• What is the difference between a fear and a phobia? 
  • How does having a phobia affect a person?   
  • What are some signs of a phobia? 
  • How can phobias be treated?



Walking down a poorly lit street at night and seeing a shadowy figure yelling angrily and swinging a baseball bat may engender fear–its realistic that this person could do damage.

If for 6 months after this event, whenever you see a child in a baseball uniform practicing his swing you consistently become overwhelmed with fear, anticipation that someone will be hurt and strong avoidance of that child, of bats or of baseball, you may have a phobia. 


Fear can be realistic or unrealistic and is usually experienced at the time of exposure to the feared situation, person or thing. However, fears may not be at the level of a Phobia.
If I have a fear that a bridge I’m driving on might collapse due to high winds I’m experiencing, I may be able to reason with myself and realistically assess my fear, calming myself and driving across.

If instead of a fear, I have a phobia of bridges collapsing I may turn around before reaching a bridge, I may find myself short of breath, and I may avoid crossing bridges completely.






Phobias involve several elements including fear, anxiety and/or avoidance. Fear can happen sometimes. Phobias remain consistent over time. Normal or typical fear can be intense or mild. Phobias are generally always intense. Fear may be based on real danger. Phobia is a fear that is out of proportion with real or perceived danger. Fear can be temporary. Phobias are considered to last 6 months or longer. Fear may or may not interfere with social life, job, school or other areas of life. Phobias can cause serious upset and poor functioning in these same domains of living.



There are 3 common way people handle phobias:

1. by completely avoiding situations, people places and things related to the phobia

2. by becoming frightened near or around the specific situation or thing.

3. by becoming anxious–anticipating the future experience of the situation, person, place or thing and obsessively thinking about the negative possibilities.



The problem with the Avoidance strategy is this–it has some limited benefit.

If you have a fear of dogs and because of your fear, you never step out of your home, well, yes, you never do get bitten by a dog.



You also never experience sunshine, picnics, walks with friends, vacations and so on. In essence, you have closed off a huge portion of life experience.
But the brain registers this as a partial win–you never get bitten by a dog. The reason people come to therapy with phobias is that they realize that there is also a big loss–a loss of life experience.



In my experience, Cognitive Behavioral Therapy or CBT is the best method for treating phobias. CBT includes Exposure Therapy–a slow, methodical exposure to the feared person, place, thing or situation that is causing fear, panic, anxiety, and avoidance. Like dipping your foot into an ice cold pool, the therapist assists the patient in acclimating slowly and methodically. As the patient’s anxiety increases, the therapist helps the patient with behavioral and cognitive processes–deep breathing, realistic self-talk-for example:

‘Even though this is uncomfortable I can actually stand this.”Look, I’m looking at a picture of a dog and I’m still ok.”It’s ok to have some fear, I don’t have to be 100% calm.’

Even patients with Post Traumatic Stress Disorder are sometimes given Exposure therapy–they go back to the war zone (after the war is over) and have a different experience, through exposure, of the feared situation, person, place, or thing.


Exposure therapy can move from looking at photos or videos of the feared person,place, thing or situation and move all the way to actual contact with those things. In some situations, therapists are finding great success with Virtual Reality exposure. For example, fear of flying or great heights.


With careful planning and implementation, the individual epxeriencing a phobia can overcome that phobia through systematic exposure therapy. 



A person with Social Phobia or ‘Social Anxiety’ is someone with an overwhelming debilitating amount of ‘shyness.’They often have fear and anxiety about being embarrassed, being humiliated, looking stupid, being rejected. They also have anxiety about their own condition including fears of sweating, looking fearful, being tongue-tied, feeling awkward.They may also have a running dialogue in their mind, telling themselves things like:”I will fail miserably in this social encounter and I can’t allow that””I must never be awkward.””People must like me or else its intolerable””I cannot have sweaty hands.””I must always have something smart and clever to say.””People must never reject me.””I cannot and must not look stupid.”

A caring, competent CBT based therapist can help the client with Social Phobia to identify and confront these distorted thoughts and cognitive demands. They can teach the client to see these thoughts as ‘theories about reality’ and not necessarily reality itself. The client can then increase their behavioral experimentation, allowing themselves to be in mildly uncomfortable and then more socially uncomfortable situations, increasing their comfort level and challenging their own erroneous thinking.


As clients dis-identify with their distorted thoughts about possible and impossible, acceptable and unacceptable, they move beyond their previous emotional and behavioral limitations to explore new possibilities for life.
Through methodical planning and careful exposure, patients with phobias can and DO GET BETTER!



Exposure therapy works!


© 2018 Ross Grossman, MA, LMFT

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