5 Facts About Phobias
Some fears are common, like fear of snakes, fear of heights and fear of flying. But some people have weird phobias, like the fear of peanut butter sticking to the roof of your mouth (also known as arachibutyrophobia). Fear, what a phobia is based on, isn’t necessarily a bad thing – it serves as a built-in defense mechanism that prevents dangerous situations. But when a fear becomes so extreme that it paralyzes you, it isn’t so productive. So what is it that you fear? What are your phobias? Plus: Find out if you’re a hypochondriac…
1. What is a phobia?
A phobia is described as a persistent, unreasonable fear of a specific thing or situation, where someone feels an intense need to avoid or flee from the fear. The threat of the phobia you feel is much greater than the actual threat it poses. Often phobic people are able to realize that their fears are unreasonable. But unreasonable or not, the phobic can experience physical reactions such as stress, anxiety, blushing, trembling, sweating, vomiting and trouble breathing.
2. How does a phobia develop?
The definition of a phobia says that it’s an unreasonable or irrational fear, so what causes such an intense reaction and desire to flee? Common phobias can be a learned behavior, such as listening to your parents swear they’ll never fly because of all the reasons it’s unsafe, or they can stem from a traumatic event. Phobias can also develop due to the signs of the times. Your grandmother may be a cyberphobe, a person afraid of computers, because she wasn’t a part of the high-tech generation and computers may seem too complicated and overwhelming.
How I Got Over My Fear of Using Public Toilets.
I don’t know when it was that I developed a fear of public toilets, exactly. It was a gradual process towards public toilet hatred. I think it started during my pre-teen years in primary school.
For the first few years of my schooling my teacher would give me a note to take up to the school nurse. As an adult I now know that this was the “toilet note.” As a child I thought I was teacher’s pet and important enough to be official bearer of whatever news the teacher was sending to the nurse. It just so happened that when I delivered the notes the school nurse would pop me on the loo — just in case.
Why did I need the school nurse to help me go to the toilet? My disability made it difficult to go by myself. Once I got a little older (and a little taller and stronger) this all changed and there was no need for notes to the nurse. But it was this change that essentially led to my fear.
The fear that gripped my mind was about germs. And not just the germs on the toilet seat. Germs on the floor, walls, flusher, door handles. In my final years of primary school I would dread going into the toilets, just in case those pesky germs got me. When I think about this dread of germs I know exactly where this phobia came from.
My mother.
I remember going away on holiday one summer, when I was about ten, and on a particularly hot and sticky day we had stopped at a park on the outskirts of a town to have a picnic lunch. Well, I say town, it was essentially a one street village with a petrol station down one end and the park down the other. In the park were some rusty swings, an extremely dusty slide, and a toilet block. Seeing as we had another few hours drive ahead of us mum insisted I go to the loo.
To say these toilets were disgusting is an understatement. Despite the men’s and women’s being separated by a corrugated tin wall, the smell of urine from the men’s side filtered through to the women’s. Dried mud caked the floor and something that could’ve been mud, or something else, clung in patches to the walls. The toilet seats were black, which probably hid a multitude of sins, and I desperately wanted to avoid putting my backside on them. Mum told me to hover — just as she did in these situations. But one thing my disability doesn’t allow me to do is hover over a toilet seat.
Mum came up with a solution to my hovering conundrum. Standing in the cubicle, mum unrolled layers of toilet paper and created a protective nest on the seat for me to sit on. Without any inch of that toilet seat touching my butt, I relieved myself and knew that I would never touch a public toilet seat ever again in my entire life. Not whilst there was toilet paper to be had. Not even if the toilet looked clean.
This initial introduction to fear of the public toilet only cascaded and grew as I became a teenager. I am certain we all know the horrors of high school toilets. At my school the toilets lived up to the horror particularly well. Between that lovely toilet smell of pee, sweat, and desperate teenage girl tears, there was also the lingering stench of cigarettes and occasionally a scent of alcohol. The floors were always wet.
Wet with what? I don’t know. I don’t really want to think about it.
The year before I attended high school I heard all the rumours about the school bullies. That they would pick you up and dunk your head in the loo and flush. Repeatedly. I know most schools have this rumour float around. It seems to be the bog standard threat that all us newbies fear.
My reasons for fearing public loos was forever mounting.
