Phobia

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A phobia is a strong fear of an object or event that drives a person to avoid it, despite that there is little or no danger. This level of fear surpasses normal aversion when faced by stimulus that carries a suggestion of danger, as the intense anxiety of a phobia can trigger a panic attack. Clinically, phobias are divided into three groups: specific phobias, such as a fear of an animal, social phobia, the fear of negative social evaluation, and agoraphobia, the fear of leaving home and having a panic attack.

A phobic response is one of sympathetic nervous system arousal mediated in part by the amygdala.

Treatment

Treatment often involves multiple modalities, both pharmacologic and nonpharmacologic. Combinations often are preferred.

Pharmacologic

Drug treatment most often is based on second-generation antidepressants or atypical drugs that are agonists of serotonin, sometimes norepinephrine, and possibly other neurotransmitters. Selected benzodiazepines also are used, especially in early intervention, both to reduce anxiety and, with specific drugs including clonazepam [1]and alprazolam,[2] possibly act as serotonin agonists. Other drugs have been used, including tricyclic antidepressants, adrenergic beta-antagonists, or the adrenergic alpha-antagonist, clonidine.

Nonpharmacologic

Perhaps the most widely used psychodynamic model is cognitive behavior therapy. Since there may be an identifiable event in brain physiology, there is interest in the more neurologically oriented emerging therapies, such as Eye Motion Desensitization Reprocessing [3] Supervised desensitization, with support during increasingly intense explosure to the trigger, has been used.

For many patients, peer, usually professionally led support groups may be effective. For persons whose social phobia or agoraphobia makes it difficult to get to meetings, there are early results with virtual group meetings that make use of telephone [4] or Internet technology.

References

  1. Davidson JR, Potts N, Richichi E, Krishnan R, Ford SM, Smith R, Wilson WH. (1993 Dec), "Treatment of social phobia with clonazepam and placebo.", J Clin Psychopharmacol (no. 6): 423-8
  2. JA den Boer (27 September 1997), "Clinical review — Social phobia: epidemiology, recognition, and treatment", BMJ 315: 796-800
  3. De Jongh A, Ten Broeke E, Renssen MR (1999 Jan-Apr), "Treatment of specific phobias with Eye Movement Desensitization and Reprocessing (EMDR): protocol, empirical status, and conceptual issues.", J Anxiety Disord 13 (1-2): 69-85
  4. Carlbring P, Gunnarsdóttir M, Hedensjö L, Andersson G, Ekselius L, Furmark T. (2007 Feb), "Treatment of social phobia: randomised trial of internet-delivered cognitive-behavioural therapy with telephone support.", Br J Psychiatry 190: 123-8