What are the Differences Between Panic Attacks and Anxiety Attacks? 

 Although people often confuse panic attacks with anxiety attacks and use the terms interchangeably, they are considered to be distinct by mental health professionals. While panic attacks are included in the Diagnostic and Statistical Manual of Mental Disorders (5th edition) known as the DSM-5, anxiety attacks are not.

Some of the major differences between panic and anxiety are as follows: 

• Anxiety is usually focused on a future situation.
• Panic is a fear reaction to what feels like imminent danger.
• Anxiety is typically accompanied by worry thoughts about the future, e.g. making serious mistakes in a job interview or receiving a diagnosis of terminal illness.
• Panic, on the other hand, is accompanied by thoughts about the immediate situation, e.g., “I’m going crazy,” or “I’m having a heart attack.” 

 Behaviors that stem from anxiety include avoiding situations or taking extra precautions. In contrast, behaviors that occur during a panic attack involve escaping the present situation or finding immediate help.  

 Furthermore, while symptoms of panic are abrupt, intense, and last about 10-30 minutes, symptoms of anxiety are longer-lasting, occurring over days or months and are usually less intense and include muscle tension, restlessness, irritability, sleep disturbances and fatigue. It is possible for anxiety to build up to a more intense level that may feel like an “attack”, however, a true panic attack would also include other symptoms such as a preoccupation with an immediate rather than a future threat.  

 What are the Different Ways that Anxiety Can Show Up? 

 Panic Disorder 

 People who experience recurrent, unexpected panic attacks accompanied by repeated worry about having more panic attacks or their consequences (e.g., passing out, having a heart attack, losing control, “going insane”) are struggling with panic disorder.

They often try to cope with their distress by avoiding situations where they think a panic attack may occur. This type of intense fear or anxiety of situations where it might be difficult to escape or get help if a panic attack occurs is called agoraphobia. Panic disorder can occur with or without agoraphobia. 

 Generalized Anxiety Disorder 

 Anxiety can also show up in the form of generalized anxiety disorder (GAD). While everyone feels anxious from time to time, excessive, ongoing anxiety and worry that interferes with day-to-day activities is a sign of GAD. People who struggle with GAD are consumed by persistent worries about worst-case scenarios in a number of areas of life such as health, relationships, and work. They have a hard time dealing with uncertainty, have trouble concentrating and worry about making wrong decisions. GAD worries often get in the way of falling or staying asleep. Relationships suffer because GAD often comes with feeling fatigued, irritable, tense, and nervous. It is even possible to experience stomach distress such as nausea, diarrhea, or IBS.  

 Social Anxiety Disorder 

 Another way that anxiety often shows up is in the form of social anxiety disorder (social phobia).  While it’s normal to sometimes feel anxious in social situations, if anxiety and avoidance of social situations is significantly disrupting quality of life it may be indicative of social anxiety disorder.  

 People who struggle with social anxiety feel nervous and uncomfortable in social situations because they worry about being judged. They dread and try to avoid situations such as meeting new people, attending parties or social gatherings, public speaking, being the center of attention, dating, going to work or school, talking on the phone, or doing things, such as eating, in front of others. They also have a hard time stating their opinions, making requests, or making eye contact. Social anxiety can cause a number of physical symptoms such as blushing, stomach upset, sweating, trembling, tension, dizziness and lightheadedness. 

 Specific Phobias 

People who are terrified of one or more specific objects or situations are struggling with a specific phobia. Phobias may fall into one or more categories, such as doctors, dentists, blood, needles, or medical procedures; confined spaces; insects or animals such as spiders or dogs; heights; driving; flying; vomiting or choking; natural phenomena such as thunderstorms; or fear of other things such as clowns. Although people with specific phobias are aware that their anxiety about these things is unjustified or exaggerated, they feel powerless to control it. Facing a phobia trigger can bring up uncomfortable physical sensations such as sweating, rapid heartbeat, chest tightness, difficulty breathing, nausea, dizziness, or fainting at the sight of blood.  

 Cognitive Behavioral Therapy (CBT) Can Help 

 If anxiety or panic is significantly interfering with your quality of life it can be very helpful to work with a clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT). CBT is an evidence-based form of therapy that focuses on changing patterns of thinking (cognitions) and behaviors associated with anxiety. CBT is supported by research and considered to be the “gold standard” treatment for anxiety disorders. Research indicates that over 60% of those who undergo CBT experience a significant improvement in anxiety symptoms in 12 – 20 treatment sessions. The tools and skills learned during CBT last a lifetime.  

