Specific phobia

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Overview

What is specific phobia?

Most people will feel some degree of anxiety and discomfort when they anticipate a painful experience, such as getting an injection, or when faced with potential danger, such as being confronted by an angry, barking dog. People with a specific phobia, however, have developed an extreme fear of a particular object, activity or situation which is out of proportion with the actual level of threat posed. People with specific phobia will actively avoid the feared object or situation, and experience a high level of anxiety if it is encountered.1, 2

Common phobias include:

  • animal related phobias (e.g., snakes, spiders, dogs)
  • phobias relating to the natural environment (e.g., storms, water)
  • blood, injection, and injury phobias (e.g., needles, medical procedures)
  • situational phobias (e.g. elevators, aeroplanes, tunnels).1, 2

Specific phobias usually develop during childhood and they are twice as likely to be diagnosed in women compared to men. Over 75 per cent of people with a specific phobia experience multiple phobias over their lifetime.3

Signs and symptoms

Specific phobia is characterised by:

  • an intense fear or anxiety related to a specific object, activity or situation which is out of proportion with the degree of danger actually posed
  • active efforts to avoid the feared object, activity or situation (e.g., taking the stairs to avoid going in an elevator).1, 2

A diagnosis of specific phobia is made when these symptoms are present for six months or longer and cause the person significant distress, or interfere with important aspects of the person’s life, such their work or relationships.1, 2

What causes specific phobia?

While many phobias have no obvious cause, a number of factors have been linked to the development of a specific phobia. These include:

  • Genetic factors. People with a family history of animal phobias, situational phobias, and blood, injection, and injury phobias have a higher chance of developing the phobia than those without a family history.4
  • Direct learning. Many phobias (especially those related to animals, injections, and enclosed-spaces) occur following a negative experience, for example, a person may develop a phobia of dogs after having been bitten by a dog.5
  • Indirect learning. A person may become fearful of a particular object or situation after observing another person’s fearful response to that same object or situation.5

Once a specific phobia has developed, a person’s continued experience of fear is thought to occur due to a number of behavioural and cognitive factors (see Figure 1). These include:

  • Avoidance. Avoidance is a common behavioural reaction to a specific phobia as it allows people to avoid feelings of fear and anxiety. However, avoidance prevents opportunities to learn to challenge fearful beliefs and develop effective coping skills to manage anxiety. As a result the specific phobia is maintained and not overcome.6
  • Unhelpful thoughts. Unhelpful thoughts such as overestimating the chance of harm or incorrect beliefs about the consequences of confronting a feared object/situation are also thought to contribute to the continued experience of a phobia.7, 8

 Specific phobia

Figure 1. The cycle of phobia

Evidence-based psychological approaches and strategies

Exposure therapy

Exposure therapy is considered the most effective treatment for specific phobias.9 In exposure therapy, the person confronts the feared object or situation without engaging in any avoidance or escape behaviours. By encouraging people to face their fears, it is thought that exposure therapy teaches a person that feelings of anxiety decrease naturally over time and that the feared consequences of the phobic object or situation are unlikely to occur.6

The most effective form of exposure therapy is in vivo exposure.9 In vivo exposure is typically conducted in a controlled environment and involves directly confronting the person’s fear through a series of activities which provoke increasing levels of fear and anxiety. For example, a person with a phobia of dogs may first decide to approach a dog on a leash, then proceed to pat a dog on the head, then allow a dog to lick his/her hand, and eventually go to a dog park. A person usually undergoes exposure therapy until the most anxiety-provoking situation has been successfully mastered.6, 10

Cognitive therapy

Cognitive therapy involves helping the person to identify and challenge unhelpful thoughts. This technique might be used alone or in conjunction with exposure therapy.9, 11

How a psychologist can help

Through discussion and the possible use of questionnaires and monitoring tools, the psychologist develops an understanding of the potential factors involved in the onset and maintenance of the phobia. A treatment plan is then developed by the psychologist together with the person. For specific phobia, this can involve exposure therapy to help bring about changes in thinking or behavioural responses. Psychologists may also suggest involving a supportive family member or friend to assist in the understanding of the person’s situation and to support treatment.

