Phobias Part 2 – treatments

This week’s post is the second in a 2 part series about phobias, and will focus on different types of treatment, and what works. If you haven’t already, read part 1 (see here) for more information on types of phobias and possible causes.

If you’r a regular reading of my blog, you may remember that a while back I did a post on Cognitive Behavioural Therapy (CBT) and how that can be used to treat people with phobias. The main principle is to reduce the anxiety felt by encountering the phobia stimulus, be it crowds, flying, or needles. By teaching the patient breathing exercises to help them relax and working to change the thoughts (cognitions) about the phobic stimulus, therapists can help the patient to work towards overcoming their fear. The behavioural part of this technique is gradual exposure to the thing the patient is afraid of, whilst the patient works hard to control their breathing and stay calm. This exposure can help towards changing thoughts which contribute to the phobia such as ‘if I’m in a room with a dog it will bite me’, which in turn reduces fear.

For example, take a look at the diagram below which shows how phobias remain if the fears aren’t challenged. If therapy targets the thoughts, and tests the fear, then it is likely the phobia will be treated successfully.


Another form of exposure therapy which has been used to treat phobias is known as ‘flooding’. Unlike in CBT, where the individual is gradually exposed to their fear, in this technique they are put straight in the worst situation they could imagine. This uses more behavioural techniques – as the body cannot sustain a physiological stress response for a long period of time, people begin to notice they feel calmer, even though they are in the presence of their fear. An example would be putting someone who was scared of birds in a room full of them! This also enables the individual to confront their worst fear and learn that nothing bad happens when they are in that situation.

Thanks for reading – there won’t be a post next week as I’ve got 2 interviews but I’ll be back the week after!


Social Anxiety Disorder

Do you ever feel shy when talking to people you’ve never met before? Or get nervous before speaking in front of a large audience?
While these emotions are normal, people with Social Anxiety Disorder (or Social Phobia) have a persistent fear of social situations. Often, sufferers believe that they will say or do something embarrassing, such as blush or shake, and so tend to avoid these situations as much as possible.
If social situations cannot be avoided then the sufferer will carry out ‘safety behaviours’ such as wearing thick make up or hiding part of their face with a scarf to hide blushing. However, these actions rarely help and instead contribute to the maintenance of the disorder.

Social Anxiety Disorder is relatively common, with a lifetime prevalence of about 12% (Kessler et al, 2005) and it normally begins in childhood or adolescence. It an extremely persistent disorder if not treated.

The Cognitive Model of Social Anxiety
– developed by Clark & Wells (1995)
– states that people with this disorder have set beliefs about what will happen to them if they perform a certain way
– they therefore monitor their behaviour very closely and turn their attention inwards during social interactions
– this causes them to ignore any evidence from their conversation partner which suggests that they are pleasant to talk to
– sufferers also have extremely distorted self-images: for example when they blush they think their whole face goes bright red, whereas it isn’t at all this obvious.


As the safety behaviours are involved in the maintenance of the disorder, one of the main aims of cognitive therapy for social anxiety is to remove them. Wells et al (1995) asked patients with social anxiety to carry out two exposure sessions (social interactions): one with and one without safety behaviours. They found that decreasing safety behaviours reduced anxiety and the belief that their most feared outcome would take place. A ‘cognitive shift’ must also occur for the therapy to be successful – the sufferer must learn to direct their attention outwards and look for evidence that contradicts their belief that they are bad or boring to talk to.

Another aspect of cognitive therapy is for pictures or videos to be taken of the individual during a social interaction, which are then shown to them during a therapy session. The aim of this is to provide more contradictory evidence to their beliefs, for example by showing them that they do not go bright red when they blush, or look really nervous when talking to others.

Thank you for reading, I hope you found this interesting – check back soon for more posts!