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Overcoming Specific Phobias
Maya (Mostaghim-Vaezi) Dousti • Aug 20, 2020

A specific phobia is defined as an intense fear of an object or situation that results in avoidance and/or distress (American Psychiatric Association, 2013). The fear or anxiety is culturally deemed to be disproportionate to the actual danger posed, last over six months, and cause impairment in either social, occupational, or other important areas of life (American Psychiatric Association, 2013). Specific phobias can be debilitating and, at the very least, limiting. The most common and effective way to overcome specific phobias is through exposure treatment. Although this sounds incredibly intense, when done correctly, it essentially means slow and graded exposure to the phobic object or situation (Peris, Storch & McGuire, 2020). This is best done with the help of a mental health professional. What they will work with you to create is something which is often called an exposure hierarchy. Based on principles of Cognitive Behavioural Therapy (CBT), an exposure hierarchy is a ranking, from lowest to highest, of what scenarios cause fear or anxiety (Peris, Storch & McGuire, 2020).

 

For example, let's take a common phobia of spiders, also called arachnophobia. Let's say this ladder has ten rungs on it. At the bottom of this ladder, causing the least distress, could be a picture of a cartoon spider, causing 10% anxiety. Next could be a plastic cartoon spider toy, causing 20% anxiety.  Third could be a picture of a real spider at 30%, a video of a real spider at 40%, and being in the same room as a spider while the spider is in a covered box at 50%. 60% distress could be being in the same room as a spider in a glass box, 70% could be being in the same room as the spider while the spider is someone's hand across the room, 80% could be the spider in someone's hand while they are seated closer to you in the room, and 90% could be you touching the spider. At the top of the ladder at 100% could be holding the real spider. Essentially, what this hierarchy does is provide us with steps to increase tolerance and reduce distress for the individual's specific phobia over repeated, gradual exposure. When you've looked at a picture of a spider repeatedly so as to reach the point of habituation (a point where you are no longer experiencing the emotional response of high anxiety) you are ready to move on to the next step. This involves a step which exposes you to a progressively, but only slightly, higher level of anxiety. In this case it might be watching a video of a spider. These "baby steps" of exposure allow for gradual exposure to anxiety over prolonged periods of time with the goal of habituation.  This results in the progression through all the steps from the lowest rung on the ladder or hierarchy up to the highest with a significant reduction in the intensity of the phobia.


This is essentially how exposure therapy works. However, it is safest to do this with a mental health professional to guide you through this process. We can help - contact us for a free 15 minute phone consultation!

Written By: Maya (Mostaghim-Vaezi) Dousti, M.Psy., B.A. (Hons)

Edited/Reviewed by: Dr. Stacy Lekkos, C. Psych


References


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
https://doi.org/10.1176/appi.books.9780890425596 

 

Peris, T. S., Storch, E. A., & McGuire, J. F. (2020). Exposure therapy for children with anxiety and OCD: clinicians guide to integrated treatment. London: Academic Press. 


