| Causes of Fears & Phobias |
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The following article is quite long and looks at how fears and phobias occur; how hypnosis can help in treating them; and includes a case study.
4) What options are available?
6) Case study – systematic desensitisation 7) Example of Implosive therapy 8) Summary How do they develop in the first instance?In order to consider the above question we first need to know what a phobia or fear is: Phobia – an abnormal or morbid fear or aversion. What causes phobias to occur?There are five main areas that have been investigated and of these areas the genetic option is seen to be unlikely, and the social option could be included with the inappropriate learning as described by the behaviourists. All five areas are listed in the following pages along with the reasoning that prevailed at the time. Early childhood traumaPsychoanalysts believe that phobias develop as a result of deeply buried early traumas, which were hidden and repressed by the subconscious mind. Due to the traumas’ very powerful emotional content they still influenced the conscious mind, presenting them in a disguised form, recognised as the phobia.Freud provided the main case study illustration in 1909, of a small child called Little Hans who had a phobia of horses. Little Hans was the son of a colleague, and who had developed a phobia of horses. The boy’s father was well acquainted with Freud’s theories, and wrote to Freud about him, and questioned him closely about his fears for the child. They concluded that the phobia was a disguised expression of the child’s Oedipal conflict. In this particular case with Little Hans, horses represented his large, powerful father, whom the child unconsciously feared as being in competition for his mother’s affections. Since he could not express his fear directly, it had become manifest in his phobia of horses. There were some other details that went undetected at the time of Freud’s reckoning, which pointed to a different cause, but these were only considered years later. The child had been out walking with his nurse when he became terrified as an overloaded horse collapsed and died nearby, making loud noises as its hoofs struck the cobblestones. Rather than the phobia being representative of the child’s Oedipal conflict it was more likely to be attributed to inappropriate learning which was associated with the trauma of the horse dying in such close proximity (Wolpe & Rachman, 1960). Physiological disordersMany medical researchers see phobias as a physiological disorder whereby physical anxiety responses are triggered inappropriately. Their suggested therapy involves the use of drugs (chemotherapy) to reduce the anxiety and therefore allow the patient to ignore the cause of the phobia. Further investigation resulted in the development of effective drugs such as beta-blockers that block the anxiety pathways and so prevent the experience of anxiety that can be caused by various fears and phobias (Gray1985). GeneticsThis suggested cause is based upon disorders such as agoraphobia being a common problem that was seen to run in families. Slater and Shields (1969) suggested identical twins were more likely to show anxiety than non-identical twins. It was later thought that the phobias shown were more likely to be learned from their social surroundings than due to their genetic build. Therefore the overall thought is that genetics are not the actual cause of phobias but may influence a higher disposition to becoming phobic. Social conditioning
Inappropriate learningBehaviourists argue that phobias develop as a result of inappropriate learning, primarily with children being subjected to various fears by their parents being role models. This type of learning can be very powerful and even unconscious. Small children are very receptive to emotional states in adults and respond very strongly if they see a parent react in a terrified manner at the sight of a spider or mouse. This can have a very deep impact on a child and can result deep-rooted phobias later in life. Role modelling was seen to be a very sensitive stage of development for children, and in most cases this was based on imitation rather than understanding (Bandura & Walters 1963)(Mead1934). How well do phobias and fears respond to hypnosis?Anxiety disorders such as fears and phobias tend to respond well to hypnosis as the therapeutic medium. The ability to replace behaviours and provide post hypnotic suggestions enables clients to reduce phobias to an acceptable level of anxiety. What options are available?Of the previous five causes it is felt that the behaviourist approach of replacing the maladaptive learning with more appropriate learning is the most successful technique (Hayes 1998). This form of behaviour therapy is known as classical conditioning and consists of three main options – systematic desensitisation, implosion therapy, and the avoidance-inducing treatment of aversion therapy. Systematic desensitisationJoseph Wolpe, a South African psychologist, first designed this method of treatment in the late 1950’s. His theories are based on the idea that it is impossible for two opposite emotions to exist together at the same time e.g. anxiety and relaxation. Implosion therapyThis is a more extreme approach, which works on the theory that maintaining the level of fear is so demanding, both physically and mentally, that it cannot be sustained indefinitely. By introducing the highest feared element there is the potential to get the client accustomed to the object and then induce further relaxation leading to habituation of the feared object. (Stampfl, 1975) Aversion therapyUsually aimed at inducing avoidance of the stimulus rather than habituation to it. This is achieved by getting the client to associate unpleasant experiences with the stimulus; eventually the two are so associated that the client will want to avoid the stimulus. This is not practical for many phobias as clients are usually seeking some form of cure rather than avoidance. Aversion therapy tends to be targeted at people who wish to give up a habit such as smoking or alcohol for example. Where does hypnosis fit in as a therapy for phobias?Hypnosis is based upon the principles of addressing the unconscious mind while the client is suitably relaxed. This enables various suggestions and instructions to be given to the client to assist them to achieve their goals. Case study – systematic desensitisationAfter a false start with a client in 1977, Michael Joseph used systematic desensitisation to successfully remove the nauseating effect experienced over the previous two years that was triggered by any image of Nelson’s column. By using an IMR coupled with a diagnostic scan he was able to pin point the cause of the nausea with the client. Having done so Michael and the client devised a simple Subjective Unit of Disturbance Scale (SUDS) and the following therapy session successfully disassociated the feeling of nausea from the trigger, Nelson’s Column, which was no longer a problem. This was confirmed by GP reports two years later. (European Journal of Clinical Hypnosis, 1994). Example of Implosive therapyBy hypnotising a client and determining a place or memory when they feel safe and calm, it would be possible to place a bird-eating spider in the hand of an arachnophobic. The extreme fear would eventually subside enough to allow the client to realise that no harm was occurring and that the fear was irrational. This in turn allows further relaxation and the client becomes acclimatised to the feared spider. If the client is unable to relax then they could go to their safe place to allay the anxiety and then try again. SummaryThe majority of fears and phobias appear to be caused by inappropriate learning, and the client is really only concerned at how they can remove the anxiety and/or any symptoms that accompany the fear or phobia. With hypnosis the majority of fears and phobias can be treated effectively, some cases may take longer than others, but the results will always be based on client expectation, which needs to be monitored and managed to obtain the best results. Whilst the techniques are proven to work and provide long-term results, it is the therapist’s responsibility to ensure that the client has realistic expectations and that suitable therapy is designed and used accordingly to achieve the required goals. |
The clearest example of social factors influencing a phobia is in agoraphobia, which is most common in women with children. Whilst having infants to look after it is thought that many women lack the opportunity to get out of the house other than to go shopping. This lack of opportunity to socialise effectively can lead to mothers viewing their surroundings in a blinkered manner, perhaps identifying their surroundings as safe and secure for them and their offspring. As the child/children grow up then the need to go out more becomes greater and most women make this transition effectively, those that don’t make the transition tend to experience panic attacks that can then develop into full-blown agoraphobia.