SELF-HELP TREATMENT FOR PHOBIAS
One good treatment is desensitization. This can work for all phobias if you approach the method with determination (and remember that any associated anxiety, depression, phobias, worries or personality problems should also be treated at the same time).
The basis of desensitization is deep relaxation. To illustrate how this can overcome a phobia, think of a man who wishes to overcome his phobia about dogs.
David, as we shall call him, starts by learning how to relax completely. He then thinks about the extent of his phobia. Obviously, if the very thought of a dog produces anxiety, he must do this while he is completely relaxed. Each time any tension begins to develop, he needs to stop and relax again before he continues his analysis.
First of all, David works out whether he has one or more basic fears about dogs; for example, does he fear that the dog may be carrying fleas or disease, or is the phobia simply related to a fear of being bitten?
David's next step is to establish a list of situations which provoke his anxiety. For example, he realizes that a picture of a dog produces much less anxiety than the sound of a dog barking, and that small dogs produce less anxiety than large ones. Thinking about it, while he is relaxed, allows him to establish a list or hierarchy of anxiety-producing situations:
1. looking at a picture of puppies
Also, identify your basic fears carefully. For example, if you find that you have more than one basic fear, you will need to establish two (or more) hierarchies. You can deal with the less disturbing one first. You may find it helpful to set a target date by which you are determined to be able to carry out a particular objective.
After you have made these preparations, you are ready to move on to the desensitization treatment itself. There are two ways of doing this: in imagination and in life.
DESENSITIZATION IN IMAGINATION
To use this technique, you relax completely and visualize yourself successively in each of the anxiety-producing situations on your hierarchy, starting with the least anxiety-making and progressing upwards. The objective is to create a detailed, complete and vivid image of each situation as though you were actually taking part in it - but to do this while your body and mind are as relaxed as possible.
You should spend sufficient time on each level of the hierarchy to be sure that you can remain relaxed while you mentally visualize the scene: and, if any anxiety does develop, consciously relax your mind and body to relieve it. When you are satisfied with your achievement at each level, you can move on to the next one in the hierarchy.
If you can consistently relax at one level of the hierarchy, but not at the next, you are probably trying to take too large a step at one go. You can solve this problem by inserting another stage into your hierarchy.
The longer you spend on the procedure, the more effective it will be. Sometimes you can achieve better results if you practice mental imagery before you start the desensitization itself. You can do this by relaxing deeply, closing your eyes and imagining brightly colored shapes and objects.
Desensitization in imagination is very effective, but it may not remove all your phobic anxiety. You may feel satisfied if you reduce your anxiety to some degree. Or you may wish to complete the process by moving on to desensitization for real, in life!
DESENSITIZATION in life
This is similar to the procedure above, in that you work through your hierarchy, achieving both mental and physical relaxation at each level before moving on to the next. This time, however, you are doing it for real. In other words, you will use real situations, events or objects connected with your phobia, perhaps together with models and photographs of it.
Obviously, this method increases the chance that you will feel some anxiety. But the important point is that by progressing up a hierarchy in this way, you will be able to control the extent of that anxiety, and thereby avoid the need to escape from the phobic situation.
One advantage of desensitization in life is that by looking at or touching photographs, models and objects related to the phobia, you will obtain a real proof of your ability to remain calm and relaxed at each level of your hierarchy.
OTHER EXAMPLES OF DESENSITIZATION
You might treat a phobia about elevators by first visualizing yourself inside one, travelling up and down, and then doing so in reality. You might watch people getting in and out of a lift from successively closer points, then touch the 'call' button, then get inside and travel one floor up or down, then two floors, and so on. You would of course ensure that you were relaxed at each stage of this progression before moving on to the next.
A fear of the dark might be treated like this. To start with, you would need to black out a room of your home. You would then position a lamp which you could switch on and off to one side of a comfortable chair. Next, you would sit down and relax. By switching off the light for progressively longer periods of time, you should be able to accustom yourself to the dark.
Each time any anxiety began to develop, you would switch the light on and relax before sitting in the darkness again. (Also try to use your senses of touch, hearing and sight to increase your comfort with the environment which has previously frightened you.) At some point, you will want to extend your anxiety-control training to environments outside your home.
Sure, you may lessen the symptoms of agoraphobia by coming to depend on someone else accompanying you whenever you go out or using 'props' such as travelling in a car whenever necessary, or hiding behind dark glasses, or pushing a pram or shopping trolley.
But these are only crutches which conceal the basic problem. Happily, no matter how serious your agoraphobia may seem to be, you should be able to make considerable improvement if you approach the problem with enough motivation.
To start with, consider the extent and basis of your anxiety. Is it a fear of 'losing control' in front of other people? Is it a fear of the effects of anxiety? Do you worry about what others will think? (One agoraphobic told us that she would feel 'stupid' if she fainted in public, yet she could not tell us why. Take a guess!) Ask yourself why you are so concerned with other people's opinions.
Do they really matter? And, anyway, how can you be sure what other people will think or do? Remember that our own beliefs about other people's attitudes and behavior may be different form reality. You may, for example, believe that other people will criticize you for 'losing control' or fainting, whereas in actual fact, they would probably feel only concern and a desire to help if they saw someone else in trouble.
If you do decide that concern for other people's standards and opinions is a contributory factor to your agoraphobia, try using self-examination and analysis to decide which of your beliefs and attitudes is causing you emotional distress.
Remember that we suggested agoraphobia can be a psychological defense against more subtle emotional problems. So spend some time 'thinking through' your agoraphobia: you may find it enlightening to ask yourself what would be the first thing you'd do if your agoraphobia was immediately taken away. Could that be what you really are afraid of? For example, meeting people, having to accept an unpleasant job, and so on. Not all cases of agoraphobia have a hidden agenda like this - but some do.
Coming to terms with your own psychology can be a slow process. Obviously, agoraphobics need other effective, short-term methods of self-help. Since many people with phobias are emotionally aroused and generally anxious, you may wish to begin by using relaxation or self-hypnosis to lower your general level of arousal.
Use the techniques described earlier to help yourself cope with anxiety attacks. Understand what to do if you experience an attack of anxiety, because anxiety attacks will probably continue for some time after you have begun to deal with your agoraphobia. (They have, after all, become a habit, and so can easily be sparked off.)
You might want to decide how to cope without escaping from the scene of an anxiety attack; if you do escape, you might strengthen your phobia.
Treatment for the phobia itself is based on the desensitization method described earlier. First of all, establish a hierarchy of situations and locations which you fear at the moment. Start with the least frightening and work upwards, so that the finished hierarchy is accurate. It might look like this:
1. standing on the front door step
You must be able to relax and imagine yourself in the different situations on your hierarchy. Remember to go through it only as fast as you are able while remaining deeply relaxed. Practice this technique frequently - at least twice a day - until you are satisfied with your achievement. The final stage is to go through your desensitization hierarchy for real. At first you may wish to have someone with you, but your ultimate aim should be to move outside independently.
ANOTHER APPROACH TO PHOBIA
For example, a phobic individual may be asked to relax and encouraged to visualize his most anxiety-provoking situation in vivid detail until the scene loses its terrors for him and simply becomes boring. This may take anything up to two hours.