Which is why, for all of my 6 years at high school, I avoided the toilets with every inch of determination that I had. I had a method to my madness. I would always pee just before heading to school. Literally squeeze every ounce out of my bladder. Figured I was giving myself the best chance of making it through the day without peeing.
I would also try not to drink much. I had a water bottle I would take to school with me, but I would only take the tiniest of sips. Until lunchtime, when my body would be crying out for water. I would then guzzle that water bottle like my life depended on it, only then to have my bladder almost full to bursting an hour later.
I would sit in class with my bladder screaming for release, but no amount of pain or desperation was going to have me go to the germy, horrible, stinky girls toilets at school. As soon as the last bell would go I would fling my books into my bag and take off to the front gates, keeping everything crossed that mum would be there already to pick me up.
As soon as I got home I would rush to the loo and it was the best feeling in the world to empty my bladder. Nothing feels as good as going to the loo when you’re busting. Honestly.
This phobia of public toilets went on for years. A phobia that actually is quite common. Perhaps you have a phobia yourself and can completely understand where I am coming from.
Toilet phobia, or anxiety, is a thing and there are even some scientific names for some types of toilet phobia — Paruresis and Parcopresis. These two phobias or anxieties relate to a shy bladder or bowel. In other words, if you have trouble peeing or pooping in public toilets because people might hear you, or smell you, or you’re worried about having an accident, then you probably have one or both of those conditions.
These two are not my problem (except for when it comes to pooping on a plane… I flat out refuse to do that, I have been the unfortunate recipient of bad smells and remaining shit in plane toilets and I don’t want to do that to someone else). My problem was just toilet anxiety, with the anxiety stemming from a germ phobia.
What is interesting, when you read about toilet anxiety, is that age of onset is usually during adolescence (for me it was pre-adolescence, or at the pre-teen stage). Apparently it affects between 6.5–32% of the population, to some degree, impacting both males and females.
But I am not here to tell you about the prevalence of toilet phobia, I am certain that many of you will have experienced it in some way, shape or form during your lifetime. Or you know someone who is a little anxious about public loos.
I’m here to tell you what I did to overcome my fear of public loos and how you could as well… if you so wish.
I was in my early twenties when I finally plucked up the courage to use a public toilet without layering toilet paper on the seat and hyperventilating at the germs that could be spreading to my skin. Remember, my phobia is about the germs, if you have a shy bladder or bowel unfortunately I can’t help you, but if you click on the link above there are some tips and handouts to help you on that website.
So what magically empowered me to realise the germs weren’t going to get me once I took a seat on the public throne?
Reading up about germs!
I read an article that described how much more germier other things I use in my day-to-day life were than the toilet seat.
Did you know your cutting board can be germier? Do you have a pet? Your pet’s food bowl has more germs than a toilet bowl. Your clean washing is probably harbouring more germs than your toilet seat — if you get germs in your washing machine they breed like crazy in the warm, moist space, transferring to your clothes.
In general, toilet seats are too dry to allow germs to multiply.
Your mobile phone is probably the grubbiest of things you touch throughout the day, that and the t.v. remote. Ew. As I sit here writing this blog, I am very aware that, even though I try to keep my laptop clean, I am typing away on a bug laden keyboard (am going to go wash my hands and my keyboard once I finish here).
Essentially, what I came to realise was that there are germs everywhere and that some of the things that I think of as clean are actually more likely to cause me harm than the humble toilet seat. In fact, in a public toilet, I should be more concerned about the tap and door handles… what you touch after you wash your hands.
I still get anxious when I use a public toilet. It is still the thing I consider and worry about the most when I am out and about. I still freak out a little when I see unknown marks and splashes of wetness on the seat, wall, or floor. I have a list of toilets I know will look clean and I feel safe to use. But I don’t have to hold onto my pee in fear anymore, doing untold damage to my bladder in the process.
I guess, what I have discovered, is that knowledge really is power and through investigating the truth behind matters you can change your behaviours and fears. The approach I took to lessen my fear of toilets and germs, I now use to face head on my other phobias and fears. Again, I cannot say that this approach will work for you, some phobias are more deeply entrenched than my toilet phobia ever was. In that case I urge you to not only educate yourself, but get support when trying to bust through your phobias. And also recognise that we all have fears of some kind. You are not alone.
But if you do have a toilet phobia that is germ based, like mine, I hope that my story helps you work through it. It is a slow process, but a rewarding one.
