By E. K. Hammond (Published in SPH Digest, University of Ghana, Legon)

Those who have been tense before a public speaking or an interview have an idea of what anxiety feels like. Tension of this sort is characterised by increased heart beat, rapid breathing, sweating and fear. When this is intense, severe, or disruptive to one’s daily life, it becomes an anxiety disorder. A common type of this is phobic disorder, or simply put, phobia. Others are generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder.

Phobia refers to an intense, irrational fear of an object or situation that is not likely to be dangerous. This usually interferes with daily life.

Phobias are classified into specific, social and agoraphobic subtypes. Specific phobia is marked by fear and avoidance of specific objects and situations like heights, blood animals, automobiles, sea or air travel. Social phobia is marked by an intense and persistent anxiety about being evaluated negatively by others, or publicly embarrassed by doing something impulsive or humiliating. This impairs a person’s hormonal functioning. Examples are fear of public speaking, “stage fright”, and fear of eating in public. Agoraphobia is a strong fear of being separated from a safe person like spouse or friend, place like home, or of being trapped in a place from which escape might be difficult. This then leads to an intense anxiety and tension whenever one attempts to leave home. Crowded places like auditoriums, stadia and public transport are avoided for fear of being helpless and incapacitated by some calamity such as intense anxiety and panic.

Research suggests that biological factors, distortions in thinking, and learning are causes of anxiety disorders, and for that matter, phobic disorders (Barlow, 1988). Regarding biological factors, Barlow (1988) implies that phobia develops out of a biological predisposition to react with anxiety to a wide range of situations, which results in part, from inheriting an autonomic system that is oversensitive to stress. According to cognitive theories, persons suffering from an anxiety disorder may exaggerate the danger associated with events or situations leading to expectations that bad things would happen and underestimating their own capacity for dealing with threatening events (for example Beck, 1985). This eventually results in anxiety, fear and desperation. Learning theories explains behaviour in part by the principles of classical conditioning. What the person did not fear initially is now feared because of its association (conditioning) with a traumatic event. For example fear of dogs may result from a dog attack. Observing or hearing about other peoples bad experiences can produce the same result.

Intense or extreme phobia, for example agoraphobia, can be a very dangerous form of stress. Stress is the response to events that threaten or challenge a person. The events themselves are called stressors. When stress is intense and continuous, body tissues can actually deteriorate. Minor problems can be made worse. This can even lead to hypertension which is a public health problem. It will therefore be helpful to treat phobias.

Biological treatments are regularly used for some problems. For example antianxiety drugs are given to alleviate symptoms of fears. The drugs reduce the anxiety by reducing excitability. But there are side effects like fatigue and dependence, whereas some are lethal. The drugs also mask the source of anxiety and allow the person to ignore the cause of the problem. Also, biological treatments are very costly compared to psychological treatments.

In psychological treatments, a client and a therapist work together to deal with psychological difficulties. A type is the cognitive approach to therapy. Albert Ellis developed the Rational-Emotive Therapy, which is one of the best examples of the cognitive approach. The therapist attempts to restructure the person’s belief system into a more realistic, rational, and logical set of views. The therapist actively and directly challenges patterns of thought that appear to be irrational. In the case of social phobia associated with public speaking, the client would be made to know that the audience are people just like him, they also have tendencies to err and that he the speaker might not make mistakes to embarrass himself. The therapist would make the client to think positively to reduce or, if possible, eliminate the irrational fear to enable him function normally.

Cognitive-behavioural theorists emphasise the practice of the desired behaviour and not merely the change of mind or positive thinking. In fact this is important since the client must confront the feared object or situation through repetitive positive behaviours.

Learning theorists use systematic desensitization, a form of therapy in which fears are lessened through gradual exposure to the source of fear.

Since biological treatments can be dangerous and expensive, it is advised that people with phobic disorders seek psychological treatments early so that their conditions do not deteriorate to require biological treatments. Help can be sought for from clinical psychologists based at some general and all mental hospitals. Seeking psychological help does not mean one is “mad”. Those who are very apprehensive can go to the general hospitals. In fact there are more severe psychological disorders that can lead to suicide and other serious problems, for example depression.

In view of these, training of more clinical and counselling psychologists and the setting up of psychology/counselling units at the major hospitals for a start, are of paramount importance.

References
Barlow, D. H. (1988). Anxiety and its Disorders. New York: Guilford Press
Beck, A. (1985). Anxiety Disorders and Phobias: A Cognitive Perspective, New York: Basic Books
Benstein et al., (1994). Psychology, Boston: Houghton Mifflin Co.
Ellis, A. (1987). Cognitive Therapy and Rational-Emotive Therapy: A Dialogue, Journal of Cognitive Psychotherapy, Issue 1, pp. 205-255.