Phobias and Fears

12 Coping Measures

Phobias go back a long way. Take this account of one phobia, written by a famous physician. "The girl flute player would frighten him; as soon as he heard the first note of the flute at a banquet, he would be beset by terror." Fear of the flute is called aulophobia, and the doctor describing the condition was Hippocrates.

One person's wind section can make another person writhe in fear. Nobody likes rust, except maybe automobile body shop owners, but people with a fear of rust (iophobia) probably carry a can of Rust-Oleum with them wherever they go.

Agoraphobics, of course, rarely go anywhere. They suffer from a fear of being separated from safe persons and places, and some won't even leave their houses. Claustrophobics, on the other hand, hate being confined, while panophobics fear everything.

"Just name it," says Jerilyn Ross, M.A., a psychologist who specializes in phobias and is president of the Phobia Society of America. "There are as many different kinds of phobias as there are different kinds of people."

Phobias are classified into three types—simple phobias, social phobias, and agoraphobia. People with simple phobias experience a dread of a certain object, place, or situation. Social phobics are people who avoid public situations, like a party, because they are afraid of doing something to embarrass themselves. And agoraphobics are victims of a complex phenomenon based on a fear of strange places.

"You don't go from fear to lots of fear to a full-blown phobia," says Ross. "It's not something that progresses. Usually people who develop phobias do so in areas where they had no previous fear."

But what exactly is a phobia? In the classic sense, a phobia is "an irrational, involuntary, inappropriate fear reaction that generally leads to an avoidance of common everyday places, objects, or situations," says Ross

In the real sense, though, a phobia is a fear of fear itself." A phobia is a fear of one's own impulses," says Ross. "It's a fear of having a panic attack and losing control. Basically it's a fear of one's own self and loss of control."

Phobics know who they are. "They always recognize that their fear is inappropriate to the situation," says Ross. "For example, if you're flying on an airplane during a thunderstorm, feeling fearful is a normal reaction. However, if your boss tells you that you'll have to take a business trip in a couple of weeks and immediately you start worrying about having a panic attack on the plane," she says, "that's inappropriate to the situation. A phobia is always irrational."

Sound like something you've experienced? If so, here's some rational advice for irrational behavior from those who deal daily with the problem.

Blame It on Your Ears

Just when you think that your phobia may be all in your mind, along comes Harold Levinson, M.D., who says it's not in your mind, it's actually located in your inner ear.

Dr. Levinson, a Great Neck, New York, psychiatrist and neurologist who is coauthor of the book Phobia Free, specializes in inner ear disorders. While treating his patients for inner ear problems, he began to notice other changes. "Not only did their inner ear problems improve, but so did their phobia problems," he says.

It was his unique background as both a psychiatrist and a neurologist that led him to this conclusion. "A significant number of my patients with inner ear problems also had phobias identical to the patients I was treating in my psychiatric practice."

After 20 years of research on more than 20,000 patients, Dr. Levinson believes that 90 percent of all phobic behavior is a result of an underlying malfunction within the inner ear system.

"The mechanisms in the inner ear are not functioning correctly," he explains. For example, balance is controlled in the inner ear. If it is not working correctly and your balance is off, you might be afraid of heights or falling or tripping.

Dr. Levinson acknowledges that his is the minority point of view. But thousands of success stories are nothing to snicker at. Dr. Levinson is convinced that a trip to an ear specialist is at least worth a try for those suffering from phobias.

Reverse negative thinking. In a phobic situation, the person experiences negative thoughts and scary images, which in turn trigger the physical symptoms, explains Manual D. Zane, M.D., founder and director of the Phobia Clinic at White Plains Hospital Medical Center in New York and associate clinical professor of psychiatry at New York Medical College. You should allow the fear to come but try to shift from the negative thoughts—"That dog will bite me"—to something realistically positive like—"The dog is tightly leashed and can't get away."

MEDICAL ALERT

When It's Time to See a Specialist

No one is certain what causes a phobia. Some experts believe it is all psychological; some believe it is biologically based. But more and more evidence indicates it is a combination of both.

What is known is that it tends to run in families. If one of your parents had a phobia, you may be predisposed to one, but not necessarily the same one. More often than not, phobias strike people who have a history of separation anxiety and perfectionism.

Some phobias are more serious than others. If your phobia is interfering with your life, you should seek professional help. Whom you seek out is as crucial as seeking help itself. "It's important that a person get help from a person who understands phobias," says Jerilyn Ross, M.A. "Many phobics end up going from doctor to doctor and hospital to hospital, so it's important to find a professional who specializes in phobias and anxiety-related disorders."

One other note. People suffering from agoraphobia should not feel left out because they can't venture outside their homes. The Phobia Clinic at the White Plains Medical Center in New York has what they call phobia aides, trained people who will come to your house to help you. Many other clinics and professionals will also make house calls.