 Therapy at Compass CBT can help you reclaim your life from anxiety and panic so you can be more calm, confident and engaged in your life. 

The GoodTherapy Registry might be helpful to you if you suffer from panic or anxiety. We have thousands of Therapists listed with us who would love to walk with you on your journey. Find the support you need today.

 About the Author 

Regina Lazarovich, PhD is a licensed clinical psychologist and founder of Compass CBT, serving clients across California and New York. She received her doctorate in clinical psychology from Hofstra University. Her work has spanned hospital, university counseling center, community health center, and private practice settings. Dr. Lazarovich has a comprehensive background in Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), Mindful Self-Compassion (MSC), and Dialectical Behavior Therapy (DBT). She utilizes evidence-based practices to help adults struggling with panic disorder, obsessive-compulsive disorder (OCD), social anxiety disorder, generalized anxiety disorder and specific phobias. She approaches binge eating disorder (BED) and body image concerns from Health at Every Size® (HAES) and Intuitive Eating perspectives. 

 

Dear GoodTherapy.org,

I’m afraid of everything. I seriously mean everything. Spiders, clowns, heights, germs, dying, dogs, small spaces, large crowds, undercooked meats, darkness, terrorist attacks, natural disasters … I could go on. These irrational fears have been affecting my life for as long as I can remember, and I never seem to get over them. If anything, I only find new things I’m afraid of.

I did a ton of research to find a place to live that was least risky—no hurricanes, no tornadoes, unlikely earthquakes, the least number of bugs, etc. I’ve insulated myself as much as humanly possible. I’m still miserable and afraid.

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Only a small number of these fears actually have roots in personal experiences. For instance, I was once bitten by a large dog, which explains my fear of dogs. But I have never been traumatized by a clown, never been caught in a violent attack, never experienced a natural disaster. I never had a negative experience in an elevator, but I have a panic attack almost every time I step foot in one.

Why do these things bother me so much? Is it possible to “cure” fears that have no basis in personal history? I want to live more freely and feel better about normal things and occurrences that should, at most, evoke minimal discomfort. Please help! —Dread Locked

Dear Dread Locked,

You write that you are scared of everything and there is no reason for most of your fears. I disagree. I think you do have reasons, even if you may not be fully aware of them, and these reasons can be worked with.

Sure, if you’ve been bitten by a dog, it makes logical sense you’d be afraid of dogs—there’s a reason for the saying “once bitten, twice shy,” after all. But you don’t have to have been in an elevator, necessarily, to be afraid of elevators—claustrophobia (fear of being trapped in small places) and agoraphobia (fear of situations that might cause panic and feelings of helplessness) are both pretty common.

Some of the other fears you describe—fear of spiders (arachnophobia), fear of heights (acrophobia), fear of germs (mysophobia), fear of clowns (coulrophobia), fear of dying (thanatophobia), and fear of earthquakes (seismophobia)—are prevalent enough to have their own names, too.

You ask whether there is a cure. That’s a strong word, and while nothing is guaranteed, I feel confident in saying therapy can help you understand your fears better, which in turn may help you manage them in more effective and productive ways.

It’s telling to me that you describe your fears as irrational. If you look at these fears, you no doubt recognize they are about things and events that do sometimes happen or present problems in human experience, but remember: the brain is wired to protect itself. Consider your fear of dying, for instance. Would you agree most people fear death on some level? Fundamentally, fear of death is protective, as it is our brain telling us to make decisions that are in the best interests of its preservation. Your brain is in fact being rational, not irrational, when it tells you to, say, keep your distance from the edge of the cliff, or to slow down, or to not eat those two-week-old leftovers. (Thanks, brain!)

Some of these fears can also go along with emotional experiences—claustrophobia, for example, can be linked to early experiences. You may not have been stuck in an elevator at any point, but you may have a history of being stuck or trapped in other, perhaps figurative, more emotional ways. As a result, seeking and finding safety may have become paramount in your life. Based on the extent of your fears and the lengths to which you go to avoid feeling fearful, I imagine that being vulnerable—as we all are in one way or another—is not something that sits especially well with you.

Can you do anything about being fearful? Well, yes. I think your best bet would be to seek a therapist who specializes in helping people with anxiety, fear, and worry. Starting therapy can be scary too, of course, but working with someone who is grounded, accepting, and knowledgeable about how to help people in your situation is a fine step toward learning how to handle your feelings.

