A new study shows that having a severe phobia can hasten aging. But what if my greatest fear is aging?
—Stephen Colbert
NANCY STILL RECALLED THE incident from her childhood in vivid detail. She was eleven years old and all the kids were playing with the neighbor’s new German Shepard. Nancy reached out to pet the dog, but it got spooked and lunged at her face.
She must have blacked out because the next thing Nancy remembered was being in the emergency room and noticing the blood all over her blouse. Her lip was numb, and she could feel the stitches with her tongue.
Over the next few months, the scar healed well, but ever since that day, Nancy was afraid of dogs. She managed to avoid them over the years, even as her own kids grew up, which wasn’t easy because so many of their friends had dogs. Nancy would only visit pet owners if they put their dogs outside, and if she saw a dog walking toward her on the street, Nancy would get out of the way and wait until it passed.
If she let her guard down and happened to find herself near a dog—big or small—Nancy’s heart would pound, and she would feel faint. Just thinking about that day the dog bit her could bring on anxiety symptoms. Interestingly, spiders, snakes, or any other kind of animal didn’t seem to bother her at all.
When Nancy’s daughter Gayle was home from college one winter break, she found a lost puppy on the street and brought it home. Gayle begged her mother to let her keep it until she could find the owner. She promised Nancy that she would keep the puppy in a crate in the laundry room at all times. Nancy was skeptical, but she finally gave in—Gayle could be so persistent.
The problem was that the puppy cried all night, and Nancy couldn’t stand it. She turned on the light in the laundry room and the puppy was so happy to see her he stopped crying, jumped up and down, and tried to lick her through the cage. Nancy stayed there a few minutes, but when she left the room, the pup immediately started crying again. Nancy didn’t want the whole family to be woken up, so she brought in a chair and sat in the laundry room until the puppy fell asleep.
The same thing happened the next few nights. Nancy would come down to the laundry room, and the happy puppy would stop crying and try to lick her. He was so cute and little that eventually Nancy felt comfortable enough to sit on the floor next to the crate. With her anxiety better controlled, Nancy eventually built up the nerve to let the caged pup lick her fingers.
When Gayle’s attempts to find the owner failed, she begged Nancy to keep the puppy. Nancy was tempted, but she was concerned that her anxiety symptoms would return. She searched “dog phobias” on the internet and learned that there were effective treatments. She decided to reach out to her doctor for a therapist referral.
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Nancy suffered from a specific phobia, or a disproportionate fear of a particular object or situation that limited her functioning. This type of restrictive fear is one of the most common forms of anxiety disorder and affects one out of every eight people at some time in their life.
Fear of dogs is also known as cynophobia and is one of the most prevalent animal phobias, along with fear of snakes and spiders. Because dogs are so common in our society, it’s more difficult to avoid them than other types of animals, making cynophobia a particularly stressful phobia. Like Nancy, most people with such phobias are either too embarrassed to seek treatment or unaware that effective therapies are available.
Phobic symptoms usually begin in early childhood and in most cases develop before ten years of age. Epidemiological studies indicate that over any twelve-month period, approximately 7 to 9 percent of people in the United States experience a specific phobia. Older adults experience a slightly lower rate—in the range of 3 to 5 percent—compared with younger adults. Women are twice as likely to suffer from phobias as are men. The rates of specific phobic disorder are a bit lower in Asia, Africa, and Latin America, ranging between 2 and 4 percent.
Even though specific phobias are less frequent in older adults than younger adults, they are still relatively common. Many times, phobias in older individuals occur in the presence of chronic medical concerns, such as heart or lung disease. Older adults are also more likely to attribute their anxiety symptoms to a physical condition.
Any negative experience can trigger a phobia, but genetics contribute to an individual’s risk as well. If you have a parent or sibling with a phobic disorder, your risk is increased. Changes in brain functioning also play a role in developing specific phobias.
Any extreme or irrational fear reaction to a situation or object may be a phobia. People with phobias often feel a profound sense of dread or panic if they encounter the feared object or situation. Phobias differ from general anxiety disorders in that the symptoms are linked to a specific stimulus.
Some people are afraid of heights or confined spaces; others fear flying, while others experience intense anxiety when exposed to a particular animal or a needle for a blood draw. In Nancy’s case, she only had a specific phobia of dogs and did not fear other situations or objects. However, many phobic individuals do suffer from multiple phobias.
The feelings of fear or anxiety that arise from specific phobic disorders definitely differ from the normal and transient fears that nearly everyone experiences from time to time. Sometimes the fearful episodes of a phobia even take the form of a full panic attack.
Phobias can range from being annoying to severely disabling. These kinds of fearful reactions can interfere with many aspects of life, impairing the patient’s educational, professional, and personal functions. A typical feature of a specific phobia is that the individual goes to great lengths to avoid the anxiety-provoking situation or object. This was certainly true in Nancy’s case. Although her phobia restricted her in many situations, she was still able to continue functioning in other areas of her life.
Often, specific phobias develop after a particular traumatic event: sometimes an individual gets stuck in an elevator; other times, as with Nancy, the person is attacked by an animal. Still other individuals have no recall of any particular precipitating event.
