Phobias

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This episode may contain content that could alarm or trigger some people listener. Discretion is advised.

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So we know that certain stimulus are more likely to develop a phobia from it. So we know from research that we are more disposed to develop a phobia around animals than, for example, flowers, because there is sort of evolutionary biological component to phobias.

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Hello and welcome to Brainstorm. I'm Guy Rowlison. We pretty much all have them, some more concerning than others, and some simply debilitating. My guest today is clinical director, co founder and principal clinical psychologist of the Sydney Phobia Clinic and International Phobia Association. She holds a Bachelor of Psychology and Master of Clinical Psychology from Western Sydney Uni, and has worked in the area of severe anxiety and phobias for more than five years.

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While her professional resume is broad, she specializes in specific phobia presentations from fear of flying and medical phobias such as blood needle phobias and emitophobia, which I might let you explain a little later, while also involved in cutting edge virtual reality experiences to help give clients the knowledge and confidence to target their fears. Corey Ackland, welcome, and thanks for joining me.

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Welcome. Hi. Great. Thanks for having me.

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Did I pronounce that correctly?

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Amitophobia a metaphobia?

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Yeah. I'm not sure whether I'm quite ready to get into that particular area of the discussion so close to lunch. So I might just let that slide for now and let anyone that's interested do the search for it in their own time. But just to kick things off, tell me a little bit about you, how you got into psychology, your current role, and ask just how prevalent Fabias are among us.

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Sure. So I got into psychology, I think, like a lot of my peers, with a particular aim that never eventuated. So my initial area of interest was in forensic psychology as a high schooler. But going through the psychology degree, it is so broad. And along the way, I think very often interests kind of morph and change. And I ended up with a master's in clinical psychology with the thought that I could still apply that in a forensic setting. But again, along the way, with my internal practice, I ended up falling in love, if we can even say it like that, I don't know, falling in love with severe anxiety and working in the severe anxiety space.

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So I worked for ten years at OCD Clinic, which saw predominantly obsessive compulsive disorder presentations, but also across the severe anxieties as well. And it was during my time there that I started developing the idea of a dedicated practice for phobias and the reason that I felt that it needed a dedicated practice. I guess this is kind of getting into a lot of detail very early, but because of the necessity to do exposure as part of anxiety treatment, and that is quite tricky in a private practice environment.

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So my goal was to start up a dedicated practice that is designed around the ability to provide exposure to our clients in sessions as much as possible. So that's how Sydney Phobia Clinic was born back in 2016 and it has been a very busy practice ever since and to this day.

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So if you could perhaps maybe just expand a little bit on the work being done at the clinic, particularly when it comes to the virtual reality side of things for those that are suffering phobia or phobias.

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Yes, certainly. So, as I kind of briefly outlined there, the most important part of most anxiety disorder treatment is the exposure component. And so this, quite generally is looking at the situations that associated with the phobias or other anxiety disorder has been avoided or else poorly managed, and designing a treatment plan to encourage a client to expose themselves to those very situations with the hope that they get a different learning outcome that then is able to see that phobia or that anxiety disorder improve over time with this practice and this better learning outcome.

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As I mentioned, it can be really hard to do in a private practice setting. We like exposure to be what we call prolonged as long as possible and so difficult in the constraints of a 55 minutes session, as is typical in a private practice setting. But it's also really hard to get access. And if we're talking about phobias, which can be so varied, it's really hard to go from an aeroplane to a hospital to a tall building to the open water to a dog park again from a private practice setting. So we had to be creative if we wanted to make sure that we were providing that exposure as supported as possible within the confines of a session.

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And into virtual reality, because virtual reality allows us to do just that in the safety of a private practice office. We can take a flight or we can get a blood test, we can do all of these things that we would only hope to be able to do in real life, but also in a more kind of controlled way. We're able to break these larger experiences up sometimes into their discrete components, which also allows clients practice to these smaller bite sized chunks before then having to go and target the entire situation down the track.

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So, let me ask a layman's question. How do phobias differ from say, simply ordinary reservations you and I may have about issues that may be quite innocuous sort of situations?

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Sure. And a seemingly basic question is a very common question and it has quite a straightforward answer, which is that, as you mentioned, these are quite normal fears. They're ones that exist across all of us to situations that are generally quite dangerous. We have these fears because of an actually dangerous outcome that we're faced with. When we're looking at a phobia, we're seeing that same threat interpretation and the same fear triggered within the body that encourages us to take the same response, be it run the hill away from the thing.

