Therapy Of Phobias And Fears

From ablutophobia (fear of washing) to zoophobia (fear of animals) – the list of “classic” and rare phobias is long. These include such widespread and many understandable fears as acrophobia (fear of heights), claustrophobia (fear of small rooms), ophidiophobia (fear of snakes), odontophobia (fear of the dentist) or trypanophobia (fear of injections) –

but also unusual and at first glance curious phobias such as cheese or buttons, with which those affected generally encounter complete incomprehension in their environment.

Phobias – the often seemingly groundless fear

Fear of cheese – people who suffer from phobias cannot smile about it. For them, the objects of their fear have nothing curious about them. While you often know that your feelings are exaggerated or irrational, the physical symptoms of anxiety (anxiety, dizziness, cold sweat) appear against your better judgment as soon as you face the subject of your phobia.

Today there is a tendency to perceive psychological problems as purely biological phenomena resulting from a congenital disturbance in the balance of neurotransmitters in the brain.

However, it is precisely the psychodynamic view of mental processes, which goes back to Freud, that has contributed decisively to our understanding of phobias today.

Depth psychological explanation of the phobia

Therapists distinguish between (unspecific) anxiety and (concrete) fear.

In the psychodynamic model, a phobia is based on anxiety-inducing experiences or ideas of those affected, the threat of which cannot be tolerated and must therefore disappear from consciousness. The fearsome contents of consciousness are suppressed and fear is shifted to a relatively meaningless exteriority – the object of phobia. By systematically avoiding the frightening object or situation, the defense against the original trigger of fear is almost double sealed.

The unconsciously “selected” object of the phobia is often some harmless perception, which is loosely connected with the actual, repressed memory or imagination. This can be a sight, smell or taste that remained in one’s memory together with the terrifying event, or a place, a touch stimulus, that once or several times activated the memory of what was to be repressed.

Some situations – great heights, narrowness or being lost in a wide space – are generally symbolic of psychological conflicts. The corresponding phobias can therefore be understood as an almost poetic expression of the underlying fears.

It seems, however, that objects and situations can also be “occupied” by phobias more or less by chance. In the field of phobias there are obviously also certain archetypes, perhaps evolutionarily developed – see spider, snake, rat & co – “conventional” objects of phobias, which offer themselves as anchors for various frightening ideas.

The suppressed fear underlying the phobia usually results from stressful experiences in childhood. Freud considered unacknowledged oedipal desires of the child as the trigger of most phobias. Today one is far away from this idea. It is more likely that what Freud interpreted as Oedipal desires could have been memories of adult abuse.

Many painful to traumatic memories, but also “illicit” ideas can find their unconscious expression in a phobia. Violence by family members, incomprehensible behaviour by parents or one’s own ideas of death, suffering and aggression are often so fundamentally threatening for children that they have to erase memories and thoughts of them from their consciousness.

Behavioural therapeutic approach to understanding the phobia

However, the psychodynamic model is not the only hypothesis for the development of phobias. Behavioural therapeutic explanatory models are based on learned and independent patterns of experience and behaviour. Especially the passing on of classical phobias within families and other groups certainly bears traits of conditioning (if everyone is panic-stricken about spiders, this is obviously the socially accepted way to behave).

The widespread fear of excrement, rodents or certain insects can certainly not be denied a certain evolutionary benefit. The fact that some people seem to concentrate more psychic energy on these learned or predisposed symptoms than others, so that they manifest themselves in them in the form of phobias – this could be interpreted as the result of a more or less biologically justified stronger psychic receptivity.

Therapy concepts for phobias

The two explanatory approaches also result in the two – not necessarily mutually exclusive – therapeutic approaches for the treatment of phobias. The depth-psychological therapy of a phobia aims to bring to light, to work on and to integrate into the consciousness of those affected the suppressed fears and conflicts on which the phobia is based.

The behavioural therapeutic approach is rather oriented towards learning how to deal with the subject of the phobia anew (keyword: desensitisation) and thus restoring the ability to act in daily life. Historically, phobias are the first psychological ailments that were successfully treated in the 1950s with new behavioural therapy methods.

Whether a comparatively fast and result-oriented behavioural therapy or a longer-term deep psychological therapy is indicated (or any therapy at all) must be decided on a case-by-case basis.