My column in last week's Southern Star explained the CBT treatment of animal phobias. The column is reproduced below.
Phobias are common. Though the fear underlying a phobia is groundless, that doesn’t make it any less real. If you’re terrified of something, you can’t just “snap out of it”, but nor do you have to live in fear – phobias are extremely treatable.
Animal phobias – of dogs, cats, spiders, and so on – are common in children and sometimes persist into adulthood. Other phobias include bodily phobias (fear of vomit, blood, having injections), environmental phobias (fear of heights, storms, deep water), situational phobias (fear of flying, driving, visiting the dentist), to name but a few.
In this article, I’m focusing on animal phobias. There is some cognitive work and psycho-education involved in treating phobias – for example, people sometimes have catastrophised notions of what will happen, perhaps thinking that a dog will attack them, or that they will lose control and “go crazy” if they come into contact with their fear.
That said, the most important work is behavioural; to get over a phobia, you must expose yourself to your fear. Exposure therapy was initially derived from animal studies. In experiments, scientists conditioned mice to become afraid of a red light by pairing it with an electrical shock. After a number of shocks, the mice began to show fear as soon as they saw the red light. How would you eliminate this conditioned fear? By continually presenting the red light without the shock. After repeatedly showing the red light without the electric shock, the mice stopped displaying the fear response. The fear had become extinct, to use the psychological lingo.
Humans learn (and unlearn) fear in the same way. Say you have a dog phobia. Your brain perceives dogs as threats, so it goes into alarm mode if you encounter a dog; adrenaline is released, your blood pressure increases, your heart beats faster. Now, the body only stays in alarm mode for so long; the nature of anxiety is it peaks, plateaus and then falls away. By staying in the feared situation, the brain learns this is a false alarm, that the dog isn’t actually dangerous after all. If you always run away, your brain never learns this important lesson. Running away ensures immediate anxiety relief but it perpetuates the problem.
In therapy, we construct a fear hierarchy or fear ladder. The client lists various scary scenarios and gives a score to each one. A picture or video of a dog might be 10/100; knowing a dog is in the next room might be 30/100; seeing the dog in the same room, on a leash, might be 50/100; walking the dog on a leash might be 70/100; removing the leash and rubbing the dog might be 90/100, and so on.
After jointly constructing this fear hierarchy, we start with the least scary scenario. The client agrees to not run away, whilst the therapist reassures them that the process is voluntary – you never force someone to do an exposure against their will. As they stand up to the fear, they notice their anxiety gradually reduces. When the anxiety has roughly halved, they move onto the next step. With each step, the client sees their predictions are false, that the dog isn’t really dangerous, and that they can manage the temporary anxiety. The client gains confidence and becomes increasingly eager to keep moving up the fear ladder.
The bulk of this work is done in a single prolonged exposure session lasting up to three hours. After the session, the client agrees to continue doing exposures in their daily life, so as to finish off the phobia for good.
This single-session approach was developed by CBT expert Prof Lars Goran Ost. If you type “snake phobia Dr Lars Goran Ost” into YouTube (or follow this link), you will see a real-life example of this evidence-based treatment. Anyone considering a DIY approach should get the book The Complete CBT Guide for Anxiety, which contains a chapter by Dr Ost detailing a step-by-step exposure guide to overcoming a phobia.
If you carefully follow his advice, the treatment has, as Dr Ost says, “an extremely good chance of helping you get over your phobia so that you can go on to lead a fulfilled and unrestricted life”.