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Phobias

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A Self Help Guide

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Phobias

- Do you have an intense fear of a particular object, situation or animal?

- Do you go to great lengths to avoid an object, situation or animal?

- When confronted with an object, situation or animal do you feel anxious, nervous or panicky?

If the answer to any of these questions is ‘yes,’ you may suffer from a phobia.

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- recognise whether you suffer from a phobia.

- understand what a phobia is, what can cause it and what can keep it going.

- find ways to overcome your phobia.

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Do I suffer from a phobia?

If you suffer from a phobia it is likely that you experience some of the symptoms described below.

Please tick the boxes which apply to you*

How do you react to your suspected phobia?

You avoid coming into contact with your phobia wherever possible (i.e. take a different route to work to avoid crossing a high bridge).a spacer image
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You use ‘safety behaviours’ to cope with your phobia (i.e. only leave the house if you have had a glass of wine to boost your confidence).a spacer image
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If you do come into contact with your phobia you are extremely uncomfortable.a spacer image
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What happens to your body when you think of, or come into contact with your phobia?

Heart racesa spacer image
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Sweat a spacer image
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Chest feels tight or painful a spacer image
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Body feels tense a spacer image
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Tingling or numbness in toes and/or fingers a spacer image
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Breathing changes a spacer image
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Dizzinessa spacer image
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Stomach churns or ‘butterflies’a spacer image
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Feel nauseous a spacer image
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Feel restlessa spacer image
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What thoughts do you commonly have when confronted with your phobia?

“I will come to harm.” a spacer image
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“I can’t cope with this anxiety.” a spacer image
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“I will have a heart attack.” a spacer image
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“I will go mad.” a spacer image
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“I will faint.” a spacer image
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“No-one else has these problems.” a spacer image
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“I only coped because my friend was with me.”a spacer image
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“If I hadn’t avoided my phobia disaster would have struck.”a spacer image
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* If you have ticked some of these boxes it is possible that you suffer from a phobia. However don’t be alarmed, this is a common problem and can often be overcome. By following the steps in this workbook, you can learn how to overcome your phobia.

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What are phobias?

Virtually all of us are afraid of something despite being aware that, in reality, it actually causes us very little threat. Common fears include insects, heights, closed/small spaces, busy environments, rodents, and needles; although we can develop fears about almost anything.

However, for many people this apprehension can be so intense that they live in fear of coming into contact with a certain item. People often go to the extreme lengths of changing their lifestyles to avoid coming into contact with their feared item (e.g. they may take a longer route to work to avoid crossing a bridge). Often, people’s minds go into ‘overdrive’ and they are flooded with negative and frightening thoughts (e.g. “this is extremely dangerous;” “I cannot cope with this”). When a fear is this intense, it is often described as a phobia.

When confronted by their phobia, people feel extremely anxious and, as a result, experience some uncomfortable bodily sensations. Sometimes even the thought of a particular item is enough to provoke an anxious response. People often describe being aware that their phobia can cause them very little harm (i.e. a house spider) however still find it very difficult to overcome their fear.


Summary

Phobia is the word used to describe an intense fear of an object, situation or animal. Although we all have fears surrounding certain items, people with phobias are more significantly affected. For instance, they often change their lifestyle to ensure they can avoid their phobic items. They also experience a variety of anxiety-based body sensations when faced with their phobias which can be frightening in themselves.

The next section will discuss how phobias develop and why, if untreated, they are difficult to overcome.

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How do phobias develop?

Most phobias develop in childhood; however they can also develop when we are adults. There are several theories which attempt to explain why we acquire phobias. Some of these can be found below.


Preparedness

Many phobias develop more commonly around certain objects, situations, or animals, than others. For instance, many people are afraid of heights, blood, enclosed spaces, dogs, spiders or rodents.

Because of this, it is argued that we may be biologically programmed, or primed, to fear specific items over others. This is because it would have perhaps been to our advantage in the past to fear certain animals such as rodents (because they can carry and spread germs), heights (which can obviously be dangerous), and blood (again as injuries can obviously be dangerous).


