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relieving phobias

Phobias appear to work in same way as trauma - part of the brain holds an image of something it fears, and when it sees something in the environment that matches that pattern it sets off the alarms.

All the common phobias are of things that could have been hazardous to our species: heights, depths, enclosed spaces, water, spiders, snakes, etc. These patterns probably exist in all of us, handed down through through time to protect us against hazards, just waiting for a match to come along in the real world so the fight-orflight mechanism can be set off.

However, while a fear of spiders might have been protective years ago it is not generally useful in 21st-century England, and neither is claustrophobia or any of the others. Treating phobias follows the same general pattern as treating post-traumatic symptoms, and the rest of this page is adapted from the page on trauma.

The way we now treat phobias is to ask the client to name three or so incidents where the phobic reaction has occurred, and they then watch an an imagined film of these events on an imagined television screen while in a highly relaxed state.

After the history has been taken and the examples of the phobic reaction have been decided on, the clinet is relaxed by whatever method works for him or her; usually a combination of extended out-breath, progressive muscle relaxation and visualisation techniques, all of which come from Yoga.  The aim is to achieve a calm, slightly disconnected state in which the patient can imagine resting in a pleasant place. This step can usually be omitted in children, who seem to have much easier access to their imagination.  Then the patient is invited to imagine that she/he has a portable TV and video, a laptop, a games console or any other kind of screen, with a remote control, and a tape, film, DVD or whatever of the phobic reactions.  The client is invited to float out of himself, press the remote control and watch him/herself watching the film, without looking at the screen.  The therapist suggests that the patient will, somehow, ‘know’ when the tape has finished playing, and that  this could happen quite quickly, and that the patient can indicate, perhaps with a nod, when that has happened.  Even though the patient is not looking at the memory, there is usually some rapid eye movement activity visible during this phase.  When the signal comes, the patient is invited to float back into his body, press the rewind button and watch the events going rapidly backwards on the screen.  It is thought that the cognitive effort involved in reconstructing the history backwards keeps the thinking brain active and prevents it surrendering to the emotion connected to the memory; in any case, the body remains reasonably calm even though the mind is visualising the phobic response. If a high degree of arousal has been experienced the patient is calmed down and taken back a step. When ready, he/she is invited to press the forward button and watch the events through, fast-forward, on the screen, then the process is repeated backwards, forwards, backwards, etc, always keeping the patient reasonably calm.  After two or three passes the view, on the backwards passes only, can be switched to a first-person view, going backwards through the memories as the patient remembers them instead of watching them on the screen.  It is useful to ground the start and finish of the film in a calm place, so the therapist may suggest, for example, that a reverse pass should end ‘back at a time when you feel ok, back before anything went wrong’; or that a forward pass could end ‘right here in the present, with you feeling calm and relaxed in that chair, knowing that all of those events are in the past now and that those particular events can never happen again’.  When the patient reaches the point where she/he can view the events forwards with no visible signs of physiological arousal, that is no obvious muscle twitching or facial distress, the process is done.  This might normally be achieved in six to twelve passes.  It is common for a phobia to be brought under control quite quickly in this way, though complex cases where the phobia is interwoven with other difficulties might take several rounds of this process.
 
 The next step might be to reframe all the distress and inconvenience of the phobic past, and then to rehearse, in the imagination, going into previously-feared situations while feeling clam and relaxed.