FAQs About Phobias: Answers From a CBT Therapist

As a therapist specializing in cognitive-behavioral therapy (CBT), I often work with clients navigating phobias. These intense fears can feel isolating, but you’re not alone. Many clients come to me with questions about their fears—why they have them, how they can overcome them, and what steps to take. In this article, I’ll address some of the most common questions my clients ask about phobias, providing insights, actionable strategies, and helpful resources from a CBT perspective.

What Are Phobias?

One of the first questions clients ask is, “What exactly is a phobia, and how is it different from just being afraid?”

Phobias are more than just fear—they’re intense, irrational fears of specific objects, situations, or activities. For example, it’s normal to feel uneasy around heights, but someone with a phobia might avoid walking across a bridge or even looking out the window of a tall building.

The DSM-5-TR defines phobias as an anxiety disorder, and they can be categorized into three types:

1. Specific Phobias: Fear of particular things, like spiders, flying, or confined spaces.

2. Social Anxiety Disorder (Social Phobia): Fear of being judged or embarrassed in social settings.

3. Agoraphobia: Fear of situations where escape might feel difficult, like crowded spaces or public transportation.

These fears often lead to avoidance, which can disrupt daily life. Understanding this distinction helps my clients see that their reactions are not just “fear” but something more significant—and treatable.

How Do Phobias Start?

A common question I hear is, “Why do I have this phobia? I don’t remember always feeling this way.”

Phobias can develop for a variety of reasons, such as:

• Traumatic Experiences: For example, a client might develop a fear of dogs after being bitten as a child.

• Learned Behavior: It’s not unusual for clients to tell me they “picked up” their fear from a parent or sibling who displayed similar fears.

• Biology and Genetics: Some clients feel reassured to know that their heightened fear response might be due to overactivity in the brain’s fear center, the amygdala, or a family history of anxiety.

While the origins of a phobia can be helpful to explore, I always emphasize to clients that we don’t need to dwell on the past to make progress. In CBT, we focus on the here and now—changing patterns of thought and behavior that keep the fear going.

What Are the Symptoms of a Phobia?

Clients often ask, “How do I know if I really have a phobia or if I’m just afraid?”

I tell them that phobias involve physical, emotional, and behavioral symptoms. These might include:

• Physical Symptoms: Sweating, a racing heart, trembling, dizziness, or shortness of breath.

• Emotional Symptoms: Feeling intense fear, dread, or panic when faced with the phobia.

• Behavioral Symptoms: Avoidance is the most common behavior I see in clients. For instance, someone afraid of flying might cancel trips or find alternative transportation, even if it’s inconvenient.

If these symptoms last for six months or more and interfere with daily life, it’s likely a diagnosable phobia.

Can Phobias Be Treated?

Another frequent question is, “Can I really get over this?”

The answer is yes—phobias are highly treatable, especially with CBT. I’ve seen clients make incredible progress using the following techniques:

1. Cognitive Restructuring

Many clients come in with distorted thoughts, such as “If I see a spider, I’ll lose control,” or “If I give a presentation, everyone will laugh at me.” In therapy, we challenge these thoughts and replace them with more realistic ones, like, “Spiders are usually harmless, and I can handle seeing one.”

2. Exposure Therapy

Clients often ask, “Do I have to face my fear?” The short answer is yes, but we do it gradually and at your own pace. For example, if you’re afraid of dogs, we might start by looking at pictures of dogs, then watching videos, and eventually being in the same room with a calm, friendly dog. Exposure helps reduce the fear response over time.

3. Relaxation Techniques

Many clients find relief through relaxation strategies, such as deep breathing or mindfulness exercises, which we often incorporate into sessions to help manage the physical symptoms of fear.

4. Behavioral Experiments

Sometimes clients believe their fear will lead to catastrophic outcomes. For example, a client afraid of public speaking might think, “I’ll freeze, and everyone will think I’m incompetent.” We test these beliefs by practicing in a safe setting, and clients often find their fears don’t come true—or if they do, they’re manageable.

What Can I Do If I Have a Phobia?

Clients often ask, “What can I do on my own to feel better?”

Here are some steps I recommend:

1. Educate Yourself
   Understanding your phobia is the first step. Many clients feel empowered when they realize their fear is common and treatable. The ADAA has excellent resources.

2. Start Small
   If your phobia is mild, you can begin gradual exposure on your own. For instance, someone afraid of heights might start by standing on a low step and working their way up.

3. Practice Relaxation Techniques
   Deep breathing, mindfulness, or progressive muscle relaxation can help calm your body when facing a fear.

4. Seek Professional Help
   If your phobia is affecting your daily life, working with a therapist trained in CBT can make a big difference.

What About Loved Ones? How Can They Help?

Clients often ask me how their family or friends can support them. I always emphasize that loved ones can play an important role by:

• Listening Without Judgment: Validating feelings rather than minimizing them is key. For instance, saying, “That sounds really hard,” is more helpful than, “Just get over it.”

• Encouraging Professional Help: Suggesting therapy in a kind and supportive way can help.

• Avoiding Forceful Exposure: Forcing someone to confront their fear often backfires. Instead, encourage them to face it when they’re ready, ideally with professional guidance.

Conclusion

Phobias are common, but they don’t have to control your life. With evidence-based treatments like CBT, it’s possible to overcome even the most intense fears. Whether your fear involves heights, spiders, social situations, or something else, taking steps to address it can lead to meaningful change. If you’re ready to start, I encourage you to reach out to a therapist and explore your options. Remember, progress is possible, and you don’t have to face this alone.

Sources

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, fifth edition, text revision (DSM-5-TR).

• National Institute of Mental Health. (2022). Specific phobias. Retrieved from www.nimh.nih.gov

• Anxiety and Depression Association of America. (2022). Phobias. Retrieved from www.adaa.org

• Harvard Health Publishing. (2022). Understanding phobias and anxiety. Retrieved from www.health.harvard.edu

• Mayo Clinic. (2022). Phobias. Retrieved from www.mayoclinic.org