Learned response

Another theory suggests that we acquire phobias through simple learning mechanisms. For instance, if a young child touched a hot oven door, the pain from this experience would quickly teach them that oven doors are dangerous and should be avoided. Similarly, it may be that items which once posed us no fear (i.e. dogs) were influenced in a similar way and we subsequently learnt to fear and avoid them.

It has also been suggested that we can learn to fear specific objects, animals or situations by simply observing others’ negative reactions towards them, or by reading negative or frightening stories in newspapers or magazines.


Negative interpretations

It has also been suggested that those who suffer from phobias are more likely to overestimate the danger of a certain object, animal or situation, and underestimate their ability to cope with it, than those who do not suffer from a phobia.

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What prevents us from overcoming our phobias?

Avoidance

Once phobias develop they can be difficult to overcome if left untreated. This is because when we develop a fear of a certain item; we typically avoid coming into contact with it at all costs.

This avoidance prevents us from learning that our phobias may not be as frightening or dangerous as we think. It also prevents us from proving to ourselves that we can indeed cope when confronted by our phobia if we give ourselves the opportunity to do so.

In addition, the relief we feel each time we avoid our phobia, simply encourages us to continue to avoid it again in the future as we know it is a strategy which works in the short term. Unfortunately, it also makes it much more difficult to face our phobia in the future. This is because the longer we have been afraid of an item and avoided it, the more daunting it seems.

Safety behaviours

Often, the only time that someone with a phobia feels capable of facing it, is when they use what is known as a ‘safety behaviour.’ An example of a safety behaviour would be - only ever attempting to walk over a bridge if you are tightly gripping a friend or relatives arm. Another example may be - only travelling on public transport at very quiet times of the day.

Like avoidance, this prevents us from having the opportunity to prove to ourselves that we can cope with our phobia by ourselves, without putting precautions into place. Instead we put down our successes to other factors, such as “I only achieved that because my friend accompanied me” and our fears remain in place.

Unhelpful thoughts

People’s unhelpful thoughts and predictions can often make it more difficult for them to overcome their phobia. As discussed above, people with phobias often underestimate their ability to cope with anxiety which makes it very difficult for them to face and overcome their fear (i.e. “I will be unable to cope and pass out if I get into that lift”).

Similarly, phobia sufferers often overestimate the likelihood of a negative event occurring if they did come into contact with their phobia. Again, this encourages them to avoid it and prevents them overcoming their fear (i.e. “I will get trapped in this lift and run out of air”).

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Vicious cycle

Often a combination of people’s thoughts, physiological symptoms and behaviour result in a vicious cycle which makes it difficult for them to overcome their phobia. See the example below:

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Summary

Various theories have attempted to explain why phobias develop and how they are maintained. A popular view is that we are biologically programmed to fear specific objects, animals, or situations due to the benefit it would have provided us with in the past. However, it is also possible that we have learnt through previous experiences of our own, or others, to fear and avoid certain items.

People with phobias often underestimate their ability to cope with their phobia, and overestimate the danger that it poses. These unhelpful thinking patterns make it difficult for them to confront their fears and overcome them.

To cope with phobias, people often avoid their feared item, or adopt safety behaviours when encountering them. This makes it difficult for them to learn that they can cope when confronted by their phobia and that it is not as dangerous as they think. This creates a vicious cycle as the longer we avoid something, the more frightening it seems and the more difficult it is to face it the next time.

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How can I overcome my phobia?

Pleasingly, there are a number of strategies that we can use to overcome our phobias. These include:

  1. Understanding more about the nature of anxiety and why it is not to be feared.

  2. Challenging our unhelpful thoughts about our ability to cope with our phobia.

  3. Tackling avoidance and safety behaviours.

  4. Tackling the physiological symptoms of anxiety.


1 - Understanding anxiety

Everyone experiences anxiety throughout certain times in their lives. Some people experience it everyday, while others do so less often. Anxiety is the feeling we get when our body responds to a frightening or threatening experience. It has been called the ‘fight or flight’ response and is simply our bodies’ way of preparing for action (i.e. to fight danger or run away from it as fast as possible). The purpose of the physical symptoms of anxiety are therefore to prepare our bodies to cope with threat.