Set your bladder free!
Facing fears and phobias
Lynne Malcolm: Hi, its All in the Mind on RN, I'm Lynne Malcolm, and today we're facing phobias, so a warning that some people may find aspects of this program confronting.
Corrie Ackland: So you've just put on the virtual reality headset, and what I'll do now is I'll take you through a number of our 360 videos that we use for the virtual reality treatment.
Lynne Malcolm: So we're in your office…
Corrie Ackland: Turn around…see that keeper?
Lynne Malcolm: Yes, I can see the keeper over there.
Corrie Ackland: Just focus on her, you'll see she is getting out Fluffy.
Lynne Malcolm: Oh yes, she's got a big blue plastic bag and she's pulled out this enormous, enormous python, and it's wrapping around her head and all around her body, it's huge, and she is just kind of trying to take it off her head and putting it around her neck. It is the most enormous snake, very disconcerting. And she is coming right over, so close to me. She looks completely calm and collected, but I'm finding this rather challenging. She's holding its head up to look at to me straight in the eye with its little time coming out. Eww…hmm…
Corrie Ackland: It's a tricky one.
Lynne Malcolm: It's a tricky one.
Corrie Ackland: But we had two clients come in and get to a point where they were handling that snake, patting it, and one of my clients are draped that snake right across her shoulders, and that was in five sessions after being so terrified that she was checking every time she left the house.
Lynne Malcolm: Wow, it just feels so real.
Do you have an overwhelming irrational fear of something? That virtual reality snake experience was quite confronting, but if I was forced to have a close encounter with rats, that'd be another story!
Corrie Ackland is a clinical psychologist and founder and director of the Sydney Phobia Clinic. She describes some of the symptoms of a phobia, and she knows because she's had a spider phobia herself.
Corrie Ackland: The very first thing that happens is a disturbance of our breathing rate, some people will note that being quite significant, racing heartbeat and a shallow and quickened breath, sweaty palms, a restlessness and agitation, the butterflies feeling. So all of those symptoms can come on pretty fast and pretty intense, and the predominant urge is to run. So the running is often what we would see, and certainly when it came to a spider in my house, running is certainly what I would do. And other people will notice more of a freeze response coming over them as well.
Lynne Malcolm: A fear becomes a phobia when it has a real impact on your everyday behaviour, as Corrie Ackland found with her arachnophobia.
Corrie Ackland: When I noticed that it was a real problem, and certainly something that I often relate to with arachnophobia clients, is when I'd find myself…I'm a runner, and I would run in the middle of the road early in the morning rather than running on the path because of the potential for webs and spiders. And I guess that's where that irrationality really comes in because you recognise that you are actually putting yourself in far more objective danger trying to avoid these other things that we can often realise aren't actually dangerous at all.
Lynne Malcolm: Between 8% and 12% of the population have a phobia. Corrie Ackland outlines the most common phobias she sees at the Sydney Phobia Clinic.
Corrie Ackland: So our most common phobia presentation would be a fear of flying or public speaking anxiety, and we also see situational phobias, like a fear of heights, claustrophobia, animal phobias. Our most common ones would be dogs, spiders and birds, and then we see some of the medical phobias, so blood, injury, injection, and vomit phobias as well.
Lynne Malcolm: What's the most unusual phobia you've come across?
Corrie Ackland: We've had a couple of people call up with a fear of buttons. None of them have actually come in for treatment but that's probably one that is often considered quite unusual.
Lynne Malcolm: And have you been able to make any sense of why somebody would develop a fear of buttons?
Corrie Ackland: The thing is with phobias and what I find so fascinating about them is we can actually learn that anything is a threat and develop a phobia around it. All we need is that negative association and then to continue to avoid it as if it really was that concerning, and then we have that phobic cycle develop. So yes, really anything and everything is possible.
Lynne Malcolm: Corrie Ackland.
So why and how do phobias develop?
Professor Adam Guastella is the Michael Crouch Chair in Child and Youth Mental Health at the Brain and Mind Centre at Sydney University.
Adam Guastella: Well, there's a number of reasons why people develop phobias and there's not any one which accounts for all phobias that develop. We definitely know there's a genetic or biology to the development of phobias. Some people are more likely to develop fears and to be more sensitive to threats. So there's certainly a component, maybe 30%, which is hereditary.
