Many of us experience fears that seem irrational yet evoke intense anxiety. Over time, I have had the chance to help clients with their fear of heights, dogs, and anxious thoughts about germs/contamination that precede compulsive behaviors like chronic handwashing. One of my favorite things to do is to explain how treatment for phobias is structured simply because it is a fine balance between using a standard framework but tailoring it for the unique needs of each client. In this post, I will attempt to explain the main approaches I use in treatment of phobias/fears and how I tailor to not only each client, but also to teletherapy platforms.

The NIMH (National Institute of Mental Health) defines specific phobias as such fears—like heights, spiders, or flying—that can disrupt daily life. Even though adults may recognize these fears as exaggerated, the mere thought or encounter with the feared object can lead to debilitating symptoms such as anxiety, sleeplessness, and even avoidance behaviors affecting work, school, and relationships.

Effective Treatment Approaches

Exposure therapy, often combined with Cognitive Behavioral Therapy (CBT), stands as a cornerstone in treating specific phobias. For instance, in the case of aviophobia (fear of flying), exposure therapy involves gradually confronting feared stimuli, like airports or airplane sounds, under therapist guidance. Here’s how exposure therapy can be structured:

Creating a Fear Hierarchy: Therapists and clients collaborate to list scenarios related to flying, starting from the least distressing (e.g., looking at pictures of airplanes) to the most challenging (e.g., taking a short flight).
Subjective Units of Distress (SUDs) Scores: Items on this hierarchy are then rated from a 0-100 of how much anxiety is experienced. So looking at pictures of airplanes may score 10, going to the airport may score 25, and taking a flight and experiencing turbulence would be at 100 on the scale. Clients slowly work to confront their least to most anxiety-inducing scenarios while learning relaxation and exploring negative cognitions with the clinician. While some of these scenarios like listening to airplane sounds can be done in session, others like visiting an airport or taking a flight may be assigned as “homework” between sessions where the client reflects on how they navigated the task and what improvements can be made to lessen their struggles in the following session.
Cognitive Behavioral Therapy (CBT): CBT targets underlying thought patterns contributing to phobias and works in parallel to exposure. For example, someone with a fear of flying might uncover deeper anxieties about safety or control. By identifying and challenging these beliefs, CBT aims to reshape negative behaviors and replace short-term coping strategies such as taking medications with sustainable techniques like engaging in calming activities during flights.
Learning Relaxation Techniques: Clients practice methods such as progressive muscle relaxation and deep breathing to manage anxiety during exposure exercises. These techniques help in breaking the anxiety cycle associated with phobias and foster positive associations with feared stimuli. Relaxing activities like exercise before flying, stretching, crocheting, and painting are skills that can be explored.

Teletherapy Adaptations

In teletherapy, treatment protocols remain consistent albeit with adjustments for the digital platform. For clients with aviophobia, therapists might use virtual tools like airplane sounds or videos of pilots to simulate flight experiences. Teletherapy's reliance on visual cues limits a therapist's ability to observe non-verbal signs fully, so establishing a comfortable environment is crucial; clients are encouraged to find a private space where they feel safe to practice exposure exercises. Open communication with the therapist is key, signaling when they feel overwhelmed and enlisting support from a trusted companion post-session if needed. If clients feel comfortable and want, therapists may even encourage them to invite a trusted companion to some more challenging sessions so they are able to feel more connected in their presence to engage in exposure activities in a safe environment.

Enhancing Therapeutic Outcomes

Despite the limitations of teletherapy in observing non-verbal cues fully, therapists employ strategies to compensate: therapists may ask clients to adjust their camera settings for better observation of nonverbals or inquire about physical manifestations of anxiety. Additionally, therapists may integrate expressive arts therapies, such as drawing or narrative rewriting, to complement traditional techniques and broaden therapeutic outcomes.

Conclusion

While teletherapy alters the dynamics of traditional face-to-face sessions, it offers effective treatment options that accommodate clients' comfort and accessibility needs. Whether in-person or virtual, the goal remains to empower clients in managing and overcoming specific phobias within their preferred environment. If you're struggling with a specific phobia like fear of flying, these therapeutic approaches can provide structured steps towards reclaiming control and alleviating anxiety.

If you are actively experiencing fear and anxiety, seeking professional guidance ensures personalized strategies tailored to your needs. At Safe Space Counseling Services, experienced clinicians can work with you to help understand how your fears manifest and create goals to help conquer them to improve your quality of life.