To understand what is happening in your body, imagine that you are about to be attacked. As soon as you are aware of the threat, your muscles tense and become ready for action. Meanwhile your heart beats faster to carry blood to your muscles and brain, where it is most needed. You also breathe faster to provide oxygen which is needed for energy and you sweat to stop your body overheating. When you realise that the ‘attacker’ is in fact a friend, the feelings die away, but you may feel shaky and weak after the experience. The physical symptoms of anxiety are therefore aimed towards protecting us and should not be feared.

This fight or flight response is a really basic system that likely goes back to the days of cave men and is present in animals who depend on it for their survival. Fortunately, nowadays we are not often in such life or death situations, but unfortunately many of the stresses we do face can't be fought or run away from, so the symptoms don't always help. Present day situations which typically result in this response include job interviews, giving presentations, important sporting events, or even when confronted by our phobias.

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Although anxiety can feel unpleasant at times it can also actually be a positive thing. It can provide athletes with extra energy before sporting events or give us the adrenaline to perform to the best of our ability in exams. Therefore if you feel anxious, do not worry, as it is a normal bodily reaction that we all experience at some point, and worrying about anxiety will only tend to keep you feeling anxious for longer.

By understanding the nature of anxiety and learning that it is a natural bodily reaction that is not dangerous, we can become less fearful of experiencing it. This, in turn, allows us to gradually confront our phobias and give ourselves the opportunity to learn that they are not as dangerous or frightening as we thought.


NOTE: Those who suffer from a blood, injury, hospital, or needle phobia often experience slightly different physiological symptoms to those discussed above. More specifically, instead of their heart rate increasing when they come into contact with their phobia, it can actually slow down. This results in less blood being pumped around the body and as a result people can often feel dizzy or light headed.

To help in this situation, you can simply tense and relax the muscles in various areas of our body (i.e. open and close your fists tightly) to ensure the rate of blood flow is kept closer to its optimum level. By completing this task for a few minutes, the feeling should soon dissolve.


Summary

Anxiety is an unpleasant feeling which everyone experiences on occasion. Anxiety increases our energy levels so that we can deal more effectively with potentially difficult or dangerous situations by either running away or staying to fight. Nowadays, we are not often confronted by situations that require us to run or fight, however other stressful situations trigger a similar anxiety response. Although anxiety feels uncomfortable, it is a natural bodily reaction and should not be feared. In fact, on occasion anxiety can actually be helpful. This information can help you to fear anxiety less and this alone can help it to pass more quickly. It can also give you the confidence to confront your phobia, despite the anxiety this causes you, so that you can learn that it is not to be feared. This will be discussed further later on.

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2 - Challenging our unhelpful thoughts about phobias

When feeling calm and at ease, those with phobias can often see that their feared item actually poses little harm or threat. Unfortunately, when confronted by their phobias, these rationale thoughts evaporate and are replaced by contradictory ones. People have a tendency to overestimate the danger or threat posed by their phobia which makes it difficult for them to face it and learn that they can cope when confronted by it.

Examples of such unhelpful thoughts are:

- “This lift could crash to the floor”
- “What if this lift breaks down and traps me inside until I run out of air”
- “This injection could go wrong and be really painful”
- “What if that dog jumps over the fence and bites me”
- “I could crash the car”
- “This aeroplane will crash”

Additionally, people often underestimate their ability to cope with the anxiety they feel when faced by their phobia. This, again, prevents them from confronting their phobias for long enough to learn that they are not as harmful as previously thought.

Examples of such unhelpful thoughts are:

- “Anxiety is dangerous”
- “I could have a heart attack”
- “This anxiety is going to become too much for me”
- “I cannot tolerate this anxiety”
- “I am going to faint”

In the box below note any unhelpful thoughts that you make when confronted by your phobia.

