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Depression and Anxiety Special Report

Facing Your Fears With Exposure Therapy

Few of us would probably enjoy snuggling with a snake or standing on the roof of a skyscraper. But for many people, just seeing a picture of a snake or setting foot on a stepladder is paralyzing. While most of us eventually get past our fears or at least learn to live with them, people with phobias are held prisoner by an irrational sense of panic.

Individuals with phobias realize that their fears are unfounded or excessive, but they're unable to overcome them. The presence of actual physical symptoms makes it even more difficult. You may experience shortness of breath, elevated heart rate, sweating, and numbness in the hands and feet -- all similar to a panic or heart attack. Given this kind of reaction, it's not surprising that most people with phobias simply learn to avoid the situations that frighten them.

But avoidance is not the best way to cope with a phobia. Besides the limitations on your life that a phobia creates, having an untreated anxiety disorder may leave you more vulnerable to psychological disorders like depression or alcohol abuse. A phobia can also strain your relationships with friends, relatives, and coworkers.

Exposure therapy. If you suspect that you have a phobia, start by talking with your doctor who can recommend a therapist. You'll likely be treated with exposure therapy for your phobia, although your therapist may also recommend additional treatments.

Exposure therapy is a form of cognitive-behavioral therapy. It involves putting yourself into increasingly stressful scenarios involving your particular phobia and overcoming your fear with new learning. The process usually has five steps:

  • Evaluation. You describe your fear to your therapist and recall anything in your past that may have contributed to it.
  • Feedback. Your therapist offers an evaluation of your phobia and proposes a treatment plan.
  • Fear hierarchy. You and your therapist create a list of scenarios involving your fear, each more intense than the last.
  • Exposure. You begin exposing yourself to the items on the list, starting with the least frightening situation. You start to realize that panic lessens within a few minutes of encountering your fear.
  • Building. As you become comfortable with each level, you move on to conquer increasingly difficult scenarios. For example, if you have aviophobia (the fear of flying), you may begin by thinking about flying then move up to looking at pictures of airplanes. Special programs offered by therapists or major airlines may give you access to a pilot who can answer your questions. You may visit the airport and sit near a gate; on your next visit you might board a plane that's not going anywhere. Finally, you'll take a flight.

Exposure therapy is successful in up to 90% of people with phobias, some experts say, but it requires finding a therapist who you trust to lead you through these difficult situations. Using additional cognitive-behavioral therapy techniques is often helpful as well. For example, a therapist can help you realize that your thoughts about flying (or whatever phobia you have) are distorted and teach you to think about it more realistically. He or she may also teach you deep breathing or relaxation exercises to help reduce your fear.

Take Away: It's important to have realistic expectations if you're beginning treatment for a phobia. If you're deathly afraid of planes or snakes now, you probably won't ever love them. But hopefully a therapist can help you get to the point where you can take a far-off vacation or visit a zoo without breaking out into a sweat.

Posted in Depression and Anxiety on April 28, 2010

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