Phobias Across the Lifespan

Abstract

Marked and persistent fear cued by specific objects or situations accompanied by the compelling desire to escape from or avoid the encounter with such objects or events are the key features of specific phobias. Depending on the type of situation that is feared or avoided, specific phobias are further subdivided into five different specifiers: (1) animal; (2) natural environment; (3) blood, injection, or injury; (4) situational; and (5) other subtypes. Specific phobias are frequent in the population and vary across life span. For adults, prevalence rates vary between 11.3% for lifetime and 8.8% for 12-month periods. For children and adolescents, prevalence rates are slightly lower. Females are affected more often than males. The nature of phobic fear varies with the proximity of the phobic object, showing a close interaction between cognitive and emotional systems in the brain. While the anticipation of a phobic object in a certain context is associated with general hypervigilance, selective attention and freezing are engaged once the phobic object is detected. When the phobic object approaches, autonomic arousal increases and the organism prepares for escape. The neural networks organizing these defensive behaviors can be activated by innate threats as well as by learned associations acquired either by direct experience or by observation and communication of other people or even media. Specific phobias can be effectively treated using single-session exposure. During exposure, session patients are confronted with their feared situations and objects in reality and remain in this situation until the fear response subsides. Such exposure treatment is highly effective with effect sizes varying between d = 1.41 and 3.80, depending of the primary outcome measure used. Exposure therapy is particularly effective for treating avoidance behavior.