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Categories of unhelpful thoughts

Many of our unhelpful thoughts like those discussed above fall under the following categories:


- Fortune telling: you predict the future negatively (i.e. “I know this lift will crash;” “I am going to have a car crash;” “I will definitely faint when I see the needle”).

- Negative filtering: you focus solely on information which confirms that your phobia is dangerous and ignore contradictory evidence (i.e. “I heard of a lift becoming jammed in the shopping centre 2 years ago” – despite it working perfectly every time you have walked past it since).

- What if questions: your mind searches for danger and you ask yourself questions such as, “what if the bus gets very busy and I cannot cope.”

- Over generalising: based on one incident you assume that all others will follow a similar pattern (i.e. “The neighbour’s dog snarled at me – they are all vicious!”).


Do your unhelpful thoughts fall into any of these categories? Note down examples in the table below.

Unhelpful thoughtCategory
i.e. “I’ll need several fillings if I go for my dental check-up!”Fortune telling

Pleasingly, we can learn to challenge these unhelpful thoughts which can go some way to reducing our fear to face our phobias. The next part of this handout will discuss how we can go about challenging our unhelpful thoughts and begin to see things in a more accurate light. This technique should help you when you come to the following section – reducing avoidance and safety behaviours.

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Challenging your negative thoughts

Once you have recognised a negative thought the next stage is to challenge it. To do this you can ask yourself the questions listed below:


Negative thought: “The lift will break down and I’ll get trapped and suffocate.”


Is there any evidence that contradicts this thought?

- “I see many people using the lift when I am in the shopping centre and it has never broken down.”

- “I cannot remember ever hearing of anyone dying from suffocation in a lift.”

- “I have never actually been in a lift that has broken down.”

- “There are air vents in a lift which will stop the air running out.”

Could you do anything to resolve this situation if it does occur?

- “I guess I could press the alarm button or use the telephone to call for assistance.”

Are you making a thinking error?

-“Yes. I guess I’m fortune telling, as I have no evidence to suggest that the lift will break down.”

What would you say to a friend who has this fear?

- “I would probably say that the chances of it happening are very slim as you don’t see or hear about it very often.”

What are the costs and benefits of thinking in this way?

- Benefits: - “I can’t really think of any to be honest.”

- Costs: - “It makes me anxious whenever I think about lifts.”

               - “Well I guess it disables me to a degree as I have to walk up                  many flights of stairs with heavy bags of shopping whilst my                  neighbours all take the lift.”

               - “It prevents me from challenging my fear and overcoming it.”

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Once you have asked yourself these questions, why not read through your answers again and see if you can reappraise your negative thought and come up with a more balanced or rationale view.

i.e. “it is unlikely that the lift will break down and if it does I will be able to raise the alarm and ask for help.”


Although you may still feel anxious about facing your phobia, challenging your unhelpful thoughts in this way can help to improve your confidence to give it a go. However, remember that any anxiety you feel when you do so is a normal bodily reaction that will pass in time.


Use the following section to challenge your thoughts in a similar way. It may help to weaken your fears and give you extra confidence that you can face your phobia and learn to overcome it. Section 3 will discuss the techniques you can use to gradually confront your phobia in more detail.


Negative thought(s)

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Is there any evidence that contradicts this thought?

Can I do anything to resolve this situation if it does occur?

Am I making a thinking error?

What would you say to a friend who has this fear?

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What are the costs and benefits of thinking in this way?
CostsBenefits

Once you have asked yourself these questions, why not read through your answers again and see if you can reappraise your negative thought and come up with a more balanced or rationale view.


Summary

People often overestimate the danger posed by their phobia and underestimate their ability to cope with it. Unhelpful thoughts pop into their heads whenever they are faced by their phobia which makes it difficult for them to confront it and overcome their fear. You can learn to challenge unhelpful thoughts however by asking yourself the questions listed above which should help you to produce a more realistic or balanced view of the situation. This can help you to be more confident to face your phobia and learn that it is not as dangerous as you thought. The next section will discuss this in more detail.

