A specific phobia is a fear of specific object (e.g., snakes) or activity (e.g., flying). Unlike most other anxiety disorders, the fear is narrow and functioning outside of the area of the phobia is usually unaffected. However, when confronted by the feared object, the anxiety can be intense. As a consequence, the individual may avoid situations in which they could come into contact with their phobic stimulus.
Any object or situation could potentially become a phobic stimulus, but in practice a relatively small number of stiumuli account for most of the specific phobias. Animal phobias are common, especially in childhood. Besides the traditional snakes and spiders, insects and dogs are popular phobic stimuli. Situations in our natural environment (e.g., heights, storms, water) can be phobic stimuli for some individuals. Certain man-made situations (e.g., flying, crossing a bridge or going through a tunne l) are often listed as phobic objects. A particularly interesting phobic stimulus is the blood/injection/injury phobia. Unlike most other specific phobias, the blood/injection/injury phobia is often associated with fainting.
In many cases, the evidence is clear that a specific phobia is learned. A tramatic incident sensitizes the individual to be fearful of a specific object or situation. For example, being chased by a big dog as a child or being on a particularly turbul ent airline flight might create a dog phobia or a fear of flying. But learning need not always be direct. We learn from observing the behavior of others. It is not uncommon for children to learn to fear many of the same things their parents fear by obs erving the obvious distress of their parents when in contact with the feared stimulus. In fact, there is even evidence that pets can learn some of the owner's fears. If you are obviously afraid of thunderstorms, your dog or cat may well pick up on that fear and develop their own fear.
There are specific phobias where it is impossible to point to a tramatic event that could account for the fear. It is possible that the event did occur but has been forgotten, or it may be that there are other ways in which specific phobias can develo p. There is substantial evidence for a process called "preparedness" by psychologists. Some fears are more readily learned than others. For example, evidence suggests that we are more prepared to learn to fear snakes than flowers in that the fear of sn akes is learned more quickly. Other species also show preparedness in their fear learning. It is almost as if the brain is hard wired to recognize certain stimuli as more inherently dangerous than other stimuli and is therefore prepared to activate fear at the slightest provocation.
The blood/injection/injury phobia appears to be a special case. Whenever we experience a puncture wound that causes bleeding, our cardiovascular system responds by dropping the blood pressure a bit to minimize the loss of blood. In some individuals, that blood pressure drop can be significant enough to cause the person to pass out, which is usually pretty embarrassing. Some individuals will generalize this response to the sight of blood, either their own or others. The phobia in this case is probab ly a fear of passing out rather than a fear of the injury per se.
Phobias are usually treated with desensitization. The process of desensitization involves gradual exposure to the feared stimulus under controlled conditions. If the exposure is done by imagining yourself in the feared situation, the process is calle d "systematic desensitization." If you are actually placing yourself in the situation, the process in called "in vivo desensitization." Traditionally, the exposure is conducted while the patient utilizes anxiety control techniques such as progressive mu scle relaxation. Desensitization is a generally effective treatment, although it does take time for the phobia to discipate.
An alternative to desensitization is an approach known as flooding. Flooding also involves exposure, but unlike desensitization where the exposure is gradual, flooding involves massive exposure to the feared stimulus. You might think that flooding wo uld only increase the fear, which is actually true if the patient escapes from the flooding before the fear has discipated. However, if the patient remains in the situation until the fear has decreased, flooding can be an effective and rather rapid treat ment approach. However, most therapists prefer desensitization because there is less danger of increasing the anxiety if things do not go well and because desensitization is much easier on the patient than flooding.
Blood/injection/injury phobias are treated a bit differently. The most common problem with this phobia is the avoidance of important medical procedures, such as blood tests or immunizations, because the person fears passing out in the doctor's office. Desensitization will reduce the fear, but will do little to prevent the person from passing out. However, there are procedures that dramatically reduce the likelihood of fainting in such situations. Laying down will permit blood to reach the brain eve n if the blood pressure drops, thus preventing the fainting. Another approach is to tense the muscles of the body, which restricts the blood vessels from dialating to reduce the blood pressure. If you are getting blood drawn, it is best to tense everyth ing but the arm from which the blood is drawn. Keeping that arm as relaxed as possible will minimize the pain of the needle insertion.
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Copyright © 1997, Michael Raulin
Revised: January 14, 1997
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