Phobias explained

Lots of people feel nervous around heights, deep water, spiders or needles. That kind of fear is part of being human, and it often fades once you get used to the situation.

Fear becomes a concern when it is intense, lasts a long time and pushes you to plan your life around avoiding something.

With a phobia, people may pass up good things, like a job on a high floor or a home near water, to stay away from what they fear.

Clinicians usually look for fear that has lasted at least six months. Only a qualified professional can say whether what you are feeling is a phobia.

The NHS separates specific phobias, which are tied to one object or situation, from agoraphobia and social anxiety, which tend to affect daily life more widely.

Animal phobias are among the most common. Fears of animals and insects are also common in preschool children, and many fade on their own.

These fears are about the world around us, such as high places, thunder or deep water.

Fears about the body can make check-ups, vaccines and dental visits very hard. This family is the one where some people feel faint.

Situational phobias are about places or activities. People may plan whole routines around avoiding them.

Some phobias don’t fit the other groups, like fears of choking, clowns or vomiting. They are just as real and just as treatable.

People describe

• A pounding or racing heart
• Dizziness or feeling faint
• Feeling sick or an upset stomach
• Shaking or trembling
• Sweating
• Tight chest or trouble breathing

People describe

• A sense that something terrible is about to happen
• Fear of fainting, losing control or dying
• Feeling detached from your body or surroundings
• Intense fear or panic

It can look like

• Changing routes, jobs or plans to stay away from the trigger
• Leaving quickly when the trigger appears
• Saying no to good things, like trips or a new home
• Worrying for days before you might face it

Young children may not have words for fear. Instead, they may cry, have a tantrum, freeze or cling to a trusted adult.

Researchers propose that humans have an evolved fear system that learns fears of ancient dangers, like snakes, heights or deep water, more quickly than fears of modern things.

That may be why few people have a phobia of electric sockets, even though they can be dangerous.

A review of twin studies found that fears and specific phobias are moderately heritable. Genes may make some people more easily startled or alarmed.

Some types, like animal, blood-and-medical and situational phobias, show up more often in relatives of people with the same type.

Phobias are often linked to a frightening event or stressful time, like being stuck in a lift or a scare in the water. Seeing it happen to someone else can be enough.

Many people with a phobia can’t remember how it began, and that is common too.

People can pick up fears by watching others react with fear, or by repeatedly seeing or hearing about a threat. Overprotective parenting may play a part.

Being met with a negative reaction when you showed fear as a child may also make a phobia more likely.

Avoiding what you fear eases panic in the short term. Over time, though, it can make fears worse and shrink your life.

Each time you escape, your brain learns “that was close, good thing I left”. It never gets the chance to learn that you could have coped.

Phobias are anxiety conditions with real effects on the body and on daily life. Mocking or pranking someone with their fear can make it worse.

Exposure therapy helps over 90% of people with a specific phobia who commit to it and finish it. For many people, it is the only therapy they need.

Phobias can fade on their own, but that is less likely without treatment, especially for phobias that last into adulthood.

How long treatment takes depends on the person. Some people need only a few sessions.

There is even a one-session treatment, where gradual exposure is packed into one long session of up to about three hours.

In graded exposure, you rank feared situations and start with milder ones. A therapist creates a safe setting and supports you throughout.

Starting with the hardest situation (called flooding) exists, but it is only one option and is used with care.

Avoidance brings quick relief but can make fears worse over time.

Exposure can feel uncomfortable at first, and that is expected. In studies, the gains from exposure tend to hold up well, up to a year after treatment ends.

In vivo means “in life”. It is the most studied form of exposure for specific phobias.

Live exposure worked a bit better than other forms at the end of treatment, though the difference faded at follow-up.

Imaginal exposure can be a starting point, or useful when the real thing is hard to arrange.

Virtual reality exposure is useful when real-life practice isn’t practical, like flying. It looks especially helpful for fear of flying and fear of heights.

Some people fear the body feelings more than the situation. Interoceptive exposure brings on those feelings on purpose, like a pounding heart, to show they are uncomfortable but not harmful.

One-session treatment packs gradual exposure, skills and encouragement into a session of up to about three hours with a trained therapist.

It is a well-established treatment for children and teens with specific phobias. For adults, research supports it too, though more sessions can add a little more benefit.

Safety behaviours are habits like gripping a rail, closing your eyes or having someone hold your hand. Researchers suggest slowly dropping them, so you learn the situation is safe, not just that the crutch saved you.

Before each step, write down what you fear will happen. Afterwards, compare it with what really happened. That surprise is where much of the learning comes from.

Breathing exercises can help you relax when fear rises.

Reminding yourself that the feelings are panic, and that they will pass, can take away some of their power.

The NHS suggests staying where you are during a panic if it is safe, rather than rushing to a “safe” place. If you are driving, pull over somewhere safe first.

Fixing your attention on something steady and visible, like a clock or items on a shelf, can help you ride it out.

The NHS warns that searching about your phobia online may show pictures that trigger your fear. Choose when you look, and who you look with.

It helps to acknowledge a child’s fear without telling them they are in danger. Calling the fear silly can make them feel misunderstood.

Try: “I can see you’re scared. We can work on being brave together.”

Child mental health experts say the most important thing parents can do is not help a child avoid what they fear, because avoidance makes the phobia stronger.

At the same time, don’t force a child into a scary situation without talking about it first.

For a child afraid of dogs, a ladder might start with a picture of a dog, then a stuffed toy, then a few minutes near a calm small dog.

One-session treatment is a well-established treatment for children and teens with specific phobias.

In a trial of 124 anxious children, a program that coached only the parents, to reduce accommodation and respond supportively, worked as well as CBT with the child.

Pranks, like hiding a spider or pushing someone toward an edge, can deepen fear and damage trust. Phobias are anxiety conditions, not a choice.

Talking to someone you trust is one of the NHS’s self-help suggestions for phobias. Just listening, without fixing, is a gift.

Families often change routines to help a loved one avoid fear, like always taking the stairs or doing the shopping for them. This is called accommodation, and reducing it, kindly, can help anxiety get better.

Exposure works best at a pace the person agrees to. Let them choose the step, cheer the effort, and over time step back so they can do it alone.

Only 10–25% of people with a specific phobia seek treatment. Gently sharing that phobias are very treatable may open the door.

If a phobia is affecting your life, talk to your doctor or clinical provider. They can rule out other causes and point you to a therapist.

Child mental health experts suggest asking any therapist whether they use exposure therapy for specific phobias. The answer should be yes.

In the U.S., FindTreatment.gov, run by SAMHSA, is a free, confidential way to search for mental health services near you.

The NHS suggests self-help groups, online or in person. Some zoos and airlines run sessions for people with phobias.