Phobias are an overwhelming experience of fear and anxiety, triggered by a specific and consciously recognised situation such as spiders, closed spaces or flying.
Phobias by definition are irrational fears. If we run away from a tidal wave or a man-eating tiger, no one says we have a phobia because it’s a rational thing to do. The unconscious and conscious minds are in perfect agreement about the right course of action.
Phobias cause distress because they create conflict; the unconscious sends along fear which the conscious mind sees as either unnecessary or as an overreaction to the level of threat. For example, a client may know intellectually that a spider a quarter of an inch across can’t do much to hurt them, even if it wanted to try, but they still run away from it. I had one client who couldn’t even look at photos of plants because there might be a spider hiding on the leaves. The unconscious mind can overrule the conscious one where survival is potentially at stake.
And part of having a phobia can be fear of others finding your situation funny, or telling you to simply ignore it. With a true phobia, neither approach is going to help.
Types of Phobia
When I searched for an image to accompany this article, using the word ‘phobia’, nearly all those that came up were pictures of spiders (the balance being primarily snakes). But phobias can be about pretty much anything, including standing upright (staisiphobia), stars (siderophobia), buttons (koumpounophobia) or clouds (nephophobia). The most common are agoraphobia and claustrophobia, along with fears of spiders, snakes, worms, birds, flying and heights. Social phobias are also widespread, and a fear of public speaking is often said to be the commonest phobia in the western world.
Having said that, psychologists and psychiatrists divide most of them into two categories [1]:
- Specific or Simple Phobias, about a single known object/situation.
- Complex phobias are wider-ranging and more disruptive of everyday life including social phobias and agoraphobia.
Most people live around their phobias, avoiding anywhere they might come across the object of their fear, until that provides impossible. Maybe they're divorcing and now have no one who can eject spiders from the bedroom, going on holiday to a place with lots of snakes, or they are being forced into giving a speech in public by their boss. That's when they turn up on the therapist's doorstep.
If you are newly qualified or working on case studies, I’d look at simple phobias first if possible.
How Phobias Develop
There are several theories about how and why phobias develop, but it’s widely assumed that we are not born with phobias already in place, and that they are learned. Having said this, some phobias are much more common than others, and it is easier to create a phobia of crocodiles or snakes (at least in Rhesus monkeys) than it is to create one of toy rabbits or flowers (Cook & Mineka, 1989). So, there may be a genetic or evolutionary influence that makes us more inclined to develop some types of phobia than others.
The term phobia also gets used in different ways. People who say they are 'phobic' about computers or technology are really talking about a dislike and not a fear. They don’t run screaming from the room at the sight of a laptop, even if their stress levels rise at the thought of having to use one!
We don’t have the space here to go into all the theories, so we’ll stick with the idea that phobias are learned. If you like, you can think of phobias as negative anchors: a negative emotion becomes linked in the client’s mind to an event, object or place and the same response reappears whenever the client is exposed to the same thing again.
This beginning is variously called the ‘initial sensitising event (ISE)’, the ‘precipitating event’ or simply ‘a trauma’. For more on this look at my article on 'How Miss Muffett could have been helped by hypnotherapy'! Or search out the Little Albert experiment on YouTube.
Reducing phobias
You will already have your favourite way of working, whether that's analytical, cognitive, something else, or a combination, so I will put some ideas out there and you can pick and choose what fits with your approach and your client’s situation. Whatever your theoretical preferences, I would recommend using SUDS (‘on a scale of one to ten, how bad is that phobia?’) at regular intervals, since it helps you measure how well you – and your client - are doing.
- Flooding/exposure therapy – exposing the client to an exaggerated version of their fear until the phobic response dies down. Distressing for all concerned and doesn’t seem to be used much these days, though it’s easier to arrange hypnotically than for real, especially with the more unusual phobias. Where would you get hold of a room full of elephants?
