Exposure Therapy & Other Effective Phobia Treatments

If you’ve ever had a nightmare, you’ve probably felt what it’s like to be gripped by fear and panic. For those with a phobia, this feeling can accompany seemingly ordinary experiences, such as seeing an insect, standing in an enclosed space, or getting a shot at the doctor’s office. Phobias can be defined as intense, irrational fears that can significantly disrupt daily life. Treatment for phobias typically includes mental health interventions aimed at confronting and overcoming fears while learning mindfulness-based relaxation techniques. CBT, exposure therapy, and mindfulness-based therapy options may prove to be beneficial, and they can often be completed either in-person or online.

Understanding phobias and fears

Phobias are typically defined as a type of anxiety disorder that can incite an excessive or irrational fear response. While fear can be a natural and temporary response to a real or perceived immediate threat, a phobia is usually an extreme, enduring, and irrational fear response toward specific objects, situations, or activities that typically pose little to no actual danger. This fear response can elicit physical symptoms, such as sweating, high blood pressure, nausea, and dizziness.

Phobias tend to be quite common, affecting as much as 15% of the world’s population. 

The Diagnostic and Statistical Manual of Mental Disorders (5th Edition) – commonly referred to as the DSM-V – usually recognizes three types of phobias: 

• Specific phobias generally involve fears of specific objects or situations, such as animals, heights, or flying. The fear response is typically triggered immediately upon encountering a particular object or situation. Examples of common simple phobias may include spiders, blood, and going to the dentist.
• Agoraphobia usually entails a fear of situations or places where escape may be embarrassing or difficult, or in which help might not be available if things go wrong. Agoraphobia often involves the fear of crowds, bridges, or being outside alone.
• Social anxiety disorder, also known as social phobia, often involves a high level of fear, severe anxiety, and avoidance of social situations. These symptoms tend to arise because of self-consciousness, embarrassment, and concern about being judged or perceived negatively by others.

The science behind phobias and treatment

The neurobiological causes of phobias can be complex and frequently involve genetic, environmental, and experiential factors. Certain brain structures involved in fear and anxiety responses, such as the amygdala and hippocampus, tend to play a significant role. When these areas overreact, the fear response can be amplified, potentially resulting in a phobia. 

Nonexperiential phobias aren't usually linked to a specific past event. Factors like genetics or environment might cause these. One example can be the fear of darkness in children, which may intensify over time. This intensifying, or sensitization, generally increases their reaction to the dark, potentially causing more fear. This heightened fear might result from a higher-than-normal sensitivity in the brain's fear centers. 

Usually, this fear decreases over time in a process called habituation. In some, however, the fear persists due to a lack of this natural fear reduction mechanism.

Experiential phobias usually come from a scary event. For example, if a child gets shocked by electricity while hearing a specific sound, they might associate that sound with fear. Even without the shock, the sound may trigger fear. This fear can be reinforced when the child avoids the sound and feels relief. Observing someone else experiencing fear can also create experiential phobias. These phobias may persist when the fear response doesn't lessen over time despite repeated exposures to the fear trigger.

Many young children commonly have specific fears, but usually, these fears go away over time. However, for some people, these fears do not subside and may become stronger due to reinforcement from a scary experience, seeing others react fearfully, or hearing negative information. 

Once a fear becomes a phobia, it may continue to be reinforced by certain thinking patterns that focus too much on the fear, exaggerate the risk, and make faulty connections between the fear and danger.

Effective phobia treatments: Exposure therapy, mindfulness & cognitive behavioral therapy

With mental health treatment, overcoming phobias and addressing faulty associated thinking patterns may be possible. While some alternative therapies may exist, effective phobia treatment typically involves working with a licensed mental health professional to treat anxiety and habituate oneself to feared objects and situations.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is generally a type of talk therapy that has been extensively researched and proven effective for treating a wide range of disorders. CBT may be an effective treatment for certain phobias, including social phobias and arachnophobia (fear of spiders).

The core premise of CBT is normally that our thoughts (cognitions) influence our feelings and behaviors. For someone with a phobia, those thoughts are often irrational or overly negative, leading to intense fear and avoidance behaviors. In CBT, the therapist can help the client identify, challenge, and change these negative thought patterns. 

This process, commonly known as cognitive restructuring, may enable the person to develop a more balanced and less fearful perspective on the phobia trigger. For example, someone with a fear of spiders (arachnophobia) may learn to replace thoughts like "all spiders are deadly" with more rational ones like "most spiders are harmless."

Exposure therapy

Exposure therapy is a type of CBT that can be particularly effective for phobias. Commonly used to treat specific phobias, social phobias, and agoraphobia, the idea behind exposure therapy is generally that by gradually and repeatedly exposing a person to their fear trigger in a safe and controlled environment, the fear response will lessen over time.

For example, a person with a fear of heights (acrophobia) might start by simply imagining being in a high place, then progress to looking at pictures of high places, then watching videos, then visiting an actual elevated site with the support of their therapist. The exposure is usually gradual and takes place over several sessions.

In each exposure, the person may learn that the fearful outcome they imagine doesn't occur, and their fear may begin to decrease—a process known as habituation. Through habituation, one can gain control over their fear response and live a less restricted life. Virtual reality (VR) exposure therapy frequently uses VR technology to immerse individuals in a virtual world, and it can provide a controlled environment to confront phobias. 

Mindfulness-based therapies

Mindfulness-based therapies have been gaining traction as effective treatments for various mental health conditions, including phobias. At their core, these therapies tend to focus on promoting awareness and acceptance of one's current state of mind and bodily sensations. In addition to deep breathing and relaxation techniques, mindfulness-based therapies can teach individuals to observe and acknowledge fear responses without becoming controlled by fearful thoughts.

• Mindfulness-based cognitive therapy (MBCT) is one type of mindfulness-based therapy that may be helpful for phobias. The goal of MBCT is generally to interrupt automatic processes to change one’s relationship with fear, instead of trying to avoid or control it. Preliminary research has suggested that MBCT can be a promising treatment for social phobias. 
• Mindfulness-based stress reduction (MBSR) is another well-known mindfulness-based approach. While not explicitly designed for phobias, MBSR can significantly reduce anxiety, which is normally a key component of phobias. 

Despite being a newer field of study, the research on mindfulness-based therapies appears promising. Several studies suggest that mindfulness-based therapies like MBCT and MBSR can effectively reduce symptoms of phobias and improve quality of life. However, more research is likely needed to fully understand their impact and the mechanisms through which they work.

Benefits of online mental health therapy for treating specific phobia and other phobias

With advancements in technology, online therapy has emerged as a potentially convenient and effective treatment for phobias, anxiety, and other mental health concerns. It usually offers greater accessibility, particularly for those who find it difficult to leave their homes due to phobias. Individuals can connect with therapists remotely via video calls, phone calls, or online chat through therapy platforms like BetterHelp. 

Effectiveness of online therapy for the better mental health of people with phobias

When it comes to treating phobias, research shows that internet- and mobile-based interventions tend to be effective in reducing distressing symptoms in people living with specific phobias. In a 2021 systematic review and preliminary meta-analysis, researchers elaborated on the overall positive treatment outcomes for phobic symptomatology when met with online therapy.