that treatment. For example, if you were on medication, he will want to know the dosage level, whether it was increased or decreased, and how long you took it. If you had psychotherapy, what kind of therapy was it, how frequently did you see the therapist, and for how many sessions?

Psychotherapy
Psychotherapy involves talking with a licensed mental health care professional such as a psychiatrist, psychologist, social worker, or counselor. There are several forms of therapy that may be used.

If you chose to work with a therapist, be sure to ask the following questions:

1. How many people have you treated with who had the same phobia as I do?

2. What was the result? What percentage showed improvement? What percent found total relief?

3. On average, how long did it take? (How many sessions over how much time).

4. What is the cost per session? What will my total cost be?

5. Do you prescribe medications along with your treatment? Are medications optional, or do you consider them to be necessary to produce results? If you prescribe medications, how much do they cost? How long do I need to take them? What are the potential side effects - short term and long term? Do I have to avoid any other medications, foods, beverages, or activities while taking the medications? Can they be addictive? What do you do to make sure that I don't experience withdrawal symptoms?

Note that therapists can charge between $50 - $300 (or more) per hour for their professional services. It may be possible to find a therapist who works on a sliding fee scale depending on your income. It may also be possible to find a free therapist through social services provided in your community. It would be very unusual for a therapist to offer a money-back guarantee.

Psychoanalysis
Up until about the 1960's, phobias, like other emotional disorders, were treated almost exclusively by psychoanalysis, which is the school of psychology founded by Sigmund Freud. Freud believed that unconscious conflict is seen as the source of anxiety, and that the subconscious mind consisted of a "seething cauldron of conflicting impulses, urges, and wishes" (Rathus, 1996). The goal of therapy is to help patients gain insight into their deep-seated conflicts and find socially acceptable ways of expressing these wished and gratifying their needs.

Techniques used during psychoanalysis may include free association, dream analysis, and analysis of the relationship between the patient and the therapist. Some therapists may take a more directive approach with their patients by actively provoking or suggesting sources of conflict.

Historically, psychoanalysis and related forms of psychotherapy prove disappointing in the treatment of phobias. There can be other benefits such as resolving conflict, decreasing general anxiety, and identifying and changing thoughts and feelings associated with panic attacks or avoiding the object or situation that triggers the phobia. But the symptoms of the phobia itself often remains. Freud acknowledged the limitations of pure psychoanalysis in treating phobias, saying: "One can hardly ever master a phobia if one waits 'til the patient lets the analysis influence him to give it up...One succeeds only when one can induce them through the influence of the analysis to go about alone and to struggle with their anxiety while they make the attempt."

Cognitive-Behavioral Therapy (CBT)
Cognitive psychologists believe that we must venture into the realm of mental processes in order to understand human nature. Behaviorists believe that our actions are conditioned by our past experiences and situations, rewards, and punishments, rather than by conscious choice. Combining these two theories gives us the Cognitive-Behavior approach, or CBT.

Research has shown that CBT can be effective for several anxiety disorders, in particular panic disorder and social phobia. It is made of up two parts. The cognitive part helps patients to understand and change their thinking patterns that prevented them from overcoming their fears.

The behavioral aspect is used to change people's reactions to anxiety-provoking situations. This is done primarily through exposure, in which people confront the objects or situations that they fear.

Another behavioral technique is to teach relaxation techniques, such as deep breathing, to the patient.

One study of a 28-week treatment program, including 16 sessions of CBT combined with antidepressant medication, indicated that "about 80 percent" of people with social phobia alleviated their symptoms. It did not state whether they were required to remain on medication or not.

Behavioral Therapy
Behavioral therapy has been used effectively to treat phobias without the cognitive component. This usually involves gradual exposure, perhaps beginning with pictures or audio recordings. Eventually, the patient may be exposed to the actual object or situation, usually with the therapist tagging along for support and guidance.

In either CBT or in behavioral therapy, exposure will only be done when you are ready, with your permission, and gradually. Neither one of these therapies have any adverse side effects, other than the temporary discomfort of increased anxiety.

The main downside to these therapies is that they generally last about 12 weeks. If you are working privately with a therapist at $50-$75 for each 1-hour session, and you need 10 to 15 sessions, this can come out to $500 - $1,125. If you are working in a group therapy situation, sessions are usually much less expensive.

