September 2, 2004

People are afraid of certain situations and objects which causes them to behave irrationally: Zainab Mahmood describes the different phobias and how they can be controlled

American president Franklin Roosevelt once said: “The only thing we have to fear is fear itself.” In everyday life most of us shy away from acknowledging our fears that cause us anxiety and embarrassment. Every human being experiences fear when faced with an unfamiliar situation. It is a survival instinct, but when it becomes unmanageable it is a warning sign.

Many of us have some phobias. A phobia is a persistent,irrational fear of some object or situation. It is a conditioned response, which means repeatedly reacting the same way to a feared object or place. The essential ingredient is irrationality, as the person knows that his/her fear is magnified out of proportion. It is not an illness, mental disorder or lack of willpower. The person is genuinely afraid and if the irrational fears are not dealt with they can greatly undermine the quality of life.

Specific phobias are caused by a single object or situation. The most common ones, for example are; a fear of animals such as dogs (cynophobia), flying (aviophobia) or thunder (astraphobia). Many of us experience specific situation phobias which can be triggered by elements in the environment such as heights (altophobia), water (hydrophobia), and enclosed spaces (claustrophobia). Social phobia affects a large number of people around the world, especially adolescents. This is a fear of social situations and interaction with people for example, fear of public speaking and eating in public.

Phobias find their root in childhood and can arise as a result of watching others having a bad experience with a specific object or situation. That object becomes associated with fear, which becomes generalized, for example, being bitten by a dog may lead to a fear of all dogs. The best time to eliminate common fears is during the impressionable years before they develop into irrational phobias. People who have weak strategies for dealing with difficult situations are prone to developing phobias as they are more likely to react negatively to situations.

Phobic individuals choose to steer clear of the source of the fear so they do not feel afraid, which encourages them to continue avoiding the problem. When a person is frightened, a panic attack ensues and he/she may feel dizzy, parched, short of breath and due to adrenaline rush, the symptoms become worse. Phobics experience an overwhelming sense of impending doom and an intense desire to escape situations that frighten them.

Phobias are extremely common around the world in all cultures and ages. Women are twice as likely to develop specific phobias of animals or places whereas both men and women are equally susceptible to social phobia. It is said that 13 per cent of the people in the age group of 18 to 54 in the United States suffer from a phobia. It is estimated that there are 10 million sufferers in the UK at present.

According to Dr Uzma, a Karachi-based psychiatrist, phobias are extremely common in Pakistan, amongst men, women and children, but very few people actually seek professional help to overcome their fears. She discloses that generally most of her clients have a cluster of problems and occasionally people come in with phobias as their primary complaint. Many people may suffer from more than one phobia at a time and almost all are able to cure their phobias completely.

Apart from the more common ones, there are some rare and unusual phobias. They include; bibliophobia (books can often send students into a frenzy near exams), gerontophobia (fear of growing old), graphophobia (writing), and cathisophobia (being unable to sit still, something common in hyper people). Nonetheless, phobias are no laughing matter. People suffering from a particular phobia simply need to evaluate the extent of their fear, what happens to them when they are overcome and what helps them to calm down.

Sonia, a 20-year-old student, ends up jumping on chairs, screaming and fleeing at the sight of a cat. “I cannot stand the feeling I get when I see a cat I get goose pimples and I feel queasy until it’s out of my sight.”

There is a practical method used all over the world to treat or manage phobias. It can be implemented at home or by consulting a therapist. ‘Systematic desensitization’ a method simpler than it sounds, is used to treat phobias and other behaviour problems involving anxiety where the client is exposed to the threatening situation under relaxed conditions until the anxiety reaction is extinguished. Firstly, we build a hierarchy of our fear, identifying which factors about an object or situation we fear most, starting with the least frightening to the most disturbing. The next step is learning to relax.

Sana, a 25-year-old graduate, finds this to be the most difficult when her social phobia kicks in. She fears she will do or say something to embarrass herself and would be judged by others for the mistakes she makes. She can never relax in other people’s presence.

Social phobics find themselves worrying weeks in advance at the thought of being in public situations. “When I have to talk or discuss something in front of a number of people, my hands get clammy and my voice begins to quiver and this makes me even more nervous. It becomes a vicious cycle and I don’t know how to break it,” admits Sana.

This kind of edginess is also experienced by social phobics towards situations which require them to perform and be evaluated by others such as examinations or presentations. Because they are already expecting to fail, they deny themselves any chance of success. Correcting our thinking, keeping calm, setting goals and taking small steps to achieve them can help. We can learn to relax by trying out various methods to find the most suitable one. One can try deep breathing, listening to music, yoga, focusing on positive thoughts or counting.

Ahmed, 26-year-old, returned from the US to work in Karachi. After a protracted refusal to fly, he has no immediate plans to take up a journey. He is battling aviophobia and still gets apprehensive at the thought of long flights. “Once I’m on the plane, I cannot stand being cooped up and get fixated on the air. The ear pressure, the noise, the closed space make me feel uneasy. I try to distract myself which isn’t easy, but that’s what it takes.”

Desensitization changes our conditioned response and as we learn to relax while in the presence of the feared object or situation, we minimize our anxiety, thus reducing the fear. This process can be carried out with the use of anti-depressants or tranquilizers, if the anxiety is high. It does not require a great deal of time, but does warrant commitment. At the end of it we can be sure our phobia will be eradicated. According to Dr Uzma, people can control their rate of progress. She observes, “Most of the people don’t go on till the end of the hierarchy, because they are satisfied on reaching stage three, where they can just be in the same room as a lizard and not have an anxiety attack.”

To begin the session, we have to be completely relaxed. Then with the help of the therapist we begin to imagine the feared object or situation, starting from the lowest level we identified. For example, with claustrophobia we begin with imagining an open elevator and stepping inside, and then gradually move on to the next phases. At each step, we pause to calm our self down when anxiety rises and then gradually imagine being inside the elevator, the door closing and riding up. The next stage is actually stepping into an elevator, practicing what we learnt to keep calm at every step and ride the elevator with a manageable level of anxiety.

The most common phobias Dr Uzma has successfully treated are fear of heights and flying. She says that therapy sessions are tailored for each individual client and the pace varies accordingly. The process can be gradual and painstaking, exposing one to the feared object in a short span of time. She explains: “The length and intensity of therapy sessions can range from a few days to a few weeks depending on the severity of the phobia and the personality of the client.”

With most people today, phobias have become such a normal part of their lives that they do not realize the importance of getting rid of them. We get used to jumping every time we see a cat, or prefer to walk seven storeys saying it’s good for our health. I myself go into an erratic frenzy when I see loose strands of hair on my body, my clothes or my pillow and cannot sit still until I have picked each of them off. The point is we don’t have to live with it. Even if we have been able to successfully hide them or just avoid the feared situation, wouldn’t it be easier if we just spent a few hours or days dealing with it, so our movements and our life are no longer restricted by an irrational fear?

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