When a phobia is not just a phobia

Specialist CBT therapy for anxiety, OCD, depression and more in West London

A strong fear of flying, dogs, needles, driving, crowds, vomiting, enclosed spaces or another situation can be described as a phobia. That word can sometimes be useful, but it does not tell us everything about a person’s experience. It does not establish a diagnosis, explain where a fear came from, or show whether one treatment approach is right. Fear can be shaped by many factors. A person may have had a frightening experience, learned to expect danger, become worried about bodily sensations, felt unsafe in a particular setting, faced an ongoing practical risk, lived through trauma, developed a medical concern, or noticed that avoidance has gradually become easier than confronting uncertainty. More than one of these can be relevant. None should be assumed from a short description. Physical sensations associated with fear, such as racing heart, breathlessness, dizziness, nausea or shaking, can also have medical causes. New, severe, changing or concerning symptoms should not automatically be attributed to anxiety and may need medical advice or urgent care. An assessment can explore the feared situation, what happens before and after it, the impact on daily life, health information, safety, prior experiences, current support and the person’s goals. It may clarify that CBT based therapy could be relevant, that a different service or medical review is needed, or that more information is required before deciding what would help. CBT based therapy may be considered after assessment where clinically appropriate. It can explore the relationship between prediction, attention, bodily sensations, behaviour and avoidance. It cannot guarantee that a person will be able to face a situation, remove all fear, determine the cause of a symptom or replace medical and specialist advice. Exposure based work is not a self help instruction. Where it is clinically appropriate, it is planned collaboratively with a qualified clinician, with attention to consent, capacity, health, risk and pacing. A blog should not ask someone to confront a feared situation, provoke symptoms, stop a safety behaviour abruptly or ignore an environmental danger alone. The next step may be a medical conversation, further assessment, practical support or a carefully planned therapy discussion, depending on the wider picture. For related information, see <a href="/therapy/anxiety/">anxiety support</a>, <a href="/therapy/panic attacks/">panic disorder support</a> and <a href="/guides/panic disorder agoraphobia west london/">the guide to panic and agoraphobia</a>. If distress includes crisis, thoughts of self harm or an inability to keep safe, urgent appropriate help is needed.