Treatment of Phobias, Anxiety & Panic

If your intense aversion to snakes, or dentists, or heights makes you feel as if you'll explode, short-term psychotherapy may be the answer to taming your fears.

Most phobics discover the anxiety that propels their hearts to beat faster and their palms to sweat is what therapists call "anticipatory." Their body's responses begin with nothing more than the thought of the feared item or situation, with no rational basis for feeling an impending explosion.

Of course, medications and various cognitive-behavioral therapies may also help rid a person of their phobia.

Why bother treating a phobia?
Because people with untreated anxiety disorders may be more susceptible to other psychological disorders such as depression, according to the American Psychological Association. The group also notes that relationships with family members, friends and coworkers can be strained, and job performance can suffer when a person's anxiety disorders are left untreated.

Perhaps the most successful therapy for phobias is exposure therapy, a kind of cognitive-behavioral therapy also known as desensitization, which shows success in about 75 percent of patients, the National Institute of Mental Health reports.

"In general, exposure therapy with response prevention is probably one of the most effective treatments," says Sheryl Jackson, Ph.D., Director of the University of Alabama's Anxiety Program, in the Department of Psychiatry. "It's a fairly straightforward type of treatment. Some people have already kind of begun it on their own."

Exposure therapy is what it sounds like, exposing the person to whatever it is that causes their fear. The process usually begins by gradually introducing the patient to the feared situation and works towards helping them develop constructive responses to their fear. For example, a patient with severe arachnophobia (a fear of spiders) may begin by talking about "creatures with eight legs" and end up being able to sweep spiders away when they see one.

Patients also learn how their thinking patterns contribute to their anxiety and how changing their thoughts can help minimize symptoms. At the same time, anxiety management is often a component of exposure therapy, wherein patients learn deep breathing and relaxation techniques. People under treatment for a social phobia may also be steered to social skills training.

Medications can be beneficial, too, depending on the patient and the phobia. While no drugs have been proven to be a cure or to treat specific phobias, some drugs are effective in relieving anxieties.

For instance, someone with a fear of flying who seeks treatment because they have a flight they must take in two days may fare well with a short-term anti-anxiety drug like Xanax (alprazolam) or Klonopin (clonazepam). Someone who must make a series of flights over the next several months may be prescribed a longer-term medication, oftentimes along with regular exposure therapy.

People with social phobias may take antidepressants (monoamine oxidase inhibitors, selective serotonin reuptake inhibitors or high potency benzodiazepines). Beta-blockers, drugs usually prescribed to control high blood pressure, are sometimes used for people who have a type of social phobia called performance phobia, according to the National Institute of Mental Health.

Some people believe that alcohol helps them reduce their social phobic anxieties. A recent study in the American Journal of Psychiatry indicates that belief alone can be powerful.

Researchers at the University of Michigan in Ann Arbor studied 40 patients who sought treatment for social phobia. The patients were asked to give two impromptu speeches. Half the subjects received a placebo alcoholic drink before each speech. The other half had a placebo alcoholic drink before the first speech, and a real alcoholic drink before the second.

Researchers found no significant difference between the two groups in anxiety levels, subjectively, physiologically or cognitively. They concluded: "Alcohol does not directly reduce social phobic anxiety. The belief that one received alcohol may reduce social anxiety."

What holds people back from seeking treatment for phobias?

Most people don't go to a therapist until their particular fear makes a big impact in their life. Their new job may be located at the top of a skyscraper, and they're afraid of heights. Their fiance may be planning a Hawaiian vacation, and they're scared to fly.

Jackson, of Alabama, says stigma doesn't really hold too many people back. The generation of people just beginning to face their phobias has been exposed to so much information about stress management and obsessive-compulsive disorders that phobias have lost their shame.

"In my experience, it seems as though people are much more willing to accept fears and phobias," Jackson says. "It just doesn't seem to be as big a deal."