Then on top of that there is evidence that there are certain types of things that humans are more likely to fear. We are more likely to fear heights, spiders and snakes. But electricity kills more people but they're not afraid of…electricity phobia is very uncommon. So there's a view that there is a biological predisposition that has been learnt over thousands of years which predisposes humans to fear certain types of things in the environment. And then on top of that there is learning factors. So when we are born we take great attention to what our caregivers are doing and what our siblings might be doing, and there's lots of research which shows that if the people around us show fear and indicate that something is dangerous, then we will take that on. And then throughout life there's all sorts of events which can trigger a phobia.
Lynne Malcolm: And what is the difference between those who have an early negative experience, say with a dog, and develop a phobia about dogs, and those who don't develop a phobia about dogs?
Adam Guastella: That's the million-dollar question. We don't really know, there's no one explanation which accounts for all the reasons. We know that there are risk factors, but people can have all the risk factors and still not develop a phobia. So we don't understand it fully.
Lynne Malcolm: Do phobias often occur in people who already have some sort of an anxiety disorder?
Adam Guastella: The evidence is fairly clear that if you have some hereditary predisposition to one anxiety disorder, then that elevation is for most anxiety disorders, and that includes phobias.
Lynne Malcolm: Adam Guastella.
Corrie Ackland has a sense that many people with phobias never seek help with their fears, they just live with it.
Corrie Ackland: Yes, I think that a lot of the early feedback that we got when we opened the clinic is people just had no idea that this would have been considered a psychological issue that could be treated. So a lot of people I think feel like it's just their thing, they can recognise that everyone has their thing and their phobia is often one of them. And certainly if it doesn't conflict with our daily life or our greatest desires in life, then we probably won't see the motivation to necessarily do anything about it. But when that changes, and often that changes at different points in our life where we may be in conflict with these things, that's when we recognise it is a problem. You know, someone with a fear of flying that actually has no desire to travel may not consider it a problem until their son moves overseas and all of a sudden this creates a real issue with being able to visit him. So it's those sorts of things that change and actually make people realise that treatment is necessary.
Lynne Malcolm: So what's the general approach to treatment?
Corrie Ackland: Treatment looks at being able to get on the same page with the client in terms of what is maintaining their anxiety, and also explaining to them what that anxiety response is and get them to understand that it's actually not problematic to feel those feelings and that they are in fact manageable.
Treatment items will include controlled breathing, identifying the particular thoughts and being able to correct them if they are unhelpfully creating that anxiety and they can be corrected because they are irrational or inaccurate, what have you. And that it's about designing a behavioural plan which is usually looking at exposure, being able to develop this plan and get a starting point as to what things we can begin to expose to and move our way up that hierarchy to meet our goals.
Lynne Malcolm: So the idea is really to confront people with their fears and have them realise that it's not so bad?
Corrie Ackland: Exactly right, that the situation that they predicted isn't going to play out like that and that any anxiety they feel in that situation they can manage.
Lynne Malcolm: So you mentioned that one of the fears that you see is a fear of flying, for example, how would you treat that?
Corrie Ackland: So the interesting thing about a fear of flying is a lot of our phobias are actually exacerbated in a plane environment. People with a fear of heights, people with claustrophobia, people with fear of vomit or social concerns, a lot of issues play up on a plane. But our fear of flying course is mainly looking at people with safety concerns. We recognise that a lot of their concerns are around not knowing what's going on, how a plane stays in the air, what turbulence is when that feels quite alarming and feels like something bad is going to happen. So part of that program will see them actually sit down with a commercially trained pilot and be given a lot of facts that they can then use to challenge their previous thoughts about that plane environment.
And then when we look at beginning the actual exposure part of the flying course, it might start by looking at planes in the sky and making sure that what we are thinking about those planes in the sky is appropriate. A typical example might be someone who looks at a plane and thinks, oh my gosh, that's terrible, I could never do that, and we would want to be challenging that with some nice plane facts such as that's a very safe situation, there's a lot of planes taking off and landing every single day and they all happen without catastrophic event, and then be able to manage the anxiety that that brings.
And then we'd work our way up, maybe looking at videos of plane environments. We will then practice in a flight simulator as our closest thing to a real flight. They might undertake other tasks that might be related to their fear for them which might be going up into tall towers or going in Ferris wheels, cable cars, lifts if their fear has generalised to those areas. All of these things are stepping stones to getting in a flight themselves.
