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I’d Rather Stay Here

Learning to live with phobias is a common social challenge. Active ways of treatment can help

If you know a person that prefers sitting on a train for two days instead of taking a three-hour flight or another one that suddenly gets up from a common lunch and leaves the restaurant with a brief, inaudible excuse – the reasons for it might be environmental or agenda-driven, or they more likely are phobias.

One in 20 people suffer from one of the 250 different phobias. As soon as you have one, for example acrophobia, being afraid of heights, it is 50% more likely, than for a healthy person, to get an additional one. In the case of acrophobia, very often the similar sounding agoraphobia joins in. The latter one is the fear of large open spaces (greek: agora = square/place) and the most common phobia. At the same time it is also the most threatening, as spaces cannot be avoided in the same way, snakes or bridges could be. This fact very often results, in the agoraphobiacs, staying at home, cutting themselves off from life and navigating into an often long lasting depression.

Other than a number of sources for depression, phobias are usually not genetic. They are socially adapted, either through a strong traumatic experience (like survivors of 9/11 suffering from claustrophobia) or through role-modeling (being surrounded by anxious family members). The good news, hence is, that the treatment of it has a much higher chance to succeed, as it deals with changeable behavior and not with a congenital disorder. Notwithstanding, living with phobias is not easy and the way to the cure can be long.

Fear as such is a perfectly normal aspect of our human existence. Especially in childhood and adolescence, being afraid of different things is an indispensable aspect of a sane and protected development. Fear of separation strikes all babies. Animals start getting scary for toddlers at three years of age, darkness with four years. Imaginary people haunt the minds of school starters, the fear of being ridiculed begins with seven and stays throughout puberty, and the fear of accidents makes children around ten more risk-averse. The trouble starts, if in adulthood the fears remain and do not convert into a realistic, grown-up trepidation, but somehow stay as an irrational and paralyzing phobia. While fears save us from danger, phobias both post-traumatic or through role-modeling, can keep us from coping with day-to-day situations.

The trouble is two-fold. First, the person suffering from a growing anxiety when being in a supermarket or from a sudden panic because all faces in the metro crowd seem to be staring, might not immediately be able to diagnose those symptoms as agoraphobia or scoptophobia. This is all the more true, if the symptoms involve somatic aspects like palpitations and sweating or appear since teen-age.

Often the awareness of having a phobia is not easily accepted by the phobiac. Because, and that is the second challenge, it contains the danger of social stigmatisation. While a scared child is an entire acceptable image in our society a grown-up person that is driven or limited by fears is not. This includes the prejudiced notion that, similar to other psychological or psychosomatic diseases, the patient “is not really ill and just needs to pull himself together” and that his difficult-to-grasp condition is costing the community a reasonable amount of money.

To increase the chance for cure, however, and to avoid isolation, these difficult conditions need to be overcome. People who are suffering symptoms of anxiety should therefore not just ignore them or start strategies of avoidance but seek a doctor’s help. An appointment with your general practitioner might be a good start to exclude physical reasons for your anxiety and give a first idea of which way will be the best to tackle the phobia.

Another important step is to look for help of family and friends. People who start telling a selected number of members of their close social environment about their phobias are often surprised about the understanding and the cases that suddenly pop up, also suffering from phobias. Remember, that one in 20 comes across a phobia experience. Also, communication about the illness makes changed behavior more understandable and saves from alienation. On top of that, according to different surveys run by the Royal College of Psychiatrists in the UK, the public opinion about some mental diseases, phobia among them, are changing. In the surveys carried out in the last years, 10-20% fewer people than in the 80s or 90s endorsed the statement that people with phobia disorders feel different from them.

With this light at the end of the tunnel, a good therapy needs to come in. This is where, unfortunately, a lot of people with phobia stop and prefer arranging their lives around the illness. Therapies with a progressive exposure of the patients to their object of fear have proven to be the most effective, far more than medication or (auto-) suggestion.

Barbara Rothbaum, professor of psychology from the Emory University School of Medicine in Atlanta started using the virtual exposure therapy method at the end of the 90s. With this approach the person who has fear of flying does not have to really go on a plane, and the person with arachnophobia does not need to cuddle with a life tarantula. Both can retrieve doing it in a safer virtual 3D environment, which can be interrupted more easily, but has the same training effect on the sub-consciousness. Regular virtual exposure sorts out the fear step by step.

After a cautious reception of this virtual method when it came on, it today belongs to the top-sellers in the business of phobia therapy. Patients, who are afraid of speaking in public, the second most common phobia, are helped with an average of 10-12 virtual sessions, before they can be given the floor in front of a real audience; patients with fear of flying within an average of eight sessions. The latter one is a particular success, as people who suffer this fear and still have to fly for business reasons very often fell back on tricky self medication with alcohol and tranquilizers. A recent WHO report into global hazards of travel (WRIGHT) revealed that this kind of medication significantly added to the risk of life-threatening cardio-vascular issues in the air.

Altogether, if you suffer from a phobia and manage to get it diagnosed, if you can rely on the support of some family members and friends, and if you choose the confrontation therapy that works for you, the chance to live without phobia is a promising 95%.

By the way, in some Asian countries the superstition towards the ill-omened number “four” is so strong, that it may cause people leaving rooms that are somehow labeled with that number, avoiding fourth floors, or even not going near a house of that number. This one is called tetraphobia and enjoys high public acceptance in those countries. A therapy in those cases might not always be indicated.

by Miguel Peromingo