Much of the efforts of carers, mentors, psychotherapists, sponsors…etc are directed towards helping individuals overcome their fears. Fear of people, places, things, and a number of other things. Fear is an extremely strong emotion which is associated with anxiety and the associated signs. These signs include, rapid pulse rate, pounding heart, irritability restlessness, discontent, tense muscles, disorientation, headaches, the need to leave a situation, person or place….These reactions can be placed into three categories.
1: MOTORIC REACTIONS: These involve avoidance of the feared individual, event or object or at the very minimum a cautious approach towards the stimulus.
2: COGNITIVE REACTIONS: These involve unpleasant subjective feelings and emotions such as ‘I have to get out of here or I’ll collapse’ or ‘What if something happens to me…’
3: PHYSIOLOGICAL REACTIONS: Which involve rapid breathing, increased heart rate, dilated pupils, and at times the desire to urinate.
When someone experiences fear in a specific situation where there is no external evidence to support the fear this is known as a phobia and is irrational. Some of the common irrational fears or phobias include; Heights, crowds, darkness, fire, death, animals, strangers, being alone, open spaces, water, germs… the list is endless. When an individual begins to avoid a certain non-dangerous situation this may result in a phobic reaction. To differentiate between fear and phobia. A phobia…
1: Is out of proportion to demands of the situation.
2: Cannot be explained or reasoned away.
3: Is beyond voluntary control.
4: Leads to avoidance of the feared situation.
5: Persists over an extended period of time and is unadaptive.
Phobic reactions are among the most common forms of maladaptive behaviours in people. Some are transitory whereas some persist over a long period of time.
When fears become unbearable or intolerable some individuals will become overbearingly maladapted to their surroundings and common behaviours and will at times seek support in helping them to address those fears. There are a number of different approaches to dealing with fear, psychoanalysis, electroconvulsive shock therapy, hypnosis, drugs…etc. Some have been found to be moderately successful in certain individuals. Some tharapies however have proven to be more successful in their outcomes. These are based on the learning theories of such pioneers as, Pavlov, Skinner, Mowrer and many more. In theory most of the methods used by these pioneers is different but each share the same underlying principles.
(a) The phobias and the avoidance reactions that run alongside them are learned by the individual.
(b) Phobias do not occur asa result of innate factors
(c) Phobias are not the result of an underlying psychic or psychological disturbance.
One specific pioneer based his theory of ‘biological preparedness’ on the fact that some individuals are ‘prepared’ to develop particular fears based on the biological and evolutionary significance of certain stimuli and situations that are tied to their struggle for survival.
Two specific therapies that have been found to be effective in the treatment of phobic reactions and fears are; Systematic Desensitization and Flooding related therapies.
Systematic desensitization was developed in the 50’s by Joseph Wolpe. The basics behind his technique is that a fear response is learned or conditioned and can be inhibited by substituting an activity that is antagonistic to the fear response. The most common response inhibited by this treatment is anxiety. An example would be that an individual has a fear of being alone, to help someone inhibit this feeling we would teach them to feel comfortable with themselves which in turn would desensitise them to the feelings raised when they felt alone and therefore countercondition their fear of being alone.
Desensitization would involve exposeing the individual. in small, graduated steps, to the situation they fear most while the person is performing the an activity that is antagonistic to anxiety. This gradual introduction to the fear stimulus can either take place in the safety of the individuals mind, creating a similar situation or in reality with a real situation.
Firstly in this situation the fear must be identified and also the circumstances in which the fear presents itself. The atmosphere for this must be one of respect, sensitivity, empathy and understanding of the general difficulties faced by the individual. The individuals past must be gently exposed to give all those involved in the process a clear understanding of the fear and its possible sources. All factors must be uncovered and explored in a safe and secure therapeutic environment. The overall goal of this process is to give a clear understanding of who the individual is and the environment in which the client was raised. There will be limitations around what the individual will want to disclose but the general goal of this process is too understand the individual, who and what they are today and how they came to be that person. This will in turn expose specific situations and circumstances that lead to the individual to react in certain situations. This is not an overnight process and may take some time as there is no set way to achieve what is needed to proceed with the right therpautic method for the specific individual.