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3 – Reducing avoidance and safety behaviours

As discussed above, the most significant factor that prevents us overcoming our phobias is our use of avoidance and safety behaviours. Avoidance and safety behaviours prevent us from learning that we can cope when confronted with our phobias and that they are not as dangerous as previously thought. Therefore the best way for us to overcome our phobias is to gradually confront them.

Although confronting your phobia may sound daunting at first, it has been shown to be the most effective way of overcoming your fear. This is because when you remain in an anxiety provoking situation for long enough, you become ‘used to’ the situation and eventually your anxiety begins to fall.

For instance, do you remember ever being nervous before starting a new job or a college course? Normally in these situations, before you arrive, it is common to feel very anxious. However, once you arrive you soon begin to feel more comfortable and relaxed as time passes. Not only this, but as each day passes in your new surroundings you begin to feel less and less nervous.

The same is true for when you confront your phobia. Although your anxiety may be high beforehand and initially rise when you confront it, this will soon begin to drop if you remain in the situation for long enough. More importantly, each time you expose yourself to your phobia, the initial anxiety you experience and the length of time it takes for your anxiety to pass will also decrease, just as it would as each day passed in a new job. Soon you should be able to confront your phobia and feel minimal or no fear at all.

Create an exposure hierarchy - brainstorming

As exposing yourself to your phobia can seem daunting at first, it can be helpful to create an 'exposure hierarchy' to make things easier for yourself. This involves breaking down the situations you fear/avoid into small steps that you can gradually work your way through.

The first thing you need to do to create a hierarchy is list all the situations and scenarios related to your phobia that cause you anxiety. To help you do this, consider:

- all the situations that you avoid.
- all the situations that you confront with the aid of a safety behaviour   (e.g. you would only cross a bridge if you had a friend with you)
- all the situations that you confront whilst experiencing anxiety.
- what aspects of your phobia are more anxiety provoking than others   (i.e. is one species of dog more frightening than another)?

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The situations that you list are likely to cause you varying degrees of anxiety (i.e. some will be more daunting than others). However this is very helpful for the next stage. Before listing items to place on your hierarchy, it may be useful to look at the example below which could be used for someone with a phobia of dogs.

Being left alone with a dog off its lead.
Looking at a video clip of a large dog.
Visiting a friend who has a dog on a lead.
Looking at a picture of a puppy.
Playing fetch with a dog.
Looking at a picture of a snarling dog.
Staying in the room with a dog off its lead.
Seeing a video clip of a puppy.
Touching a dog whilst it is on a lead.
Walking past a nearby garden with a dog behind a fence.
Looking at a picture of a large dog.


See if you can create a similar list below. Try to include items of various degrees of intensity (i.e. choose some very anxiety provoking items, some moderately anxiety provoking items and some minimally anxiety provoking items). Try to come up with around 10 items.

If you are struggling to come up with items to place on your hierarchy, why not ask a friend or family member to help you out. They may have some good ideas that you have not considered.
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Create an exposure hierarchy – finalising your hierarchy

Once you have listed all the items to include on your hierarchy, the next step is to rank them in order of least anxiety provoking to most anxiety provoking. To help you do this, try predicting how anxious you believe each item would make you feel on a scale of 0-100 (where 0 = no anxiety and 100 = extreme anxiety). Once you have rated each item, all you have to do is place them in order of least anxiety provoking to most anxiety provoking.

See the example below.

Hierarchy itemsPredicted anxiety levels (0-100)
  1. Looking at a picture of a puppy.
  2. Looking at a picture of a large dog.
  3. Looking at a picture of a snarling dog.
  4. Looking at a video clip of a puppy.
  5. Looking at a video clip of a large dog.
  6. Walking past a garden with a dog behind a fence.
  7. Visiting a friend who has a dog on a lead.
  8. Touching a dog whilst it is on a lead.
  9. Staying in a room with a dog off its lead.
  10. Being left alone with a dog off its lead.
  11. Playing fetch with a dog.
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30
40
45
50
60
70
75
80
85
90


Now try to finalise your hierarchy in a similar way.

