Does cognitive behavioral therapy work for phobias

Take the ground off of fear

When fear rules life (page 9/11)

Realistic through behavior therapy or psychoanalysis

Udo B. is very afraid of taking the subway. He believes that it is very likely that an accident or an attack could happen there. Often he vividly imagines that the subway stops in the tunnel and he is trapped there for hours, or that a fire breaks out and he cannot escape through the tunnel.

During the course of therapy, he succeeds in changing his thoughts: “The subway can sometimes stop in the tunnel. However, this very probably does not mean any danger. Usually it drives on again after a few minutes. A fire or an attack has never happened before, although I've been using the subway since I was a child. "

Cognitive behavioral therapy

Cognitive behavioral therapy has proven to be a particularly effective method for overcoming fears. The main aim of this therapeutic approach is to gradually face the fear-related situations or stimuli and thus experience that the fear subsides over time and the feared negative events do not occur.

In the first step of the therapy, it is worked out together with the patient how his fears arose and what factors are maintaining them. This makes it clear to many patients that the fear is related, for example, to a stressful experience or to long-term stress. This knowledge is already a relief for many of those affected, and it also forms the basis for the following therapeutic steps.

The information or the experience that the various physical symptoms are caused by fear and not by a serious physical illness is also a relief for many patients.

The confrontation with the anxiety stimuli can be carried out “in vivo” or first “in sensu” and then “in vivo”. The Latin term “in sensu” in psychology denotes processes that take place in the imagination, the term “in vivo” also comes from Latin and means translated in the living and denotes reactions and processes that occur in the living organism under physiological conditions take place under natural circumstances.

Before confronting the fearful stimuli, a list of the various fearful situations is compiled. These are then categorized from the least to the most fear-inducing situation.

During the confrontation in sensu, the patient imagines the various situations one after the other as vividly as possible - in each case until the fear has completely or almost completely disappeared.

Exposure Therapy: Facing Fear

When confronted in vivo, on the other hand, he has to face the fearful situations in reality and also remain in each situation until the fear has completely or largely subsided. The first situations are usually visited together with the therapist, after which the patient continues to practice alone.

For many patients, it is initially an effort to face precisely those situations that they are most afraid of. But if this has been successful a few times, many are motivated to continue practicing.

When confronting the anxiety it is important that no sedatives are taken. Patients should also refrain from so-called safety behavior, for example taking an "emergency medicine" or a cell phone with them in order to be able to call for help in an "emergency". The reason for this is that during the exercises you should experience that you will be able to endure and cope with the fear on your own.

In addition to these gradual forms of confrontation, there is also the method of overstimulation (“flooding”). The patient is immediately confronted with the most fear-inducing situation and has to endure it until the fear has clearly subsided. However, due to ethical concerns, this method is rarely used today.

The treatment of exposure is usually supplemented by methods of cognitive behavioral therapy. The patient learns to recognize which mistakes he is making when assessing a fear-inducing situation. For example, he overestimates the likelihood that something bad will happen or he has exaggerated catastrophe fantasies. In the course of the therapy, the incorrect assessments should be replaced by a more realistic view of things.

Special features in the therapy of blood phobia

A blood phobia or injection phobia is treated in a similar way to other anxiety disorders: under guidance, those affected are initially confronted with the less frightening and gradually with increasingly fear-inducing stimuli - in each case until the fear clearly subsides.

In order to prevent fainting at the same time, the patients learn the method of "applied tension" before the confrontation. First they practice tightly tensing the thigh muscles for about 15 to 20 seconds, which counteracts the "sagging" of the blood in the body. Then the patients are confronted with the anxiety, step by step, and should tense the thigh muscles every time they notice the first signs of fainting (e.g. sweat on the forehead, ringing in the ears). Muscle tension should be maintained until the signs of fainting have disappeared.

In this way, those affected quickly learn that contact with syringes or blood does not necessarily lead to fainting. Therefore, the blood phobia can often be successfully treated with this method in a relatively short time.

Psychoanalysis and depth psychological procedures

In these therapeutic approaches, the attempt is made to uncover the unconscious conflict that lies behind the fears together with the patient. This is then "processed". To do this, the feelings that led to the conflict are awakened so that the patient practically relives it.

In therapy, the patient also learns to be able to cope better with any fears that arise. The therapy should make the fear associated with the conflict superfluous and thereby disappear again.