Applied Tension

Description of the Strategy

Specific phobias are a common experience in people, and yet relatively few present with these concerns for [Page 28]formal treatment. In this respect, specific phobias differ significantly from other anxiety disorders. People who suffer with a variety of other common anxiety disorders (e.g., social anxiety, generalized anxiety, panic disorder) frequently present themselves for psychological interventions. Interestingly, specific phobias, when treated, often remit faster, and gains endure well over time. This phenomenon may in part be due to the circumscribed nature of specific phobias. Whereas many of the other anxiety disorders may have an insidious fashion of spreading into large parts of a person's life, specific phobias, virtually by definition, are limited to some relatively confined stimulus. In this way, by its very nature, it may also be easier to confine the interference that the fear and anxiety from the specific phobia produces. Indeed, it may be as “easy” as avoiding, for example, flying, certain animals or insects, dental or medical procedures, or the sight of blood. Because the excessive or extreme fear occurs only in the presence of the particular object, animal, or situation, these can usually be avoided almost wholesale.

People are quite adept at building mostly functional lives around avoidance and escape of feared circumstances, and they are typically quite successful with specific phobias, since the accompanying distress is commonly limited to a single or just a few variations of the specific target stimulus. This is quite different from most other anxiety disorders, which typically, when left untreated, will begin to permeate the sufferer's life, regardless of level of impact (e.g., intrapersonal, interpersonal, professional). Indeed, when individuals suffering with specific phobia present themselves for psychological treatment, it is not uncommon to hear that some life circumstances have changed (e.g., a job promotion that requires increased flying or driving, exacerbation of health problems produced by avoidance of medical care). Indeed, such change is forcing them to more directly face their fears, either by sheer necessity or by a desire to not let the fears negatively affect their personal or professional lives. In short, avoidance and escape typically used to cope with the offending stimulus have either directly or artificially been removed from the person's response repertoire.

It has been long recognized and accepted that the common ingredient of many, if not most, behavioral treatments that affect anxiety is exposure to anxietyprovoking stimuli. In fact, through repeated, prolonged exposure to the offending stimulus, anxiety, fear, and other intense negative emotions are reduced. Persons who are exposed to that which makes them feel afraid, and when this is done repeatedly, experience a reduction in their reactions of anxiety. Indeed, through repetition of this general process, the anxiety response can be extinguished. Specific phobias present a unique challenge to this commonly accepted treatment regimen in that some specific-phobia patients exhibit the vasovagal syncope, or fainting, response when faced with their feared stimuli. Such fainting response prevents habituation and, therefore, extinction of the fear response. This is especially common among blood and injury phobias, where fainting is often one of the main symptoms experienced.

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