You say you’ve “insulated” yourself as much as “humanly possible,” but you are still afraid and “miserable.” Clearly, the actions you’ve taken to protect yourself, while well-intentioned, aren’t working for you. You yearn for some relief. You ask whether there is a cure. That’s a strong word, and while nothing is guaranteed, I feel confident in saying therapy can help you understand your fears better, which in turn may help you manage them in more effective and productive ways.

I salute you for identifying an issue that is blocking you. You’ve taken a fine first step by writing in and explaining your situation. I wish you well as you take the next step in addressing your fears by partnering with a qualified mental health professional.

Take care,

Lynn

At least 30% of Americans have a fear of spiders, or arachnophobia. According to a new study published in Biological Psychiatry, just two minutes of therapy could eradicate that fear.

For most people, arachnophobia does not interfere with everyday life. In most natural habitats, however, people are usually not farther than a few feet from a spider. This means that for some people with arachnophobia, intrusive thoughts of spiders can become a chronic source of distraction and fear.

Treating Arachnophobia with Therapy

Lead researchers Marieke Soeter and Merel Kindt, of the University of Amsterdam in the Netherlands, wanted to explore whether memory reconsolidation, a treatment originally developed by neuroscientist Joseph LeDoux for the treatment of posttraumatic stress, could treat arachnophobia. The concept behind reconsolidation is to change the way the brain processes memories that may be upsetting, thereby altering trauma-related thoughts and behaviors.

Soeter and Kindt recruited 45 subjects with arachnophobia. Each group was exposed to a tarantula for two minutes, resulting in a predicted fearful response. After being exposed to the spider, half of participants received a 40-milligram dose of propanolol. The other half received a placebo. Propanolol is a beta-blocker but has also been shown to have amnesic properties.

[fat_widget_right]LeDoux’s idea of reconsolidation theorizes that fearful memories require protein synthesis in the brain’s amygdala. After these memories are retrieved, this protein synthesis makes the memories more susceptible to change, but only for a few hours. Thus treatment that occurs immediately after triggering the fear—as was the case with the people exposed to the tarantula—could help extinguish it.

As predicted, participants who received the beta-blocker experienced significant reduction in fear-related avoidance behavior. They were also more willing to approach spiders, even a year after the study.

Treatment Options for People with Phobias

Scientists have multiple approaches to treating fear. Some providers use cognitive behavioral therapy and medication, but this can require numerous sessions. Others offer a form of treatment called exposure therapy, which gradually exposes someone to a frightening stimulus. Though usually effective, these treatment options can be time-consuming and stressful.

The new study could offer a more cost-effective option for people seeking relief from phobias. More research is necessary to assess whether this treatment works with other phobias.

References:

1. Buddle, C. (2012, June 5). You are always within three feet of a spider: Fact or Fiction? Retrieved from http://arthropodecology.com/2012/06/05/you-are-always-within-three-feet-of-a-spider-fact-or-fiction/
2. Kaplan, J. S., PhD, & Toplin, D. F., PhD. (n.d.). Exposure therapy for anxiety disorders. Retrieved from http://www.psychiatrictimes.com/anxiety/exposure-therapy-anxiety-disorders
3. LeDoux, J. E. (2015). Anxious: Using the brain to understand and treat fear and anxiety. New York, NY: Viking.
4. Whiteman, H. (2015, December 14). How a 2-minute therapy could help cure fear of spiders. Retrieved from http://www.medicalnewstoday.com/articles/304048.php

Hypnosis is often recognized as being used by performers in comedy or entertainment and is typically seen as fun and harmless in those situations. However, hypnosis has a broader application when used in helping practices. Essentially, there are three main platforms for hypnosis:

1. Hypnosis used for entertainment.

2. Hypnosis is used by a person trained in specialized uses, such as helping people to stop smoking, manage weight, or deal with sleeping problems.

3. Hypnosis is used by a licensed mental health practitioner (hypnotherapist) as one of the tools in the counseling/therapeutic toolbox.

Hypnosis and hypnotherapy have an extensive history as reputable methods used the therapeutic process by trained and skilled hypnotists and hypnotherapists alike. The difference between hypnosis and hypnotherapy is that hypnosis is defined as a state of mind, while hypnotherapy is the name of the therapeutic modality in which hypnosis is used.

