March Spotlight-April -Fears/Phobia

(Review of November, 2022 training delivered to PBS Mental Health team by Dr. Christopher Smith)

Specific phobias are marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood). The phobic object or situation almost always provokes immediate fear or anxiety, and is actively avoided or endured with intense fear or anxiety. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context. The fear/anxiety/avoidance causes clinically significant distress or impairment in important areas of functioning, and lasts for 6 months or more. Some examples of phobias include: A fear of animals (e.g., spiders, insects, dogs), a fear of things in the natural environment (e.g., heights, storms, water), a fear of blood or injection injury (e.g., needles, invasive medical procedures), or situational fears (e.g., airplanes, elevators, enclosed places).

  According to the DSM, the average individual with specific phobia fears three objects or situations, and approximately 75% of individuals with specific phobia fear more than one situation or object. Specific phobia sometimes develops following a traumatic event (e.g., being attacked by an animal, being stuck in an elevator), observation of others going through a traumatic event (e.g., watching someone drown), or informational transmission (e.g., extensive media coverage of a plane crash). Specific fears often develop before the age of 10 and many individuals are unable to recall the specific reason for the onset of their phobia.

A fear evolves into a phobia when an individual’s response to a stimulus or event becomes increasingly extreme or irrational in nature. Research suggests that fears and
phobias are significantly more prevalent and emerge in response to a greater variety of stimuli, among children with ASD than among typically developing peers. The prevalence of specific phobia in typically developing peers is estimated to be between 5 and 18%, whereas in individuals with ASD the estimate is between 30 and 64%. Individuals with ASD may also be more likely to present with fears/phobias considered to be “unusual” compared to individuals without ASD. Examples of “unusual” fears may include noises, other people, toilets, clouds in the sky, and mechanical objects. The presence of unusual fears makes it more challenging for assessment and intervention for individuals with ASD, and individuals with ASD may have more difficulty identifying,
labeling, and reporting the emotions or feelings they experience, a skill needed for accurate completion of self-report and other assessment measures.

Responses to feared stimuli include cognitive reactions, such as the belief that the stimulus or event poses a greater threat to the individual than it does in reality; behavioral responses, which may include wincing, crying, shaking, and avoidance behaviors; and physiological responses which may include increased heart rate, blood
pressure, and/or skin conductance. The difference between fears and phobias are that fears are unpleasant feelings arising in response to a real or perceived threat, whereas a phobia may be more severe, long-lasting, or age-inappropriate in nature. While fears are considered to be part of typical development, a fear can evolve into a phobia when an individual’s response to a stimulus or event becomes increasingly extreme or irrational.

Interventions for Fears and Phobias are similar to those described in last month’s newsletter. Skill-building includes teaching the individual how to identify and become aware of their cognitive, behavioral, and physiological responses; Functional Communication Training can be used to teach the person to communicate their fears and/or seek assistance when needed; and Relaxation/meditation can be used to teach coping skills. In addition, direct instruction can be used to debunk irrational fears (e.g., lightning cannot strike when you’re indoors”) and facing your fears in smaller doses
(e.g. reading a book about lightning) can help in developing a new positive history.

Craske, M.G., Antony, M.M., & Barlow, D.H. (2006).
Mastering Your Fears and Phobias: Therapist Guide (2nd
Ed.).