Living with phobias: Understanding and managing deep-seated fears

Imagine this: You receive an invitation to a social gathering. However, the thought of encountering people makes you feel intense anxiety and distress. The idea of stepping into that social scene fills you with dread and an overwhelming fear of being judged. This scenario paints a vivid picture of life with a social phobia, where irrational fears dictate actions and shrink the world into zones of safety and danger.

Phobias are not just simple fears. They are complex emotional and physiological responses that can disrupt daily functioning and overall quality of life. Dr Raisul Islam Parag, Registrar of the Department of Psychiatry at DMC (Dhaka Medical College), explains the difference between phobia and fear.

“Fear is a human response to danger. Anxiety is a feeling of worry, nervousness, or unease and phobia means irrational fear and avoidance from a specific situation. Phobias differ from anxiety because they are intense and irrational. A person with phobia always avoids the situation,” clarifies Dr Parag.

Understanding the difference between anxiety and phobias is essential. While anxiety is characterised by worry, nervousness, and unease, phobias manifest as an overwhelming and unreasonable fear leading to complete avoidance of certain situations or objects.

Anxiety might involve overthinking or difficulty concentrating, accompanied by physical symptoms such as palpitations, tremors, or headaches. In contrast, a phobia triggers more intense and specific reactions like panic attacks, often disabling and isolating the individual.

Dr Parag further elaborates on the causes of phobias.

“Phobias may persist for at least six months and cause marked functional impairment, qualifying them as a disorder. The cause of phobia involves a combination of factors: genetics, as phobias can run in families; learned experiences, where a negative experience with an object or situation can trigger a phobia; and brain chemistry with imbalances in brain chemicals related to fear and anxiety playing a role.”

From acrophobia (fear of heights) and agoraphobia (fear of open or crowded spaces) to more obscure fears such as nomophobia (fear of being without mobile phone coverage), phobias weave through the fabric of human psychology, presenting unique challenges to those they afflict.

According to Dr Parag, phobias can cause avoidance behaviours that limit activities and opportunities – consequently, triggering anxiety attacks with physical symptoms like sweating, rapid heartbeat, and dizziness. Moreover, extreme fear and avoidance behaviour may contribute to depression and isolation.

And the result?

A person with a phobia may be humiliated or criticised by surrounding people for which s/he may feel ashamed and in extreme cases, even suicidal.

Research suggests that phobias are not merely psychological but have a biological foundation. When confronted with the source of their fear, an individual’s amygdala (the part of the brain involved in emotional processing) activates, triggering a fight-or-flight response. This response is evolutionary, meant to protect us from danger, but in the case of phobias, it is misfiring –reacting to perceived threats that are not harmful.

The journey to overcoming a phobia begins with self-awareness. Recognising and accepting one’s fear is the first step toward addressing it.

Dr Parag advises, “Educate yourself about phobias, understand the expert explanations, and consider the available treatment options.”

Seeking professional help is vital, as therapists can offer tailored treatment plans based on an individual’s needs.

Support from loved ones is equally invaluable. Dr Parag suggests that friends and family should educate themselves about phobias, provide empathy, and encourage professional consultation. Patience and understanding are important and so is avoiding any judgment that could further alienate the individual.

Fortunately, phobias are highly treatable. According to Dr Parag, exposure therapy, one of the most effective methods, involves gradually and repeatedly confronting the feared object or situation within a controlled environment, helping to desensitise the individual. Cognitive-behavioural therapy (CBT) is another cornerstone of phobia treatment, focusing on altering negative thought patterns and building coping mechanisms.

In some cases, medication such as antidepressants may be prescribed to help manage symptoms, although they are generally used in conjunction with therapy rather than as a standalone treatment.

With the knowledge, support, and treatment, individuals can learn to manage their fears and lead fulfilling lives. As Dr Parag notes, “Phobias do not have to define you. With help, there is always a pathway to better understanding and significant improvement.”

Phobias, though deeply rooted in our psychological and biological makeup, need not dictate the contours of one’s life. Just as one learns to swim by gradually wading deeper into the water, so too can those affected by phobias find their strength and resilience in the face of fear. In doing so, they can expand their horizons, embracing a fuller, more engaged life.