Treating phobias

Many people with a phobia don't need treatment, and avoiding the object of their fear is enough to control the problem.

However, it may not always be possible to avoid certain phobias, such as a fear of flying. In this instance, you may decideto get professional help and advice to find out about treatment options.

Most phobias are curable, but no single treatment is guaranteed to work for all phobias. In some cases, a combination of different treatments may be recommended. The main treatment types are:

• self-help techniques (see separate page)
• talking treatments
• medication

Talking treatments

Talking treatments, such as Counselling and psychotherapy , are often very effective methods for treating phobias. In particular, cognitive behavioural therapy (CBT) and mindfulness have been found to be very effective methods of treating phobias.

Cognitive behavioural therapy (CBT)

CBT is a type of counselling that can help you manage your problems by changing the way you think and behave. It can be used to develop practical ways of dealing with your phobia.

One part of the CBT treatment process that's often used to treat simple phobias involves gradual exposure to your fear, so you feel less anxious about it. This isknown as desensitisation or exposure therapy.

For example, if you have a fear of snakes (ophidiophobia), your therapist may start by asking you to read about snakes. They may later show youa picture of a snake. They may then arrange for you to visit the reptile house of your local zoo to look at some real snakes. The final step would be for you to hold a snake.

Exposure therapy works by gradually increasing the level of exposure to your fear, which allows you to gain control over your phobia. As the treatment progresses, you should begin to feel less anxious about your phobia.

The National Institute for Health and Care Excellence (NICE) doesn't recommend the use ofcomputerised CBT to treat specific phobias in adults.

Medication

Medication isn't usually recommended for treating phobias, because talking therapies are usually effective and don't have any side effects. However, medication is sometimes prescribed on a short-term basis to treat the effects of phobias such as anxiety .

Three types of medication are recommended for treating anxiety. These are:

• antidepressants
• tranquillisers
• beta-blockers

Antidepressants

Antidepressants are often prescribed to help reduce anxiety. Selective serotonin reuptake inhibitors (SSRIs) are most often prescribed to treat anxiety , social phobia or panic disorder . These can include:

• escitalopram(Cipralex)
• sertraline (Lustral)
• paroxetine (Seroxat)

Venlafaxine (Efexor), a serotonin and noradrenaline reuptake inhibitor (SNRI) may also be prescribed for anxiety.

Common side effects of these treatments include:

• nausea
• headaches
• sleep problems
• upset stomach

They may also, initially, make your anxiety worse and can cause sexual problems.

Clomipramine(Anafranil) is a type of tricyclic antidepressant (TCA) that's licensed to treat phobias. Side effects include:

• dry mouth
• drowsiness
• blurred vision
• tremors (shaking)
• palpitations (irregular heartbeat)
• constipation
• difficulty urinating

Moclobemide(Manerix) is a type of antidepressant from the monoamine oxidase inhibitor (MAOI) group of antidepressants. It's sometimes prescribed to treat social phobia.

Moclobemide interacts with certain types of food, so if you're prescribed this medication, read the information leaflet that comes with it to find out which foods to avoid.

Other possible side effects of moclobemide include:

• sleep problems
• dizziness
• stomach problems
• headaches
• restlessness
• agitation

If you're prescribed antidepressants, it's very important that you don'tsuddenlystop taking them.Suddenly stopping can cause withdrawal symptoms. See your GP, who can gradually lower your dose.

Tranquillisers

Benzodiazepines are a group of medicines that are categorised as minor tranquillisers. They include medicines such as diazepam (Valium) and are sometimes used on a short-term basis at the lowest possible dose to treat severe anxiety.

Like antidepressants,benzodiazepines should be stopped gradually to avoid withdrawal symptoms.

Beta-blockers

Beta-blockers are often used to treat cardiovascular conditions, such as heart problems and high blood pressure (hypertension) . They are also sometimes prescribed to help reduce the symptoms of anxiety, such aspalpitations (irregular heartbeat).

Beta-blockers slow down your heart rate and decrease your blood pressure. Propranolol (Inderal) is a beta-blocker that's commonly used to treat anxiety. Possible side effects include:

• stomach problems
• cold fingers
• tiredness
• sleep problems