MAKING SENSE OF THE FEAR

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People typically put up with mild phobias for long periods until something happens which turns a manageable discomfort into a serious hindrance requiring treatment. A full blown phobia such as a fear of leaving the house, (agoraphobia) or fear of throwing anything away (hoarding) only appears strange to an outsider. For the person suffering, however, the phobia serves to protect against an unknown danger. In an inside-out sort of way, the phobia seems to make sense.

What are some causes of phobias, or what causes a person to develop what appears to be a fear that lacks any rationality, insofar as the thing feared does not have an inherent danger? Generally, phobias develop after an experience of discomfort or danger, and after the mind has linked the danger to a concrete concept. For example, a patient presented with a mild but annoying fear of cotton. She complained that she developed a discomfort in her throat whenever she touched cotton balls, or items that reminded her of cotton balls. It was discovered that as a child, she underwent a mild traumatic experience in the dentist’s chair when her mouth was stuffed with cotton in conjunction with a procedure. She had gagged and tried to remove the cotton but was made to endure it for the remainder of the procedure.

This is an example of a relatively minor phobia with minor consequences, but it illustrates how fear becomes linked to concrete concepts. Unfortunately, phobias and the anxiety they generate can inhibit healthy sexual activity, healthy social activity, travel, work, and general daily functioning.

When a phobic person comes into treatment for phobias, they are looking for help with the riddle of their fear. Since they also realize that therapy will eventually solve the riddle by exposing the thing they are most afraid of, the therapist must be sensitive to these competing desires. Phobia treatment or phobia therapy recognizes that simply exposing the causes of a specific phobia is not, in and of itself, worthwhile. Overcoming phobias certainly requires insight, but it also requires attending to the anxiety and the possible panic attacks that frequently accompany phobias and phobia treatment.

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