Medication
It is important for you to realize that "medications won't cure an anxiety disorder." That quote comes straight from the National Institute of Mental Health website. Medications will only help mask your symptoms, which can help you to function in the short term. This does not stop many doctors from saying that medications will "treat" your phobia. In severe cases, medication may be beneficial to reduce intense symptoms enough for someone to function in day-to-day life while beginning other forms of treatment. Medications may also be prescribed to help with other forms of generalized anxiety disorder that may be present along with a phobia, including depression, obsessive-compulsive disorder, or panic attacks.

However, in the big picture long range view, there are several potential problems with using medications to "treat" a phobia.

First of all, medications can take time to work in your body. It can sometimes take up to several weeks before you could see the symptoms of your phobia begin to fade. If you need immediate relief from symptoms, certain medications may not be helpful. Be sure to ask the physician how long you can expect to wait until the medication takes

Second, it may be helpful to read the results of the drug study for your specific problem before you take the drug. Analysis of the statistics provided can help you determine whether or not you want to take this particular drug.

For example, in a double-blind 12-week study of Escitalopram (an SSRI) in the treatment of social anxiety disorder, the abstract stated that there was a "statistically superior therapeutic effect for escitalopram compared with placebo." That is true - almost 40% more patients responded to the drug than to the placebo.

When you look at the numbers, however, you will find that only 54% of the people receiving the drug showed improvement. That means that it didn't help 46% - or nearly half - of the people enough to be statistically significant.

Reading further, I found it even more interesting that 39% of the people receiving the placebo had statistically significant improvement! Remember that the placebo has no chemical effect in the body. If you consider that 39% of the people will get better without any chemical, would it be plausible to assume that 39% of the people who took the drug could have shown improvement that was not due to the drug, but due to the placebo effect, or some other factor? If so, then it could be reasonable to assume that only about a third of the people responded to the actual drug itself.

The study concluded that Escitalopram was "efficacious and well tolerated." If you owned a business selling TV's and nearly half of your customers could not get a clear picture or watch the shows they wanted, would you call that effective? Additionally, they didn't define "well tolerated," which brings us to the next point.

Every drug study that is properly conducted according to FDA regulations will include two sections in the final report: "Adverse events" and "extremely adverse events." "Adverse events" are "side effects." Almost every drug has side effects, and most of the time they are not desirable. At best, they can be mildly annoying, like nausea, apathy, or feeling jittery. At worst they can impair your ability to think clearly, cause sexual dysfunction, seizures, or even death.

According to an article written by Dr. Barbara Starfield of the Johns Hopkins School of Hygiene and Public Health and published in the July 26, 2000 Journal of American Medical Association (JAMA), there are 106,000 deaths each year from the negative side effects of prescription drugs. This does NOT include errors in medications, which account for an additional 7,000 deaths.

The primary medications for treating general anxiety disorder include antidepressants, anti-anxiety medications, and Beta blockers.

Some of the newest antidepressants used to treat phobias are called selective serotonin reuptake inhibitors (SSRIs) and include Fluoxetine, sertraline, fluvoxamine, paroxetine, and citalopram. Prozac, Lexapro, and Zoloft are also SSRIs.

Another type of antidepressant called tricyclics has been around longer than SSRIs, and has a greater number of clinical studies. However, the tricyclics seem to have a larger number of side-effects, sometimes causing "dizziness, drowsiness, dry mouth, and weight gain."

Monoamine oxidase inhibitors, or MAOIs, are the oldest class of antidepressant medications. They include phenelzine, tranylcypromine and isoprocarboxazid. When taking these MAOIs patients must go on a restricted diet because these medications can interact with some foods, including cheese and wine, and other medications, causing dangerous elevations in blood pressure or other "potentially life-threatening reactions."

Anti-Anxiety Medications called benzodiazepines can relieve symptoms quickly, and have few side effects, but drowsiness can be a problem. They include clonazepam alprazolam, and lorazepam.

Beta-blockers such as propanolol can also be prescribed to be taken before encountering a fearful situation (like giving a presentation in front of a group). They can reduce or prevent the the physical symptoms of phobias from developing. Of course, you do have to know in advance, and plan ahead.

With all of the problems that can arise from taking medications, if I had a choice I would rather keep the phobia!

