Phobias: what they are and how to overcome intense fears

If you are reading this, perhaps there is something you have been avoiding for a while: getting on a plane, stepping into a lift, going near a dog, seeing the doctor for fear of an injection or even leaving home without feeling your heart pound. Other people may not fully understand it, or you yourself may keep telling yourself that it is silly, that it should not affect you so much. And yet it does affect you, a great deal. We want to start by telling you something with complete honesty: what you feel is not an exaggeration or a weakness, it is a phobia, and phobias have a feature that gives a lot of hope. They are, precisely, among the psychological problems that respond best to treatment. With the right support, the intense fear that conditions you today can stop directing your life.

What a phobia is and how it differs from a normal fear

Fear is a healthy and necessary emotion. It protects us from danger, it makes us pull our hand away from the fire or look before crossing. Feeling a certain respect towards heights, some nerves before a flight or caution around an unfamiliar animal falls within what is to be expected. The problem is not fear itself, but when that fear becomes disproportionate to the real danger and starts to dictate your decisions.

We talk about a phobia when three elements come together. The first is disproportionate intensity: the alarm reaction is much greater than the situation justifies, to the point that it can be set off merely by imagining what you fear. The second is avoidance: you organise your life so as not to come across what frightens you, even if it costs you significant sacrifices. The third is interference: the phobia starts to limit your day to day, your relationships, your work or your plans. When you turn down a trip, a promotion or a medical check-up because of the fear, that fear has stopped protecting you and has started to harm you. That is the line that separates an everyday fear from a phobia that deserves attention.

The most common types of phobia

The most usual phobias are the so-called specific phobias, centred on a particular object or situation. Among those we see most frequently in the practice are:

• Fear of flying, which can prevent trips for leisure or work and cause weeks of anticipatory distress before a flight.
• Fear of heights, which appears on balconies, bridges, viewpoints or even when leaning out of a window in a high-up flat.
• Fear of animals, very often of dogs, insects, spiders, snakes or birds.
• Fear of blood, wounds or injections, with the particular feature that here blood pressure sometimes drops suddenly and dizziness or fainting can appear.
• Fear of enclosed spaces, or claustrophobia, which is triggered in lifts, tunnels, MRI scans or windowless rooms.
• Other common fears such as the fear of driving, of storms, of choking, of vomiting or of certain dental procedures.

Alongside these, there are two phobias worth naming because of their reach. Agoraphobia is the intense fear of situations from which it would be hard to escape or receive help if a panic attack appeared: public transport, crowds, queues, open spaces or, at times, being alone away from home. And social phobia is the marked fear of being judged or evaluated by others, which can turn public speaking, eating in front of people or even an everyday conversation into a source of great distress. All of them share the same emotional root and respond to the same principles of treatment.

What keeps a phobia alive

One of the questions that comes up most in the practice is why, if the danger is not real, the fear does not fade on its own over time. The answer lies in a mechanism as understandable as it is treacherous: the circle of avoidance.

When something frightens you a great deal, avoiding it produces immediate relief. That relief is so pleasant and so quick that the brain learns the wrong lesson: that avoiding is what saved you. So, each time you dodge the feared situation, you confirm to yourself that it really was dangerous and that you would not have been able to face it. The phobia is not only not cured by avoiding, it grows stronger. With each avoidance, the world narrows a little more and fear gains ground.

The same happens with what are called safety behaviours: always being accompanied, carrying an anti-anxiety pill in your bag just in case, sitting near the exit, checking a thousand times that everything is under control. They relieve in the short term, but they keep alive the idea that without them you would not manage. Understanding this circle is liberating, because it means that the phobia is sustained by something that can indeed be changed, and that is exactly where therapy works.

How your body reacts to fear

Many people with a phobia feel that their body betrays them, and it reassures them to understand what is happening inside. In the face of a threat, real or perceived, your body activates an ancient alarm response, designed to help you fight or flee. The brain gives the order and, within seconds, adrenaline is released.

