PHOBIAS & FEARS

Individuals with a specific phobia have anxiety related to a specific situation or object, such as fear of flying, needles, blood, or a particular animal (snakes, spiders) or insect. The specific object or situation is perceived as an overestimated threat of harm to the person, and this perception leads to avoidances and safety seeking behaviors in relation to situations or places where they may come into contact with the feared stimulus.

Emotional and physical changes during phobias are similar to panic, as are the range of avoidance, reassurance seeking and checking behaviors that occur. People can end up leading highly impaired and restricted lives.

Blood and injury phobias (including needles) are the only anxiety disorder in which the individual may faint. For a person to faint, a rapid reduction in blood pressure has to happen. When a person is anxious during a panic attack, generally blood pressure increases rapidly and there is no possibility of fainting. In contrast, in blood and injury phobias blood pressure actually drops, so it makes evolutionary sense for the individual to fall or lie down, so that the head and heart are on the same vertical level, thereby maximizing blood flow to the brain (the so-called vasovagal response).

Cognitive Behavioral Therapy (CBT) is the cornerstone of treatment, but other approaches may also have a role such as EMDR in order to address a traumatic history.

WHAT IS AIRPLANE FEAR / FEAR OF FLYING?

Fear of flying or aerophobia is an unreasonable fear of flying. As with all phobias, the person with fear of flying does not feel any fear as long as the phobic stimulus (airplane travel) is absent. It is only when an airplane trip is planned that anxiety arises.

WHAT ARE THE CAUSES OF AIRPLANE FEAR OR AEROPHOBIA?

It is difficult to find specific causes for fear of flying or aerophobia. In some cases we identify a history of trips that went wrong: air travel with turbulence for example, but also experiences of panic in other transport where the person felt trapped: Subway or Metro North or Long Island Railroad, long-distance train/bus (Amtrak, Greyhound), or even the lift. In the majority of cases of fear of flying there is no specific history, but it is common for fear of flying or aerophobia to be associated with other transport phobias.

WHAT ARE THE COMMON SYMPTOMS OF FEAR OF FLYING OR AEROPHOBIA?

People with fear of flying or aerophobia experience anticipatory anxiety from the time an airplane trip is planned. This anticipatory anxiety increases as the travel date approaches and becomes intense in the few hours before the flight. It is common to experience insomnia the night before travel and to experience significant discomfort on the journey from the airport to the departure lounge. Once on the plane, the anxiety state may fluctuate depending on the conditions of the trip: some will experience intense anxiety throughout the trip with panic attacks, while others will experience fluctuations and moments of lull. Usually there is hyper-vigilance with the environment: people suffering from fear of flying will be very attentive to any noise that could be disturbing, but also not to show their discomfort to other passengers or flight attendants. . In some cases, there is total avoidance of air travel, with the person confessing their fear of flying, or more often finding various excuses to cancel their trips. This situation can create a professional handicap for those who have to travel on business. Anticipatory phobia can also affect relatives: for example, a phobic father will be particularly anxious when his children are on an airplane trip.

HOW TO CURE FROM A FEAR OF AIRPLANE OR AEROPHOBIA?

The treatment of a fear of flying or aerophobia can be considered at different levels . Airlines offer internships that help some. The most “effective” courses against the fear of flying include a flight accompanied by the organizers of the course, so a scenario. Often this is not enough, hence requests for psychosocial follow-up… A follow-up by a psychiatrist / psychotherapist may first focus on learning relaxation techniques that help the phobic to lower his stress level during his trip. The prescription of a tranquilizer to be taken before and during the trip may be necessary, and it reassures the person concerned. Depending on demand and the time available, a more frequent and intense follow-up may be offered: it will seek to reduce the level of anxiety in people who are generally in “hyper-control”. This type of support should be considered particularly for people who have to travel frequently. Relatives / Family: How can I accompany a relative or a friend who suffers from fear of flying or aerophobia? If you have a loved one with fear of flying or aerophobia, you need to show understanding and support first. However, understanding should not go so far as to deprive yourself of travel when they are anxious to know that you are on a plane! On the contrary, it may even be another reason for seeking help to deal with his phobia.

MY FEEDBACK ON FEAR OF FLYING OR AEROPHOBIA.

