We all experience fear and anxiety from time to time, for example going to the dentist, getting caught in a thunderstorm, or when faced with a ferocious dog that looks like it wants to eat you for dinner. For the individual with a phobia, there is an intense, overwhelming sense of extreme fear and panic in relation to a specific object, animal, or situation. Although we often realise that our fear is irrational, we feel powerless to control it and work hard at trying to avoid whatever we are afraid of.
What are Phobias?
How Common are They?
Phobias are the most common type of anxiety disorder with approximately 12.5% of the population having a specific phobia in their lifetime. Of those individuals, only about ¼ have one fear, with the most having at least two, with dental phobia being one of the most common of specific phobias.
Types of Phobias and Fears
There are 5 types of specific phobias:
Animal phobias e.g. snakes, spiders, dogs etc.
Natural environment phobias e.g. heights, storms, water
Situational phobias e.g. enclosed spaces (claustrophobia) such as elevators, tunnels, fear of flying
Blood-injection-injury phobias e.g. fear of seeing blood, having blood drawn or having a shot, or other medical procedures including going to the dentist
Other phobias e.g. fear of choking, vomiting, or getting an illness/disease, and in children, fear of loud sounds, clowns or other costumed characters
So What Causes Phobias?
There are different factors that can contribute to the development of specific phobias, including genetics and the environment. An individual’s genetic susceptibility to developing a specific phobia is increased when an immediate family member has a specific phobia. Furthermore, they are more likely to have the same phobia than any of the other types of phobias. Environmental factors include having something bad happen such as being bitten by a dog or getting stuck in an elevator. A phobia could also develop after learning about something bad happening, such as a plane crash, or seeing someone very scared of something. Other factors may also play a role, including an individual’s temperament and may explain why not everyone who experiences similar situations, or all family members develop the same fears and phobias. One study evaluating the use of Eye Movement Desensitization and Reprocessing (EMDR) in the treatment of dental phobia, by De Jongh and colleagues, found that 87% of the patients with dental anxiety reported a prior traumatic event. This could have been painful dental treatment, insufficient numbing, or feeling a lack of control while receiving dental work. Almost half of those patients had symptoms of post-traumatic stress disorder (PTSD) such as intrusive memories, hyperarousal, and avoidance behaviour.
Signs and Symptoms of Phobias
Physical symptoms include racing heart, chest pain or tightness, sweating, hot/cold flashes, shaking or trembling, tingling sensations, difficulty breathing, dry mouth, feeling dizzy or light-headed, churning stomach, and nausea
Emotional symptoms include a feeling of overwhelming anxiety or panic, fear that you are going to die or pass out, a feeling powerless to control and of losing control. You may also feel unreal or detached from yourself and have an intense need to escape.
The physical symptoms of blood-injection-injury phobia differ slightly from other phobias. The usual speeding up of the heart, which happens with anxiety, is quickly followed by a sudden drop in blood pressure. This leads to feeling faint, nausea, and dizziness and is the only phobia where fainting can actually occur.
What Help is There for Phobias?
Most people don’t seek help for their phobias if they are not interfering too much with their lives. For some however, it can make life a misery, stopping them from doing enjoyable activities with family and friends.
Avoiding treatment can be one solution however, if you are avoiding medical or dental treatment, any minor treatment needed now could lead to needing more intensive treatment in the future. We now know from new research that there is a connection between dental health and health in general whereby poor dental health can contribute to health problems such as heart disease, stroke, and diabetes.
So, What Treatment is Available?
Medications may be prescribed by your doctor to manage the symptoms of anxiety, often in combination with psychological therapy. These may include a class of antidepressants called selective serotonin reuptake inhibitors (SSRIs) or anti-anxiety medication.
CBT is used to treat phobias, in which exposure therapy is the main part of treatment. This involves imaginal or actual exposure to the feared object, animal, or situation, in a gradual manner. A single session of exposure therapy, averaging 2 hours duration, has been found to relieve most phobias, with improvement maintained 4 years later (1).
EMDR is a trauma-focused therapy that is a highly effective approach used to overcome trauma, anxiety, and phobias. EMDR is most effective for phobias which have a traumatic origin or a clear beginning such as blood, injections/needles, injury, and dental phobias and fears. Memories related to the traumatic incident are reprocessed and the fear quickly resolved.
Studies have shown EMDR to significantly reduce anxiety, irrational and unhelpful beliefs concerning dental treatment, avoidance behaviour, and symptoms of PTSD in as little as two to three sessions with lasting benefits, enabling individuals to have ongoing, regular dental treatment (2,3).
Lars-Göran Ö. (1989). One-session treatment for specific phobias. Behavior Research and Therapy, 27(1):1-7. Doi.org/10.1016/0005-7967(89)90113-7.
De Jongh, A., van den Oord, H.J., & ten Broeke, E. (2002). Efficacy of eye movement desensitization and reprocessing in the treatment of specific phobias: Four single-case studies on dental phobia. J Clin Psychol, Dec;58(12):1489-1503.
Doering, S., Ohlmeier, M., de Jongh, A., Hofmann, A., & Bisping, V. (2013). Efficacy of a trauma-focused treatment approach for dental phobia: a randomized clinical trial. European J of Oral Sciences, Dec;121(6):584-593. Doi:10.1111/eos.12090. Epub 2013 Sep 23.
Depending on how close to the feared object or situation the individual is, the symptoms of a phobia can range from feeling mild anxiety to experiencing a full-blown panic attack.
For individuals who have a fear of the dentist (dentophobia) their fear can be triggered by the sound of the drill, the characteristic smell of the dentist, the sight of the dentist or hygienist, or even just thinking about these situations. Similarly, those with needle and injection phobias typically have similar reactions at the sight of a needle or receiving reminders for immunisation shots, and will avoid travelling abroad if it involves needing shots.