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But the thing in the case of phobias is not actually objectively dangerous. It's not something that is right in front of us trying to kill us. It's not something that warrants the level of fear that we experience, and it's certainly something that does not warrant our ongoing avoidance. So it's when we see all of those things together around things that are not objectively dangerous that we start looking at this as a phobia and we start attaching this exposure treatment to it as such.

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So what kinds of phobias do people commonly develop? And what are the symptoms and behaviors, perhaps that might indicate that?

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So the more common phobias that we would see would be a fear of flying, fear of injections, public speaking, claustrophobia and animal phobias, key of which would be fears of spiders, birds and dogs. But in saying that, what we like to say in the clinic is it's not uncommon to have an uncommon phobia as well. So we also see quite seemingly unusual phobias come in. But in saying that, often people consider the a metaphobia that you mentioned before, be it the fear of vomit or vomiting, as quite an unusual one, but it's a very common one that we would see in the clinic.

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So what are the factors that are likely, if that's the case, to increase a person's risk of, say, developing a specific phobia?

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So we know that certain stimulus are more likely to develop a phobia from it. So we know from research that we are more disposed to develop a phobia around animals than, for example, flowers, because there is this sort of evolutionary biological component to phobias, because it's all in line with our fear response, as you mentioned. And so these things we're likely to see an increase in phobia development.

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Personal characteristics that increase the likelihood towards the development of a phobia would include an anxious temperament, family history of any other anxiety disorder. And we also know that there are what we would consider critical events which also increase the likelihood of someone developing a phobia. And these critical events would be where something quite alarming has happened, that the individual has then laid down this negative or threat based learning due to, and then the phobia generalizes and develops from that.

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So a history of mental health or such as anxiety, it does have a part to play as far as an increased predisposition, say, in children, for example.

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Yes, we often see phobias developing out of childhood incidents. It doesn't have to be the case, though. We know that one of these critical events can occur at any point over the lifespan and onset of phobia. But there are critical development periods, so say around four, seven years old, which we do see that events that happen during this time, whether to the individual themselves or to people around them through vicarious learning of threats is also associated with an increased development of phobias.

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Outside of the work you do and others, are there ways of preventing specific phobias?

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So one of the things that can be quite protective against the later development of a phobia is what we call latent inhibition. But basically what we're talking about is previous good or neutral experiences with this stimulus or stimuli. For example, if you've grown up around dogs, around a local dog park, all your friends have dogs. So you've grown up with these experiences that have emphasized that dogs can be friendly, harmless or manageable.

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Then if later on down the track you have a negative experience with a dog, it growls at you and lunges at you. You are less likely to develop a phobia because of the background good learning. Compare this with someone who has never grown up around dogs, which we do see with certain cultural backgrounds particularly so they actually have very little, if any experience at all with dogs. And then they have the same negative event with a dog.

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They're more likely to develop a phobia.

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Now you mentioned OCD and it's one of the areas you specialize in. Is there any level of OCD that can be viewed as good? Such as when people are cleaning or they're being orderly and being that inverted commas, little bit OCD.

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And we do certainly hear this a lot, and some people will say it as if there is a positive attribution of this, but it is a misunderstanding of what we're looking at when we are looking at OCD. So really importantly, when we see these outward excessive behaviors of OCD, the compulsions, it might be easy to assume that that's all there is. But actually within the obsessive compulsive disorder presentation, these behaviors are coming about because of really distressing thoughts that the person is trying to, what we say neutralize or get rid of.

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So these behaviors are not coming about because someone is just the keenest bean for cleaning and just loves a clean space. This person is terrified about that area not being clean, terrified about what will happen if they don't clean to excess. And so the experience is one of extreme, extreme distress. And so we often do want to raise awareness that even saying that phrase I'm a little bit OCD or I'm so OCD can be quite offensive to what is actually an increasing population that really struggles with obsessive compulsive disorder to quite a debilitating extent.

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Is there a time in your life where OCD is more likely to surface or take a hold? And what are the more common types of OCD?

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So we see that OCD does usually come about in that sort of early adolescence, up to early twenty s. And surprisingly there are actually quite a number of different themes of OCD. So still, we would consider that the kind of stereotypical presentation would be one where there is an excessive cleaning, washing of cell four surfaces or consuming checking, household checking of appliances and doors, et cetera.

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But we also see quite commonly other themes of obsessive compulsive disorder which are marked by abhorrent. What we consider against one's character intrusive thoughts that have an array of behaviors that an individual may conduct to try to neutralize those concerns. And some of those themes are that the individual fears that they might harm people that are close to them. They might have intrusive thoughts or images of stabbing their loved ones or pushing their loved ones or other people in front of trains.

