Cognitive Behavioral Therapy as a Psychological Treatment of Phobias

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Cognitive behavioral therapy is one type of psychological treatment used for mood and anxiety disorders, including the treatment of phobias. Cognitive behavioral therapy is a form of treatment that focuses on examining the relationships between thoughts, feelings, and behaviors. It is a widely utilized type of psychotherapy in the U.S. and combines aspects of both cognitive therapy and behavioral therapy to address mental health problems.

Cognitive Components of the Treatment of Phobias

The cognitive aspect of the therapy focuses on the person’s thoughts and patterns of thinking. The main goal of cognitive therapy is to identify maladaptive beliefs and patterns of thinking that lead to negative emotions and actions so that people can learn ways to modify their thinking and improve their ability to cope. This may be called cognitive restructuring. For someone with a phobia, beliefs surrounding the feared object or situation are identified, discussed, and changed to decrease the anxiety connected with the fears. For instance, a person with a phobia of driving over bridges may be asked to identify negative and unrealistic thoughts related to bridges (e.g., “If I drive over a bridge, it is likely to collapse and I am going to die”) and change those beliefs into more realistic and helpful ways of thinking (e.g., “It is very unlikely that this bridge will collapse and it is safe to drive over the bridge.”). Similarly, people who experience persistent panic attacks are encouraged to test out beliefs they have related to such attacks, which can include specific fears related to bodily sensations (e.g., “During the next panic attack, I am going to suffer a heart attack and die.”), and to develop more realistic responses to their experiences. This can be beneficial in decreasing both the frequency and intensity of panic attacks.

Behavioral Components of the Treatment of Phobias

The behavioral component of therapy focuses on the maladaptive actions or behaviors that a person is doing which are related to their fear of an object or situation. For most people with a phobia, they are careful to avoid the feared object or situation. For instance, a person with aerophobia may avoid flying while someone with musophobia may go out of their way to avoid basements, meadows, and attics where they may encounter a mouse or a rat. The behavioral component of treatment often encourages a person to stop avoiding the object by exposing the person to the feared object or situation, often in a gradual manner, and allow the person’s anxiety to slowly decrease as the person realizes they are not in any real danger or harm. Often mindfulness or relaxation skills, such as breathing exercises or progressive muscle relaxation, are taught and practiced. This is often done following systematic desensitization procedures.

What to Expect from Cognitive Behavioral Therapy

Cognitive behavioral treatment of phobias is goal-oriented and problem-focused. It is often a short-term therapy lasting from four to sixteen weekly hour-long sessions.

This treatment for phobias focuses more on the present-day life and future goals of the person, and less focus is on a person’s past history or background.

The therapist actively works with the patient towards reaching their goals, but the patient also needs to be an active participant throughout the treatment.

An agenda is often set at the beginning of each session between the patient and therapist and this agenda helps structure the therapy session.

Most cognitive behavioral treatments expect the patient to be working outside of sessions on their goals, so homework and practice assignments are often assigned. These may include keeping activity diaries, completing worksheets about one’s thoughts and behaviors over the week, and practicing relaxation skills.

While cognitive behavioral therapy is commonly recommended as a treatment of phobias and has been demonstrated to be efficacious for many people with anxiety disorders, it is not helpful for everyone. People interested in receiving treatment of a phobia should speak to their doctor or a trained therapist or psychologist to discuss the pros and cons of this type of treatment. A person should only engage in treatment of a phobia with a trusted healthcare provider.

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