Specific phobias occur when individuals experience significant fear and anxiety in response to a particular object or situation. This fear is disproportionate to the actual threat of the situation and results in the individual having acute physical anxiety, including panic attacks. Interestingly, people who experience phobias are aware the fear is excessive; however, this awareness does not diminish their experience of panic.
Symptoms of the anxiety associated with phobias include panic attacks, sweating, dry mouth, chest pain or tightness, difficulty or rapid breathing, disorientation, dizziness, and tachycardia.
These symptoms occur in the presence of the feared stimulus, as well as in anticipation of this stimulus. For example, consider an individual with a phobia related to flying on an airplane. This individual will likely experience anxiety when they book their flight, the night before travel, the morning of their trip, and during their time in the airport. It is most likely that symptoms will become worse over time, increasing as the individual gets closer to the actual situation (i.e., flying on a plane).
Phobias present in a variety of different forms. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies five formal groups of phobias (i.e., animal, natural environment, blood-injection-injury, situational and other); however, these categories are quite general and can include many variations. For example, within the “animal” subtype, individuals may have a phobia related to spiders, snakes, or dogs.
Although the DSM-5 only includes these general classifications, there are a variety of different terms, used throughout the general public, that relate to specific fears. For example, as mentioned, the DSM-5 would diagnose a phobia of spiders as “Specific Phobia, Animal Subtype.” However, many individuals may use the term “arachnophobia” to more specifically define this condition. Claustrophobia and cleithrophobia are two of these terms used to more specifically explain one’s fear; however, these two terms are commonly confused with each other. Although they are quite similar, they have an important distinction.
Claustrophobia, or the fear of confined spaces, is one of the most commonly known phobias. Technically, this phobia falls under the “situational” classification in the DSM-5, as individuals with this disorder experience significant fear related to situations in which one has limited space and feels “closed in.” X . Some situations that would be distressing for individuals with claustrophobia include elevators, planes, crowded spaces, bathrooms, MRI machines, and windowless rooms.
Alternatively, cleithrophobia, a lesser known phobia, relates to the fear of being trapped, locked in, or unable to escape. Often, this fear is related to a concern that one will experience panic or significant discomfort, yet will be unable to leave the situation. Even though this phobia would technically require the same diagnosis as claustrophobia (i.e., Specific Phobia, Situational Type) and similar situations may trigger symptoms (e.g., elevators, planes), there is a significant difference.
Within claustrophobia, the fear is related to actually being in an enclosed space. In cleithrophobia, the fear is less about the size of the space and more related to being unable to leave. For example, imagine someone being inside of a closet. If this individual had claustrophobia, sitting in the closet would be distressing. Alternatively, if the individual had cleithrophobia, they would only experience panic if the closet door was locked. If they could open the closet door, they would likely not experience anxiety.
Although claustrophobia and cleithrophobia do have differences, individuals with these concerns will likely follow similar treatment plans.
Generally speaking, individuals with specific phobias are first encouraged to pursue psychotherapy, prior to medication. Although there has not been a direct comparison between therapy and medication for this patient population, research for therapy consistently demonstrates treatment effects, while medication trials have yielded mixed results.
Cognitive-behavioral therapy with exposure is the most supported therapeutic approach for treating specific phobias.
Exposure is an essential component of the therapeutic process. In layman’s terms, this strategy refers to “facing your fears.” This technique is based on decades of behavioral research and suggests that repeated confrontation of a feared stimulus, while effectively managing anxiety, will eliminate one’s fear response.
Needless to say, this can be quite scary and difficult for patients to hear. The majority of individuals attend therapy in hopes of feeling better – asking them to willingly endure panic and anxiety symptoms can be challenging. However, it is the therapist’s job to help the patient feel confident and comfortable. This is done through significant education, introduction and practice of multiple coping skills, as well as the gradual progression through exposure activities.
“Systematic Desensitization” refers to the concept of steadily working through each level of exposure. Individuals are asked to identify multiple situations or stimuli that may create an anxiety response. Next, they are instructed to rate each one of these situations in terms of the level of fear they will experience (0 to 100; this number is referred to as “subjective units of distress,” or SUDs).
In the case of claustrophobia, an example of this hierarchy may look like this:
- Looking at a photo of an elevator (10)
- Watching a video of people in an elevator (25)
- Thinking about being in an elevator alone (35)
- Thinking about being in an elevator with other people (40)
- Watching an elevator open and close (50)
- Standing in the elevator with the door open (60)
- Standing in the elevator with the door open, with other people (75)
- Taking the elevator alone (90)
- Taking the elevator with other people (99)
Therefore, exposure would begin with the first step – looking at a photo of an elevator. The individual would be asked to engage in this activity, while practicing their relaxation and coping strategies.
Throughout the course of each exposure exercise, it is expected that one’s anxiety will increase slightly. However, after sitting in the exercise for an extended period of time, the individual’s symptoms will begin to decrease.
Since the exposure activities are completed in a gradual manner, when the individual reaches the last step, they typically feel much more confident about their ability to confront and navigate this situation.