The first session of this process would involve identifying specific places people of things that are causing the reactions. Some questions here might include how long the fear or phobia has been evident to try and identify specific incidents or situations where the feelings associated may be most prevalent. There may also be questioning around exactly how it feels when these reactions happen. The next stage would focus on general background information, date and place of birth, family relationships, children, significant others that may have had a significant part in the individuals life while growing up. Set and setting of the family environment. How punishment was administered when growing up, which characteristics were liked in each person mentioned as a significant part of the individuals life, which were disliked. What fears they had while growing up. If there were any fears while growing up that can be remembered, when they ended or if they carried on into adulthood. The next category would involve looking at school and employment history, likes and dislikes during school years. Favourite subjects, most hated subjects. What happened after leaving school, any extracurricular activities. Some focus should be centred on specific friendships while growing up and how those friendships may have affected the individual at specific times throughout their lives. Were there any close friends and if those friendships have still been maintained over the years. Particular attention may be paid to work likes and dislikes, ability to advance and consistency of current job. Including a specific focus on goals and desires. Moving on from this there should be a session on sexual relationships, dating patterns when growing up through teenage years and onto any stable relationships, Sexual experiences and difficulties that may have been experienced in relationships. This is known by experience to be a touchy subject for some so has to be approached in a nonjudgmental, understanding and acceptance based manner. This should then bring us comfortably into the current situation with enough information to make an informed assessment as to whether or not this therapeutic method is suitable for this particular individuals care.
Some of the questions that may be asked during this whole process might be…
What is the problem behaviour….what is troubling you?
(a) How long have you had these feelings?
(b) When does the fear or associated feelings usually come to your mind?
(c) Are there any specific situations that you associate with when these feelings occur?
(d) Have the feelings remained the same for any period of time or have they got worse or improved?
(a) Where were you born, when?
(b) How many siblings do you have?
(c) How do you get along with family members in general?
(d) Are you’re family members still alive or are have they passed?
(a) Were there any significant individuals in your life other than family members as you were growing up?
(b) How important were they to you and what role did they play in your life?
Fears during childhood.
(a) Did you have any fears as a child or when you were growing up?
(b) Can you remember how they made you feel or when they occured, at any particular time?
(c) When did they stop?
Education and Employment.
(a) Did you like school, what did you like or dislike?
(b) Did you enjoy sports?
(c) Did you have many friends?
(d) Were you afraid of anyone specific at school, if so how did you deal with that?
(e) What did you do when you left school?
(f) What kind of work do you do?
(g) Do you like your job?
(h) What other kinds of employment have you had?
(i) Are you a homemaker?
(j) What kind of home environ,ment have you created for yourself?
(k) Is there anything you would change in your current work or home setting?
(a) At what age did you start having sexual feelings?
(b) In what kind of situation were you in when they began?
(c) Were you monogamous?
(d) When did you become really serious in your sexual endeavours?
(e) What are your feelings around sexual relationships in general?
(f) Are you happy with your sexual relationships?
(a) Do you like where you are living?
(b) Is there anything that you are not satisfied with?
(c) What would you change/
(d) Are you religious?
(e) How do you like to spend your time and where?
All information gathered during these sessions should give you a clear understanding of the individual’s life situation, circumstances, situations where fear and surrounding feelings may occur, intensity associated with specific situations and circumstances and a clearer understanding of whtther this or another method would be best suited to the individuals needs. At all times it must be understood that the individual is also assessing whether or not they are being heard, understood and allowed freedom to answer what is relevant and what is not. They may also be reliving situations that may have been buried due to painful memories and or specific fear related situations. Therefore you must always be aware of change in mood, stance, body posture and speech. Nothing should be ‘extracted’ at the expense of the clients comfort. Specific and direct questions must be asked in order to determine the goals wished to be achieved. Which is namely to reduce the discomfort of the individual in any way shape or form possible. It may be that there is a physical or mental disorder that is causing the problem or it may be that the problem is enforcing the physical or mental conditioning of the individual…..This needs to be determined and the best method of therapy administered to reduce and understand the root of fear itself.