Hierarchy itemsPredicted anxiety levels (0-100)

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Confronting the items on your hierarchy

STEP 1: Once you have finalised your hierarchy, the next step is to confront the first item on it. This should be the item that you predict will cause you the least amount of anxiety from your list.

It is important that when exposing yourself to this item, you remain in the situation until your anxiety has reduced by at least half. For instance, if your anxiety initially rises to 30 out of 100, make sure you remain in that situation until your anxiety reduces to at least 15 out of 100.

Why not create a diary like the example below to chart your progress for each item on your hierarchy.

Exposure task 1: Looking at a picture of a puppy

Attempt 1
Attempt 2
Attempt 3
Attempt 4
Attempt 5
Attempt 6
Attempt 7
Attempt 8
Attempt 9
Minutes
into task
Anxiety
(0-100)
Anxiety
(0-100)
Anxiety
(0-100)
Anxiety
(0-100)
Anxiety
(0-100)
Anxiety
(0-100)
Anxiety
(0-100)
Anxiety
(0-100)
Anxiety
(0-100)
Start
55
45
25
5
55
35
20
10
50
30
10
15
45
20
10
20
45
15
0
25
35
10
30
35
10
35
25
0
40
15
45
0
50
55
60
65
70
75
80


NOTE: The amount of time it will take for your anxiety to reduce may vary. You may even surprise yourself and learn that when you actually confront items on your hierarchy, they are not as anxiety provoking as you predicted and your anxiety may reduce quickly. However for other items you may have to expose yourself for around 45 minutes or more before your anxiety falls. Remember to be patient, if you remain in the situation for long enough, your anxiety will fall.
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STEP 2: Once you have completed your exposure task once, the next step is to do so again, over and over, as often as possible, until the item no longer makes you feel anxious. Only then should you move onto the next item on your hierarchy. As a rule of thumb, try to ensure that you engage in your exposure task at least once everyday. Remember that the more often you expose yourself to the item on your hierarchy, the quicker you will overcome your fear.


STEP 3: Once you have overcome your fear towards the first item on your hierarchy, you should then move onto the next item and complete steps 1 and 2 again. Continue through your hierarchy in this manner until you have reached the top and overcome your fear!


NOTE: Remember that as you progress through each stage of your hierarchy, your confidence will begin to grow. This should mean that items that are higher on your hierarchy, which seemed very daunting at first, will be less frightening when you actually come to face them because of your previous achievements. It may help to imagine your hierarchy as a ladder and with each step up a rung you are gradually moving towards the top.
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Handy Hints

- Why not challenge your fears, as discussed in the section above, before and during exposure tasks. Identify what you fear may happen during your exposure task and see if you can challenge these and view things in a different light. This can help to give you extra confidence to face and overcome each step on your hierarchy.

- Remember that the more often you expose yourself to items on your hierarchy, the quicker your fear will reduce.

- Ensure that you engage in your exposure task until your anxiety drops by at least half.

- If an exposure task on your hierarchy seems too daunting, see if you can put in an extra step or two before it, to allow your confidence to grow further before facing it.

- Remember that anxiety is a normal physiological reaction that we all experience at certain times. Although it is uncomfortable, it is not dangerous and should not be feared.

- Remove all safety behaviours during your exposure tasks. They prevent you from fully exposing yourself to your fear and learning that you can cope without them.

- Reward yourself after each exposure task and also when you overcome each step on your hierarchy (i.e. buy yourself a treat). This can give you something to focus on and work towards.


Trouble shooting

If you find that your anxiety is not reducing during exposure, ask yourself the following:

- are you engaging in safety behaviours which are preventing you from fully exposing yourself to your fear (i.e. walking over a bridge but only with your eyes closed whilst holding onto a friends arm)?