This is a type of follow-up that I particularly enjoy doing: I take it as a “challenge”, the goal is for the trip to go well! I recommend starting monitoring several months before the trip, which allows time for more in-depth monitoring: generally learning relaxation techniques is not enough to ensure a comfortable trip. I help my clients getting rid progressively of the hypervigilance which is the source of all the stress associated with the fear of flying. I consider that this follow-up should be a real accompaniment: as far as possible, I try to make myself available for interviews when the phobic is in the departure lounge, or in a transit airport. My follow-up is complementary to the internships offered by the airlines.

WHAT IS FEAR OF VOMITING OR EMETOPHOBIA?

The fear of vomiting or emetophobia is an unreasonable fear that can cause a panic attack, of vomiting, or of being in contact with someone who may be vomiting. What are the causes of fear of vomiting or emetophobia? As with other anxiety disorders, the causes are “multifactorial”: genetic, congenital, educational and social participations are mentioned. In some cases, traumatic events are found in the history.

WHAT ARE THE COMMON SYMPTOMS OF FEAR OF VOMITING OR METOPHOBIA?

People with emetophobia or fear of vomiting have an almost obsessive fear of vomiting or of being in the presence of someone who might be vomiting. That is, this fear is unreasonable and invades mental activity irrationally: vomiting is not that common! It is accompanied by anticipatory anxiety (there is an anticipation that vomiting can occur at any time) and avoidance of situations: for example the presence of young children (who may regurgitate their meals) or even animals. pets (dogs and cats).
Emetophobia is usually accompanied by other anxiety symptoms: social phobia, or even depression or eating disorder.

HOW TO TREAT THE FEAR OF VOMITING OR METOPHOBIA?

The treatment is essentially based on a psychotherapeutic approach. Cognitive and behavioral psychotherapies are particularly recommended, but other approaches may also have their place such as EMDR to address the traumatic history. A systemic approach can have its place when the entourage seems dysfunctional. In some cases, additional medication can be useful, but certain antidepressants that may cause nausea should be avoided.

Relatives / Family:

How can I accompany a relative or a friend who suffers from the fear of vomiting or emetophobia?

If you have a loved one suffering from fear of vomiting or emetophobia, it is of course important to be understanding, patient and to avoid mockery. An attitude of “benevolent neutrality” is required.

MY FEEDBACK ON FEAR OF VOMITING OR EMETOPHOBIA.

I regularly have patients who suffer from fear of vomiting or emetophobia: usually young adults. These problems can be easily disabling and are often associated with other anxiety symptoms or even a dysfunctional environment.

What is social phobia or social anxiety?

Social phobia or social anxiety disorder is an anxiety disorder characterized by anxiety occurring during situations involving social interactions. The feared situations may be limited (for example, performance situations such as public speaking) or more general, impacting the life of the individual. Like other phobias, there is no discomfort outside the feared situations, hence a tendency to avoidance. The prospect of being in a feared situation can cause anticipatory anxiety: and the person suffering from social phobia or social anxiety worries in advance of a public speaking, if that is their phobic tendency.

What are the causes of social phobia or social anxiety?

As with other anxiety disorders, the causes of social phobia or social anxiety are multifactorial, involving an interaction of genetic, congenital, learning, and social factors. Nevertheless the families of these individuals often exhibit limited social interactions: for example these parents themselves are unsociable.

What are the common symptoms of social phobia or social anxiety disorder?

People with social phobia (or social anxiety disorder) usually have the following symptoms:

Anticipatory anxiety of the feared situation with tendency to avoidance;

More or less intense discomfort when they find themselves in the feared situation with the possibility of physical symptoms (tremor, stuttering, sweating, blushing) in addition to the fear of being criticized by others or perceived as inadequate or bizarre;

When the person is afraid of blushing, it is called ereutophobia.

Social phobia or social anxiety disorder can be so debilitating as to impact the social and professional life of the person who is affected. It is likely to lead to addictive behaviors such as alcohol or drugs misuse in order to facilitate social contacts.

What is the treatment of social phobia (or social anxiety disorder)?

While medications have proven their effectiveness (antidepressants and tranquilizers) and can be prescribed in very severe cases, the treatment is based on mainly psychotherapy.

Cognitive and behavioral psychotherapies are particularly recommended, individually and in groups, but other approaches can also have a role, for example systemic therapy and EMDR. The therapeutic work will focus on expanding the “comfort zone” of the individual, therefore helping them to gradually confront the distressing situations by challenging the cognitions that underlie the discomfort.

