By Psych 105 Student
For as long as I can remember, I have had a cripplingly severe case of emetophobia – the fear of vomiting. I avoid any situation that increases my chances of encountering someone getting sick (amusement parks, whale watches, etc.), and even the sound of someone burping of fake-gagging at a gross joke is enough to set me on edge. I spend my days doing things like triple- and quadruple-checking expiration dates, chewing peppermint gum to fight off even the idea of nausea, and crossing my fingers against a stomach flu outbreak in my dorm. If it sounds exhausting, trust me: it is.
The life of a phobic is tense and anxious, complicated and overly detailed. I would love nothing more than to be able to move past this; the logical step towards doing so lies within therapy. The most commonly used treatment for specific phobias is exposure therapy – a form of behavior therapy, this involves exposing the patient to whatever stimulus might trigger their phobic reaction (Myers, 2013). We all learn to ignore annoying noises and other stimuli through the process of habituation. Think of the weird noise your radiator makes at night, and how you gradually get used to it and are eventually able to fall asleep even while it rattles and groans. The process of extinction is very similar, but involves learning to ignore a stimulus that somehow became a trigger, including triggers for fear. For those of us with phobias, treatment is similar, only far, far more intense.
There are two main approaches to exposure therapy: slow, prolonged exposure and short-term, intensive exposure. The former category is made up mainly of what is called systematic desensitization. Working with a therapist, the patient will identify varying levels of phobic triggers. Starting with whatever provokes the least anxiety, the patient will gradually and slowly be exposed to said triggers, one by one. During the exposure, the therapist will generally provide a number of relaxation techniques, helping to diminish any panic response that might come up. Slowly but surely, the patient will work their way up their phobia scale, not moving on to the next step until they are able to handle the one before it with little to no anxiety. In the best-case scenario, this will eventually train the patient to react to their phobic trigger with less panic and more calm.
While systematic desensitization therapy is popular, some patients look for a more rapid, immediate solution. There are two possible versions of this: flooding and implosive therapy. While both involve overwhelming the patient with their triggering stimulus, there is a subtle difference between the two. While flooding relies on actively presenting the patient with their worst fear (for example: for an arachnaphobic patient, bringing a tarantula into the room and having them pick it up) without the slow build up that systematic desensitization offers, implosive therapy focuses on having the patient visualize their worst nightmare in graphic detail. Both of these therapies function off of the idea that over-stimulating the patient and then helping them to relax will produce an even stronger learned calm-response to the trigger.
Sound like a terrible idea? You might be surprised: in a 1972 case where implosive therapy was used to treat an 8 year old boy with a fear of bodily injuries, the child reported a rapid decline in the number of sleepless nights his anxiety caused him to suffer through; within just five months, he reported no trouble sleeping at all (Gruen & Ollendick, 1972). Though there is always the fear that putting the patient through such major mental trauma will have a worsening effect on their condition (and this certainly does occur in some cases), Hand and Lamontagne (1976). Point out that many of the negative psychological symptoms that can surface after these rapid forms of treatment are actually linked to previous conditions or other external circumstances, and are not “symptom replacing.”
Also, flooding might seem like it’s a successful idea in practice, but I can personally attest to the very important point that the patient must be ready and willing to face such extreme mental pressure. I want to overcome my phobia more badly than I want anything else in my life, but I am also aware that I am nowhere near mentally strong enough to stand up to that big a challenge. I have very recently begun systematic desensitization therapy, and though I am starting off with the smallest steps imaginable – listening to audio recordings of people coughing and burping – I am hopeful that one day, I will be able to confront the challenges of more intensive therapy and come out swinging. (more…)