A trained hypnotist uses hypnosis to help people with issues such as smoking cessation and weight management, but is not licensed as to practice hypnotherapy. Hypnotherapy is practiced by a hypnotherapist who is a trained, licensed, and/or certified professional. Only a hypnotherapist may use hypnotherapy to work with such mental health concerns as phobias, stage fright, eating disorders, and certain medical conditions.

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How Does Hypnosis Work?

Hypnosis is defined as a harmless altered trance state characterized by very deep relaxation, highly focused attention, and an extreme openness to suggestions which are usually positive and foster positive therapeutic changes. However, a hypnotic trance is not necessarily therapeutic on its own. For example, when someone is driving to the mall, seemingly suddenly arrives, and is not sure exactly how he or she got there so soon, he/she has experienced an altered, hypnotic state. People may also experience this altered state when they are just beginning to fall asleep and are in a dreamy and drowsy state, aware but not completely focused—just focused enough to have a simple conversation but not remember talking at all.

When used for therapeutic approaches, specific suggestions and images given to people in a trance can alter their behavior in a positive manner. When in this state of hypnosis, you are more inclined to permanent change and more likely to be successful in making the lasting changes you desire. Almost all lasting changes happen in your subconscious mind.

Another example of how visualization in hypnosis works is when a hypnotherapist helps a person experiencing claustrophobia to visualize being in a very open space, without fear, when entering an elevator. By learning to positively visualize entering the elevator without fear, the person is often able to then do it in reality. The subconscious mind does not distinguish between a genuine experience and a suggested one. If you visualize it in a trance state, your body will react to it.

Who Can Be Hypnotized?

The simplest answer is that almost anyone can be hypnotized if they want to be. Modern research has shown that most people can be hypnotized to some degree and that the real question is how deep and to what degree they go into trance. Being able to be hypnotized is not a sign of being weak-minded, gullible, or giving up control. The ability to be hypnotized—or “hypnotizability”—is actually correlated with intelligence and the ability to have heightened awareness and focus while being in complete control.

For example, if while in a hypnotic trance you were asked to give the hypnotherapist your wallet or take off all of your clothes, you wouldn’t unless you truly wanted to. Likewise, if you were in the audience of a stage performance by a hypnotist and you were selected to participate in the show, you would quack like a duck only if you truly wanted to. In fact, the participants are usually chosen because the hypnotist believes you want to act silly and be part of the show. This is in contrast to someone who is not showing any indication he or she wants to be at the event or even have fun.

Hypnosis has long been fodder for television shows and stand-up acts, and most people are familiar with hypnotists who claim to be able to make anyone do anything while under hypnosis. But hypnosis is no longer just a sideshow performance, and an increasing number of people are turning to hypnosis to quit smoking, get over depression and anxiety, lose weight, and forget about phobias.

Hypnosis is still controversial within mental health, partially because it’s often part of a comedy act and not real treatment and partially because some hypnotherapists have induced false memories under regression-based hypnotherapy.

What Is It?
Hypnosis isn’t a magic trick. It’s an altered state of consciousness that hypnotists induce via the power of suggestion. Hypnotists may use relaxation techniques, key words, guided imagery, or some combination of these to help clients slowly relax. Then, while under hypnosis, hypnotists make suggestions about changes in behavior.

The idea behind hypnosis is that, even when the conscious mind wants to do something, the unconscious mind might not fully accept this change. Hypnotists claim that, under the right conditions, they can subtly alter the effects the unconscious mind has on the conscious mind and help bring about behavioral changes. Some hypnotists use hypnosis to help gradually alter a client’s perceptions. A person struggling with pain, for example, might undergo hypnosis to help him or her see the pain as pressure. An increasing number of women are even using hypnosis to help cope with the pain of childbirth.

Does It Work?
You can’t be hypnotized to do something that is outside of your moral compass or that you don’t really want to do. People who try to quit gambling or spending through hypnosis will likely not see results if they’re quitting only because of family pressure. Hypnosis can’t change the way you think; it simply makes it easier to follow through with behavioral changes. Hypnosis can also bring about a state of relaxation, and some hypnotherapists teach their clients how to self-hypnotize under stressful conditions. For people with anxiety issues, severe stress, or depression, this can help ease the symptoms.

But hypnosis is not a panacea, and is most effective when it’s used in conjunction with therapy and lifestyle changes. Particularly for long-term, chronic problems, it may take several hypnosis sessions to see results. Some people don’t see any results at all; because hypnosis thrives on suggestibility, if you’re not particularly suggestible it probably won’t work.