Complementary / Alternative Treatment Options
For many years, anything that was not officially sanctioned by the medical community was referred to as "alternative." As there is increasing acceptance of these methods by Western medical practitioners, these forms of treatment are being referred to as "complementary." Treatment options for phobias that are not traditionally used or acknowledged by Western medical professionals are included in this section. However, some doctors, psychiatrists, and psychologists are beginning to utilize complementary forms of treatment in their practice.

Traditional psychologists will point out that rigorous clinical studies have not been conducted to prove the efficacy of these methods. I believe the main reason for this is that drug companies have not found a way to make huge profits from doing so. However, there is enough empirical data to show that these forms of treatment can be very effective. A person's individual results means more to that person than a thousand clinical studies. Regardless of that, I believe it is important for each person to thoroughly research all of the methods of treatment available, and to make their own educated decision as to which methods will best suit them.

Energy Psychology
Energy Psychology is a new approach to therapy that dramatically reduces emotional distress and restores emotional well-being by clearing the flow of the body's "energy system." Energy Psychology is also known as "energy-based psychotherapy," or simply "energy therapy."

It has been very effective in treating phobias because it is safe, effective and long lasting. Best of all, the client plays an active part in their own treatment, and has complete control over the process.

Energy psychology is based on the centuries old philosophy that there are lines of energy, called meridians, that run through the body. Every negative emotion that we experience is simply a blockage of energy somewhere in the body. Furthermore, the symptoms of blocked energy can include emotions such as fear, anxiety, etc. and behaviors such as avoidance or neurosis.

All of these symptoms can fade away on their own if you simply clear the blocked energy. This is done by tapping on a series of points on the body, usually while focusing on the specific problem, either as an image, or by saying a word or sentence out loud. When your energy is balanced and runs clear, your emotional distress goes away on its own. There is no need to explore it, analyze it, or therapize it in any way. It's simply gone.

As for the effectiveness of energy therapies for treating phobias, here is an excerpt from an article called "Energy Psychology: Theory, Indications, Evidence" by Joaquin Andrade, M.D. and David Feinstein, Ph.D.:

More than 29,000 patients treated at 11 allied clinics during a 14-year period were followed for at least one year after the termination of the therapy. In addition to strong, lasting treatment gains, several preliminary sub-studies using randomized, blinded designs allowed comparisons of energy interventions and other treatments. In the largest of these sub-studies, 2,500 patients diagnosed with anxiety disorders and treated with an energy approach and no anti-anxiety medication were compared with a matched sample treated with Cognitive Behavior Therapy (CBT) and medication as needed. The energy psychology treatments surpassed the CBT/medication protocol in the proportion of patients showing some improvement (90% vs. 63%) and the proportion of patients showing complete remission of symptoms (76% vs. 51%). In a related sub-study by the same team, the length of treatment was significantly shorter with energy therapy than with CBT/medication (mean = 3 sessions vs. mean = 15 sessions).

One tremendous advantage of Energy Therapies is that you do not have to believe or be convinced that it works in order for these methods to help you produce results. In fact, most people who use energy therapies for the first time are skeptical, yet still get the results they want.

There are many variations of Energy Therapies. A partial list includes including

Side-effects to energy therapy seem to very extremely rare. An informal survey of 250 therapists asking for descriptions of significant abreactions with EFT or TFT reported only 20 cases of abreactions out of an estimated 10,000 applications of the energy tapping procedures. This approximates 2/10 of 1%. This includes the use of energy therapy for all purposes, not just phobias.

On some occasions, people undergoing energy therapy have normal tears or other forms of distress that accompany the recalling of their troublesome memories. On other occasions some physical pain may "get worse" - at least temporarily. Skilled practitioners are able to handle these occasions very quickly and easily.

The most important aspect of finding a practitioner who is using Energy Therapy is to make sure they are experienced. There can be subtleties involved that only experienced practitioners can address. Relief can usually be found in one or two sessions. Rates can vary from $35 - $150 or more per session, depending on the experience of the practitioner.

Neuro-Linguistic Programming
Neuro Linguistic Programming (NLP) was developed by Richard Bandler and John Grinder in the early 70's. Much of early NLP was based on the work of Virginia Satir, a family therapist; Fritz Perls, founder of Gestalt therapy; Gregory Bateson, an anthropologist; and Milton Erickson, M.D., a hypnotist. NLP was specifically created in order to allow us to understand how verbal and nonverbal communication affect the human brain. It gives all of us the opportunity to not only communicate better with others, but also learn how to gain more control over what many considered to be automatic functions of our own neurology.

