What is a phobia?
Most of us have at least one phobia about something in the real world. A phobia is best described as an irrational fear: it doesn’t make sense from a logical point of view, but we are scared to death of it anyway. Common examples are fears of snakes, flying, public speaking, crowds, the number 13, tunnels , cockroaches, elevators, subways, wide open spaces, closed spaces…the list is endless. But despite the fact that we know that our fear is irrational, that knowledge seems to have minimal effect on the fear itself.
Exposure and Response Prevention
There is a tried and true mechanism for getting rid of fears in the real world. It is called Exposure and Response Prevention. This technique teaches you how to face your fears in a gradual and controlled way, while preventing your usual escape responses. Lots of people know about this technique, but many don’t use it, because we naturally avoid putting ourselves in uncomfortable situations.
Exposure and Counter-Conditioning
I use a slight variation of Exposure and Response Prevention to treat my patients. It is called Exposure and Counter-Conditioning. This variation is less uncomfortable, easier to use, and usually produces faster results. The trick is to learn how to act as if you are safe in everyday life before facing your phobias. Then you apply this skill when you start the exposure work.
Whether your fears are rational or irrational, you automatically activate the Fight or Flight response to prepare to escape or defend yourself in some way. However, by using a simple counter-conditioning method you can train yourself ahead of time to act as if you are safe in situations where you know the fear is irrational, but still feel the need to run away from real dangers. This involves practicing two simple behaviors that you can use to counteract the fear response whenever fear raises it ugly head. And the more skillful you become with these reactions, the more confident you will feel about facing this world.
Learning To Act As If You Are Safe
- The first skill involves learning the Gentle Belly Breathing, as this type of breathing sends a message to the Fight or Flight mechanism that you are not preparing to escape from the situation.
- The second skill is learning how to be stay completely relaxed, which can be achieved by learning the Systematic Relaxation Exercises. Again, this skill gives a message to the Fight or Flight mechanism that you have no intention of running away.
I recommend you practice these two exercises for at least two weeks before you start the exposure work. Without these two simple skills, you are likely keep getting uptight around your phobias, which will greatly delay your progress. You also need to continue practicing these exercises as you go through the exposure treatment. Even as you go about your daily life, acting as if you are safe, you will find that the world in general seems to feel a less scary place.
Exposure and Counter Conditioning in Action: Treating Someone Afraid of Dogs
To illustrate this technique, I am going to give a step-by-step run through of how I taught a patient to overcome her life-long fear of dogs. This method can be easily modified to handle just about any phobia that you may encounter in the outside world.
Nancy was a 55 year old woman who claimed that she had been afraid of dogs all her life. She had no idea what started the fear, but she certainly was aware of her mistrust of dogs from a very early age. She was happily married, held an important job in the corporate world, and had many friends. However, she would start to panic whenever she saw a dog. If she saw a dog when she was alone on the street, she would have to cross the street or turn back. When she was with her husband, she would hide behind him. She could not go into buildings that allowed dogs, and the thought of being in an elevator with a dog was her worst nightmare. She would even have to turn off the TV or leave the room if a dog appeared on the screen. She had been in may types of therapy most of her life, had tried many medications, but nothing appeared to help. As she got older, she also became depressed, feeling how most of her life had been ruined by this phobia.
Having taken a detailed history of Nancy’s phobia, I next had Nancy go through the following steps:
- Step 1
Nancy practiced the Gentle Belly Breathing, and the Systematic Relaxation Exercises every day throughout the whole of the treatment. I cannot emphasize enough that you need to practice these exercises so well that you can immediately act as if you are safe when facing your phobia.
- Step 2
Nancy wrote down a list of scary situations where she might encounter dogs, starting with easy ones, and going on to more scary ones. The list started with her looking at still pictures of scary dogs, and ended with the image of her sitting on the floor and petting a big dog. We used this list to build the homework assignments where Nancy would start facing her fear.
- Step 3 (Exposure with Counter-Conditioning)
Next, Nancy started exposing herself to the easiest situation, where she felt the fear, but was able to act in a relaxed way, while breathing very gently. She needed to feel a mild fear, but was able to act as if she is not in danger. It usually takes several days before the fear subsides to something close to zero.
A good rule of thumb is to try to practice this type of exercise for at least 30 minutes each day, working with the easy situations before moving on to the more difficult ones. It usually takes about a week for the counter-conditioning to reduce the anxiety to zero.
Here is the list of Nancy’s assignments over the 8 weeks:
- Looking at pictures of small dogs, 30 minutes a day. By the end of a week, she was unable to feel any anxiety when looking at the pictures.
- Looking at pictures of large fierce looking dogs, 30 minutes a day. Again, she was unable to feel any anxiety after a week of this exposure.
- Going to a pet stores with her husband for 30 minutes, 5 times during the week acting in a relaxed way and getting as close to the puppies as possible. She was completely relaxed by the fifth visit.
- Walking with husband to a dog run that contained small dogs on a daily basis.
- Walking alone to the small dog run.
- Sitting alone in small dog run.
- Standing alone outside of large dog run
- Going inside large dog run
- Sitting in therapist office with a large dog, while stroking it, stating, “where has all the fear gone?”
To overcome a fear you always need to act in the same non-defensive manner as Nancy. And the trick is to use the right level of fear. If you push too hard, you begin to be unable to maintain your relaxed state. At the same time, it is important to feel some discomfort, otherwise you will show little progress and get discouraged. If you have made the task easy enough, and if you have stayed relaxed, you should find that your fear will initially fight you, but should subside in about 4 or 5 sessions.
When you have become comfortable in one situation, you move on to the next slightly more scary situation on your list. Altogether, it takes a person with a severe dog phobia about 20 hours of exposure to reach the point where they can comfortably pet a large dog.
Related Reading on Quora:
How do I overcome fear in the real world?
More Techniques:
Relaxing Away Stress
Gentle Belly Breathing
Conquering Procrastination
Reducing Fear Through Imagination
Fighting Depression Through Movement