Fears and anxiety are a constant element in the history and evolution of humanity.

Fear is one of the primary, normally unpleasant, emotions triggered by exposure to a certain stimulus.

The latter is considered dangerous and sets in motion a series of defensive responses. It is a universal emotion, in fact, it is not exclusive to the human being. Many species feel the same emotion and thanks to which they have survived.

We recognize it through both physiological and behavioural changes.

When fear reaches disproportionate and really intense levels it is called phobia (from the Greek Phobos, God who instilled terror in his enemies), and it is a real anxiety disorder.

While fear, as a primary emotion, is a natural reaction to an object or situation involving danger, a phobia is related to the interpretation of the subject of a given stimulus.

Besides, many fears disappear with growth and experience.

Another difference is that phobia, as opposed to fear, is not rationally controllable and in many cases requires specific treatment to prevent it from becoming a serious obstacle in daily life.

TYPES OF PHOBIAS

There are literally thousands of phobias, and in the modern world, it’s a growing phenomenon.

To make recognition and treatment more objective, international classifications recognize three macro-categories of phobia: simple, complex and agoraphobia.

Simple or specific phobia is closely related to an object, animal or concrete situation.

This category includes phobias against spiders, insects or dogs, while others are connected to a specific environment or situation, such as height, enclosed space, medical examinations, etc.

Simple phobias show common symptomatology, such as accelerating heartbeat and breathing, sweating, and shaking. Apart from that, he deserves blood phobia, injections or injuries because he shows very different symptoms, such as hypotension and fainting.

The various studies on the subject have not yet succeeded in clarifying the subject. The simple phobias develop in most cases in childhood, between 4 and 8 years.

The second category is that of complex phobias, which includes social phobias.

These develop more in adolescence, but the cases are also increasing in old age.

Social phobia consists of disproportionate fear of all those situations in which it is necessary to establish a relationship, verbal or not, with others.

Social phobia consists of disproportionate fear of all those situations in which it is necessary to establish a relationship, verbal or not, with others.

Speaking in public, actively participating in meetings, meetings and all those situations that require contact and showing themselves to the public produce in the person a huge malaise.

This negative state of mind only makes worse those same symptoms that the person wants to hide from others, such as strong sweating or shaking hands. At this point the subject will try to avoid all those situations that are the source of the malaise, gradually becoming isolated.

Again, it is important to distinguish social phobia from the normal anxiety that anyone has experienced at least once in social contexts.

For example, in adolescence, the feeling and fear of being judged or the fear of being inadequate is a very widespread experience but in non-pathological cases it is overcome with maturation and experience.

In subjects over the age of 65, a social phobia may be related to the possible deterioration of sensory functions, shame for a physical appearance not younger or other medical aspects related to this age group.

For example, many elderly people with Parkinson’s disease are ashamed of that uncontrollable tremor and will try to avoid some socialization opportunities where this problem is most obvious.

It is evident that in the development of these phobias both hereditary and environmental factors and those related to personality play an important role. An extremely shy person will be more exposed to this kind of issue.

The third category is agoraphobia. This is defined as the fear of all those situations in which the person feels sunk and exposed, without the possibility to escape or ask for help. It is characterized by the fear of being in open spaces, or closed but wide and crowded, so the person will avoid squares, large streets, shops, public transport, etc.

Being in these places will be a source of uncontrollable anxiety and will lead the person to isolate himself, both to avoid what scares and to the shame of not being able to control their reactions.

In the most serious cases, the isolation can be so marked as to avoid any exit from one’s home. The impact that this phobia has on the individual’s daily life is really powerful.

SYMPTOMATOLOGY

The main symptom is the excessive manifestation of fear and anxiety over the stimulus, to the point of causing significant discomfort and impairment of the person’s functioning. In the diagnosis of phobias, the symptoms must be present serious manifestations for at least 6 months.

These two symptoms are usually accompanied by other physiological symptoms such as tachycardia, dizziness, gastric and urinary disorders, nausea, suffocation, redness, excessive sweating and tremor.

These pathological manifestations are only evident if the individual approaches the feared object or situation, but they can also appear when the person thinks of that particular stimulus. For example, it is not uncommon for a phobic subject to manifest symptoms long before confronting what terrifies him.

The phobics, just to avoid this state of physical and psychological malaise, tend to avoid the situations that cause it, but in the long run, this mechanism becomes a real trap.

Avoidance only reinforces conduct and confirms the danger of the situation. Thus we enter a vicious circle from which it will be increasingly difficult to get out.

ETIOLOGY

As for the origins of phobias, particularly simple or specific ones, all investigators agree on the role of learning.

In this sense, the work of Watson was really important, and in the experiment of the little Albert, he managed at least in part to prove his thesis (1920).

The aim was to understand if it was possible, through classical conditioning, to create phobias.

In the first phase, little Albert was examined to rule out that there were already pathologies and phobias. After some tests, it turns out he was just afraid of loud noises.

In the second phase, loud noise is associated with a white mouse. The child was shown the small animal and as soon as it tried to approach it a loud noise was emitted behind its back.

The presentation of the two associated stimuli is proposed 4 times and is followed by the presentation of the mouse alone. The series is repeated 10 times.

At the end of the cycle, showing little Albert only the mouse, this will cry and will try to escape even in the absence of the sound stimulus. Subsequently, Watson discovers that the response has been generalized to other stimuli seemingly similar to touch, such as other animals, hair and even the doctor’s own beard.

After a few months, the negative response is still present, albeit to a lesser extent. The next step would be to eliminate the phobia, using the same technique, but little Albert was removed from the institute so the experiment does not continue.