- are you exposing yourself long enough to your phobia? Remember it can sometimes take 45 minutes or more until your anxiety begins to drop.

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Summary

The best way to overcome you phobia is to begin to confront it in small steps using an exposure hierarchy. This gives you the chance to learn that your phobia is not as frightening as you once thought. It is important to remember that each time you expose yourself to an item on your hierarchy; the anxiety you feel towards it will begin to reduce until you feel little or no fear towards it. Remember - the more often you expose yourself to your phobia, the quicker your fear will diminish!


4. Tackling the physiological symptoms of anxiety

When faced by our phobias, we normally experience a variety of uncomfortable physiological sensations that can sometimes be frightening in themselves. However, you can become more confident in your ability to tolerate these uncomfortable symptoms by regularly practicing relaxation exercises. This is because relaxation exercises can improve our ability to control and reduce many of these sensations.

However, it is important not to use relaxation exercises during exposure tasks. Although this may seem illogical at first, when examining it closely it begins to make more sense. Remember, the purpose of regularly exposing ourselves to our phobia is to allow us to become ‘used to’ the anxiety that we experience until it eventually disappears altogether. By engaging in relaxation exercises during exposure tasks we would be preventing ourselves from fully experiencing the anxiety that we need to expose ourselves too in order to overcome our phobias. In a way it would be like exposing ourselves to our phobia whilst using a safety behaviour, which we know from earlier pages, actually slows down the process of overcoming our phobias. The purpose of learning relaxation exercises is actually to make you feel generally more confident in your ability to tolerate and control anxiety. This should make you feel more confident to face the anxiety provoking items on your hierarchy.


NOTE: Not only can relaxation exercises help you to overcome your phobia, you can also use them to help you cope more effectively with other stressors in your daily life (i.e. workplace stress, relationship difficulties or financial pressures). This is because relaxation exercises can be used to help you feel more relaxed in general, at any time throughout the day. This is because having a relaxed body can influence your mind to feel more relaxed, just as an anxious mind often causes you to have a tense body.

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Muscular relaxation exercises

The following exercise describes muscular relaxation which teaches you to recognise and reduce the tension we experience when we are anxious.

At first, it may be helpful to read the instructions as you go through the task until you gradually learn them over time.

- Start by selecting a warm, comfortable place where you won't be disturbed. To begin with, choose a time of day when you feel most relaxed.

- Lie down, get comfortable and close your eyes.

- Concentrate on your breathing for a few minutes, breathing slowly and calmly: in two-three and out two-three. Say the words "calm" or "relax" to yourself as you breathe out. The relaxation exercise takes you through different muscle groups, teaching you firstly to tense and then relax. You should breathe in when tensing and breathe out when you relax.

- Starting with your hands, clench one fist (but not too tightly). Think about the tension this produces in the muscles of your hand and forearm. Study the tension for a few seconds and then relax your hand. Notice the difference between the tension and the relaxation. You might feel a slight tingling. This is the relaxation beginning to develop.

- Do the same with the other hand.

- Each time you relax a group of muscles think how they feel when they're relaxed. Don't try to relax, just let go of the tension. Allow your muscles to relax as much as you can. Think about the difference in the way they feel when they're relaxed and when they're tense.

- Now do the same for the other muscles of your body. Each time tense them for a few seconds and then relax. Study the way they feel and then let go of the tension in them.

It is useful to stick to the same order as you work through the muscle groups:

· Hands - clench first and then relax.

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· Arms - bend your elbows and tense your arms. Feel the tension especially in your upper arms. Remember, do this for a few seconds and then relax.

· Neck - press your head back and roll it from side to side slowly. Feel how the tension moves. Then bring your head forward into a comfortable position.

· Face - there are several muscles here, but it is enough to think about your forehead and jaw. First lower your eyebrows in a frown and then relax your forehead. You can also raise your eyebrows, and then relax. Now, clench your jaw, notice the difference when you relax.

· Chest - take a deep breath, hold it for a few seconds whilst noticing the tension and then relax. Let your breathing return to normal.