People with a neurotic personality style are at greater risk of developing specific phobias. An overprotective parent during childhood or a loss of a parent through divorce or death also predisposes a child to phobias. Genetic factors increase risk: someone with a parent or sibling with a specific phobia has a greater risk of developing a phobia.
Some people suffer from social anxiety disorder, which is also known as social phobia. These individuals have a marked fear or anxiety about social situations where they feel exposed to possible scrutiny by others. Sometimes they are afraid of having conversations or meeting unfamiliar people. Others with social phobias feel anxiety if they are observed eating or drinking or giving a speech in public. Any situation that could potentially make the individual feel negatively evaluated, humiliated, embarrassed, or rejected may trigger the symptoms.
Another form of phobia, agoraphobia, can develop in individuals who suffer from panic attacks. Agoraphobia actually means “fear of open spaces,” and these individuals are often frightened of venturing outside their homes. They may also experience anxiety when in confined or crowded spaces.
For specific phobias like Nancy’s fear of dogs, exposure therapy is very effective. Multiple controlled clinical trials have demonstrated its efficacy—one investigation even showed 90 percent effectiveness that was sustained after several years of follow-up. It turns out that understanding the cause of a phobia is not as important as focusing on how to deal with the avoidance behavior that patients develop over time. For people suffering from multiple phobias, the therapy usually involves focusing on one phobia at a time.
Exposure therapy helps patients face their anxieties through exercises that gradually expose them to the anxiety-provoking situation or object. With gradual exposure therapy, the patient creates a hierarchy of feared scenarios and then begins with exposure to the least frightening one. As their confidence builds, patients then move on to the next most frightening experience. They continue the process until they eventually become desensitized to their fears.
On her own, Nancy gradually exposed herself to the caged puppy and began to gain control over her fears. Her doctor referred her to a cognitive behavioral therapist who very gradually helped Nancy approach a dog while he coached her on ways to deal with her anxiety. Nancy learned relaxation exercises and continued with the exposure therapy in a systematic way until she was comfortable keeping the puppy. After several months of therapy, Nancy began to feel more at ease around other dogs. With the help of her therapist, she learned that dogs, as well as the anxiety they caused her, were not as dangerous as she had imagined.
Exposure therapy, a form of cognitive behavioral therapy (CBT), and other elements of CBT can be effective in treating phobias. This usually involves combining exposure therapy with strategies to help the patient learn more effective ways to view and cope with the feared object or situation. By learning to understand their fears and body sensations, patients can reduce the negative impact that the disorder has on their lives.
Although exposure therapy is usually effective in treating specific phobias, sometimes, medications such as beta-blockers or benzodiazepines can further decrease the anxiety and panic symptoms patients experience when exposed to their feared object or situation. Medications can be helpful for patients suffering from fear of flying, public speaking, or coping with fear of enclosed spaces such as MRI scanners; however, it’s best to limit the use of medications to the initial treatment period.
When people are experiencing their anxiety, they usually feel physical symptoms, including a pounding heart (palpitations), rapid heart rate, shaking voice, and excess perspiration. The stress hormone adrenaline causes these physical symptoms, and medicines known as beta-blockers can reduce anxiety by interrupting the stimulating effects of adrenaline. Sedating medications called benzodiazepines can also help relax the patient but should be used cautiously because they can be addictive.
Patients with agoraphobia secondary to panic attacks also benefit from exposure therapy and other forms of CBT. Their panic attacks, however, often need to be treated using an SSRI antidepressant.
Many of the alternative and self-help strategies that reduce anxiety associated with panic attacks are also helpful for patients suffering from phobias. Mindfulness strategies can help patients better tolerate their anxiety symptoms and reduce their avoidance behaviors. Deep breathing, progressive muscle relaxation, yoga, or related techniques also may reduce stress and help patients cope with their symptoms. Numerous studies have shown that physical exercise can improve mood and reduce anxiety symptoms as well.
Although the natural response to fearful stimuli is to avoid them, patients can reduce avoidance behavior by attempting to stay near to feared situations as long and as often as they can rather than avoid them completely. Engaging the support of family, friends, and trained therapists can also help reduce avoidance behavior.
Joining a self-help or support group can help patients connect with others who understand the condition and can provide both practical and emotional support. Engaging in other positive lifestyle habits that boost brain health may also improve the patient’s level of functioning. Consuming a healthy diet, getting enough rest, and avoiding excess caffeine may further help patients cope with phobias.
Complementary medicines and therapies also have been used for phobic disorder. Some herbal medicines like kava have demonstrated beneficial effects. Limited data support the use of acupuncture, tai chi, and homeopathy for treating phobic disorders.
In recent years, many clinical investigations have utilized virtual reality technologies to enhance the effectiveness of exposure therapy. For example, a recent study used a computer game involving various traffic situations that simulated driving scenarios. The investigators found that volunteers using this technology experienced a reduction in anxiety symptoms suggesting the utility of this approach for specific phobias. Virtual reality exposure therapy has also shown initial success for dental phobias, fear of storms, and several other specific phobias.