Section Learning Objectives

• Describe how specific phobia presents itself.
• Describe the epidemiology of specific phobia.
• Indicate which disorders are commonly comorbid with specific phobia.
• Describe the treatment options for specific phobia.

4.3.1 Clinical Description

Specific phobia is distinguished by an individual’s fear or anxiety specific to an object or a situation. While the amount of fear or anxiety related to the specific object or situation varies among individuals, it also varies related to the proximity of the object/situation. When individuals are face-to-face with their specific phobia, immediate fear is present. It should also be noted that these fears are more excessive and more persistent than a “normal” fear, often severely impacting one’s daily functioning and causing significant distress (APA, 2013).

Individuals often experience multiple specific phobias. In fact, nearly 75% of individuals with a specific phobia report fear of more than one object or situation, and on average people with specific phobia fear three objects or situations  (APA, 2022).  When making a diagnosis of specific phobia, it is important to specify the class of specific phobic stimulus. The specifiers for specific phobia are animal, natural environment (height, storms, water), blood-injection-injury (needles, invasive medical procedures), situational (airplanes, bridges, elevators, enclosed places), and other (e.g., choking, vomiting, characters in costumes (APA, 2022). Given the high percentage of individuals who experience more than one specific phobia, all specific phobia specifiers should be included in the diagnosis in an effort to identify an appropriate treatment plan.

4.3.2 Epidemiology

The prevalence rate for specific phobias is 7-9% within the U.S. While young children have a prevalence rate of approximately 5%, teens have nearly double the prevalence rate than that of the general public at 16%. There is a 2:1 ratio of females to males diagnosed with specific phobia; however, this rate changes depending on the specific phobic stimuli. More specifically, animal, natural environment, and situational specific phobias are more commonly diagnosed in females, whereas blood-injection-injury phobia is reportedly diagnosed equally between genders. Rates of specific phobia are lower in Asian, African, and Latin American countries, with prevalence estimates around 2-4%.

4.3.3. Comorbidity

Given the onset of specific phobia occurs at a younger age than most other anxiety disorders, it is generally the primary diagnosis with generalized anxiety disorder as an occasional comorbid diagnosis. It should be noted that people with specific phobia are at an increased risk for other disorders including other anxiety disorders, depressive disorders, bipolar disorders, substance-related disorders, somatic symptom disorders, and dependent personality disorder.

4.3.4 Treatment

4.3.4.1 Exposure Treatments 

While there are many treatment options for specific phobia, research routinely supports behavioral techniques as the most effective treatment strategy. Behavioral theory posits that phobias are developed via classical conditioning, accordingly, the treatment approach centers around breaking the maladaptive association developed between the object and fear. This is generally accomplished through exposure treatments. As the name implies, the individual is exposed to their feared stimuli. This can be done using several different approaches: systematic desensitization, flooding, and modeling. 

Systematic desensitization is an exposure technique that utilizes relaxation strategies to help calm the individual as they are presented with the phobic stimulus. The notion behind this technique is that both fear and relaxation cannot exist at the same time; therefore, the individual is taught how to replace their fearful reaction with a calm, relaxing reaction. To begin, the clinician will work with the client to identify a fear hierarchy or a list of feared objects/situations ordered from least feared to most feared. After learning intensive relaxation techniques, the clinician will present items from the fear hierarchy – starting from the least fearful object/situation – while the client practices using the learned relaxation techniques. The presentation of the phobic stimulus can be in person (in vivo exposure) or it can be imagined (imaginal exposure). Imaginal exposure tends to be less intensive than in vivo exposure; however, it is less effective than in vivo exposure in eliminating the phobia. As such, the client and therapist can progress from imaginal exposure to in vivo exposure. Depending on the phobia, in vivo exposure may not be an option, such as with a fear of a storm. Once the patient is able to effectively employ relaxation techniques to reduce their fear/anxiety to a manageable level, the clinician will slowly move up the fear hierarchy until the individual does not experience excessive fear of any objects/situations on the list.

Another exposure technique is flooding. In flooding, the clinician does not utilize a fear hierarchy, but rather repeatedly exposes the individual to their most feared object/situation. Similar to systematic desensitization, flooding can be done either in vivo or using imaginal exposure. Clearly, this technique is more intensive than systematic exposure. Because of this, patients are at a greater likelihood of dropping out of treatment, thus not successfully overcoming their phobias. This technique is not commonly used in clinical practice.

Finally, modeling is a common technique that is used to treat specific phobias (Kelly, Barker, Field, Wilson, & Reynolds, 2010). In this technique, the clinician approaches the feared object/situation while the client observes them. As the name implies, the clinician models appropriate behaviors when exposed to the phobic stimulus, implying that the phobia is irrational. After modeling several times, the clinician encourages the client to confront the phobic stimulus with the clinician, and then ultimately, without the clinician.