Most of us can think about certain things or situations that make us feel worried or anxious. Many of these are understandable, for example, when preparing to speak or perform to a large group of people, travelling at high speed, coming in contact with a large animal, or heights. These are all situations where it is easy to understand why we would become anxious. Most of us can also name at least one less rational thing or situation that makes us anxious, the most common of these being small insects, flying in aeroplanes and a fear of the dark or ghosts. These are fears, particular to us and particular to certain situations, for which no amount of reassurance completely takes away our sense of apprehension. Sometimes just the thought of coming into contact with our own particular worry can provoke anxiety symptoms.
Phobias are similar to the irrational fears that we all possess, the difference being that a phobia makes the sufferer feel extreme anxiety, even terror, at the thought of coming in contact with their feared thing or situation.
Phobias can lead the person to avoid situations where they think they might come in contact with their feared thing or situation and this can inhibit their activities or enjoyment of life.
Fears and phobias often start in early childhood but we can develop an irrational fear at any time throughout our life.
Feelings we get when we are anxious are usually unpleasant, therefore we avoid things and situations that make us feel anxious. The stronger the feeling of anxiety the more likely we are to avoid the thing or situation that provoked these feelings.
As young children we learn what to avoid by copying the behaviour of other children or important adults. If our parents or older siblings appear frightened by a situation then it is likely that we will learn to feel anxious and avoid that situation as well. This helps to explains why many of our irrational fears develop in early childhood. For example, if our mother shows very anxious behaviour around spiders then we are likely to copy her behaviour.
In adolescence or adulthood, fears and phobias can develop from our own thinking. One of the most common of these is social anxiety/phobia. This is an intense fear or avoidance of certain social situations, often provoked by worries of embarrassment or ridicule. Sometimes the sufferer is unable to clearly work out why that situation makes them so anxious.
People may have experienced a sense of overwhelming fear or panic in a particular situation and therefore a very strong desire to avoid a similar experience.
Sometimes they will not be able to recall the original event but still be affected by it.
Fortunately most of our irrational fears are easily managed or avoided but when this is not possible, or if we allow our fears to get out of control, then our avoidance can start to seriously interrupt our enjoyment of life or our normal activities.
Fortunately most fears and phobias do respond well to simple relaxation and gradual exposure to the feared thing or situation. In severe or complex cases it can be useful to seek the advice of a specialist to support and coach the young person.
Mild phobias are very common, especially in early childhood, although most of these fears disappear by the age of about 6. About one in ten people will experience fears severe enough to cause them regular distress and to disrupt their normal daily life.
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In trying to understand why a child or young person may have a phobia, ask yourself the following:
- Has the phobia been learned or picked up from another person? This is especially common in young children where another family member either shows or describes a fearful reaction to a thing or situation that would not normally be dangerous, e.g. spiders or flying insects. It is important to consider whether family members are helping to maintain a phobia by their own fear or by their fear of the child’s anxiety or discomfort.
- Has the young person had a direct experience that has scared them, for example being bitten by a dog or stung by an insect? This type of phobia can also happen because a young person witnesses or hears a story about a bizarre or frightening situation. When the young person thinks about this they become more and more anxious and uncomfortable.
- Is the young person stressed and experiencing anxiety symptoms, for example over school exams, parents separating or a bereavement? They may incorrectly connect feelings of anxiety with an object or situation that they are in.
- How are family members responding to the young person’s fears and anxieties? Are they remaining calm and reassuring or are they reinforcing the young person’s fears, because of their own fears or of the young person being upset?
- Is embarrassment or fear of getting into a panic increasing the young person’s avoidance behaviour?
- How much is the fear interfering with the young person’s normal daily life? If the phobia does not severely limit their lifestyle, then simple reassurance may be all that is required.
- How old is the child? For example, it is fairly normal for a 3 year old to be afraid of the dark.
- Is the young person gaining any benefits from their avoidance behaviour, such as extra time or attention from parents, teachers or friends?
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Remember that phobia is an irrational fear and is very personal to the sufferer. Try and avoid your own personal experience of fear influencing how you react to the young person. For example, if you have experienced a phobia yourself this can be very useful in helping the young person but can also influence the way that you react to them, i.e. if you share a similar fear or phobia the young person may pick this up in your reaction. You may be less inclined to become involved or may become unhelpfully over-involved. Our own embarrassment or frustration with ourselves about our fears can make us annoyed with the young person’s lack of courage, motivation or progress.
For more information, see section on being aware of yourself and your own response.
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- Think about your body language. For example try and remain calm and relaxed with an open body posture. For more information, see section on counselling techniques.
- Think about your tone of voice; it should be calm and reassuring.
- Reassure them that fears and phobias are common and can be managed or resolved.
- Be aware that although the fear is irrational, the young person’s feelings of stress are real to them. They cannot easily relax or recognise that the thing or situation is not threatening.
- Challenge any irrational thoughts the young person has but don’t minimise the intensity of their feelings.
- Explain that you understand how anxious they are and that you are going to try and help.
- Ask them about their fears. Get a better understanding of how common their fears are and how much the fears interfere with their lifestyle.
- Ask them about their anxiety symptoms. How severe and disabling are their physical and emotional symptoms?
- Explain that their physical and emotional symptoms are normal and not life-threatening.
- If they are distressed, distract them by talking about normal things.
- Through conversation, find out who or what might be reinforcing their fears, for example family members or embarrassment about fainting or having a panic attack.
- Allow the young person to leave the situation that is causing them distress to go somewhere quiet and relaxing, but stay with them.
- Find out how long they have been experiencing anxiety and if there are any other obvious stressors in their life, for example exams, family problems or bullying.
- Find an age-appropriate way to explain phobias, how they develop and that avoidance of the thing or situation will encourage the phobia to continue.
- If appropriate, and with the young person’s co-operation, set small achievable targets to help the young person become more confident when dealing with the thing or situation they are phobic about.
- With the young person’s permission, explain the situation to important others, for example teachers, family members and carers.
- Give the young person age-appropriate reading material that might help them understand fears and phobia better.
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- If the phobia is causing the young person extreme distress or is severely inhibiting their normal daily life and if reassurance and simple support are not helping.
- If the phobia occurs in combination with other worrying behaviours or psychological problems, for example self-harm, depression, sleep disturbance, deterioration in school performance.
- If the young person discloses that they have been sexually abused or has suffered other serious traumas.
You should get in touch with your local health centre or hospital to obtain a contact number for the appropriate children and young people's mental health specialists.
Remember - you can contact your local mental health specialists for a number of reasons, for example:
- For advice on how to make a referral about a named child.
- For advice about whether or not to make a referral (it is normal practice to seek this advice without naming the child in the first instance).
- For advice about what to do (once again there should be no necessity to name the child).
By not naming the child you are protecting their right to confidentiality. This method of seeking advice also has the advantage that you do not need to get anyone’s consent in advance of your contact phone call.