Therapy for phobias in Glasgow

What a phobia looks like

A specific phobia is a strong, immediate fear of a particular object or situation, well beyond any real danger it poses. The most common ones we see are flying, needles and blood, vomiting (emetophobia), driving, heights, enclosed spaces, dogs, spiders and the dentist. You may recognise some of these:

• Even thinking about the thing sets your heart racing
• You go to considerable lengths to avoid it, and plan your life around it
• If you cannot avoid it, you get through with intense dread, or with someone holding your hand
• You know the fear is out of proportion, and that knowledge makes no difference
• It has cost you something real: a holiday, a medical treatment, a job that involves driving, time with a friend who has a dog
• You feel embarrassed about it, so you have not told many people

Why it keeps going

Phobias are kept alive by avoidance. Every time you avoid the feared thing, or escape from it, the relief teaches your brain that avoidance was what kept you safe. You never get the chance to learn that the fear would have peaked and faded on its own, and that the situation was manageable. Meanwhile the mind fills the gap with predictions: the plane will drop, the dog will bite, I will faint, I will be sick in front of everyone. Because they are never tested, the predictions stay as certain as ever.

Some phobias have a clear origin, a bad flight, a bite, a childhood illness. Many do not. Either way, the treatment is the same, because what maintains the phobia now is the avoidance, not the origin.

How we treat it

Cognitive behavioural therapy with graded exposure is the recommended treatment for specific phobias, and it is one of the most reliable treatments in psychology. Done well, it is not an ordeal. It is a series of steps, each one slightly beyond the last, taken with someone who knows how to pace them. A course usually involves:

1. Understanding your phobia: what exactly you are afraid will happen, what you do to prevent it, and how the fear has grown.
2. Building a ladder: a list of situations from the barely uncomfortable to the currently unthinkable, in your own order.
3. Learning how fear works: why it rises, peaks and falls, and why staying in the situation is what changes it.
4. Climbing the ladder: exposure to each step, in the session and between sessions, staying until the fear drops and the prediction is tested.
5. Dropping the props: doing it without the lucky charm, the specific seat, the person you cling to.
6. Making it stick: planning how to keep the gains and what to do if the fear creeps back.

For blood, injection and injury phobia we add applied tension, which stops the drop in blood pressure that causes fainting. Where a phobia began with a frightening event, EMDR can process the memory that the fear is still attached to. Emetophobia, the fear of vomiting, is often more tangled than other phobias and usually needs a longer course combining exposure with work on the beliefs around control and disgust.

What to expect

Sessions last 50 minutes and how often you meet is agreed between you and your psychologist. Many specific phobias respond in 1 to 6 sessions, and for some a single extended session of two to three hours is the most effective format; your psychologist will suggest this if it suits your phobia. Between sessions you will practise the steps you have agreed. Most people are surprised by how quickly a fear they have carried for decades starts to give way.

If the fear is of the panic itself rather than the situation, see panic attacks. If it centres on illness, our health anxiety page may fit. If it is about being watched or judged, see social anxiety.

Who you might work with

Dr Kevin Murray is a clinical psychologist who works with phobias, OCD and trauma using CBT, ACT and EMDR.

Dr Adele Mackintosh is a clinical psychologist who works with anxiety, panic and phobias using CBT, ACT and compassion-focused therapy.

Dr Zounish Rafique is a clinical psychologist working with phobias and anxiety through CAT, DBT and EMDR.

Dr Cara Diamond is a clinical psychologist who works with phobias, anxiety and OCD using CBT, ACT and compassion-focused therapy.

View our full team to find a psychologist who feels right for you, or tell us what is going on and we will suggest someone.