What are phobias?

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Phobias are exaggerated, unjustified fears of everyday objects or situations, such as fear of certain types of animals or fears of doing things in front of other people. Though many people experience irrational fears or phobias, few seek treatment; as a result, they suffer emotional pain and may find their lives limited by their phobias.
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Introduction

Phobias are a type of anxiety disorder characterized by a persistent, exaggerated, irrational fear of certain objects or situations and by efforts to avoid the object or situation. In many cases, the distress and the avoidance efforts significantly interfere with an individual’s daily life. Phobias are common in the general population; approximately one person in ten suffers from mild phobias, and severe, disabling phobias are found in one person in five hundred.

The three major types of phobias are agoraphobia (a fear of situations in which escape is perceived to be difficult or assistance unavailable), social phobias, and specific (or “simple”) phobias. In social phobias, being observed by others may elicit anxiety and the desire to avoid such situations. The person fears doing something that will lead to embarrassment or humiliation, such as being unable to speak or showing nervousness through trembling hands or other signs. Persons with specific phobias avoid a certain type of object or situation or suffer extreme anxiety when in the presence of these objects or situations. Some examples of common specific phobias are acrophobia, fear of heights; arachnophobia, fear of spiders; claustrophobia, fear of being in small, enclosed spaces; pathophobia, fear of diseases and germs; and xenophobia, fear of strangers.

In the presence of the feared object or situation, the severely phobic person’s experience and reaction differ dramatically from the average person’s. Physiologically, changes in the body cause an increase in heart rate and blood pressure, tensing of muscles, and feelings of fear. In many cases, a panic attack may develop, characterized by muscular trembling and shaking, rapid, shallow breathing, and feelings of unbearable anxiety and dizziness. Behaviorally, the person will stop or redirect whatever activity in which he or she is engaged, then try to escape from or avoid the phobic object or situation. Cognitively, a phobic person at a distance from the object or situation can recognize it as posing little actual danger; on approaching it, however, fear rises, and the estimation of risk increases.

Theoretical Explanations

The many theories that attempt to explain how phobias develop can be grouped under three general headings: those that stress unconscious emotional conflicts, those that explain phobias based on the principles of learning, and those that consider biological factors. For Sigmund Freud, phobias represented the external manifestation of unconscious internal emotional conflicts that had their origin in early childhood. These conflicts typically involved the inhibition of primitive sexual feelings.

Learning-theory explanations of phobias are based on Pavlovian conditioning, instrumental conditioning, and social learning theory. According to a Pavlovian conditioning model, phobias result when a neutral stimulus—a dog, for example—is paired with an unconditioned stimulus (US), for example, a painful bite to the leg. After this event, the sight of the dog has become a conditioned stimulus (CS) that elicits a conditioned response (CR), fear; thus, a dog phobia has been learned. Instrumental conditioning (the modification of behavior as a result of its consequences) has been combined with Pavlovian conditioning in the two-factor model of phobias. After the establishment of the phobia by Pavlovian conditioning, as above, a person will attempt to escape from or avoid the phobic object or situation whenever it is encountered. When this is successful, the fear subsides. The reduction in fear is a desirable consequence that increases the likelihood of escape/avoidance behavior in the future (that is, the escape/avoidance behavior is reinforced). The two-factor model thus accounts for both the development and the maintenance of phobias. Social learning theory suggests that human learning is based primarily on the observation and imitation of others; thus, fears and phobias would be acquired by observing others who show fearful behavior toward certain objects or situations. This occurs primarily during childhood, when children learn many behaviors and attitudes by modeling those of others.

Two theories suggest that inherited biological factors contribute to the development of phobias. The preparedness theory suggests that those stimuli that are most easily conditioned are objects or situations that may have posed a particular threat to humans’ early ancestors, such as spiders, heights, small spaces, thunder, and strangers. Thus, people are genetically prepared to acquire fear of them quickly. Similarly, people vary in susceptibility to phobias, and this is also thought to be based at least partly on an inherited predisposition. A phobia-prone person may be physiologically highly arousable; thus, many more events would reach a threshold of fear necessary for conditioning.