Come face-to-face with fear. Avoiding your fear will prevent you from overcoming it, says Dr. Zane. Instead, desired control can be achieved through a process called exposure treatment, in which you expose yourself to the object of your fears little by little and learn that what you imagine and expect to happen does not actually occur. Such graduated exposure can help you get used to it, he says. For example, let's say your phobia is spiders. In exposure treatment training you may start to face your fear—usually in the presence of another person—by looking at pictures of spiders. When you learn to handle this, you may move on to looking at a dead spider, then a live spider—and you may even progress to holding one in your hand. Each time you may still feel some fear, but you learn by such exposure that the awful things you dread do not actually occur.

How to Fight a Panic Attack

"I felt like I was standing in the middle of a six-lane highway with cars coming at me from either side." That's how 26-year-old Tanis felt whenever she tried to leave her home. Tanis suffers from the most common of all phobias, agoraphobia, a fear of being away from a safe person or place.

Just the thought of venturing outside of her Virginia home would bring on a paralyzing panic attack. "One moment you feel fine, then the next moment you feel like you are about to die," she says. "Physically, my heart started beating faster, I got nauseous, and I felt shaky and like I was about to faint." For Tanis, these were the signs of a full-blown phobia. Tanis did manage to leave her house for therapy, though, and that did the trick. Now she ventures out all the time, trying to help those still stuck inside. Here are some of the tactics she learned in therapy that helped set her free.

Recognize the attack. "If a panic attack comes on, recognize it for what it is," she says. "You've had them before, so you know you're not going to die. You've gotten through it before and you can do it again. Acceptance is the key."

Be sensitive to yourself. "Phobics are usually perfectionists and are usually hard on themselves, but you shouldn't be," says Tanis. "When you are going through the exposure treatment [facing your fear in stages], be easy on yourself. Give yourself credit because you did it—even if it brought on an attack."

Go slowly. "Start out slowly, but do some exposure treatment every day. Set goals for yourself; set an 8-week goal and a 16-week goal. Once you start dealing with your phobia over and over again, it really does become conditioned. As impossible as that may sound to a phobic, you can do things like a normal person again."

Believe her. When we called her house the first time to do an interview, we were told that Tanis "wasn't home."

Play mind games. "When you feel your fear taking hold, do manageable things like counting backward by 3s from 1,000, reading a book, talking aloud, or taking deep, measured breaths," says Dr. Zane. "When you are involved with doing something manageable in the present, you reduce your involvement with fear-generating thoughts and images. Your body quiets down and you maintain control."

Measure your fear. Label your fear on a scale of zero to ten, suggests Dr. Zane. You'll find that the severity of your fear is not constant, that it goes up and down. Write down thoughts or activities that make it increase and decrease. Knowing what triggers, increases, and decreases the fear may help you learn to control it.

Look over the rainbow. Use thoughts, fantasies, and activities that make you feel good to shift yourself away from frightening thoughts, suggests Dr. Zane. For example, think more about the high probabilities of a safe flight and the pleasures of lying on the beach in Hawaii instead of focusing on and reacting to only the unlikely dangers of the flight.

Pat yourself on the back. Functioning successfully with a level of fear is a big achievement, says Dr. Zane. Dealing with it successfully in this way is much more plausible and realistic than trying to completely erase your fear. Each encounter that you overcome in your exposure treatment training should be considered a personal victory and can build your self-confidence in being able to control the situation.

Avoid caffeine. "People who have repeated panic attacks may be very sensitive to caffeine," says David H. Barlow, Ph.D., director of the Phobia and Anxiety Disorders Clinic and a professor of psychology at State University of New York at Albany. "Caffeine re-creates some of the symptoms they have during panic attacks. People prone to panic attacks may want to omit caffeine from their diets."

As the stewardess comes walking down the aisle with the drink cart, remember that caffeine isn't limited to coffee. It's also in tea and certain soft drinks, such as colas, and chocolate.

Burn that adrenaline. "With panic attacks you have an excess of adrenaline in the body, and when you move, you burn it up," says Christopher McCullough, Ph.D., director of the San Francisco Phobia Recovery Center in California. Trying to sit still and relax is a mistake. You need to move to burn up the adrenaline, so walk around or exercise during the attack.

Play muscle games. "If you can't move around, the next best thing to do is to start tightening and untightening various muscles in your body. "Tighten the large muscles of your thigh, then do a quick release," suggests Dr. McCullough. "This kind of rhythmic tensing and releasing will also burn up the adrenaline."

PANEL OF ADVISERS

David H. Barlow, Ph.D., is director of the Phobia and Anxiety Disorders Clinic and professor of psychology at the State University of New York at Albany.

Harold Levinson, M.D., is a psychiatrist and neurologist in Great Neck, New York. He specializes in inner ear disorders. He is coauthor of Phobia Free.

Christopher McCullough, Ph.D., is director of the San Francisco Phobia Recovery Center in California. He is coauthor of Managing Your Anxiety and author of the how-to audiotape How to Manage Your Fears and Phobias. He has also developed a home study program, "Outgrowing Agoraphobia."

Jerilyn Ross, M.A., is president of the Phobia Society of America and associate director of the Roundhouse Square Psychiatric Center in Alexandria, Virginia.

Manuel D. Zane, M.D., is founder and director of the Phobia Clinic, White Plains Hospital Medical Center in New York and associate clinical professor of psychiatry at New York Medical College in Valhalla.

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