Choosing a Hypnotist
If you’re thinking about trying hypnotherapy, get a recommendation from your therapist. The American Society of Clinical Hypnosis also maintains a directory of qualified hypnotists with a clinical background. Make sure you know how long your hypnotist has been practicing and what methods he or she uses. The messages you hear under hypnosis should not come as a surprise, and your hypnotist should discuss the specific tools he or she is going to use before hypnotizing you.

Regression-based hypnosis, which is used to recover repressed memories, can be dangerous. Because people are more suggestible under hypnosis, the hypnotist can inadvertently fabricate memories that didn’t actually occur. Particularly if these memories are traumatic, this can lead to additional mental health issues. People with a history of psychosis should not undergo hypnosis without first taking to their doctors, because hypnosis increases their risk of a psychotic episode.

References:

1. About the society. (n.d.). American Society of Clinical Hypnosis. Retrieved from http://www.asch.net/
2. Beattie-Moss, M. (n.d.). Does hypnosis work? Research Penn State. Retrieved from http://www.rps.psu.edu/probing/hypnosis.html
3. Mental health and hypnosis. (n.d.). WebMD. Retrieved from http://www.webmd.com/anxiety-panic/guide/mental-health-hypnotherapy
4. Portenoy, R. (2008, August 18). How does hypnosis work, can anyone be hypnotized, and when is it used? ABC News. Retrieved from http://abcnews.go.com/Health/TreatingPain/story?id=4047906

Most people have experienced brief periods of anxiety while riding in an elevator, stuck in the midst of a large and tight crowd, or even while playing hide-and-seek. But for people with claustrophobia, the fear of being trapped in a small space can be so debilitating that it interferes with regular life activities.

In fact, the distinction between “normal” anxiety about enclosed spaces and phobic-level fear is the fact claustrophobia tends to interfere with life activities such as climbing a stairwell or riding in an elevator for work, playing with one’s children, or going to certain locations.

What Is It?
Claustrophobia is categorized by a chronic and unreasonable fear of being trapped in a small or enclosed space with no hope of escape, and it is classified as an anxiety disorder. People with claustrophobia also frequently experience a related fear of suffocation. Being in a small space can cause people with the issue to fear that they won’t be able to breathe, and for this reason, people with claustrophobia sometimes experience fear in settings that don’t seem enclosed or frightening. For example, a person with claustrophobia sitting in a dentist’s chair might be so afraid of confinement that the person becomes convinced that he or she will suffocate if he/she remains in the chair. People with the issue may experience extreme anxiety, panic attacks, difficulty breathing, profuse sweating, and difficulty concentrating when they are in a small space.

People with claustrophobia tend to experience anxious reactions in a variety of settings rather than just one particularly frightening setting. For this reason, claustrophobia tends to become generalized and may worsen over time. A person who was once afraid of elevators might generalize his or her fears to closets, apartments, doctor’s offices, and small stores. In extreme cases, people with claustrophobia may be so afraid of confinement that they refuse to leave their homes or travel to unfamiliar locations.

What Causes It?
Claustrophobia is one of the most common phobias, with about 5% of the population experiencing it to one degree or another. Some scientists believe that this indicates an evolved, genetic fear of closed spaces. The reasoning for this explanation is that being trapped in a small space can be dangerous, so the brain has evolved a special fear of these situations to prevent people from taking potentially life-threatening risks. However, there is also evidence that claustrophobia is learned. People who have been trapped in a small space—such as people who were trapped in an elevator or who were locked in their bedrooms as children—are more likely to become claustrophobic, and children of people with claustrophobia are more likely to become claustrophobic. This is probably due to a combination of genetics and parental modeling.

How Is It Treated?
Although phobias can be debilitating, they are generally fairly easy to treat. Counter-conditioning and exposure therapy work by gradually exposing people with claustrophobia to triggering circumstances to help them build a tolerance and learn coping mechanisms for their fears. People with mild claustrophobia sometimes benefit from deep-breathing techniques and distracting thoughts, and people with severe claustrophobia may take anti-anxiety medications to help them function until therapy can help them address the underlying causes of the phobia. Some people with claustrophobia also benefit from cognitive behavioral therapy, which helps them identify the negative thoughts that lead to fear-based reactions and to slowly adjust these thoughts to more positive, less fear-inducing ones.

