Phobia
SYMPTOMS Fear is a natural emotion but irrational fear makes life miserable for the affected person. It does not only affect the person but also results in difficulties for his whole family. As soon as a person encounters the feared object, the heart throbs very fast; body starts to tremble and he feels as if these are the last moments of his life and he is about to die. In such moments some people start shouting, and may sweat profusely. These symptoms continue till the feared object is removed or the person removes himself from the situation. Phobias may be due by animals, places, elevators, heights, bus, car, aeroplanes and several other things. Causes The question is why some people develop this irrational fear? It is very natural to have fear of dangerous things or objects but having fear of innocent objects or peaceful situations is illogical. In some people the very thought of such objects or situations may result in fear and/or anxiety. Actually our brain works as a computer that stores all that happens in our life. Some incidents go very deep and settle in our brain’s storage. When some similar incident happens again the past experience is recalled to the mind and all such emotions like joy, hate or fear are also recalled. For example the father of one child was a very angry, and aggressive man, arrival of whom resulted in intense fear in the child. Since his father usually came on a horse the child developed fear of horses, which continued even after his father’s death. The horse remained a symbol of fear for him, whenever he saw a horse he showed signs of fear. It seems strange that a young male, who is ready to face every danger in the world, is terrified by a horse. He himself was not aware of the actual reason for this fear. Psychologists made a very interesting experiment in this regard. A white object with long hair was brought close to a child. When he was about to touch this object a huge bell was rung, this action was repeated and it finally resulted in the fear of that object, that increased gradually. The child subsequently developed fear of all similar objects. This was then treated by exposing the child in a graded manner, to a similar white object. The object was first placed in the farthest corner of the room. This object was then gradually brought closer to the patient and finally it could be kept in the child’s lap without any fear. This way the child was treated and his fear disappeared. Types of phobias Fear of closed places, high places, going outside from home alone, crowded
places, of authoritative figures like teacher or boss, as well as various
objects, animals etc. TREATMENT (I) Systemic Desensitisation Treatment is done by a process called Systemic Desensitisation. This consists of exposing the phobic patient to the feared object or situation in a graded manner, starting with the situation or object which causes the least fear and anxiety and then gradually exposing to situations or objects causing greater fear and anxiety till the maximum feared situation is reached. Such a list of phobias is prepared before hand and it is called the “Phobic Hierarchy”. It is important that this be done in a detailed and thorough manner because on that depends the success of the treatment. Attempt should be made to find out from the patient the details of all the painful, fightening and unpleasant sensations, thoughts and feelings as well as the sights, smells, noises, voices and other aspects of the environment at the time that he experienced the phobic attacks. This will help in recreating the phobic experience when he is being treated. There are two ways that systemic desensitisation can be done: A) In vivo or real life. B) In imagination or fantasy. A) In Vivo or Real Life Desensitisation This is always preferable as it is more effective. One must start the treatment of the phobia-stricken patient with the least bothersome situation and then go over to the one next higher in intensity and so on till the most intense phobia is treated. In the desensitization procedure the patient should first be relaxed with hypnosis or with a mild sedative like Alprazolam. Then the patient should confront the object or situation in the company of the therapist. This should also be done in a graduated manner, starting from the least fearsome, going gradually up the scale of fear till the greatest feared situation is reached. Take for example a person who fears travelling in a bus. The first step would consist of the therapist taking the patient towards a bus but stop a long distance away. If this is tolerated then the next day this action is repeated but the distance to the bus is reduced. In subsequent days this distance is consistently reduced till the patient and therapist are standing adjacent to the bus, and later even touching it, while it is stationary. The next step may consist of both stepping into a parked bus. If all these steps are tolerated without anxiety, then the next step should be to ask the bus driver to drive the bus a short distance. This distance can then be increased gradually till the patient has lost his fear of travelling in the bus. B) Desensitization in Imagination Suppose that instead of the bus-traveling phobia, a patient was afraid of travelling in an aeroplane, then obviously all the steps given above would not be possible. In such a case a person is calmed by hypnosis or relaxation. The whole procedure is explained to him before hand. It is important that male patients are desensitized by male therapists and female patients by female therapists. The therapists needs to take each phobic situation as written in the phobic hereachy list, starting from the lowest intensity of fear. The patient is requested to sit comfortably in a chair or lie down on a bed or settee. The room should be quiet, and the therapist should make sure no phone should ring nor anyone go in or out of the room. The patient should preferably be alone with the therapist. The patient is asked to close his eyes and relax his whole body, including the neck, arms and legs. He should be asked to take deep breaths and try to imagine that his body is relaxing more with each breath. The patient is advised not to talk during the procedure. If he ever feels unbearable anxiety he should just raise his hand. The therapist then sees the phobic situation causing the least anxiety in the phobic hierarchy list. He then starts talking about that fearful situation. He should describe the situation, time of day or night, and environment as best as he can gather from the phobic hierarchy list. Then he should paint a verbal picture of the frightening situation, describing how the patient felt, what were his scary thoughts, how severely his feelings were affected and what symptoms his body developed. An attempt should be made to approximate the fear of the actual experience as much as possible. This frightening session should last about ten minutes. The patient should be left alone for about five minutes and then asked how he feels. If he is not excessively anxious the session can be ended there. These sessions should ideally be given daily or at most on alternate days. Usually fifteen session suffice. Research and experience has shown that Desensitization in real life as well as in imagination, is a very effective treatment of phobia. (II) MEDICINES Anxiolytics reduce some of the anxiety but do not remove the phobic anxiety. Clinical Cases 1. Mr. Rahim 31-year-old Mr. Rahim is working as a chemical engineer in a pharmaceutical factory. He has complete command of his work and has no difficulty in performing his duties, but when he has to submit his performance report he becomes fearful, especially if he has to submit it in a meeting. Because of this fear his body starts trembling, he becomes very anxious, loses his confidence and is unable to express himself properly. When his turn to speak comes, he becomes very frightened, he can neither speak fluently nor can pronounce words correctly, his heart starts running so fast that he can easily hear the sound. He develops anxiety even days before the meeting. He specially fears speaking in front of his seniors. On the other hand Mr. Rahim has absolutely no fear or anxiety of any thing else. 2. Shahida When Shahida was two years’ old, her servant had thrown a feathery chicken leg at her to frighten her. This incidence is nineteen-year-old but Shahida still has fear of feathers. Because of this fear she does not go near a chicken shop, never cleans chicken, and if some feathers touch her body or clothes, she becomes intensely anxious. Sometimes she starts weeping, shouting or even starts running. She also has fear of injections. Shahida belongs to a middle class family. She has received her education in a local college and has obtained her BA. She has been an average student. She was diagnosed as having phobia, and treated by systemic desensitization in imagination. After the treatment she overcame her phobia. 3. Ayesha A lady, who has fear of being alone, causes disturbance for her husband and children. At times she pleads her husband to remain with her at home and sometimes she keeps her children at home by making false excuses for their absence. Her husband remains worried because of his frequent absence from work as he has to rush back home to attend to his ill wife, each time he receives a telephone call from her. In such a situation the husband also remains very anxious and worried because from his first day at office after a week’s leave, his colleagues show much concern about his wife’s health and ask, “why don’t you seek proper treatment for the illness of your wife.” How to tell them the fact that she went through various examinations and lab. Investigations, and all results were normal. At school the teachers too keep complaining about the children’s frequent absence. But since the patient herself is very much disturbed, she takes all the blame on herself, and often grumbles, “All this is happening because of me.” |
Index |