From there, very recognisable sensations appear: the heart speeds up to pump more blood to the muscles, breathing becomes rapid and shallow, you sweat, you tremble, you feel a knot in your stomach, a dry mouth, dizziness or a sense of unreality. All of this is not a sign that something is wrong with you, but that your alarm system is doing its job, even though in this case it has been triggered without a real danger. Understanding that these are normal reactions, intense but harmless, and that they rise, reach a peak and come down on their own, is a huge first step towards no longer being afraid of your own sensations.

The treatment that really works

Here is the good news we announced at the start. Phobias have treatments of amply proven effectiveness, and improvements are usually clear and relatively quick compared with other psychological problems.

The approach with the greatest scientific backing is cognitive behavioural therapy. On one hand, it helps to review and loosen the catastrophic thoughts that feed the fear (that thing your mind takes for granted will happen and almost never does). On the other, and centrally, it works with gradual exposure: approaching, little by little, in a planned way and at your pace, what you fear, so that your brain checks through its own experience that it can tolerate the fear and that the catastrophe does not arrive. It is not about throwing yourself all at once into the hardest part or having a bad time for its own sake. A ladder of manageable steps is built with you, starting with what feels manageable today, always with support and with tools to regulate anxiety along the way.

At ER Psicología we also add a look at the origin. When a phobia is born of a specific experience that was recorded in a painful way (a flight with turbulence, an accident, a traumatic medical situation, a fright in childhood), we also work with EMDR, a technique aimed at processing those memories that keep setting off the alarm so that they stop carrying that charge. The combination of these approaches, adapted to your history and your pace, is what allows change to be deep and lasting. Even so, we want to be honest: therapy does not offer magic guarantees or medical promises, but it does offer a path with a great deal of evidence behind it and with results that, in the case of phobias, tend to be very encouraging.

What you can start doing yourself

While you decide to take the step of asking for help, there are things you can begin practising that add up:

• Put a name to your fear without judging yourself. Acknowledging that you have a phobia, instead of reproaching yourself that you should not feel it, already reduces part of the added suffering.
• Watch out for avoidance. Whenever you can, try not to flee completely from the feared situation and stay a little longer than the fear asks of you. No great feats are needed, small gestures are enough.
• Learn to breathe slowly. Slow breathing, lengthening the exhalation, helps your body to lower the level of alarm. Practise it when you are calm so you have it available when you need it.
• Remind yourself that anxiety comes down on its own. No episode of fear lasts forever; it rises, reaches a peak and descends even if you do nothing.
• Reduce anticipation. Dwelling for days on what you fear only trains the fear. Looking after your rest, movement and the things that do you good gives you a firmer base.

These steps are a good start, but it is important for you to know that they do not replace guided treatment. Poorly planned exposure, done alone and from a place of distress, sometimes reinforces the fear instead of reducing it. That is why professional support makes the difference.

When to ask for professional help

You do not need to hit rock bottom to deserve help. If you notice that fear conditions your decisions, that you avoid more and more situations, that you give up on plans, trips, opportunities or health care because of it, or that anticipatory anxiety takes up too much of your time and energy, it is a good time to consult. Also if you have lived with the phobia for years and have come to accept it as part of your life: having got used to it does not mean it has to stay that way.

Asking for help is not giving up, it is stopping fighting alone a battle that is won much better with company. And in the case of phobias, that support usually translates into changes that surprise many people by how achievable they turn out to be.

If you would like to keep reading, we recommend our article on panic attacks and the information about our therapy for anxiety and stress.

If fear has been deciding for you for some time, we would love to accompany you in reclaiming that space. At ER Psicología, Emiliana and Raquel work calmly, without rushing and at your pace, at our practice in Tres Cantos and Colmenar Viejo or online. You can book a first appointment with no obligation to tell us what is happening to you and to see together how to start letting go of that weight. There is still time for things to be different.