How Phobia Is Treated

Specific phobia is an intense fear of, or anxiety about, specific types of objects or situations, such as flying or spiders. Phobias and phobia-related disorders are types of anxiety disorders. Other types of phobia-related anxiety disorders include social anxiety disorder, agoraphobia, and separation anxiety disorder.

Young woman talks to attentive therapist

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The main approach to treating specific phobia is a type of therapy called cognitive behavioral therapy (CBT). Medications are not a common treatment option, but in some circumstances they may form part of a treatment plan.

It is estimated that only about one in 10 people with specific phobias will eventually receive treatment. This is possibly because many cope by avoiding the object or situation their phobia is related to. Treatment is more likely in these situations:

  • Cases where symptoms are severe and debilitating
  • For particular phobias such as flying, closed spaces, and heights
  • For those with multiple phobias

Therapies

Cognitive behavioral therapy will usually be recommended as the first-line treatment. Specifically, exposure-based CBT is an effective treatment for anxiety disorders such as specific phobia.

Exposure Therapy

Exposure therapy involves being exposed to the object or situation that triggers the phobia. This is done repetitively, usually in a graduated fashion over a period of time, until distress has decreased significantly.

During the exposures, you will be instructed to resist avoidance. You will also learn ways to manage and get used to the fear and anxiety associated with that phobia.

Exposure therapy aims to reduce fear and decrease avoidance. This happens through learning that fear, anxiety, and avoidance do not help in reducing anxiety. You also come to recognize that the outcomes you feared were inaccurate.

For example, someone experiencing specific phobia relating to heights might be exposed to a situation such as standing on a bridge or going to the top of a high-rise building.

Therapy sessions may involve exposure to real or imaginary situations. They may also involve using virtual reality (VR), also referred to as in virtuo exposure.

During VR exposure therapy sessions, you will see things through special VR glasses or a projection-based system. You will hear things through either headphones or a loudspeaker. This system can then be programmed to help you seemingly directly confront the objects or situations connected to your phobia.

Randomized controlled trials (RCTs) have found positive treatment outcomes for exposure-based therapies for anxiety disorders, including phobias. These types of studies randomly assign subjects to a treatment group or a control group that doesn’t receive the treatment. Outcomes are then compared to see if the treatment is effective.

In vivo (real-life) exposure has historically been viewed as better than virtual reality exposure. But recently, there has been evidence that both approaches are equally effective. A 2019 review of randomized controlled trials found no evidence that VR exposure was significantly less effective than in vivo exposure in phobia treatment.

There are some drawbacks to exposure therapy, however. One is that it requires the patient to be open to being put into a very stressful situation. It has been estimated that between 13% and 27% of patients will stop attending exposure therapy.

Prescription Medications

No medications are currently approved for the treatment of specific phobias by the Food and Drug Administration (FDA).

It is generally thought that medications by themselves are of limited use in the treatment of specific phobias. However, they may be considered in certain situations, such as if the patient is resistant to exposure-based therapy or if that kind of therapy is not available.

Specific phobias also have high comorbidity with other mental health disorders. Comorbidity is where there is the presence of two or more disorders.

In particular, phobias often occur with anxiety disorders, mood disorders, and substance abuse disorders. As such, it is not uncommon for those with specific phobias to be treated for these disorders as well.

Common medications used to treat anxiety disorders are antidepressants, anti-anxiety medications, and beta blockers.

Antidepressants

Antidepressants are used to treat depression, but they can also be helpful for treating anxiety disorders. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the most common antidepressants used as first-line treatments for anxiety.

These include Prozac (fluoxetine), Celexa (citalopram), and Effexor (venlafaxine).

Anti-Anxiety Medications

Anti-anxiety medication can help rapidly reduce the symptoms of anxiety and panic attacks. The most common of these are called benzodiazepines, which are a type of sedative. These include Klonopin (clonazepam), Valium (diazepam), and Ativan (lorazepam).

This type of medicine has both benefits and drawbacks, and not everyone should take them. Make sure you speak to your doctor about the pros and cons before including them in your treatment plan.

