Phobia Treatment: Medications and Therapy for Phobias

Phobia treatment aims to handle both the physical symptoms and psychological impact of phobias. Some phobias can be very debilitating and significantly impair day-to-day life. Treatment for phobias is critical in regaining control over everyday functioning.

Phobias are an irrational, persistent and exaggerated fear of an object or situation. There are three types of phobias, each type with different indicated treatment. The three types of phobias are:

• Social phobia (social anxiety disorder) – fear of social or performance situations
• Specific (simple) phobia – fear of a specific object or situation
• Agoraphobia – fear of being in a place where escape would be difficult or embarrassing (more on panic disorder with agoraphobia)

Phobia treatment primarily consists of therapy, medication or both. Medications for phobias are normally continued for 6-12 months after they start becoming effective. At that point, if the symptoms have cleared up, the patient can consider tapering off the medication.

Reducing or eliminating caffeine intake may also be involved in phobia treatment. Even small amounts of caffeine may make anxiety and phobia symptoms worse.

Changes in diet may also help. In one study, a tryptophan-rich diet showed a positive effect on social anxiety.¹

Therapy for Phobias

Behavioral therapy or cognitive behavioral therapy for phobias are the two most used types of psychotherapy. Cognitive behavioral therapy (CBT) has been shown effective in studies. Computerized CBT (called FearFighter) is recommended for panic and phobic disorders by the National Institute for Health and Clinical Excellence guidelines. CBT for phobias has been shown to reverse some of the dysregulation in the brain seen on functional brain scans.

Psychodynamic therapy (talk therapy, or insight therapy) is rarely used for phobia treatment unless the phobia is combined with other disorders such as personality disorders.

Exposure therapy may be used to treat any type of phobia. Exposure therapy for phobias involves slowly increasing exposure to the feared situation or object. This phobia therapy can be done alone or may be facilitated by a therapist. For social phobia, self-led exposure therapy has been shown to work as well as clinician-led exposure therapy.

Education and skills training is also a useful therapy for phobias. Social skills training can be useful for social phobia. Relaxation training is also helpful, particularly for treating agoraphobia.

Medication for Phobias

Several types of medications are used to treat phobias. Medication is not recommended for mild phobias, those not associated with disability, as many of them remit on their own. When medication for phobias is prescribed, it is done on an outpatient basis unless the anxiety is very severe with suicidal ideation.

Types of medication for phobias include:

• Antidepressants – the most common medications for phobias are selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs). These medications are particularly used in treating social phobia while there is little evidence for their use in specific phobias.
• Benzodiazepines – tranquilizers often used for short-term management of severe phobia symptoms like panic.
• Antianxiety medication
• Anti-high blood pressure medication (antihypertensive) – often used in conjunction with other phobia medications for social phobia treatment.
• Anticonvulsants – selected anti-seizure medication have been shown to treat phobic disorders.

Successful Phobia Treatment

Like all anxiety disorders, phobias are treatable. Treatment for phobias is most successful in those with:

• A less severe diagnosis
• A higher level of functioning before the diagnosis
• Greater motivation for treatment
• Greater level of support such as family and friends
• An ability to comply with medication and/or therapy regimen

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