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Adult Psychiatry
Specific Phobia

Patients with specific phobias, when they see the objects they fear, will experience disproportionate symptoms of terror. They may become extremely panicky, shaky, have an accelerated heartbeat, or even display dissociative symptoms. Sometimes, even if the feared object is not present, their emotions are still affected, and they exhibit avoidant behavior.


What is a phobia? Can adults and elderly people have phobias?

Everyone has fears, some people are afraid of heights, some are afraid of small animals, some are afraid of blood and injections, and even doctors themselves may be afraid of cockroaches. So, does everyone have a phobia?

Patients with specific phobias, when they see the objects they fear, will experience disproportionate symptoms of terror. They may become extremely panicky, shaky, have an accelerated heartbeat, or even display dissociative symptoms. Sometimes, even if the feared object is not present, their emotions are still affected, and they exhibit avoidant behavior.

Taking arachnophobia as an example, patients will of course be alarmed when they see a spider. In fact, many ordinary people are like this too. However, arachnophobic patients, whenever they go to a new place, will check all the bedding to see if there are any spiders, refuse to bathe because they are afraid that spiders will crawl out of the holes in the bathtub, and so on. These symptoms seriously affect the patients' daily life and social interactions.

Phobias are generally more common in children, and the cause is often unknown, simply because everyone has forgotten the memories of childhood. The cause of phobias is often due to personally experiencing or witnessing other people experiencing traumatic events, such as being attacked by animals or trapped in elevators as a child. Other patients may have panic symptoms that appear for no reason in a certain scene or have heard rumors that make them think a certain scene is terrifying.

Among adult patients, the proportion of phobia sufferers is relatively lower, and their feared objects may be different. Their fears are mostly related to the natural environment. Some patients also frequently have simultaneous cardiovascular and respiratory system diseases. Sometimes, when facing their feared objects, even if they experience panic symptoms, they will blame it on other illnesses in their body. Apart from that, they may also display other anxiety and depressive symptoms, rather than just typical panic symptoms.

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Why do fears persist and not fade away? The basic principles of phobia formation

To treat phobias, we first need to know the nature of fear. Why is it that when we face the things we are afraid of, our bodies show various reactions that do not gradually fade away over time?

Many people have fears. Doctor Uccello is most afraid of cockroaches. Whenever I see a cockroach, my body will involuntarily tremble, and I will feel an inexplicable panic in their hearts, with heart beating steadily and then hastily leaving the scene.

Sometimes, when arriving at an unfamiliar place, such as the back seat of a minibus or a bus, people will be extremely nervous, fearing to encounter this old "friend" of many years. To relieve this tension, people will examine the corners and cracks of the seats. While riding a minibus or bus, they will also constantly touch their hands, feet, and back to see if there are any uninvited guests crawling on them.

Whether it's avoidance or inspection, every time we perform these actions, the good news is that the anxiety in our brains can be relieved, but the bad news is that these actions will tell our subconscious that the threat of cockroaches indeed exists, as avoidance and inspection have confirmed this message.

To treat phobias, we must break this vicious cycle and tell our brains that the threat from our fears does not exist. Even if we are very anxious, we should try our best to avoid behaviors such as avoidance or inspection.

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The first step in treating phobias: When will anxiety and fear leave?

Imagine that, like Dr. Cheung, you are extremely afraid of cockroaches. Now you walk into a room, a dark room, and someone tells you there is a cockroach inside. What would you do? What would you think?

You might start panicking like the doctor, looking around to see if this old "friend" is crawling on you. Have you ever thought about the worst-case scenario? It might be the cockroach crawling on your face. So, what would happen? Of course, you would be scared to death. Of course, you would be scared to death.

It is this answer, "Of course, you would be scared to death," that makes us avoid and fall into a vicious cycle every time, unable to face the fear in front of us.

Many people believe that fear is an upward straight line, with the fear index increasing as the time spent facing the fearful object increases. So, when they see something they fear, they immediately run away; running away can instantly reduce anxiety and fear to zero, but it cannot cure phobias.

In fact, fear is like a mountain; it starts by continuously rising, but at some point, it begins to decrease, with the anxiety index gradually decreasing and eventually reaching zero.

Knowing this is very important. When treating phobias, therapists will work with patients step by step, gradually facing their fears. To reduce avoidance behavior, patients need to know that their fear will eventually subside, that fear will not grow endlessly, and that they won't be "scared to death."

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Working Out Beliefs and Safety Behaviors for Patients with Specific Phobia: Case Examples


Specific phobias can significantly impact a person's daily life, causing them to avoid certain situations or objects out of fear. One of the crucial steps in overcoming specific phobias is identifying and addressing the beliefs about danger and safety behaviors associated with the phobic object or situation. This article discusses how to work out these beliefs and safety behaviors, using case examples to illustrate the process.


Case Example 1: Spider Phobia


Surriane, a patient with a spider phobia, discusses her fears with her therapist. She believes that if she encounters a spider and is unable to escape, she would die from a heart attack induced by panic. This belief is quite strong, at 90% when she imagines the situation, but drops to 40% when discussing it rationally with her therapist.


In this case, Surriane's belief about the danger of spiders is based on the idea that the intense panic she experiences could lead to a heart attack. To challenge this belief, she would need to confront her fear of spiders and observe whether her worst fears actually come true.


Case Example 2: Claustrophobia


Pete, a 48-year-old man with claustrophobia, fears getting trapped in a lift. He believes that if this were to happen, he would have a severe panic attack, eventually leading to suffocation due to lack of air. In addition, he is concerned about embarrassing himself in front of others in the lift.


When discussing this fear rationally with his therapist, Pete still maintains a high level of certainty (95%) that he would die from suffocation and 100% certainty that he would embarrass himself. To challenge these beliefs, Pete would need to confront his fear of lifts and observe the actual outcomes.


Identifying Beliefs and Assessing Their Strength


To work out your own beliefs about your specific phobia, ask yourself the following questions:


What do you think will happen if you confront your phobic object/situation and cannot leave?

And then what do you think would happen?

What is the worst thing that would happen?

Imagine you are in the situation where you confront your phobic object/situation and cannot leave. How certain would you be when in the situation that it will lead to the worst thing happening?

And now, when you are sitting here reading this article, how certain are you that it would lead to the worst thing happening?

Working Out Your Safety Behavior


Once you have identified your belief about the danger, ask yourself whether you engage in any safety behaviors to prevent the danger from happening. These behaviors may not be immediately apparent, but they usually become obvious when you begin to face your fear.


To change your beliefs about the danger, you will need to let go of these safety behaviors and confront your fear directly. This can be challenging, but it is necessary for overcoming specific phobias. The information provided on behavior experiments in previous sections can help you find the courage to do this.




In order to change and overcome specific phobias, it is crucial to work out the specific beliefs about danger and safety behaviors that maintain the problem. By confronting these beliefs and letting go of safety behaviors, individuals can begin to challenge their fears and make significant progress in overcoming their phobias.

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