4 things to consider before your first session.
Nineteen million Americans experience phobia, or an overwhelming and irrational fear of an object or situation, often causing difficulty in one or more areas of their lives. Common examples of fears include spiders (arachnophobia), snakes (ophidiophobia), and heights (acrophobia), but a phobia can develop around anything.
“Phobias may make no sense on the outside, but once the brain and the alarm center—the amygdala, to be specific—decides that something is dangerous, the whole system goes on alert with a big ‘NO’ whenever these triggers are heard, seen, or thought of,” says Tamar Chansky, psychologist and author of ”Freeing Yourself from Anxiety and Freeing Your Child from Anxiety.” [Editor’s Note: if you’re on alert just reading this, try the Anxiety pack.]
I recently investigated my lifelong fear of cotton balls and discovered that my phobia, known as sidonglobophobia, is, to some extent, a result of vicarious conditioning (observational learning), where a phobia can be acquired through observing someone else respond in a fearful fashion to an object or situation. My older sister also has an irrational fear of these horrific downy globes, and, as a small child, I picked up her distress cues.
In addition to vicarious conditioning, other pathways to developing a phobia include a traumatic conditioning experience, where people have direct experience with a phobic object or situation, which causes a powerful trigger, and informational transmission, where a phobia can develop from consuming threatening information via the media, conversation, and other mechanisms.
Another realm of phobia acquisition lends itself to great debate among experts. During my investigation, I learned that my phobia could be “pregnant with deeper meaning”—there could be some hidden symbolism that I’ve repressed or forgotten. In psychology, this is what’s called a psychodynamic or psychoanalytic understanding, originally outlined by Freud.
“From a psychoanalytic perspective, we’re always looking for what things mean of which a person is not aware,” said Frank Summers, a clinical psychologist and psychoanalyst. “Why would you fear cotton balls? Why would some people fear a harmless insect? Or other people fear the dark?”
Helen Marlo, a licensed clinical psychologist and Jungian psychoanalyst, explained that psychoanalytic perspectives propose that phobias may develop from the complexity and challenges of the human experience, which can result in conflicts, complexes, and traumas. More specifically, Freud’s psychoanalytic theory of phobias suggests that people have unconscious impulses or thoughts that cause conflict between the three parts of the human personality or psyche: the id, superego, and ego. The id is the primitive and instinctive part of the mind that consists of all the inherited components of the personality. It functions chaotically and irrationally, almost at an infantile level. The superego composes morals and values learned from parents and others. It passes judgments and introduces higher-order feelings such as shame and guilt. The ego is the conscious, waking part of the mind responsible for making decisions based on what is acceptable and consistent with societal expectations. It acts as a moderator between the id and superego.
When at odds, the ego attempts to moderate the conflicting goals by using several coping and defense mechanisms including repression and displacement. Repression involves blocking a threatening memory, idea, or event from consciousness. Thoughts that are repressed are typically associated with shame, guilt, and anger. Displacement is an unconscious defense mechanism where the anxiety of repressing a memory, idea, or event is projected onto another object or situation—like cotton balls, spiders, or snakes. This can result in a specific phobia, which, in most cases, may feel less threatening to deal with than repressed thoughts or conflicts.
“You don’t know what you don’t want to know,” says Summers. “If you have the anxiety focused on something else, you tend to be not so anxious about a lot of other things and it allows you to function better.”
Although there are many critics of psychoanalysis, recent data supports a link between Freud’s theory of unconscious conflict and conscious symptoms experienced by people with anxiety disorders including phobias. “The object of the phobia is not the original source of the anxiety and may symbolically represent, or be associated with, the complex, conflict, or trauma—a victim of rape who is fearful of snakes; a diabetic who fears needles; and an adult, lacking limits and boundaries as a child, who now fears heights,” said Marlo.
I’m not a patient of Summers and we’ve never met, but he suggested that my fear of cotton balls could very well be connected to my older sister. We grew up in a dysfunctional environment, and because eighteen years separate us, I looked to her for guidance and support as a young child.
My earliest memory is me, age 4, hanging onto my sister’s leg as she moved out to start her own life. I didn’t want to be left alone in a home where there was constant arguing and emotional turmoil. “I’ve got to think that the cotton balls became the focus of all your anxiety and that the cotton balls do represent your sister,” Summers says. “You realize how anxious you were about her leaving, right? This is what we call abandonment anxiety. The anxiety of abandonment left a big hole for you and it left you vulnerable.”
Summers believes that when I see a cotton ball, the anxiety of abandonment, the anger at my sister for leaving me, and the subjugation to have to personally deal with the dysfunction all come flooding through. In my mind, many feelings can be represented by a cotton ball.
So, how do we know if our phobias have a deeper, symbolic meaning? “Phobias with unconscious, deeper, symbolic meaning have more effect and feelings; are significantly distressing; engender more conflict; are associated with greater avoidance; impact one’s functioning in meaningful ways,” says Marlo. “A person is more likely to display more defense mechanisms and defensiveness in response to a phobia with symbolic meaning.”
Although not all phobias require treatment, Summers suggests therapy to explore a phobia in depth. “You need another person who can see the things that you can’t see. It’s very difficult to get rid of these things on your own or to become aware of what you’ve repressed. We all have so many defenses. We tend to deceive ourselves.”
In Marlo’s practice, phobias with deeper meaning can be less likely to respond to cognitive behavioral interventions, like exposure therapy. The phobia sufferer can also be more likely to show “symptom substitution,” or develop new or different symptoms following the resolution of a phobia.
“Psychoanalytic treatments emphasize helping the person develop a relationship between his or her unconscious and the conscious symptom—the phobia—through an attuned, effectively engaged therapeutic relationship,” says Marlo. Practicing mindful awareness, as well as conscious engagement and exploration of images, sensations, memories, dreams, and thoughts are each components of treatment.
Artwork by KAREN HONG