References:

1. Claustrophobia. (n.d.). Epigee. Retrieved from http://www.epigee.org/mental_health/claustrophobia.html
2. Kahn, A. P., & Doctor, R. M. (2000). Facing fears: The sourcebook for phobias, fears, and anxieties. New York, NY: Checkmark Books.

Food Network chef Paula Deen is known for her bubbly personality, so many fans were shocked when she explained in her biography that she had agoraphobia for 20 years. Deen is hardly the only celebrity to experience this potentially debilitating condition, however. Kim Basinger and Woody Allen also reportedly have experienced it, and the father of modern psychiatry himself—Sigmund Freud—may have struggled with the issue as a young man.

In an increasingly busy, crowded, and connected world, anxiety can be overwhelming even for famous people, and agoraphobia will affect about 1.4 percent of the U.S. population at some point, with 40% of cases reported being “severe,” according to the National Institute of Mental Health.

What Is It?
Agoraphobia means “fear of the marketplace,” and is commonly associated with a shut-in lifestyle and social avoidance. However, agoraphobia is distinct from social phobia and characterized by a chronic fear of feeling anxiety or panic in a place where one is unable to escape or get help. For this reason, many people with agoraphobia are hesitant to leave their homes, unwilling to go out alone, or visit only familiar locations. Some people with the condition experience panic, generalized anxiety, and other issues classified as anxiety disorders.

Although everyone experiences anxiety in unfamiliar or social settings from time to time, people with agoraphobia experience overwhelming anxiety and panic on a regular basis. They might feel dizzy, restless, short of breath, or confused in unfamiliar settings. Agoraphobics are often fearful of feeling out of control, and the physical symptoms of anxiety can exacerbate this fear.

What Causes It?
Agoraphobia is typically a side effect of panic disorder. People who have had panic attacks in public settings may fear that they’ll have another panic attack and grow increasingly fearful of going out in public. Sometimes agoraphobia is caused by other circumstances, such as a traumatic event in a public place, social anxiety, or other mental health conditions that cause anxiety and panic. The disorder may be caused by a combination of genetic and environmental factors. Children of parents with panic disorder are more likely to develop agoraphobia; this could be due to either genetics or parental modeling.

How Is It Treated?
Because people with agoraphobia are often terrified of having panic attacks, one of the most important steps in treatment is giving the person a sense of control over his or her tendency to panic. Relaxation techniques can help many people regain a sense of control. Medication is also highly effective. Anti-anxiety medications and antidepressants can also help people with agoraphobia.

Sometimes agoraphobia causes so much fear that people refuse to leave their homes. People with severe agoraphobia sometimes need several months of progressive desensitization to fearful settings. For example, a person might start by walking outside, graduate to getting in the car, progress to driving to a parking lot, and ultimately master going to the grocery store. Most people with agoraphobia undergo some form of psychotherapy. Cognitive behavioral therapy can be especially helpful, and some people with the issue benefit from group therapy. Group members often share coping strategies and can help an agoraphobic feel less isolated; the group setting itself can also serve as a form of desensitization to unfamiliar people and settings.

References:

1. A.D.A.M. Editor Board. (2011, November 18). Panic disorder with agoraphobia. PubMed Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001921/
2. Agoraphobia among adults. (n.d.). NIMH RSS. Retrieved from http://www.nimh.nih.gov/statistics/1AGOR_ADULT.shtml
3. Agoraphobic celebrities. (n.d.). The Daily Beast. Retrieved from http://www.thedailybeast.com/galleries/2011/12/13/photos-paula-deen-kim-basinger-and-other-famous-people-with-agoraphobia.html
4. Mayo Clinic Staff. (2011, April 21). Agoraphobia. Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/agoraphobia/DS00894
5. Moskin, J. (2007, February 28). From phobia to fame: A southern cook’s memoir. The New York Times. Retrieved from http://www.nytimes.com/2007/02/28/dining/28deen.html?pagewanted=all

Corrective learning is a process that occurs when existing conceptions and beliefs are replaced by more adaptive ones. For individuals with anxiety, panic, and phobias, exposure therapy is a common form of treatment that aims to produce corrective learning.