Lynne Malcolm: How successful are they, say the particular treatment for fear of flying?
Corrie Ackland: We have great results for such a very brief treatment, relatively brief treatment, we do that in five sessions. And for the people that have completed the course, they've all met their goals, to our knowledge, in terms of the feedback that we have received, which has often been to get on a scheduled flight. Often people are wanting to travel to see loved ones that they may not have seen for decades.
Lynne Malcolm: Corrie Ackland explains that central to effective treatment is carefully and gradually exposing people to their fears. She uses virtual reality to place her clients in situations which they most fear, without having to leave the clinic. She exposed me to a couple of phobia scenarios.
Corrie Ackland: So now I'm showing you a hospital setting.
Lynne Malcolm: Oh yes, there's a blue chair in front of me and a curtain, and I'm looking around to the right and there's a bed. And there's my arm down there about to get a needle and the nurse's dabbing something on my arm and just injected me with a needle, and now she is taking the belt off and she is taking blood from my arm. It is very real, also very unnerving.
Corrie Ackland: Yes, so this one is the virtual reality for the blood test.
Lynne Malcolm: I'd imagine that some people who really aren't comfortable with needles and getting blood taken, they'd shield their eyes, but in this situation you can actually watch everything that's going on.
Corrie Ackland: That's right, yes, and the more that you adjust your perspective to make that your actual arm, the more that practice will generalise across into the real-life situation.
And the great thing about this is there's no expectation of how the client would manage initially but what we do want is them to get to a point where they are managing that anxiety, where they are feeling a little bit more comfortable. So we might go through this on repeat 20 or so times.
So that's our blood test. We'll go into birds. So you can probably hear those seagulls. And if you turn around a little bit you should start to see them flying in.
Lynne Malcolm: Oh yes, it looks like it's at Hyde Park or something like that and I've got gulls sitting right in front of me, squawking away. There's a man standing in front of me feeding the birds, so they are all going a bit frenzied very close to me. And it does feel very real. I'm turning around and looking around behind me to my left, and I can see another girl surrounded by seagulls.
Corrie Ackland: And it's that characteristic sound of the seagull as well, isn't it. So it's often the flapping that clients with a fear of birds will find concerning, and in this video we've made sure that you've got a lot of that movement up close.
Lynne Malcolm: Oh okay, so now I'm inside a cage and they've just shut the cage door. It feels very confined.
Corrie Ackland: That's right, and if you turn around you'll see you're not alone in there, there's a whole host…
Lynne Malcolm: Oh, behind me a whole host of birds. They look like budgerigars, I think there's some parrots. There's so many of them and they are very, very close to me and chirping quite loudly. We're quite high up in the cage and I'm looking down to the bottom of the cage as well, and the birds are just lining the walls.
Corrie Ackland: So that's probably the closest we will get. Not all people with a fear of birds have concerns of budgies, so it will also depend on the particular kind of bird. Actually quite a few of the people that come to us, their main bird of concern is the seagull, the pigeon or the ibis. So you've got some ibis footage as well.
Lynne Malcolm: Corrie Ackland, clinical director of the Sydney Phobia Clinic.
You're with All in the Mind on RN, I'm Lynne Malcolm.
Many people feel anxious when faced with snakes, spiders, heights, travelling by plane and social situations. A fear of confined places (claustrophobia) or of open space (agoraphobia) is also common. But when these fears are extremely irrational or cause the person to have uncontrollable reactions they become phobias and can be associated with panic attacks.
Professor Adam Guastella from the Brain and Mind Centre at Sydney University researches phobias and their treatment. He says they typically develop in childhood, but can appear at any stage in life.
Adam Guastella: Most phobias don't naturally go away. There's some reason why they go away and it's usually about experience, and treatment provides a really great way of developing corrective experiences that help you to understand whether something is dangerous or not, but they won't just magically go away.
Lynne Malcolm: So it's important that phobias are treated so they don't extend well into adult life.
Adam Guastella remembers one man in his eighties who came to him for help with his social phobia.
