Exposure Therapy for Specific Phobias

Ph.D., CPsychol., AFBPsS, Health Professional

The aim of most approaches to the treatment of specific phobias is to modify both the response to the feared item/issue and the thought processes that help to sustain the fear. Collectively, this treatment approach is known as cognitive behavior therapy (CBT). A client with a specific phobia will work alongside the therapist, allowing them to be exposed to the feared situation whilst using specific coping strategies.

It's a big step for someone when they first fully acknowledge their phobia and agree to be treated. The process of treatment is, for most people, surprisingly straight forward. There are uncomfortable moments during therapy but the therapeutic setting is a safe environment in which to practice coping techniques. For those who may be thinking about CBT for a specific phobia, this Sharepost will provide some rudimentary guidelines as the process and what you might expect.

The psychologist or cognitive behavior therapist will first want to know more about your phobia. For example, they'll be interested in whether it is restricted to certain times and places and whether the thing that triggers the fear is very specific or not. This is often not as straight forward as it first sounds so the therapist may ask you to keep a log book in order to record the events that built up to the feared situation, what actually happened during it and what happened afterwards. They will ask you to be very honest and open about the things that appear to maintain the phobia and even things you gain as a result of your fears (comfort, time, sympathy). Once this analysis has been undertaken both you and the therapist will start to see the scope of the problem.

The goals of therapy will be next on the list. The ultimate goal for someone with a specific phobia is to get rid of it, but they may need to achieve smaller goals along the way. Another insight the therapist will share is the possibility of the fear returning one day or even shifting to something else. Goals are not dictated by the therapist but they may suggest one or two in order to provide some structure. Ultimately, the person with the phobia is the one who must agree the goals.

At the outset it will be important for the therapist to establish a measure of the phobia. This provides a yardstick or baseline against which future progress will be compared. This is usually done through some form of ranking system (perhaps a 0 - 10 scale) where the client assigns a rating to situations they believe would cause them greatest anxiety. Where practical a behavioral test may also be used (e.g. someone with a fear of birds being asked to look at feathers) and the client will rate their anxiety at the time.

Once all this is done the treatment plan will be agreed on by the therapist with their client. Treatment will vary according to the specific issues the client raises but the most common intervention will require some measure of exposure to the feared situation.

The most common form of exposure is known as systematic desensitization. Here the client is taught how to relax. They must practice this until they achieve a level from which the therapist is happy to proceed. Typically, the client is asked to fully relax and to imagine a neutral scene. As they remain relaxed the therapist asks them to imagine one of the lesser anxiety provoking situations they previously developed during the assessment phase. If the therapist believes the client is becoming anxious they will revert to a neutral point and ask the client to relax once more. Equally, the client can invoke this simply by raising a finger. The relaxation with imagery sessions finish once the person can imagine their worst fear without feeling anxious. It is also quite common for certain behaviors to be undertaken as part of the desensitization process. Homework tasks after formal sessions also help the client to practice and this reinforces the key therapeutic issues. Very often a close friend or relative can be included as part of the treatment program.

The treatment for specific phobias has changed little since the 1960s and this is because it is effective. The role of exposure, particularly the duration of exposure, seems an important factor in helping both the thought processes and behaviors that previously reinforced the phobia.