Health Watch: Tackle phobias by the horns

Most of us have a healthy fear of spiders and snakes, enough to set our nerves on edge at the sight of the latest reality show contestant trapped in a spider-filled cage or awash in a slither of snakes.

Fear is an innate part of the survival mechanism for humans and animals alike. But, for a small percentage of people with a phobia, even a fleeting encounter with the object of fear is enough to unleash a full-fledged panic attack.

A phobia is an intense fear reaction run amok. The initial fear my be grounded in reality, but a phobic magnifies the risk to the point where he or she becomes immobilized. Rather than working as a protective mechanism, the fear becomes a destructive force, often interfering with psychological well-being as well as social contacts and work requirements.

Jim, a Midwest English professor with an intense fear of flying, has missed numerous family events on the West coast as well as professional meetings and research opportunities in Europe as a result of his phobia. He drives and takes the train when possible, but the longer travel times usually don't mesh with his teaching schedule.

When a friend suggested a boat trip to Europe, he admitted he also feared crossing large bodies of water by boat. Unless he is able to conquer his phobia, Jim is essentially land-locked.

Phobias can take many forms. Among the more common objects and situations that inspire intense fear are thunder storms, spiders, snakes, rodents, flying, heights and public speaking.

The fear center is the amygdala, located near the base of the brain. When fear strikes, a complex set of reactions is set into motion.

As the chemicals epinephrine (adrenalin) and norepinephrine flood the body, the person's heart rate accelerates and breathing becomes rapid. These physiological fear reactions prime the body for fight or flight. But, for the person who's afraid of heights heading for the 10th floor in a crowded elevator, the fight or flight response has no outlet.

The physical reaction to the ensuing fear of loss of control causes many people with phobias to go to extreme measures to avoid the feared situation or object. Fear of crowds (agoraphobia) causes some people to isolate themselves in their homes; fear of heights (acrophobia) may cause another individual to commute an extra hour each way to work to avoid a high bridge or to quit her job on the 26th floor of a building.

Meeting fear head on

Phobias can be successfully treated in the majority of cases. Scientists believe fear is a learned response and can also be unlearned. Without intervention, once a fear has been established it tends to become lodged in memory and recur.

One psychotherapy technique is to use exposure therapy. The patient is exposed to the thing he fears in a controlled, safe environment, gradually increasing the intensity of the exposure. The therapist might teach the patient relaxation techniques such as controlled breathing, muscle relaxation or meditation. The object of this type of therapy is not to ignore or deny the fear but to confront it while practicing staying in control.

As well as confronting fear, the patient also is taught to rationalize and put the fear into perspective: understanding the fact that flying in a commercial plan is safer than driving in a car, or that of the 34,000 species of spiders known to exist, only 12 species are poisonous to humans.

Some psychologists now have access to high-tech virtual reality helmets that make expansive therapy simpler to carry out. A patient can sit in the safety of the therapist's office while experiencing all the realistic steps of arriving at the airport, checking in, boarding a plane and taking off. Originally developed for military purposes, this kind of virtual reality treatment will become less expensive as more therapists invest in the technology.

Antidepressant drugs, especially the selective serotonin reuptake inhibitors, beta blockers and monoamine oxidase inhibitors are all commonly used to treat phobias, usually in conjunction with psychological therapy. The drug Paxil is specifically recommended for treating social anxiety.

Another treatment advance that has already shown promise in small studies is the use of a new medication coupled with exposure therapy. New research is zeroing in on a drug that seems to work on the area of the brain associated with fear memories.

Just as the brain can create fearful memories, studies show that there is also an area associated with fear inhibition, where an "I'm safe" message is stored. The drug D-cycloserine seems to work on the area of the brain, speeding up the process or reconditioning fearful memories.

Researchers at Emory University School of Medicine in Atlanta conducted a study of about 30 patients with acrophobia (fear of heights). Ten patients were given a placebo, 10 others a 50 milligram dose of D-cycloserine and the remaining 10 a 500 milligram dose of the drug.

Normally, a desensitization treatment for these patients would require eight sessions, each about an hour long. In this study the patients taking the drug showed the same improvement after only two sessions as those taking the placebo showed after eight sessions. Interestingly, the larger 500 milligram dose of the drug was slightly less effective than the 50 milligram dose.

Further larger studies will be needed to duplicate these study findings. If the therapy does fulfill its early promise, it could mean a significant breakthrough in phobia treatment. One problem with current desensitization therapy, which requires eight or more sessions over a couple of months is that it is expensive and time consuming. Impatient to see results, many patients discontinue therapy after only a couple of sessions.

Scientists believe that D-cycloserine works by reacting with a protein in the amygdala, speeding the process of learning and forming memories.

Fear can form an invisible cage, robbing us of our freedom to socialize, work and be at peace with ourselves. Seeking help is the first step in learning how to manage the fear and regain control of life.

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