Got Anxiety? The anatomy of a phobia
March 1, 2015
When discussing the factors that contribute to the development and maintenance of specific phobias, it is important to first understand the difference between Anxiety, Fear, and Disgust.
Anxiety is an emotion that is anticipatory in nature. A person who is anxious is typically worried about a future negative outcome.
That is, they are predicting (overestimating) that something bad is going to happen at some point in the future, which may be hours, months or even years away.
For example, a person with panic disorder may worry about the possibility of having a panic attack while grocery shopping that afternoon.
A freshman at Sierra Nevada College may be anxious regarding his or her ability to find employment four years later.
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I frequently say to those I see in my private practice, "depression has eyes in the back of its head — anxiety has eyes all over its head."
That is, those who experience depression focus on past negative life events, where as people who possess an anxiety disorder are worried about what could go wrong.
I frequently refer to those with an anxiety disorder as… "what if thinkers, who behave in just in case scenarios."
These individuals are always on alert, have their guard up, hyper vigilant, and looking for potential threat in their environment.
Individuals who are highly anxious are looking for trouble, and thus they are certain to perceive danger, even when it doesn't exist.
In contrast to anxiety, fear is experienced in the face of actual danger, occurring at the moment.
The person is not anticipating fear, they are experiencing this emotion at the time in which the negative event is taking place, such as when a bank teller is standing in front of a man pointing a gun at her, demanding money.
Those who experience the emotion of disgust are simply displaying a low tolerance level when interacting with a particular stimulus.
For example, a woman who steps on a dead rat, screams and quickly runs away, is feeling neither anxiety nor fear, but instead a sense of revulsion, or being "grossed out", when suddenly coming into contact with an unexpected and unpleasant situation.
In the case of phobias, a person will typically experience anxiety, as well as fear. However, fear will be the dominant emotion.
Consider a man who lives in Oakland, works in San Francisco, and has a phobia of driving over bridges. Each night when going to bed, he anticipates driving to work the next morning, and imagines himself losing control of his car on the bridge, resulting in a horrific accident.
These thoughts and images trigger anxious arousal, such as rapid heart rate, sweating, dizziness, etc.
The next day when he approaches the Bay Bridge, the emotion of fear surfaces, resulting in avoidance behavior as he turns the car around and drives home. Thus, the four primary features of phobic behavior include:
An intense fear reaction to a particular object/situation,
Extreme emotional distress, causing significant interference with one's social, occupational and/or personal life,
The person recognizes his or her fear is excessive or unreasonable; and
The phobia leads to avoidance behaviors when exposed to the feared stimulus.
From a diagnostic standpoint, Specific Phobias are divided into four categories:
Animal (e.g., dogs, spiders, fish)
Natural Environment (e.g., storms, heights, water)
Situational (e.g., enclosed places, flying, clowns)
SO, HOW DO PHOBIAS DEVELOP?
Although an in depth discussion concerning how fear pathways are formed in the brain regarding the development of phobias will be reviewed in Part 2 of this series, a brief overview of this process is summarized below:
1. Direct Personal Learning: The most common pathway for developing a phobia results from having a negative experience with a particular object/situation (stimulus). The negative experience may involve being physically harmed, such as being severely bitten by a dog, or may involve experiencing unexpected and unrelated panic sensations, in the presence of the stimulus.
2. Observational Learning: Phobias may also develop by observing another individual undergoing a traumatic experience involving physical or psychological harm. The observation may be either direct (in person) or indirectly, such as watching a TV documentary on snakes.
3. Informational/Instructional Learning: A third modality for the development of fear pathways related to phobias involves acquiring new information about the feared stimulus via various media sources such as books, articles, electronic resources, etc., as well as through being told by authority figures (parents and teachers) that a particular object or situation is dangerous and should always be avoided.
Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California and is co-executive director of the Center for Anxiety & Chronic Worry, with offices in Incline Village. He may be reached for comment at firstname.lastname@example.org; visit anxietytreatment inclinevillage.com to learn more.
This is the first in a four-part series of columns from Barry Barmann about phobias.