Stressful life situations, including extreme conflict or frustration, may also predispose a person to develop a phobia or exacerbate an existing phobia. Further, a sense of powerlessness or lack of control over one’s situation may increase susceptibility; this may partly explain why phobias are more common in women, as these feelings are reported more often by women than by men. Once initiated, phobias tend to persist and even worsen over time, and the fear may spread to other, similar objects or situations. Even phobias that have been successfully treated may recur if the person is exposed to the original US, or even to another US that produces extreme anxiety. Thus, many factors—unconscious, learned, and biological—may be involved in the onset and the maintenance of phobias. As every person is unique in terms of biology and life experience, each phobia is also unique and represents a particular interaction of the factors above and possibly other, unknown factors.

Case Studies and Therapy Techniques

The following two case studies of phobias illustrate their onset, their development, and the various treatment approaches typically used. These studies are fictionalized composites of the experiences of actual clients.

Ellen P. entered an anxiety disorders clinic requesting large amounts of tranquilizers. She revealed that she wanted them to enable her to fly on airplanes; if she could not fly, she would probably lose her job as a sales representative for her company. Ellen described an eight-year history of a fear of flying during which she had simply avoided all airplane flights and had driven a car or taken a train to distant sales appointments. She would sometimes drive through the night, keep her appointments during the day, then again drive through the night back to the home office. As these trips occurred more often, she became increasingly exhausted, and her work performance began to decline noticeably.

A review of major childhood and adolescent experiences revealed only that Ellen was a chronic worrier. She also reported flying comfortably on many occasions prior to the onset of her phobia, but remembered her last flight in vivid detail. She was flying to meet her husband for a honeymoon cruise, but the plane was far behind schedule because of poor weather. She began to worry that she would miss the boat and that her honeymoon, and possibly her marriage, would be ruined. The plane then encountered some minor turbulence, and brief images of a crash raced through Ellen’s mind. She rapidly became increasingly anxious, tense, and uncomfortable. She grasped her seat cushion; her heart seemed to be pounding in her throat; she felt dizzy and was beginning to perspire. Hoping no one would notice her distress, she closed her eyes, pretending to sleep for the remainder of the flight. After returning from the cruise, she convinced her husband to cancel their plane reservations, and thus began her eight years of avoiding flying.

Ellen’s psychologist began exposure therapy for her phobia. First she was trained to relax deeply. Then she was gradually exposed to her feared stimuli, progressing from visiting an airport to sitting on a taxiing plane to weekly flights of increasing length in a small plane. After ten weeks of therapy and practice at home and the airport, Ellen was able to fly on a commercial airliner. Two years after the conclusion of therapy, Ellen met her psychologist by chance and informed her that she now had her own pilot’s license.

In the second case, Steve R. was a high school junior who was referred by his father because of his refusal to attend school. Steve was described as a loner who avoided other people and suffered fears of storms, cats, and now, apparently, school. He was of above-average intelligence and was pressured by his father to excel academically and attend a prestigious college. Steve’s mother was described as being shy like Steve. Steve was her only child, and she doted on him, claiming she knew what it felt like to be in his situation.

When interviewed, Steve sat rigidly in his chair, spoke in clipped sentences, and offered answers only to direct questions. Questioning revealed that Steve’s refusal to attend school was based on a fear of ridicule by his classmates. He would not eat or do any written work in front of them for fear he was being watched and would do something clumsy, thus embarrassing himself. He never volunteered answers to teachers’ questions, but in one class, the teacher had begun to call on Steve regularly for the correct answer whenever other students had missed the question. Steve would sit in a near-panic state, fearing he would be called on. After two weeks of this, he refused to return to school.