If you have a friend or significant other with social phobia (or social anxiety disorder), it is of course important to be understanding, patient and avoid any sort of mockery. Undoubtedly one way to help would be to accompany them to gradually confront the feared situations: dinners, meetings, public events. The goal of exposure therapy is for the individual to one day be able to face the feared situation alone.

What is agoraphobia?

Agoraphobia is an anxiety disorder characterized by anxiety occurring in a space that the individual considers to be dangerous or uncomfortable: in particular open spaces where a crowd gathers. In these situations the individual fears that they may have a panic attack, and they also suffer from anticipatory anxiety in the moments prior to heading to such places, and this can lead to avoidance. Agoraphobia can occur in any location where the individual cannot escape easily: airport or train station, supermarket, crowded community clinic waiting room, but also just a meeting room.

What causes of agoraphobia?

As with other anxiety disorders, the causes are multifactorial and consist of an interaction of genetic, congenital, learned and social factors.

What are the common symptoms of agoraphobia?

People with agoraphobia generally have a history of panic attack associated with places where they become scared. Then occurs a phenomenon of overgeneralization whereby they feel scared in other places having the same characteristics. Thus a panic attack will occur in the subway, and the person become fearful of the subway, then any place resembling the subway such as trains, shuttle buses elevators and airplanes.

The phobia is accompanied by anticipatory anxiety and avoidance tendencies. So agoraphobia confined to crowded places will make you avoid stores, but also very busy streets, stations, malls, and so on…until it becomes vey debilitating. Usually the individual is ashamed of their disability and will find plausible reasons to avoid such environments.

The concept of being able to escape is central. So an employee can become agoraphobic of business meetings through the thought that they are unable to escape without showing their vulnerability. In this scenario, the individual usually escapes to a safe place in order to avoid the gaze of others.

What is the treatment of agoraphobia?

While medications have proven efficacious (antidepressants and tranquilizers) and can be prescribed in very severe cases of agoraphobia, treatment is based mainly on psychotherapy.

Cognitive and behavioral psychotherapies are particularly recommended in agoraphobia but other approaches may also have a role, for example systemic therapy and EMDR. The therapeutic work will focus on expanding the “comfort zone” of the agoraphobic, so helping them gradually confront the distressing situations all the while challenging the unhelpful thoughts that underlie the discomfort.

In my practice, the demands for this type of problems are quite common and diverse: from agoraphobia that is confined to heavily crowded places (streets, shopping centers, airports and train stations) to agoraphobia confined on closed spaces (subway, plane, bus, elevator), without forgetting the employee who is agoraphobic of business meetings. I have helped many people understand and cope better with these debilitating problems.

The individual with hypochondriasis (also known as health anxiety) has fear of having particular illness or disease, and misinterprets physical symptoms as a sign that confirms that illness. In a panic attack, the fear might be of collapsing right now, whereas in hypochondriasis, the fear is of significant and nasty illness that will cause harm or damage to the person some time in the future. It is important to confirm the diagnosis of health anxiety (hypochondriasis) with a proper physical history and appropriate investigations, as many physical disorders also cause anxiety-style presentations (such as heart disease, asthma, thyroid dysfunction and diabetes). Do not fall into the trap of making a premature and incorrect psychological diagnosis when the problem has a physical cause.

In health anxiety, anxiety is predominant. The anxious concerns lead to physiological arousal, and selective attention focused on the person’s own body, which is then misinterpreted as evidence of the illness. The same occurs with common everyday bodily sensations and also symptoms of mild but self-limiting diseases such as colds and tummy bugs. For example, the individual may have health anxiety related to a brain tumor, and may misinterpret eye strain or headaches as a sign that they have a tumor.

Patients with hypochondriasis are likely to seek repeated consultations with health professionals, and some may even have had exploratory tests or treatment. Safety behaviors such as presenting and re-presenting to health professionals for further tests and reassurance only reduce anxiety for a short time before the person seeks even more tests and still more reassurance.

As with other anxiety disorders, the causes of hypochondriasis or health anxiety are multifactorial and involve an interaction of genetic, congenital, learning and social factors. In some cases the individual has had traumatic events in their life such as a relative or significant other who died abruptly from an illness.

The treatment of health anxiety is essentially based on psychotherapy first. Cognitive Behavioral Therapy (CBT) is particularly recommended, but other approaches can also have a role such as EMDR or systemic therapy. In some cases of health anxiety, the psychiatrist might be tempted to prescribe a psychotropic medication, such as an antidepressant or tranquilizer, but any intolerance or side effect can increase anxiety.