What that all means is that every behavior has a specific structure. If you know what that structure is, you can change it, and you can change it quickly. It is not necessary to analyze the reasons or causes of a behavior, only to change it to what you want. In other words, it's about results.

NLP has several "presuppositions," or what you might call operating principles. Two of these that are Important to phobia relief are:

  1. The resources an individual needs in order to effect a change are already within them.
  2. The ability to change the process by which we experience reality is more often valuable than changing the content of our experience of reality.

NLP became infamous early on with what was called the "Fast Phobia Cure" in which lifelong phobias were cured in less than one hour.

NLP practitioners can usually help a client eliminate a phobia in one hour. If you are seeing an NLP practitioner who is also a licensed mental health care professional, they make take up to ten or twelve sessions, and include NLP methods as part of their cognitive or CBT process.

Pricing varies greatly. "Celebrity" NLP practitioners such as Tony Robbins have charged upwards of thousands of dollars for a single one-hour session. Not-so famous practitioners can be found at more affordable rates of $125 - $250 per session. Some practitioners charge "by the result" and not "by the hour." Most of the time they will give you the opportunity to test their work to make sure you have the result that you want.

Hypnotherapy
Hypnotherapists help their clients go into a deep state of relaxation. Contrary to popular belief, clients are not in a deep sleep-like state, but are in a state of enhanced awareness. While in this state, the conscious mind is less active, and the therapist is able to directly suggest ideas, concepts, and lifestyle changes to the patient's subconscious mind.

The goal of hypnotherapy in phobia treatment is to reprogram the patterns of negative behavior.

Hypnosis, or hypnotic trance, in and of itself, is not dangerous. However, the biggest challenge with hypnosis as an effective treatment method is finding a competent practitioner. However, this is true with any therapist. It is best to find someone through referrals or someone you know who has achieved positive results.

EMDR
EMDR stands for "Eye Movement Desensitization and Reprocessing" and was developed by the American psychologist Francine Shapire, PhD in 1987. There are eight phases to EMDR. Specific to EMDR are phases three through six. The client is told to focus on the image, negative thought, and body sensations related to the phobia while simultaneously moving their eyes back and forth. Although eye movements are used most commonly, other types of stimulation can be applied, including auditory tones or tapping.

After using EMDR, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and usually result in spontaneous behavioral change.

According to the EMDR Institute, ". . .since EMDR is a treatment for distressing memories and related pathologies, it may be most effective in treating anxiety disorders which follow a traumatic experience (e.g., dog phobia after a dog bite), and less effective for those of unknown onset (e.g., spider phobia)."

As with any form of psychotherapy, there may be a temporary increase in anxiety which using EMDR. According to the EMDR institute this may include:

  1. distressing and unresolved memories may emerge
  2. some clients may experience reactions during a treatment session that neither they nor the administering clinician may have anticipated, including a high level of emotion or physical sensations
  3. subsequent to the treatment session, the processing of incidents/material may continue, and other dreams, memories feelings, etc., may emerge.

Because of this, if you are going to use EMDR as a treatment, it is recommended that you find a licensed mental health care practitioner who is trained in EMDR, rather than a lay-practitioner. It can take anywhere from 3 to 14 sessions to see results. This includes 1-2 "preliminary sessions" and 3-12 sessions using the EMDR technique.

Self-support Techniques
There are a number of other techniques that can be used along with any other method. These techniques can be thought of as holistic, because they can help improve your overall level of health and fitness. They include:

While these strategies may not in and of themselves cure a phobia, individuals who are physically weak or malnourished may be more susceptible to the effects of panic attacks or other types of anxiety.

Conclusion and Recommendations
There are many different methods for treating phobias. I encourage every person to do their own research and compare the cost of treatment, time (how long it will take), and effectiveness. Also, if you choose to seek professional help (whether it is through a traditional or alternative practitioner) be sure to ask about their experience.

Generally, without knowing about your specific situation, if you have been suffering from a phobia that you have not been able to get a handle on for yourself, here is what I recommend.

1. Start with Energy Psychology, or NLP. These methods have been proven to

a. produce results very quickly,
b. have lasting results, and
c. usually cost significantly less compared to other methods.

2. See a hypnotherapist and / or EMDR practitioner.

3. Seek out the help of a Cognitive-Behavior therapist

4. Take medications only if absolutely necessary.

If you have any comments or questions, please feel free to contact me.