Phobias

A phobia is a strong fear of one certain thing or situation, such as needles, flying, heights, dogs or spiders. The fear is much bigger than the real danger. Most people with a phobia know this, yet the fear still takes over.^1,2

Phobias are very common, and they can quietly shape a life. Someone may skip a blood test, miss a family trip, or stop taking walks. The good news: phobias are among the most treatable of all anxiety problems. Many people improve in just a few sessions of a type of therapy called exposure therapy.^3,4

What is a phobia?

Everyone feels afraid sometimes. A phobia is different in three ways. The fear is intense. It shows up almost every time you meet the trigger, or even think about it. And it leads you to avoid the trigger or get through it with great distress.^2,5

Doctors call it a specific phobia (once called a simple phobia) when the fear lasts about 6 months or more and gets in the way of daily life, work or relationships.⁵

When you face the trigger, your body's alarm system goes off. You may notice:^1,3

• A pounding or racing heart
• Shaking or trembling
• Sweating
• Short breath
• A strong urge to escape

Sometimes the fear builds into a full panic attack. Fears of being judged by others are a separate problem called social anxiety.¹

Common types of phobias

Doctors group specific phobias into five kinds:⁵

Below are three that often come up for adults and families: needles, flying and falling.

How common are phobias?

Specific phobias are one of the most common mental health conditions. In a large U.S. survey, about 9 in 100 adults (9.1%) had one in the past year. Women were about twice as likely as men to have one (12.2% vs 5.8%).⁶

Phobias were less common in people age 60 and older: about 1 in 18 (5.6%) had one in the past year. Even so, about 1 in 5 adults with a phobia in the past year had serious problems from it in daily life.⁶

Why do phobias start?

Most phobias begin in childhood or the teen years, and they can last into adulthood if not treated.¹ Several things raise the chance of having one:²

• A frightening event involving the object or situation, like a dog bite or a rough flight
• Temperament, such as being a child who felt very nervous in new situations
• Family history of anxiety or other mental health conditions

Both genes and life experience play a part.² Many people cannot remember how their fear began, and that is fine. Knowing the cause is not needed for treatment to work.

How avoidance keeps fear alive

When you avoid what scares you, you feel relief right away. Your brain takes note: "That was dangerous, and I escaped." The next time, the fear is just as strong, or stronger. Over time, the list of things you avoid can grow.

Exposure therapy breaks this cycle. When you stay with a fear long enough, in small, safe steps, your brain learns that the danger is smaller than it expected. The alarm system calms down.^2,4 To learn more, see exposure therapy.

Fear of needles, blood and medical care

Fear of needles, blood or medical procedures is more than unpleasant. It can lead people to put off vaccines, blood tests, dental work, or care for serious health problems.

This kind of phobia has a special feature. Many people with it feel faint or pass out when they see blood or a needle. This happens because of a vasovagal reaction (a sudden drop in heart rate and blood pressure that can cause fainting).⁵ That is different from most other phobias, where the heart speeds up.

Two things can help with the fainting:^4,5

• Stay seated or lying down during shots and blood draws.
• Applied tension. You tighten the large muscles of your arms, legs and body for several seconds, relax, and repeat. This helps keep your blood pressure up. A therapist can teach you the exact method and practice it with you.

The CDC also suggests these steps for people who fear needles:⁷

1. Learn what will happen. Ask the nurse or doctor to walk you through each step before, during and after the shot.
2. Practice ahead of time. Rehearse the visit in your mind or talk it through with someone you trust.
3. Ask for privacy if you feel calmer away from other people.
4. Ask about numbing. A numbing cream or spray put on the skin beforehand can lessen pain.
5. Use other sensations. Cold, rubbing the skin, or a small buzzing device can draw attention away from the needle.
6. Keep your mind busy with a video, music or conversation.
7. Breathe slowly. Slow, deep breaths can help you stay calm. Try the cyclic sigh.
8. Make a plan with your doctor. If the fear is severe, ask to see a specialist who treats fears.

Fear of flying

Fear of flying can stop people from visiting family, traveling for important events, or taking jobs.

