Specific Phobia Treatment
Maybe you have a profound, persistent fear of flying or driving or heights. Maybe you fear getting injections and seeing blood. Maybe you have a fear of spiders or snakes or closed spaces. And because of this powerful fear, you regularly avoid those situations, procedures, or animals.
Or maybe your child is struggling with a specific phobia. Maybe they have an intense, excessive fear of dogs, the dark, blood, bugs, water, or clowns. For instance, they might cry, cling to you, or throw a tantrum when they see a dog at the park, or in a photo, or on TV. Your child might avoid going on a school field trip because they’re afraid that dogs might be there. They might not want to walk to school, because they have to pass a dog park.
Phobias can be very disabling and downright exhausting. However, the great news is that phobias are also very treatable in both kids and adults.
The treatment of choice for a specific phobia is exposure therapy. Medication might be used to alleviate anxiety short term for some phobias, but overall it appears to have limited value.
Specific phobias commonly co-occur with other conditions. For instance, kids might also have generalized anxiety disorder, separation anxiety disorder, oppositional defiant disorder, or attention deficit hyperactivity disorder. Thus, your child’s overall treatment might vary depending on their other diagnosis (e.g., they might take a selective serotonin reuptake inhibitor for their generalized anxiety disorder).
Psychotherapy for Phobias
Again, the first-line treatment for specific phobias is exposure therapy. This involves repeatedly and systematically confronting the thing you fear. You and your therapist will come up with an exposure hierarchy based on the least to the most feared and avoided scenarios. You will repeat a step until your fear is reduced, and then you’ll move on to the next step.
For example, according to Canadian clinical practice guidelines, if you’re afraid of spiders, you might “look at pictures of spiders, hold a rubber spider, look at a live spider in a jar, touch the jar containing the spider, stand two feet from a live spider, and finally touch a live spider.”
There are three types of exposure techniques: “in vivo,” which is done in real-life situations in a safe, controlled way; imaginal, which means mentally confronting the fear in session until it’s reduced; and virtual reality, which is a computer simulation for situations that might be too costly or difficult to reproduce (such as flying on a plane).
It’s important that your exposure includes different contexts and settings, so your fear doesn’t return. That is, if you fear spiders or snakes, you should be exposed to different types and sizes of animals and in different places.
Regarding length of treatment, sometimes successful exposure is done in one 2- or 3-hour session (called “One-Session Treatment” or OST). Other times, people need five to eight 60- to 90-minute sessions. It really depends on the severity of your phobia and your progress in reducing the fear.
Your therapist also might incorporate other cognitive-behavioral techniques into your treatment, such as psychoeducation, which might debunk myths about your specific phobia; progressive relaxation and deep breathing techniques; and cognitive restructuring, which challenges thoughts that perpetuate your fear. For instance, research has shown that for people with blood injury and injection phobia, it’s helpful to combine exposure therapy with muscle tension exercises that prevent fainting (see the self-help section for practicing “the applied tension technique”).
Exposure therapy can sound intimidating. After all, you’re going to confront your fear. But keep in mind that you can take as long as you need with each step. Also, your therapist will be supportive, discuss your concerns, and won’t force you to do anything. In short, you’re in the driver’s seat.
Exposure therapy also is highly effective for kids and teens. The therapist will encourage your child to think of themselves as a scientist or detective testing out distorted thoughts through a series of behavioral “experiments.” These experiments are the anxiety-provoking situations (again listed from least to most feared and avoided). For instance, if your child is afraid of dogs, they might draw a dog, read about dogs, look at pictures of dogs, view videos of dogs, play with a stuffed dog, be in the same room as a small dog, stand closer to the small dog, and eventually pet the small dog. Your child’s therapist also will model how to handle these fearful situations.
Medications for Phobias
No medication has been approved by the U.S. Food and Drug Administration for the treatment of phobias, and there’s very little evidence of any effective medication. Your doctor might prescribe a benzodiazepine, such as lorazepam (Ativan), if you don’t encounter the feared situation often and it’s unavoidable, such as flying or a dental procedure.
The research on medication for kids and teens with specific phobias also is limited, and medication is typically not prescribed.