Beta Blockers

Beta blockers are most often used to treat high blood pressure and other cardiovascular conditions. But beta blockers such as Inderal (propranolol) can be taken over a short time period to help relieve the physical symptoms of anxiety, such as rapid heartbeat, shaking, and trembling.

Adjunctive Treatment

As mentioned above, it is believed that medications by themselves are of limited use in the treatment of specific phobias. But there have been investigations into whether some medications might be effective at enhancing therapy treatment of specific phobias when taken alongside, before, or after exposure therapy.

D-Cycloserine

One medication that has been explored is D-cycloserine (DCS), which is an antibiotic used to treat tuberculosis. It is thought to affect certain receptors, namely NMDA (N-methyl-D-aspartate) receptors, in a part of the brain associated with fear.

As opposed to directly treating the phobia, it appears to stimulate an area of the brain responsible for unlearning fear responses.

Initial studies into its use to augment exposure therapy showed promise. However, subsequent larger-scale studies have not been conclusive.

A 2017 systematic review looked at double-blind randomized clinical trials of DCS as an augmentation strategy for exposure-based CBT. The reviewers looked at subjects diagnosed as having specific phobia, social anxiety disorder, panic disorder with or without agoraphobia, obsessive-compulsive disorder, or post-traumatic stress disorder (PTSD).

The review found evidence that short-term use of D-cycloserine as an augmentation of exposure-based CBT was better than placebo, but that the effect on symptoms was small.

Glucocorticoids

Another treatment option for specific phobias that is being explored is glucocorticoids. These are a type of steroid hormone that regulate immune, inflammatory, and stress responses while also potentially affecting learning and memory processes.

They are also thought to have a role in fear extinction processing, which is what behavioral exposure therapy of anxiety disorders is believed to rely on. As such, the use of glucocorticoids to enhance the results of therapy has been explored.

A 2011 randomized trial administered 20 mg of cortisol one hour before virtual reality exposure for fear of heights. Researchers found this enhanced the efficacy of treatment relative to placebo-controlled exposure therapy.

Alternative Treatments

A number of alternative treatments are thought to be useful in the treatment of specific phobias and other phobia-related disorders.

Hypnotherapy

Hypnotherapy involves being induced into an altered state of consciousness (hypnosis) where the patient is more open to suggestion.

While it is a popular treatment, research into its effectiveness in treating specific phobias is very limited. However, there have been some instances where its use, alongside other therapies, has been part of a successful recovery.

Herbal Medications

The most widely studied herbal medication in relation to anxiety disorders is a compound called kava. This comes from the kava kava plant, which is a member of the pepper family.

Some clinical evidence suggests that kava may be effective in relieving some types of anxiety. A 2018 systematic review of randomized clinical trials noted that kava may be helpful for short-term use in anxiety, but should not replace established longer-term anti-anxiety medications.

It is important to know that not everyone should take kava and it is known to have some severe side effects. It has been linked to a risk of severe liver injury and can cause digestive upset, headache, dizziness, and other side effects. Kava may also have special risks if taken during pregnancy or while breastfeeding.

You should talk with your healthcare professional about any complementary health approaches you use or want to use. Together, you can make sure you make well-informed decisions about your treatment plan.

Summary

The first-line treatment for specific phobia is exposure therapy. Prescription medications are not considered to be effective as the only treatment. But antidepressants, anti-anxiety medications, and beta blockers might be used in addition to therapy or to treat comorbid conditions.

Treatments with D-cycloserine and glucocorticoids have been studied to see if they can enhance therapy. Alternative treatments such as hypnotherapy and kava have also been studied.

A Word From Verywell

If you are struggling with specific phobia, effective treatment is available. While avoidance can be useful for some with specific phobia, it can be damaging if it involves changing your life dramatically. Seeking treatment from a medical professional may help you live a healthier and less restrictive life.

If you have a loved one experiencing specific phobia, remember that it is a mental health condition. They cannot control the symptoms they are experiencing. Support them to stick with their treatment plan. This will increase their chance of a successful recovery.

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