During exposure therapy, individuals are exposed to things they fear or that threaten them. Because these situations or things are usually avoided as a result of anxiety, the theory behind exposure therapy posits that being confronted with the feared item or event in a controlled environment will allow the individual to realize that his or her fears surrounding that item or event will not be realized. It is also believed that the level of fear or anxiety that is experienced during the exposure directly predicts the level of reduction in anxiety at treatment outcome. In other words, the more fearful or anxious someone is during a session, the more he or she will be able to overcome that fear in the long run.

This theory has been tested at length. However, Alicia E. Meuret of the Department of Psychology at Southern Methodist University in Texas wanted to examine this further. In a recent study, Meuret assessed the physiological and emotional responses of 34 participants with agoraphobia and panic as they underwent either a cognitive behavioral or breathing-based exposure therapy. She found that the participants all experienced increases in panic and anxiety during the sessions, as evidenced by physiological markers and emotional responses, but that these increases did not lead to better outcomes. In fact, the more panicked and fearful the individuals were, the worse their treatment outcomes. Additionally, in contrast to existing research, Meuret found that symptom reduction during treatment did not predict treatment outcome. In other words, even if the individuals experienced spikes in treatment severity during exposure and then were able to reduce their anxiety as the session continued, this drop did not lead to better overall outcome.

It has been suggested that allowing a client to experience symptom reduction during exposure provides a sense of self-control and mastery for the client and accomplishment for the therapist. And although this may indeed be true, the reduction of symptoms after exposure does not seem necessary for treatment success. In fact, the treatment outcomes were similar for those who left sessions with symptoms that were elevated as well as with symptoms that were diminished. Meuret believes that these results contradict the theory that fear reactivity is an indicator of treatment outcome, although her study was limited by sample size and the fact most of the participants were well-educated white females. “More research is needed to examine the underlying mechanism of corrective learning during exposure across therapy types,” she said.

Reference:

1. Meuret, Alicia E., Anke Seidel, Benjamin Rosenfield, Stefan G. Hofmann, and David Rosenfield. Does fear reactivity during exposure predict panic symptom reduction? Journal of Consulting and Clinical Psychology 80.5 (2012): 773-85. Print.

Most people experience some form of irrational fear or anxiety, and many are concerned about germs and disease in particular. Amid a flurry of films and media reports about antibiotic-resistant infections and life-threatening flu strains, it’s easy to understand why some people actively worry about what they touch and breathe.

While concern about germs can motivate people to make health-conscious decisions such as frequently washing their hands, a serious germ phobia can drastically alter how a person functions and engages with society. Even actor and television host Howie Mandel concedes he has been unable to shake the grip of mysophobia—the technical term for fear of germs. Phobias are differentiated from general fears by degree. A person who is concerned about germs might wash his or her hands or get a flu shot, but a germ phobia can interfere with every area of life. Phobias are treatable, and people experiencing them should seek medical or psychological assistance.

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Symptoms
The primary symptom of mysophobia is an irrational fear of germs. This can manifest differently in different people. One person, for example, might be fixated on a specific germ or disease, while another person might be afraid of germs and dirt in general. Common behaviors associated with mysophobia include:

• Compulsive hand washing
• Excessive use of disinfectants and antibacterial soap
• Fear of physical contact with others
• Extreme fear of getting sick
• Reacting with extreme fear to media reports of new diseases
• Fear of certain locations, such as doctor’s offices and airplanes, where germs or sick people might be present or confined

Effects
Mysophobia doesn’t simply inspire fear and avoidance. The phobia can be all-encompassing and life-altering. While people with mysophobia often recognize that their reactions are irrational, they can’t control them. They may avoid going out in public, developing intimate relationships, or eating food they did not cook. Because mysophobia affects so much of a person’s life, it can lead to other mental health issues such as depression, social isolation, and anxiety. Complete avoidance of germs can actually contribute to the development of health problems. Overuse of antibacterial and disinfectant products has been implicated in the spread of new, resistant infections, and children who are not exposed to germs are more likely to develop allergies.

Causes
No one knows exactly why people develop phobias, but mental health experts have developed a few theories. Some believe that people are more likely to develop phobias that protect from danger. These phobias include germ phobias, fear of large animals, and fear of heights. People who develop phobias may take these natural fears too far and react with extreme anxiety, placing them in danger they are believed to be trying to avoid.

Early experiences also can make a person more likely to develop a phobia. Childhood illness, the death of a parent, or painful medical procedures can condition a person to be extremely fearful of germs and to take extreme measures to avoid them. Phobias also tend to run in families; they may be genetic or simply learned from parents.