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They might have intrusive thoughts that they are inherently a bad person or that they might have intrusive thoughts that they are not in love with their partner or that they are not the sexuality that they otherwise identify with. And these obsessions become really, really distressing and preoccupying. And often the behaviors that come from that are a lot of avoidance research, reassurance seeking, constantly going through life trying to get evidence that they are not the person that the intrusive thoughts suggest that they are.

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So those that may be hoarders, we've all seen on news. Is this a situation where they can be classified as having OCD.

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So the hoarding is very similar. We do consider an obsessive compulsive related disorder here. What we're seeing is a strong impulse or compulsion to acquire things and then difficulty getting rid of things for fear that this object might be valuable, that it might be needed at some point, that there is a sentimentality that they're not going to be able to cope with being without the object due to.

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So yes, it is very similar in a number of ways and considered an associated condition. Many clients with OCD do also have.

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A hoarding disorder because the term has become part of the lexicon. You'll hear people say oh, they're a neat freak or I'm a germaphobe. From a psychologist's perspective, this is simply a misuse of the term, isn't it?

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Absolutely. Because if this was really one of our clinical conditions, we would see that the distress is impairing and that the behaviors associated with those concerns are so time consuming that they are taking upwards of 2 hours out of someone's day and often much, much more.

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So speaking more broadly then, how do you or someone, you know, how do you deal with or recover from a particular phobia?

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So, phobias and obsessive compulsive disorder. The frontline treatment that we use is a cognitive behavioral therapy. Cognitive Behavioral therapy looks at the interrelationship between our thoughts, our feelings and our behaviors. How these interrelate in certain problems, but also how these things interrelate in what we could consider normal range. And our job is really trying to using certain strategies which are key to cognitive behavioral therapy, get the interrelationship between these factors, looking more and more like they would in the normal range.

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So when we're looking at a phobia treatment, for example, the most important part is what we call psychoeducation, getting the client themselves to understand why we do what we do, why these issues develop and maintain, and how the treatment aims to work. Some anxiety management strategies on the physiological feelings of anxiety, and also some thought based strategies on the inaccurate interpretations of threat associated with certain stimuli and being able to correct those thoughts.

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And then the treatment becomes almost primarily behavioral. Sometimes we refer to it as a catch to five K plan around one's phobia. So we're looking at all of the steps that we might need to take to get a client from where they are when they walk through the door to where they need to get to, to be able to treat these triggers in the normal range.

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So, taking first steps, what are the services? Where should people start to look to begin that journey when it comes to dealing with issues? And is it ever too early to start that journey?

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So it's never too early. In fact, early intervention has the best prognosis in terms of treatment effect. But I would also say that in many cases, the steps to take are reasonably intuitive. So there's also no harm trying to sort this out yourself, taking intuitive steps to approach situations that you're finding challenging over and over and over again. To see if practice makes perfect, to see if you get the benefits of that increased practice and if not, if you're getting stuck. If it is challenging, that's the time to reach out to someone like me.

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I would always say first steps would be your most local psychologist. And I would say that because being able to commit to the therapy is really important. And so we don't want any unnecessary barriers such as might exist if you were having to travel far and wide for your treatment. And then if that doesn't seem to be as effective as one would hope, that's when we might look for a more dedicated practice for your particular concern, such as Sydney Phobia Clinic. But there's also a number of other dedicated practices around the country, in the world.

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So if anyone listening to this, if there's one message that you could get through and as a takeout, what would that be?

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It would be take that first step, take that easy step, that early step, whatever that looks like with where you are, and really just be practicing it as often as possible just to get an idea yourself if you can do this or if you need help. Because like you said, it's never too early. And so we just want to get started. And whether that is you getting started yourself with really little steps, or whether you identify at that early, easier step that you need some help, it's important to reach out.

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And if people want to reach out to you, how can they get in touch?

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They want to reach out to me. It would be through our website. So www.sydneyphobiaclinic.com dot au or emailing us directly at admin@sydneyphobiaclinic.com dot au. But as I said, I would also really encourage someone to the local psychologist is a really great first step too.

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It's a fascinating field and the treatments available are just as significant as they are varied when it comes to phobias. Corey Acquaint of the Sydney Phobia Clinic. Thank you for your time.

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Thank you.

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The views and opinions expressed in this podcast are for informational purposes and not intended as a substitute for professional advice, diagnosis or treatment. For questions about your own emotional health and well being, please consult a medical professional.