Photo by 
cottonbro from Pexels

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No matter how complex or simple it is, when you have a reason to do something, you are more likely to actually follow through with it. Remember to remind yourself why you want to focus on this area of your life. This will be particularly important when the going gets tough or if you fall victim of your previous routine way of functioning. Remember, meaningful change (in this case, sleep) does not happen overnight. Limit Blue Light Exposure Cutting out screen time before bed is one of the most effective ways to improve sleep quality. However, I’m fairly confident that most of you reading this will end the last moments of your night on a screen, whether it's a phone, computer, iPad, or the television. Throughout human evolution, humans evolved to be awake when the sun was up and to fall asleep when the sun went down. The problem with blue light specifically is that it has shown to stimulate the brain in areas that are active during alert day hours, disorienting the body’s natural preparation for sleep. Furthermore, blue light suppresses melatonin production (the hormone that makes you sleepy) and elevates cortisol (the hormone associated with stress ). Mariana Figueiro, PhD., found that two hours of screen time before bed displayed a suppression in melatonin levels in the brain (Figeuiro et. al., 2011). In fact, even when our eyes are closed, we have photo-receptors all over our skin that absorb light just as our retinas in our eyes would. Thus, having screens on anywhere around our sleeping areas is problematic. Tips to manage blue light exposure: Setting a screen time curfew Wearing blue light protective glasses Turn on blue light blockers on devices, i.e. phones and computers (f.lux and Nightshift are recommended for iOS users and Twilight for android users) Instead of watching TV, movies, or YouTube before bed, listen to a podcast or audiobook with the screen off or on sleep mode. Ensure your room is completely pitch black at night, with no lights on, curtains closed, and any technology still on should be covered. For those of you who sleep with a light on, it’s recommended to buy a red light for your bedroom. Not only do these look cool but red light on the visible light spectrum has been shown to have little to no effect on both melatonin and cortisol levels. This is hypothesized to be due to the fact that humans have evolved sleeping by fire throughout human history (Stevenson, 2016). Caffeine Consumption Before getting into what you can do to manage your caffeine consumption, let’s take a simplistic look at what caffeine actually does to the brain that impacts our sleep. During normal functioning hours, the brain slowly accumulates a chemical called adenosine that binds to receptors to slow down brain activity and make you feel tired. The longer you are awake, the more tired you feel. Where caffeine comes into play is that it is shaped very similarly to adenosine and it binds to brain receptors. When these receptors are blocked by caffeine instead of adenosine, this tricks the brain into thinking it's not tired. Caffeine has a half-life of about 6-8 hours. A standard cup of coffee has roughly 150g of caffeine in it. What this means is that after about 6-8 hours there is still about 75g of caffeine in your system. Therefore, the timing of your caffeine consumption is just as important as the quantity. With this being said, the best strategy involves setting a caffeine curfew in order to reduce the amount of caffeine in your system by bedtime. It is recommended to cut out all sources of caffeine approximately 8 hours before bed. This includes coffee, caffeinated teas, espresso, or any other source of caffeine. Change Your Mindset in Regards to Sleep Although the other two points mentioned will probably apply to most readers, this one was the most influential point towards improving my sleep. I associated sleep with a negative outlook, specifically with loss of time. I knew through research and extensive thought that if I was going to improve my quality of sleep I was going to have to change my mindset. That isn’t the easiest task, especially when you spend years of your life thinking you dislike something. Some things that I did that helped me with this was reinforcing my why . The more I thought about why I was addressing my sleep, the easier it became to desire wanting sleep. Once I slowly worked towards this, I found that my anxiety associated with loss of time began to reduce and I was able to associate sleep with a positive mindset. Meditate Mindfulness is the act of becoming aware in the present moment, without judgement. The practice of mindfulness through mindful meditation can provide an opportunity to create mental space at bedtime and to help you feel more relaxed. Mindfulness can also help you to cope with negative thoughts surrounding sleep and to help you shift your focus to your body and to be present. This technique is easily accessible by downloading free apps or using beginner guided sleep meditation videos on YouTube. Other Minor Tips to Improve Your Sleep Journaling is an excellent release before bedtime, especially if you are an over thinker. Letting out the thoughts on paper and getting them out of your head will allow you to focus more on sleep and less on what’s on your mind. Invest in a good mattress. As mentioned earlier, we are going to spend about one third of our lives sleeping so why not ensure that we get the best sleep possible? If you are not in an ideal financial situation at the moment, perhaps investing in a proper mattress isn’t realistic. For you, I suggest buying a memory foam topper or just a mattress topper. This is an inexpensive way to improve sleep quality. Sleep and wake at consistent hours. Our super complex yet lazy brain loves to work off of routines so do your brain a favour and go to bed and wake up around the same time. This will make the process easier on yourself and will make you less likely to give up from frustrations of not being able to accomplish what you set out to. Do not, and I repeat do not, do any work or eating or anything in your bed besides sleep. The brain works off of associations so don’t confuse your brain into thinking your mattress is an office, movie theater, or a kitchen table. This is just the beginning when it comes to ways to improve your sleep, as solutions often depend on one’s specific sleep challenges. However, trying any of these tips can be beneficial as improving our sleep is crucial to improving our physical and psychological well-being. Best of luck on your sleep journey and sweet dreams. Written By: Erik Michalik, M. Psy Candidate, BASc, Edited/Reviewed by : Chantal Legere, M. Psy References Figueiro MG, Wood B, Plitnick B, Rea MS. (2011) The impact of light from computer monitors on melatonin levels in college students. Neuro Endocrinol Lett .; 32(2):158-63. PMID: 21552190. Stevenson, S. (2016). Sleep smarter: 21 essential strategies to sleep your way to a better body, better health, and bigger success . New York, NY: Rodale Books. Photo by Andrea Piacquadio from Pexels
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