In fact, the Canadian Anxiety Guidelines Initiative Group concluded that “Exposure-based techniques, including virtual exposure, are highly effective, and are the foundation of treatment for specific phobias. Pharmacotherapy is generally unproven, and thus not a recommended treatment for most cases.”
Self-Help Strategies for Phobias
Regularly practice relaxation techniques. Relaxation techniques might be used during your exposure to reduce your anxiety. Which is why it can help to get comfortable with various exercises outside of therapy. For instance, you might practice deep breathing or progressive relaxation. You might listen to a guided meditation on your phone.
Regularly practice “the applied tension technique.” This is especially helpful if you or your child has a blood injury and injection phobia that leads you to faint. Developed by psychologist Lars-Göran Öst, this technique involves tensing your muscles to raise your blood pressure, which makes it less likely that you’ll faint.
According to Anxiety Canada, this is how you do it: “Sit in a comfortable chair and tense the muscles in your arms, legs and trunk for about 10 to 15 seconds. You should hold the tension until you start to feel a warm sensation in the head. Then, relax your body for 20 to 30 seconds. Repeat 5 times.”
Model helpful behavior around fear. If your child has a specific phobia, show them how they might encounter what they fear. If your child is working with a therapist, ask them for suggestions on effectively modeling healthy behavior around facing one’s fears. Similarly, ask your child’s therapist about things you shouldn’t do (e.g., inadvertently minimizing your child’s fear).
Read reputable resources. If you’re struggling with a specific phobia, consider using a workbook, such as The Anxiety and Phobia Workbook written by anxiety specialist Edmund J. Bourne, Ph.D.
If your child was diagnosed with a specific phobia, this is an excellent book by an anxiety expert: Freeing Your Child from Anxiety: Practical Strategies to Overcome Fears, Worries, and Phobias and Be Prepared for Life—from Toddlers to Teens. The author, Tamar Chansky, Ph.D, also has a website called WorryWiseKids.org.
Plus, if your teen has a phobia, they might find this expert-authored workbook to be helpful: Conquer Your Fears and Phobias for Teens: How to Build Courage and Stop Fear from Holding You Back.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Eaton, W.W., Bienvenu, O.J., Miloyan, B. (2018). Specific phobias. Lancet Psychiatry, 5, 8, 678–686. DOI: 10.1016/S2215-0366(18)30169-X.
Katzman MA, Bleau P, Blier P, Chokka P.., Kjernisted, Van Ameringen, M., … Walker, J.R. (2014) Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry 14(Suppl. 1): 1-83. DOI: 10.1186/1471-244X-14-S1-S1.
Oar, E.L., Farrell, L.J., Ollendick, T.H. (2019). Chapter 7: Specific Phobia. In S.N. Compton, M.A. Villabo, H. Kristensen (Ed.), Pediatric Anxiety Disorders (pp. 127-150). Cambridge, MA.: Academic Press. DOI: https://doi.org/10.1016/B978-0-12-813004-9.00007-4.
McCabe, R.E., Swinson, R. (2017, December 14). Cognitive-behavioral therapies for specific phobia in adults. UpToDate.com. Retrieved from https://www.uptodate.com/contents/cognitive-behavioral-therapies-for-specific-phobia-in-adults.
Ryan, S.M., Strege, M.V., Oar, E.L., Ollendick, T.H. (2017). One session treatment for specific phobias in children: Comorbid anxiety disorders and treatment outcome. Journal of Behavior Therapy and Experimental Psychiatry, 54, 128-134. DOI: http://dx.doi.org/10.1016/j.jbtep.2016.07.011.
Specific Phobia. Child Mind Institute. Retrieved from https://childmind.org/guide/specific-phobia/.
Swinson, R., McCabe, R.E. (2018, January 15). Pharmacotherapy for specific phobia in adults. UpToDate.com. Retrieved from https://www.uptodate.com/contents/pharmacotherapy-for-specific-phobia-in-adults.
Tartakovsky, M. (2019). Specific Phobia Treatment. Psych Central. Retrieved on April 7, 2020, from https://psychcentral.com/anxiety/specific-phobia-treatment/