Adam Guastella: We provided treatment and he overcame his anxiety and phobia. What he described in the assessment though was a long history of missing out on things because of the phobia; he'd turn down promotions, he wouldn't supervise people, he wasn't willing to go to parties, he wasn't able to have a close relationship because of social fears. And so he missed out on a whole range of things in his life, and he reported not ever having a girlfriend. And then 3 to 6 months later I got a letter from him saying he had his first girlfriend. I thought that was wonderful, but it was also really sad because I thought to myself, you know, if people get treatment early and he could have had a completely different life course. And that's what I say to young people, particularly young people coming to me at school or in their early years, if you get treatment early it's not going to impact on your life.
Lynne Malcolm: And so he had that treatment really late in his life. What sort of treatment was that?
Adam Guastella: We use cognitive behaviour therapy, which is the evidence-based most effective way for treating phobias. What CBT or cognitive behaviour therapy does is examines the thoughts that you have around fears and it challenges, examines the evidence for those thoughts, but then also gives you experiences through what is termed exposure therapy, but experiences which teach you gradually that what you fear is actually safe.
Lynne Malcolm: Here's how his treatment process would be applied to someone with a spider phobia.
Adam Guastella: Firstly we would try and identify exactly what their fears are, if they feel like they'd lose control, if they feel like they'd go crazy, if they feel like the spider would attack them. And then we'd put them in controlled environments with spiders to test out those beliefs. For example, we might have someone just stand three metres away from a spider in a box where it can't get out, and just watch it and just see what happens. And in that time the person is learning about what spiders do, but they are also learning about their own ability to cope with the spider in their presence and to cope with their own anxiety.
And what we know is you can put people in their worst nightmare situations and if it's a safe place and nothing bad does happen, they'll be fine, they'll cope and their anxiety will go down. And so eventually over time their anxiety goes down. And so then you might get the person to go a bit closer and go a bit closer. And as they get closer they'll start to have doubts again about 'if I get any closer may be the spider will come and get me', 'maybe it's asleep, maybe it doesn't even know I'm here', they'll have all these excuses around why they are not being attacked, which is inconsistent with their beliefs.
And then eventually you'll get them to a point where they are doing something with the spider, so we will get them to open the box up and maybe put their fingers in the container and see what happens, and the spider will do nothing, or we get a chopstick and get them to move the spider and the spider will run from one thing to the other side of the box to the other and sometimes rear up, but it won't actually lunge at them and try and harm them.
And through all these corrective experiences the person gradually learns, oh, the spider isn't a predator. We know we get them when they are moving the spider around all the place and they say to me, 'Adam, can we leave the spider alone? I'm harassing it.' And in that moment their fear goes because their view of the spider has changed from being one which is a threatening predator to one that is to be not feared and actually one that we can feel sorry for. So the next step, which might be putting the hand in the box and getting the spider to run over the hand, well, that step is pretty easy there.
Lynne Malcolm: The amount of time this treatment takes varies, and there is a way to fast-track this process, though it's not ideal for everyone. Adam Guastella:
Adam Guastella: You can put people in their absolute worst nightmares, which is what we call flooding. So that's just say we are claustrophobic and our worst nightmare would probably be being in enclosed spaces, being in a coffin. So we could get a coffin, we could ask the person to lie in that coffin, we could close the coffin, and as long as the person is not doing it without their consent, so it's not a trauma in the true sense of the word, they are doing it with their consent, their anxiety can go to 100 out of 100 but they'll be okay, and then over time, it might be an hour, it might be half an hour, it might be two hours, the anxiety will drop and they will realise they are not dead, they can breath, and actually they can cope with being in a coffin. So flooding is a good example of if you want to do things quickly what we might do. The problem with that type of treatment though is that lots of people don't like it and drop out, so we don't tend to use flooding in most clinical services.
Lynne Malcolm: You do it more gradually.
Adam Guastella: We do it more gradually. And the key to really good therapy is that it's got to be generalisable, and what that means is the more times you do it when you're feeling good, when you're feeling stressed, when you're feeling tired, then you are generalising across how you feel, and then the different types of environments, so in the case of spiders the different types of spiders that you might see, whether you do it with the therapist or whether you do it at home alone or whether you do it when you are walking in a park, the more broader experiences you get, the better the therapy response is.
Lynne Malcolm: And are there any medications or anything else to assist the process of treatment?