Treatment
Phobias are highly treatable and often require only a few sessions with a qualified mental health professional. Cognitive behavioral therapy, which helps people to reframe intrusive and phobic thoughts, can be extremely beneficial. Desensitization, a process whereby a person is slowly exposed to a frightening stimulus, also is highly effective. Some doctors may prescribe anti-anxiety medications to help people with mysophobia cope with their fears during treatment or to enable them to function in public. Some clients also experience success with hypnotherapy, often in only two or three sessions.

References:

1. Audesirk, T., Audesirk, G., Byers, B. E. (2008). Biology: Life on earth with physiology. Upper Saddle River, NJ: Pearson Prentice Hall.
2. Overcoming your Fear of Germs. (n.d.). Fear of Germs. Retrieved from http://www.fearofgerms.com/
3. Kring, A. M., Johnson, S. L., Davison, G. C., Neale, J. M. (2010). Abnormal psychology. Hoboken, NJ: John Wiley & Sons.
4. Phobias. (n.d.). U.S. National Library of Medicine. Retrieved from http://www.nlm.nih.gov/medlineplus/phobias.html

The world of psychiatry is full of unusual phobias. There’s symmetrophobia, the fear of symmetry, xerophobia, the fear of dryness, and ideophobia, the fear of ideas. But these phobias are exceedingly rare, and in the psychiatric interest on strange phobias, more mundane—and more dangerous—phobias are easily forgotten. Needle phobia is one such fear. There is significant evidence that fear of needles sparks physical changes in the body that can result in cardiac episodes and other health problems when a patient is exposed to needles. But needles are a part of life and are often necessary for medical treatment. Needle phobia, then, can cause a person to avoid life-saving care and, if a needle is forced upon a phobic patient, the results could be disastrous.

Needle Phobia and Cardiac Episodes
Most people dislike needles, but a true needle phobia feels overwhelming and uncontrollable to patients. People who have needle phobia may experience an extremely elevated heart rate and blood pressure immediately before a needle puncture. When the puncture occurs, the heart rate may drop precipitously. This exposes them to significant danger of heart arrhythmias and other cardiac episodes. Dr. James Hamilton, a pioneer in the treatment and study of needle phobia, reports that at least 23 deaths have been caused by a needle puncture that led to a cardiac episode.

Medical Issues
Doctors, nurses, and other people tasked with administering vaccinations and drawing blood are not typically properly educated about needle phobia. They’re accustomed to patients who dislike needles and may reassure them with promises that the puncture won’t hurt or will only take a minute. But with a true needle phobic, these reassurances don’t work. The person isn’t afraid of pain or injury: he or she is afraid of the needle itself. This poses serious obstacles to medical treatment. As many as 10% of people have some degree of needle phobia, and a significant portion of these individuals report that they would rather die than receive a needle puncture. These people tend to avoid medical care because of their fear, allowing their illnesses much more time to worsen than illnesses of nonphobic people.

Causes
Although traumatic experiences with needles such as painful blood draws or blood transfusions can cause needle phobia, people can’t typically trace the origin of the phobia. Needle phobia seems to run in families, but this does not mean the fear is genetic. Children may learn it from watching their parents show fear of needles. Restraining children during vaccinations and blood draws is strongly correlated with the later development of needle phobia. Consequently, parents should strive to ensure that their children’s early experiences with needles are positive and that children are not restrained unless the needle puncture is needed immediately to save the child’s life.

Treatment
Some people have good luck with hypnotherapy, but the most common treatment for needle phobia is counterconditioning. This process can take several years because the mere sight of a needle is sufficient to send many patients into a full-blown panic attack. Treatment providers typically start by asking the person to envision a needle, progress to showing the person a needle, and ultimately move toward getting the person to accept a needle puncture. For people who require needles for medical treatment, it may be necessary to administer general anesthesia to prevent life-threatening reactions. In less severe cases, anti-anxiety medications can lessen the symptoms of needle phobia.

Sources:

1. Hamilton, J. G. (n.d.). Needle phobia: A neglected diagnosis. Needle Phobia. Retrieved from http://needlephobia.info/pages/Hamilton-Needlephobia.pdf.
2. Emanuelson, J. (n.d.). The Needle Phobia Page – fear of needles and needle procedures. The Needle Phobia Page – Fear of Needles and Needle Procedures. Retrieved from http://www.needlephobia.com/
3. The phobia list. (n.d.). The Phobia List. Retrieved from http://phobialist.com/

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