No. Fear is a perfectly natural, healthy, and helpful reaction. “It is often taken with a negative emotion, but it is one of the most basic we have, essential for an adaptive survival response”, says Ricardo João Teixeira, clinical psychologist and coordinator of REACH – Clínica de Saúde Mental and researcher of the Research Center for Neuropsychology and Cognitive Behavioral Intervention of the University of Coimbra. In other words, it is fear that keeps us from situations that can be dangerous, such as running away from an animal or avoiding going into the sea when the waves are too big.

Most of us have fears that we don’t think are very rational—of a harmless animal or very high places, for example—but, as a rule, we manage to control the anxious response without it interfering too much with our lives or well-being. -be. But a phobia is an exacerbated fear response that occurs when our perception of a certain stimulus (real, remembered or anticipated) arouses a feeling of threat.

Phobias can be defined as an uncontrollable, irrational, excessive and persistent fear of an object, animal, place or situation and are a very common anxiety disorder. A 2017 study by researchers at various universities shows that the lifetime prevalence of specific phobias is around 7.4%.

In practical terms: a person who is afraid of flying can feel anxious the day before the trip and a little uncomfortable during the flight. Someone with a phobia, on the other hand, refuses to board or feels such a strong physiological and emotional response during the trip that it becomes difficult to tolerate, and may even have a panic attack.

Phobias can be directed at anything or any situation and, as a rule, have a cultural and contextual component. as he Diagnostic and Statistical Manual of Mental Disorders (DSM-5), of the American Psychiatric Association, and the International Classification of Diseases (ICD-11), of the World Health Organization, divide phobias into three large groups:

Agoraphobia: It covers the fear of leaving the house, going to stores, being in crowds, open spaces or public places;

Social Anxiety Disorder: Extreme fear of scrutiny from others that leads to avoiding some or many social situations.

Specific phobias: Restricted to very particular situations, such as heights, certain animals, enclosed spaces, needles, blood, flight, or thunder.

There are three main types of symptoms that can vary in frequency and intensity: physical (what you feel in your body), cognitive (what you think), and behavioral (how you act).

“Some of the main physiological symptoms that arise with the activation of the sympathetic nervous system (one of the components of the autonomic nervous system, which prepares the organism to react to situations of fear and stress), are palpitations, tremors, dizziness, lack of energy . of the breath. , disorientation or confusion, sweating, crying, gastrointestinal disorders and rapid breathing”, lists the clinical psychologist Ricardo João Teixeira.

Cognitive symptoms, the psychotherapist clarifies, can include thoughts like “I’m going to vomit”, “I’m going to faint”, “I’m going to suffocate”, “I’m going to make a fool of myself”. ”, “I am going to be paralyzed with fear”.

Finally, the behavioral symptoms: the person with a phobia refuses to be in contact with the phobic object or situation in order not to feel anxiety, which can have a negative impact on their life.

For example, a person with a phobia of dogs may have difficulty walking down the street alone for fear of running into one; a person with a phobia of heights can see their personal or professional life conditioned by refusing to go up to the first floor: a person with a social phobia can avoid eating or drinking in front of others.

The causes can be more or less easy to identify. The psychologist Ricardo João Teixeira mentions that there are three factors that can be important: “Issues related to one’s own personality – there are people who are more afraid; a response modulated by parental concerns or fears, in the case of children; and the experience of previous adverse experiences or even traumas, related to the phobic object or situation”.

In the latter case, there may be a phobic response to an identical situation. For example, someone who has been bitten by a dog may develop a phobia of dogs. But it can also happen that the phobia arises from a bad association, or even from an excessive generalization, that the brain generates and conditions. However, even if the cause of the phobia is not known, it is possible to evaluate it and define the treatment plan.

Depending on whether they are simpler or more complex, more or less intense, and according to the person’s own preferences, phobias can be treated with psychological intervention, although some patients feel that they may also need medication. “Many times the clinical psychologist refers to psychiatry, other times, the psychiatrist refers to psychotherapy”, says Ricardo João Teixeira. “Medication can be a ‘cushion’ that allows the person some comfort in controlling the physiological response, allowing them to expose themselves to their fear, not only to reduce symptoms, but also to learn new things.”

One of the main ones is exposure therapy in which, gradually, the person learns to face the stimuli that trigger anxiety, instead of continuing to avoid them. The goal is to help the person regulate responses to anxious apprehension.

“Exposure therapy involves a psychoeducation process, so that the person understands what is happening to their body, understands the anxious response and learns to better tolerate it. Subsequently, he goes through a process of familiarization with fear stimuli, using, for example, breathing techniques that stimulate the activation of the parasympathetic nervous system (which acts in opposition to the sympathetic nervous system)”, explains Ricardo João Teixeira.

Then follows the process of prioritizing the unpleasant experiences or scenarios to begin what experts call “systematic desensitization”: the person is gradually exposed to scenarios that cause sensitivity, to tolerate responses to fear. “That is, it is intended that the person develop a certain habituation, through a gradual and prolonged exposure. The goal is always to promote a greater degree of autonomy and well-being.”

Sometimes the exposure process begins with guided imagery, which involves using mental imagery to promote relaxation and well-being, reduce pain, or facilitate healing. This can also be done with the help of virtual or augmented reality, where that option is available. This is followed by exposure to specific scenarios, which may or may not be done with the therapist present.

Phobias, especially those related to traumatic events, can also be the object of EMDR (Eye Movement Desensitization and Reprocessing) intervention, a bilateral stimulation (visual, auditory or tactile), which activates the information processing system of the brain, allowing traumatic memory to be reprocessed.

It depends largely. Generally, more complex phobias (such as agoraphobia or a social phobia) tend to have longer interventions. And specific phobias (such as fear of a particular animal) have relatively shorter treatments. Even so, “the time is always highly variable, also depending on the context, the intensity and frequency of the symptoms, as well as the time elapsed since their appearance,” says psychologist Ricardo João Teixeira. Which leaves a caveat: “It takes caution and an experienced professional for it to actually be helpful and not aggravate the existing situation.”