Adam Guastella: That's a great question. I mean, there are medications to treat anxiety generally. So we know that SSRIs, for example, can be effective in reducing anxiety generally. But we've been really interested in looking at how if we understood the biology of how people overcome fear, could we speed that up and could we make sure that when people learn that information, that, say, the spider is safe, that that is learnt really well and the fear that it's a predator doesn't come back. That's some of the work that we've been doing over the last 10 years and we've been looking at different medications. You can think of it as like neural enhancement or you can think of it as going to the gym and taking gym powder to make more out of your gym sessions. We give the medication just before we do the therapy to try and speed up and strengthen the learning that what they fear is safe. And the evidence around that has been pretty good, it doesn't produce miraculous outcomes of people who would never have overcome their fear are now overcoming their fear, but the evidence is fairly clear that it produces a small improvement above the experience of overcoming their fear, so it does actually seem to, if you like, act as that neural enhancer.
Lynne Malcolm: But Adam Guastella recommends cognitive behavioural therapy as the best and most effective treatment approach for phobias. He knows this from personal experience as he had a phobia himself when he was a post doc student.
Adam Guastella: I've mentioned spider phobias a number of times for a good reason. And I decided that spider phobia was a really good phobia to work with experimentally, but it had been a long time since I had encountered a spider, and it wasn't until the spiders arrived that I went into full defensive mode, my entire body was like a martial arts person ready to defend, and I had to go to the toilet, I was dry retching, and my entire body was just overcome with fear. And I realised I was going to have real difficulty treating other people with spider phobia. So I had to treat myself, and I did all the things I was supposed to do. And with those specific spiders actually, they became like pets to me. One of them was actually poisonous and looked hairy, like the ones that everyone fears.
Lynne Malcolm: And you gradually introduced yourself to the spiders, is that right?
Adam Guastella: Yes, so I did what became the study actually, which was looking at the speed and whether we could increase the speed at which people overcome fear of spiders. So I was getting spiders to run on my hand and changing the spiders around. I went from wanting to vomit from the sight of the spider to being able to feel comfortable. I was quite sad actually, I had to let them go into the wild at the end of the experiment, it was quite an emotional experience for me.
Lynne Malcolm: Letting your friends go!
Adam Guastella: Letting my friends go. I still think of them actually.
Lynne Malcolm: So what do you think is the most important area of research to be done in this field now in the future?
Adam Guastella: There's some really big questions around how we can improve the speed at which people overcome fears, the learning of that information. We are still doing that type of research and it's fascinating, I really love the idea that we can understand the brain mechanisms and really help people to learn much faster. I think there's also a big societal issue. Anxiety is very common, and people need access to good treatments. So how do you improve access and how do you deliver treatments in a way which can affect large numbers of people?
You know, for people that are supporting someone with anxiety, it can be really frustrating because when they watch the person, fear, whatever it is, it's heights, it's spiders, it's snakes, they sit there and they go, well, why can't you just do that, it doesn't make any sense, you should be able to do it, and they get frustrated. But that frustration, it's aimed at the part of the brain that drives decision-making and sensible decision-making. You know, if I said to you, 'Here's $10,000, invest it and bring it back in a year's time with as much money as you can,' then you'd sit down and hopefully use the decision-making part of the brain to make that decision. But anxiety is not like that. You see it, you feel it, just as you react you are starting to think 'what am I thinking now', and that problem means that part of the therapy process is helping to get the decision-making part of the brain to talk to and to begin to control the situations that drive the anxiety.
So, often my clients will say to me, 'Adam, I know that's not going to happen, I know I'm going to be safe, but get me out of here because I'm about to die,' and they are just describing the biology of anxiety, which is you've got the decision-making process which makes complete sense, but then you've got the fear which is automatic, habitual, responds without any thinking process and just says, 'I'm afraid, get me out of here.'
And I think that if you are supporting someone with anxiety, you need to be patient, you need to be supportive, you need to make sure they are in control. One of the worst things you can do is surprise them and to try and push them and to goad them into doing things they don't want to do. But then also as their confidence builds, then gradually encouraging them to face their fears.
Lynne Malcolm: Professor Adam Guastella who's the Michael Crouch Chair in Child and Youth Mental Health at the Brain and Mind Centre at Sydney University.
If you've been disturbed by anything you've heard in today's program, call Lifeline on 131114, and head to the All in the Mind website where we'll put links to further support.
Thanks to producer Diane Dean and sound engineer Joe Wallace. I'm Lynne Malcolm. It's great to have your company, catch you next time.
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