Steve was diagnosed as having a severe social phobia. His therapy included a contract with his teachers in which it was agreed that he would not be called on in class until therapy had made it possible for him to answer with only moderate anxiety. In return, he was expected to attend all his classes. To help make this transition, a psychiatrist prescribed an antianxiety drug to help reduce the panic symptoms. A psychologist began relaxation training for use in exposure therapy, which would include Steve volunteering answers in class and seeking social interactions with his peers. Steve finished high school, though he left the state university at the end of his first semester because of a worsening of his phobias. His therapy was resumed, and he graduated from a local community college, though his phobias continued to recur during stressful periods in his life. These cases illustrate many of the concepts related to the study of phobias. In both cases, it is possible that a high emotional reactivity predisposed the person to a phobia. In Ellen’s case, the onset of the phobia was sudden and appeared to be the result of Pavlovian conditioning, whereas in Steve’s case, the phobia likely developed over time and involved social learning: modeling of his mother’s behavior. Steve’s phobia may also have been inadvertently reinforced by his mother’s attention; thus, instrumental conditioning may have been involved as well. Ellen’s phobia could be seen to involve a sense of lack of control, combined with a possibly inherited predisposition to fear enclosed spaces. Steve’s phobia illustrated both a spreading of the phobia and a recurrence of the phobia under stress.

Historical Variations in Perspectives

As comprehensive psychological theories of human behavior began to emerge in the early 1900s, each was faced with the challenge of explaining the distinct symptoms, but apparently irrational nature, of phobias. For example, in 1909, Sigmund Freud published his account of the case of “Little Hans,” a young boy with a horse phobia. Freud hypothesized that Hans had an unconscious fear of his father that was transferred to a more appropriate object: the horse. Freud’s treatment of phobias involved analyzing the unconscious conflicts (through psychoanalysis) and giving patients insight into the “true” nature of their fears.

An alternative explanation of phobias based on the principles of Pavlovian conditioning was proposed by John B. Watson and Rosalie Rayner in 1920. They conditioned a fear of a white rat in an infant nicknamed “Little Albert” by pairing presentation of the rat with a frightening noise (an unconditioned stimulus). After a few such trials, simply presenting the rat (now a conditioned stimulus) produced fear and crying (the conditioned response).

Experimental Models

As B. F. Skinner’s laboratory discoveries of the principles of instrumental conditioning began to be applied to humans in the 1940s and 1950s, experimental models of phobias in animals were developed. In the 1950s, Joseph Wolpe created phobia-like responses in cats by shocking them in experimental cages. He was later able to decrease their fear by feeding them in the cages where they had previously been shocked. Based on this counterconditioning model, Wolpe developed the therapy procedure of systematic desensitization, which paired mental images of the feared stimulus with bodily relaxation.

Social learning theory as advanced by Albert Bandura in the 1960s was also applied to phobias. Bandura conducted experiments showing that someone might develop a phobia by observing another person behaving fearfully. It was later demonstrated that some phobias could be treated by having the patient observe and imitate a nonfearful model. Cognitive approaches to phobias were also developed in the 1970s and 1980s by therapists such as Albert Ellis and Aaron T. Beck. These theories focus on the role of disturbing thoughts in creating bodily arousal and associated fear. Therapy then consists of altering these thought patterns.

Applications to Psychology

Phobias can thus be seen as providing a testing ground for the major theories of psychology. Whether the theorist adopts a psychodynamic, learning/behavioral, or cognitive perspective, some account of the development and treatment of phobias must be made. No one theory has been shown to be completely adequate, so research continues in each area. The study of phobias also illustrates the importance to psychology of animal research in helping psychologists to understand and treat human problems. For example, Susan Mineka has used monkeys to demonstrate the relative importance of social learning versus biology in the development of phobias. Future research will also likely consider the interactions among the various models of phobias and the conditions that might predict which models would be most effective in explaining and treating specific cases of phobias. As the models mature and are integrated into a comprehensive theory of phobias, this knowledge can then be applied to the prevention of phobias.

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