Phobia clinics and group therapy can help with common fears like flying.³ Therapy that uses exposure works well. In recent studies, several types of treatment for flying fear, including ones that used virtual reality, lowered people's fear.⁴

Virtual reality (VR) exposure lets you practice facing a feared situation with a headset, without leaving the therapist's office. Studies suggest VR exposure works well for phobias. Right after treatment it may not beat real-life practice, but results over months look similar.⁴ In one study of dental fear, about 3 in 4 people (77%) who had a VR session went on to get dental care within six months, compared with half of people in the comparison group.⁴

Fear of falling in later life

Fear of falling is common in older adults, especially after a fall.⁸ Not everyone with this fear has a phobia. But for some people, fear grows so large that it shrinks their life.

More than 1 in 4 adults age 65 and older fall each year. Many people who fall, even without getting hurt, become afraid of falling again. They may cut back on walking, errands and seeing friends. Less activity leads to weaker muscles and poorer balance, which makes a fall more likely. The fear can then grow.⁸

What helps:

Tell your doctor if you have fallen or are worried about falling. Fewer than half of older adults who fall tell their doctor.⁸ A doctor can check your balance, vision and medicines. For more, see fear of falling, preventing falls and anxiety in later life.

Exposure therapy works, and often fast

Exposure therapy is a form of cognitive behavioral therapy (CBT). It is the treatment experts recommend most for phobias.^2,5 Here is how it usually goes:

1. Build a fear ladder. With your therapist, you list situations from least scary to most scary. For a fear of dogs, the bottom step might be looking at a photo of a dog. The top might be petting a calm dog.
2. Start low. You face the easiest step and stay with it until your fear starts to settle.
3. Climb step by step. You move up only when you are ready. You stay in charge the whole time.
4. Practice between sessions. Repeating the steps helps the new learning stick.

Some therapists add relaxation or breathing skills.² Some use pictures, imagination or VR before moving to real-life practice.^3,4

How well does it work? In some studies, about 8 or 9 in 10 people responded to real-life exposure.⁴ For many phobias, treatment is short. In several research studies, treatment was a single session lasting up to about three hours.⁴

People who finish exposure-based CBT usually do well, and booster practice helps keep the gains.⁵ Another option, acceptance and commitment therapy (ACT), teaches you to make room for fear while you do what matters. It has less research behind it for phobias.² See ACT and treatment for anxiety.

What about medicines?

No medicine is approved by the FDA specifically for specific phobia.⁵ Therapy comes first.

In some cases, a doctor may prescribe a medicine for a one-time situation, such as a flight or a dental visit. This might be a beta-blocker (a heart medicine that calms a racing pulse and shaking) or a short-acting anti-anxiety medicine.^2,3 A benzodiazepine (a type of sedative) can take the edge off, but the benefit fades once you stop it, and it does not cure the phobia.⁵ Sedatives should not be mixed with alcohol, and some can cause physical dependence.³

Older adults need extra care with sedatives. See medicines for anxiety. Talk with your doctor or pharmacist before starting or changing any medicine.

Common questions

Can a phobia go away on its own?

Phobias tend to last over time if not treated.³ Some fears fade, but many stay the same or grow when the feared thing is avoided. Treatment helps most people.¹

Will therapy force me to face my worst fear right away?

No. In exposure therapy you agree on each step with your therapist, starting small. You never have to do a step you are not ready for.

I am in my 70s. Is it too late to get over a phobia?

No. Exposure therapy is about learning something new, and adults of any age can do it. Your therapist can set the pace around health issues like balance, breathing or heart problems.

Can I work on a phobia by myself?

For a mild fear, you can try a fear ladder on your own. Go slowly and practice often. See self-help for anxiety. If your fear is strong, involves fainting, or you keep getting stuck, a therapist can help you move faster and more safely.

How can I help a family member with a phobia?

Be patient and do not tease or force them. Praise small steps. Try not to do all the avoided tasks for them, since that can keep the fear going. Offer to help them find a therapist. A calm plan can help them prepare for a hard day, like a medical visit.

When to get help

See a doctor or therapist if a fear:³

• Makes you avoid medical care, travel, work or time with people you love
• Takes up a lot of your thoughts or energy
• Has lasted for months and is not easing
• Comes with panic attacks, low mood, or heavy use of alcohol to cope

Your primary care provider is a good place to start. They can refer you to a psychologist, psychiatrist or clinical social worker.² See how to find a therapist and what Medicare covers for mental health.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.