Baseer Maroof, LCSW · Raleigh, NC · Adults 21+
Specific phobias
Dogs, heights, needles, flying, elevators. The object changes, the fix is the same: planned steps toward it.
In short
- A specific phobia is intense, immediate fear of a particular thing or situation, out of proportion to the real danger.
- It’s the most common anxiety disorder: 9.1% of U.S. adults in a given year.
- Exposure is the treatment. A meta-analysis of 33 trials found it beat both placebo and other therapies.
- Fear of blood or needles is different: it can cause fainting, and it has its own technique, applied tension.
What it is
Paraphrased.
The pattern
Fear shows up immediately when you face the thing (or even think about it), it’s out of proportion to the real risk, you avoid it or endure it with intense distress, and it typically lasts 6 months or more. (StatPearls Specific Phobia)
How common
9.1% of U.S. adults in the past year and 12.5% in a lifetime; 12.2% of women vs 5.8% of men. (NIMH)
Types
The five types
Tap a type to see examples and what a ladder might look like.
Blood, needles and fainting
Why it’s different
Most fear speeds the heart up. Blood and needle fears can do that briefly and then drop heart rate and blood pressure fast, which is why people actually faint. (Öst & Sterner 1987)
Applied tension
Developed by Lars-Göran Öst: tense the big muscles of your arms, chest and legs until your face feels warm, release, and repeat. It raises blood pressure and helps prevent fainting. You practise it first, then use it during exposure to blood draws or videos. (Öst & Sterner 1987)
Medical procedures
If you’ve skipped needed care because of this fear, tell the clinic. Many will let you lie down for draws and give you time.
Evidence
Exposure works
A meta-analysis of 33 randomized trials found exposure-based treatment produced large effects vs no treatment and outperformed placebo and non-exposure therapies, at the end of treatment and at follow-up. Live (in vivo) exposure did best right after treatment; that edge faded by follow-up. (Wolitzky-Taylor 2008)
Build yours
Use the ladder builder. There are example ladders for dogs and driving.
Sources
All sources, linked5 references⌄
- StatPearls. Specific Phobia. NCBI Bookshelf NBK499923. www.ncbi.nlm.nih.gov/books/NBK499923/
- National Institute of Mental Health. Specific Phobia (NCS-R statistics). www.nimh.nih.gov/health/statistics/specific-phobia
- Wolitzky-Taylor KB et al. (2008). Psychological approaches in the treatment of specific phobias: a meta-analysis. Clinical Psychology Review, 28(6), 1021–1037. pubmed.ncbi.nlm.nih.gov/18410984/
- Öst LG, Sterner U (1987). Applied tension: a specific behavioral method for treatment of blood phobia. Behaviour Research and Therapy, 25(1), 25–29. pubmed.ncbi.nlm.nih.gov/3593159/
- Craske MG, Treanor M, Conway CC, Zbozinek T, Vervliet B (2014). Maximizing exposure therapy: an inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. pmc.ncbi.nlm.nih.gov/articles/PMC4114726/
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