The experiment explains how phobias in human being are possibly born.

Other theories follow a similar mechanism but replace the real and concrete stimulus (mouse) with models or verbal transmission of information.

Model-based conditioning starts from the basis that people learn to react to certain stimuli by observing and imitating other individuals close to them such as a family member.

If, for example, in a family, parents are overly afraid of a certain stimulus or situation, their children will have a special tendency to react in the same way and to develop phobias. This type of learning, excluding the possible pathological implications, has played a fundamental role in the adaptation of the human species.

About learning based on verbal information, it also considers excessive negative transmission as a possible phobic stimulus. And this theory finds some feedback even in the difficult period we are living.

There has been an increase in cases of people reporting pathological, or at least elevated, anxiety after months of lockdown in which the news was mainly focused on the pandemic and its consequences.

But the theories deriving from associative learning, even if they have contributed a lot of material, do not explain 100% the origin of the phobias.

This is probably because he excludes subjective aspects such as character and personality from his study.

In recent years the theory that best explains the development of the origins of phobias is the one that integrates the various approaches.

In other words, many aspects play a decisive role, including learning, cultural conditioning, previous experiences, personality traits and genetics.

THE BRAIN CIRCUIT OF FEAR

What happens in our brains when we’re scared?

Research in the field of neuroscience has shown that two circuits are activated when the emotion of fear is felt.

There are therefore two ways that the stimulus can travel to get to the answer from the person. What differentiates the two circuits is just the speed with which the person reacts.

Rapid Circuit

The visual stimulus gets to the thalamus and from it goes directly to the amygdala, which is the main core for controlling emotions, including fear.

The main function of the amygdala is to integrate the stimulus with an adequate response and for this reason, it has connections with most of the brain.

This circuit leads to a very fast response, and this speed is also derived from an inaccurate representation of the stimulus.

In certain circumstances, a harmless object, such as a stick or cable, could be mistaken by the person for something very dangerous, such as a snake, thus provoking seemingly exaggerated defensive responses.

This happens because the stimulus is not fully elaborated, in fact, the defensive response in the rapid circuit arrives in a few seconds.

The rapid circuit, according to many researchers, is closely connected with what we call the conservation instinct of the species.

Slow circuit

The visual stimulus, from the thalamus, passes into the cortex before reaching the amygdala. This lengthening of the route affects the response speed, but not only.

The reaction is much slower but more proportionate and rational thanks to the more detailed analysis of the stimulus.

Both circuits are fundamental and equally effective depending on the situation and the danger of the stimulus. However, it is not yet clear whether there are some mechanisms or subjective characteristics that influence the activation of one circuit or the other.

TREATMENT

Only between 10 and 25% approach a professional for treatment.

The willingness to start a therapeutic path depends on how much the phobia affects the quality of the person’s life.

The currently recognized and most used therapeutic approaches are 4.

Behaviour Therapy

The two main techniques of this therapeutic approach are exposure and presentation of a model.

In the first, the subject is exposed to the phobic stimulus, in vivo or through images.

The second shows the patient how other people react to what he perceives as danger.

The goal is to make the subject understand, autonomously, that his reaction is not proportionate and rational.

Cognitive Therapy

It focuses on modifying those mechanisms of irrational thinking that involve phobias, trying to create an alternative and realistic one towards the phobic stimulus.

Cognitive Behavioral Therapy

It is probably the most used because it integrates the action of exposure with cognitive restructuring. The goal is to work both on the conducts and on the thought that provokes them.

Psychoanalysis

It includes both traditional and short sessions, but in the case of the treatment of phobias, it is not currently considered the most reliable.

Many researchers say that this method, as well as being slow in achieving results, is too bound up with the subjective aspects of phobias.

Whatever therapeutic path you choose, the starting point is motivation.

Without it, the results will be less long-lasting and the chances of relapse will increase considerably. After all, any psychotherapy requires effort and will throughout the whole process, and if a fundamental key pillar as motivation fails, it will be really difficult for the patient to complete it.

And the drugs?

In some cases, there are more serious and even prohibitive physical symptoms for the beginning of psychotherapy.

The use of drugs is of great help to stop the circle of increased symptoms- increased anxiety.

The pharmacological treatment focuses only on the symptoms so it is advisable to integrate it with psychotherapy.

It should also be remembered that this type of drug causes dependence so they are not suitable for long-term use.

PREVENTION

So we know that many treatments can help you deal with phobias, but is it possible to prevent it from developing?

There are currently no scientifically proven techniques for the prevention of phobias, but in the light of what is known about the disorder, it is possible to make some useful considerations, especially concerning childhood. Many of these observations are useful for the mature age person's caregiver, just as sensitive in the development of phobias.

At an early age, it is essential to foster an environment of emotional security and tranquillity, in which its fears are not dramatized.

On the contrary, it is advisable to accompany the child so that he can gradually face what scares him, praising him in case of positive behaviour. This promotes and strengthens its independence and at the same time will avoid problems of self-esteem and anxiety.

It is also important to monitor the appearance of certain symptoms such as avoidance, which can be the signal of the onset of phobias in mature age.

It should be remembered that ageing, some diseases and the gradual loss of independence make this age particularly delicate. Communication becomes fundamental. Transmitting safety and affection to the elderly can help them to overcome the phase of change, as well as make them feel useful within the family.

We can all do something to avoid the appearance or aggravation of phobias, which is to be well informed and to remember that asking for help, both for ourselves and for someone we care about, is not nearly a failure.


Photo by Eri Pançi

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