What to Expect in CBT Treatment Series: Specific Phobias

What to Expect in CBT Treatment Series: Specific Phobias

Written by: Hillary Gorin, PhD, LCP

This blog series will help you understand what to expect in Cognitive Behavioral Treatment (CBT) for a variety of different anxiety disorders, OCD, and PTSD. No matter what you are seeking help for, it can be very scary to start treatment. I assume most of my patients enter their first appointment with me with anxiety. I assume this for several reasons. 1. You are taking a big first step in your life to change something that may feel impossible to change; 2. Most of my patients experience an abundance of anxiety on a daily basis and new experiences make us all feel anxiety.

My hope is that this blog series helps you to have a better sense of what to expect in your treatment if you choose exposure-based CBT interventions. First and foremost, the first appointment will be a lot of data collection. In order to determine how I can be helpful, I must determine what your problem looks like. You can plan on me asking you a ton of questions. My goal is to determine what diagnoses you meet criteria for (to ensure I can treat those diagnoses) and to instill some hope in you that I can help you. Just like we would hope our doctors would evaluate what is broken before treating a broken bone and then tell us how they can be helpful, I want to use a scientific approach in my practice and give you some hope that the science works. Although a one size fits all approach does not work for everyone, I apply all evidence-based techniques or techniques that have been supported by ongoing research. In this series, you will find the general what’s and why’s of treatment with me. Also, if you are struggling with the motivation to get started, I include some information on why it may be worth it to take a chance on this treatment.

Specific Phobia Treatment

​What is a Specific Phobia?

Extreme anxiety about specific situations or objects (American Psychiatric Association, 2013). Phobias range from fears of driving, flying, animals, insects, natural environment (such as storms), and elevators, to needles, vomiting, and medical procedures. They can be incredibly impairing and impact many aspects of your daily life. 

What will we work on? 

• Exposure Therapy: Most of your treatment will involve creating what is called a hierarchy, which is a list of triggers related to you feared object or situation, and then engaging in the activities listed on the hierarchy (Craske et al., 2006). For instance, if you are afraid of spiders, your first exposure exercise, in which you are exposed to the fear, might be to look at image of spiders online or even to picture a spider in your head. Slowly, I will ask you to do more challenging exposure activities. 

• Cognitive Therapy: While you engage in exposure therapy, I will challenge your thoughts about the feared object or situation (Craske et al., 2006). How likely is it to cause serious harm? How likely are your fears in the first place? If the fear does come true, how will you cope with it? These are the questions we will process together. 

• Insight: Gaining insight into both the origins of your phobia and how your phobia impacts your daily life, will be part of your treatment journey (Craske et al., 2006). At the beginning of treatment, I will help you understand what maintains specific phobias. The answer is quite simple: Avoidance. Oftentimes, my patients will encounter something scary to acquire the phobia in the first place. Sometimes this is through experiencing trauma involving your feared situation or object, sometimes through observing or seeing someone else afraid of or hurt by the situation or object, and sometimes through learning information about the dangers of the object or situation (Craske et al., 2006). Understanding the origins of and maintaining factors will assist you in overcoming the fear and maintaining your gains in treatment. 

Why Engage in this Treatment?

I am assuming you are reading this page because you are tired. Tired of structuring your life around your phobia? Tired of feeling unable to engage in certain parts of your life because you are afraid you might encounter your feared object or situation? Maybe your phobia is starting to impact your sleep, your relationships, and generally your ability to enjoy your life, without the persistent fear in the back of your mind (Grayson, 2014)? Maybe you are unable to travel or to drive or to perform day to day tasks without fear? If so, you may want to give treatment a try. 

Why this treatment works? 
At some point, it is likely you were living your life without constant fear related to your phobia. However, over time, your amygdala, the threat detector in your brain, has falsely programmed your response to your feared object or stimuli. Over time, we will create new associations to override the old ones and this treatment helps you see, by facing the fear, that it is not as threatening as it feels now. 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Craske, M. G., Antony, M. M., & Barlow, D. H. (2006). Mastery of Your Anxiety and Panic: 
Therapist Guide (2nd ed.). Oxford University Press.

Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books.