Other professionals who might be involved

A medical review with a GP or another mental health specialist such as a psychiatrist may be suggested to determine whether another condition could account for the person’s symptoms. A GP or psychiatrist can offer advice and assistance around whether medication might be of benefit.

When to seek professional help

If any of the signs and symptoms mentioned in this information sheet are affecting a person’s work, safety, home life, or relationships, psychological assistance should be considered. The APS Find a Psychologist service can be used to locate a psychologist in your local area: call 1800 333 497 or visit www.findapsychologist.org.au. A GP can also organise a referral to a registered psychologist under the Better Access to Mental Health Care items.

More information

The Australian Psychological Society
Australia’s largest professional association for psychologists
www.psychology.org.au

beyondblue
Provides information on anxiety, depression, and related disorders
www.beyondblue.org.au

headspace
Australia’s National Youth Mental Health Foundation, providing assistance for people aged 12-25
www.headspace.org.au

Lifeline
A 24-hour counselling, suicide prevention and mental health support service
Telephone: 13 11 14
www.lifeline.org.au

  • Contributor(s)
    APS Member Resources Team

    Dr Peter McEvoy
    Associate Professor
    School of Psychology and Speech Pathology
    Curtin University
  • Publish date
    10 Mar 2015
  • References
    View

References

1.    American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington DC: Author.

2.    World Health Organization. (2008). ICD-10: International Statistical Classification of Diseases and Related Health Problems (10th Rev.). New York, NY: Author.

3.    LeBeau, R. T., Glenn, D., Liao, B., Wittchen, H.-U., Beesdo-Baum, K., Ollendick, T., & Craske, M. G. (2010). Specific phobia: A review of DSM-IV specific phobia and preliminary recommendations for DSM-V. Depression and Anxiety, 27(2), 148-167. doi: http://dx.doi.org/10.1002/da.20655

4.    Van Houtem, C. M. H. H., Laine, M. L., Boomsma, D. I., Ligthart, L., van Wijk, A. J., & De Jongh, A. (2013). A review and meta-analysis of the heritability of specific phobia subtypes and corresponding fears. Journal of Anxiety Disorders, 27(4), 379-388. doi: http://dx.doi.org/10.1016/j.janxdis.2013.04.007

5.    Hofmann, S. G., Alpers, G. W., & Pauli, P. (2008). Phenomenology of panic and phobic disorders. In M. M.  Antony & M. B. Stein (Eds.), Oxford handbook of anxiety and related disorders (pp. 34-46). New York, NY: Oxford University Press,.

6.    Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2011). Exposure therapy for anxiety: Principles and practice. New York, NY: Guilford Press.

7.    Hood, H. K., & Antony, M. M. (2012). Evidence-based assessment and treatment of specific phobias in adults. In T. E.  Davis III, T. H. Ollendick & L-G. Öst (Eds.), Intensive one-session treatment of specific phobias (pp. 19-42). New York, NY: Springer Science + Business Media.

8.    McCabe, R. E., Ashbaugh, A. R., & Antony, M. M. (2010). Specific and social phobia. In M. M. Antony & D. H. Barlow (Eds.), Handbook of assessment and treatment planning for psychological disorders (2nd ed., pp. 186-223). New York, NY: Guilford Press.

9.    Wolitzky-Taylor, K. B., Horowitz, J. D., Powers, M. B., & Telch, M. J. (2008). Psychological approaches in the treatment of specific phobias: A meta-analysis. Clinical Psychology Review, 28(6), 1021-1037. doi: http://dx.doi.org/10.1016/j.cpr.2008.02.007

10.    Cisler, J., Lohr, J., Sawchuk, C., & Olatunji, B. (2010). Specific Phobia. In J. C Thomas & M. Hersen (Eds.), Handbook of Clinical Psychology Competencies (pp. 697-722). New York: Springer

11.    Choy, Y., Fyer, A. J., & Lipsitz, J. D. (2007). Treatment of specific phobia in adults. Clinical Psychology Review, 27(3), 266-286. doi: http://dx.doi.org/10.1016/j.cpr.2006.10.002

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