What Treatments are available?
If you want treatment for your phobia, the first place to go is normally your family doctor. They can provide an assessment and explain what treatments are available. If you find it hard to get to the family doctor for an appointment, they should also be able to provide an assessment over the phone or in writing.
Your family doctor should explain all of your options to you, and your views should be taken into account before starting any treatment.
There are different types of talking treatments that may be offered to treat a phobia. Some phobias, such as a fear of flying or driving, are so common that there are therapists who specialise in treating them. Your family doctor should be able to explain what options are available and may refer you for treatment.
Cognitive behaviour therapy
Cognitive behaviour therapy (CBT) aims to identify connections between thoughts, feelings and behaviour, and to help develop practical skills to manage any patterns that might be causing you problems. (See Mind’s booklet Making sense of cognitive behaviour therapy for more information.)
When CBT is used to treat phobias, it should include a range of different techniques, including a technique called exposure therapy (or desensitisation). Exposure therapy involves gradually exposing you, in a safe and controlled way, to the object or situation that you fear. For example, if you have a phobia of going to the dentist, you might read about the dentist, then look at a picture of a dentist’s chair, sit in the waiting room and talk to the dentist, before finally sitting in the dentist’s chair.
“I have been helped by a course of CBT. We looked at the circle of fear and did exercises to combat the fear… I’m not cured by any stretch of the imagination but I’m definitely better than I was. I only wish I’d done it sooner!”
Through repeated experiences of facing your fear, you feel an increasing sense of control over your phobia.
“I used to be scared to pick up the phone and go shopping alone, but practice helped and boosted my confidence.”
This technique needs to be carefully managed to avoid causing distress and anxiety, so it is important that you understand the treatment fully and feel comfortable with your therapist.
You may also be offered a programme of CBT using a workbook or a computer, which you can follow either by yourself or alongside sessions with a therapist. This might be particularly helpful if you experience social phobia, telephone phobia or agoraphobia, as you can complete the therapy in your own home.
Many people who have phobias find hypnotherapy helpful for relieving their symptoms.
If your phobia causes significant anxiety, you may be offered medication to help you deal with this. Currently, there are three classes of drugs considered useful in managing anxiety. These are:
- tranquillisers (benzodiazepines)
The most commonly prescribed drugs are selective serotonin reuptake inhibitor (SSRI) antidepressants, such as paroxetine (Seroxat), citalopram (Cipramil) and escitalopram (Cipralex). These drugs can be helpful, but may also have side effects that include sleep problems and increased anxiety. If SSRIs do not work or are not suitable, you may be offered a tricyclic antidepressant, such as imipramine HcI or clomipramine.
If you have social phobia, you may be offered the reversible MAOI (monoamine oxidase inhibitor) antidepressant, moclobemide (Manerix). MAOI antidepressants interact dangerously with certain foods, and a warning about which foods to avoid is given with the drugs in the Patient Information Leaflet (PIL).
All of these drugs may take several weeks to work. They may also cause side effects, which your family doctor should discuss with you. When you stop taking the drugs, you may experience withdrawal symptoms, such as dizziness, tingling, an upset stomach or headaches. It is therefore important to reduce the dose slowly.
If you experience very severe anxiety that is having a significant impact on your day-to-day life, you may be offered a benzodiazepine tranquilliser, such as diazepam (Valium), to reduce anxiety. Benzodiazepines can be addictive, so they should be taken at a low dose and for a short period of time, preferably as a one-off dose and for no longer than four weeks. (See Mind’s online booklet Making sense of sleeping pills and minor tranquillisers for more information.)
Beta-blockers, such as propranolol, are sometimes used to treat the physical symptoms of anxiety, such as a rapid heartbeat, palpitations and a tremor (shaking). However, they are not psychiatric drugs, so they do not reduce any of the psychological symptoms. They may be helpful in certain situations if you have to face a phobia, such as going on an aeroplane. Beta-blockers can cause side effects, such as sleep problems and nightmares, but they do not have withdrawal symptoms and are not addictive. Because of the effects they have on the heart and blood pressure, you should stop taking them gradually, by slowly reducing the dose.