· Stomach - tense your stomach muscles as tight as you can and relax.

· Buttocks - squeeze your buttocks together and relax.

· Legs - straighten your legs and bend your feet towards your face.

· Finish by wiggling your toes.

NOTE: You may find it helpful to get a friend to read the instructions to you or record the instructions on a tape or CD. Remember; don't try too hard, just let it happen.
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Use the relaxation chart below each time you practice relaxation exercises to monitor your progress. Rate your relaxation levels at the beginning and end of each exercise on a scale between 0-100, where 100 is very anxious and tense, and 0 is very calm and relaxed.

Attempt Number
Relaxation level before 0-100
Relaxation level after 0-100
Attempt number
Relaxation level before 0-100
Relaxation level after 0-100
i.e. 18060
i.e. 28050
i.e. 37030

NOTE: Remember that relaxation is a skill, and like all skills, takes time and practice before you can master it. To make the best use of relaxation you should practice daily.

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Rapid relaxation

Once you feel you can become relaxed by following this exercise at home in a comfortable place, you are ready for the next stage. This involves going through each of the muscle groups listed above and simply trying to relax them without tensing your muscles first. Remember to keep your breathing at a slow and constant pace throughout. This exercise should allow you to become relaxed more quickly. Again, try using the relaxation chart to monitor your progress.

Attempt Number
Relaxation level before 0-100
Relaxation level after 0-100
Attempt number
Relaxation level before 0-100
Relaxation level after 0-100

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Controlled breathing

Often when people become anxious, changes in their breathing occurs. For instance, they can begin to gulp air, or breathe very quickly and shallowly. This has the effect of making them feel dizzy and often more anxious.

We begin to feel dizzy because when our breathing pattern changes, the amount of oxygen and carbon dioxide within our body is affected. This is because we breathe in oxygen and breathe out carbon dioxide. As a result, the levels of carbon dioxide and oxygen within our bodies are not at their optimum levels. It is because of this imbalance that we begin to feel dizzy or light headed. However don’t be alarmed if you notice yourself over breathing or feeling light headed as this can be easily corrected and poses no long term threat.

If you notice yourself doing this, you simply have to slow your breathing down. Get into a rhythm of in two-three, out two-three and your breathing will soon return to normal. Try to think the word relax each time you breathe out. Some people find it useful to use the second hand of their watch to time their breathing.

NOTE: It can take up to 3 minutes of using controlled breathing exercises before your breathing returns to normal and your dizziness dissolves. Again, try using the relaxation chart to monitor your progress.

Attempt Number
Relaxation level before 0-100
Relaxation level after 0-100
Attempt number
Relaxation level before 0-100
Relaxation level after 0-100

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NOTE: You can also simply use this technique as another relaxation exercise, even when you are not experiencing dizziness. Often, by simply concentrating on your breaths and slowing them down, we can begin to feel more relaxed. It is a particularly effective relaxation technique as you can implement it anywhere, whenever you begin to feel anxiety and no-one would even know (i.e. even when your are sitting at work or at a meeting). Why not give it a go?


Summary When we become anxious we often experience a variety of uncomfortable physiological symptoms. By engaging in relaxation exercises you can begin to deal with these symptoms more effectively.

Muscular relaxation exercises and controlled breathing exercises can help you to achieve a more relaxed body and mind. This can help you to feel more confident in your ability to tolerate the physiological symptoms of anxiety whenever you engage in exposure tasks (although you should not directly use relaxation exercises during exposure tasks). You can also engage in relaxation exercises whenever you are generally feeling tense or anxious, irrespective of the cause. Remember that relaxation is a skill and like all skills requires regular practice before you can master it.


Final word

Although phobias can be terrifying and have a significant impact on our lives, we can learn to overcome them. By following the suggestions in this guide you can begin to win the battle against your phobia. Good luck!

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Written by James Clark, Clinical Associate in Applied Psychology
© 2007, Forth Valley NHS Trust