- Systematic desensitisation – ask the client to make a ‘hierarchy of fears’ list, and work your way from the least scary thing on it to the most. There is more about using this technique in another blog on this site.
- Rewind (fast phobia cure) – originally designed to work with PTSD, this technique is extremely effective with phobias as well but, in my experience, it can be tricky for those who don’t visualise easily since there is a lot of manipulation of imagery. Again, no time to discuss that here in detail, but have a look at my book The Hypnotherapist’s Companion which has a lot of information on working with non-visual people. And for the rewind, here’s a nice example.
- Collapsing anchors – if a phobia is pretty much a negative anchor, collapsing that anchor can be very helpful – there is an article elsewhere on this blog which talks about how to use this technique.
- Hypnosis scripts – this is a tricky one since there are so many different phobias. If your client has a common phobia, say of dogs, flying or needles, you might find a script that specifically covers it but, for the less common fears, you’ll have to improvise. There are several articles on this blog about using scripts effectively (just put the word script in the search bar) but ‘How to have a free hypnotherapy script for everything’ will be particularly useful.
- Metaphors – there are many metaphors around for releasing unwanted thoughts and feelings, and any of them can adapt well to working with a phobia. For example, in a control room turn down ‘fear of [whatever]’ and turn up a feeling or behaviour the client thinks will help them deal better with the phobic situation. Pulling up weeds in a garden, sorting out the junk drawer in the kitchen, editing a piece of written work, deleting viruses on a computer, can all be used as release metaphors, and you can choose one to suit your client’s interests.
- Parts work – work with the part that controls the phobia and look for resolution, release or coping strategies. You can do this informally or use an outline such as a six-step reframe or visual squash. If you’re unfamiliar with parts work, you can send for a free guide to the six-step reframe from my training website.
Finding the ISE
Now we come to the knotty issue of whether you need to find the ISE of the phobia; in hypnotherapy, this is usually done via regression. The first point to make is that clients may already be aware of what has caused their phobia (their fear of dogs dates from being bitten by one) but sometimes they don’t have a clue, or may even prove (with hindsight) to be mistaken. This can be because:
- the incident they believe started the fear is actually a ‘secondary sensitising event’ (SSE) which increased a pre-existing, and possibly unrecognised, fear to phobic levels,
- the ISE has been forgotten, at least by the conscious mind,
- the presenting phobia is the result of generalisation from a different one. (The unconscious mind tends to err on the side of caution and doesn’t do much logic. If your original phobia is of wasps, it may try to keep you away from all small buzzy things, or even all yellow and black things, including those which don’t pose a threat.)
- the phobia arises from repeated exposure to warnings from or anxiety displayed by someone else. The impact of each experience is negligible, but the repetition makes it powerful, even hypnotic you might say. This is called ‘compounding’,
- the phobia arises from a series of events that are not actually linked, but which make an emotional impact on the unconscious because they seem to form a pattern.
As you can see, in many of these cases finding one specific incident that caused the problem can be challenging. People are complex and the cause and effect of their problems can be the same. You could spend a lot of time on it and get nowhere or, a regression might highlight a representative experience or even a metaphor that you can work with to reduce the phobia. It’s really down to your personal preferences and beliefs around doing regressions, combined with responding to the information the client gives you and their willingness to undertake deep level therapy.
I really enjoy working with phobias. They have twists and turns, and the presenting issue might not always be what the fear is really about, but that just makes it interesting work, and you can have a huge impact on your client’s quality of life in just a few sessions. Feel free to post case studies (being careful to preserve client confidentiality), questions, or your favourite techniques in the comments below.
References
[1] http://en.wikipedia.org/wiki/Phobia - cite_note-2#cite_note-2
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Author: Debbie Waller is an experienced hypnotherapist and hypnotherapy trainer. She is the author of The Hypnotherapist's Companion and Their Worlds, Your Words and a co-writer of the Hypnotherapy Handbook, all of which are available from Amazon.
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