May 20, 2022 • 18 mins
Snakes? Thunderstorms? Flying? A lot of us—11%, in fact—have phobias, and women are twice as likely as men to be phobic. Luckily, phobias are highly treatable. Dr. Saltz answers a listener who has extreme fear of spiders—and reveals the techniques that can help anyone shed their over-the-top anxieties.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:12):
These are challenging times, but you don't have to navigate
them alone. Welcome to how can I help? I'm Dr
Gail Salt. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:33):
hopefully with understanding, insight and advice. Summer is coming, and
with it an uptick in patients who are struggling with
a simple phobia to the things that summertime makes them
confront or try to avoid, such as spiders and other insects,
(00:55):
snakes and other outdoor reptiles, dogs and cats wandering around,
and a big one thunderstorms, and actually even water in general,
like oceans, lakes, or ponds. Also common in terms of
phobias is the fear of flying, which can limit travel
for vacations, but also needed travel for work. So today
(01:18):
I'm answering a question from someone struggling with an intense
fear of spiders. A specific phobia is an irrational fear
that causes you to consciously avoid the feared object, activity,
or situation. The person with a phobia knows their reaction
(01:39):
is excessive, and yet they cannot stop feeling very distressed
when in the situation or in anticipation of the situation. Generally,
this fear causes them to avoid anything having to do
with their phobia and often interferes with the person's overall
function in life. Specific phobias are actually the most common
(02:05):
mental health disorder in women and the second most common
one in men, second only to substance abuse. It affects
women to men two to one, and overall affects eleven
of the population. A simple or common phobia is an
(02:27):
unreasonable fear of animals, insects, and natural elements like thunderstorms
or water, heights and closed spaces. Even germs, odors, or
illnesses fall into this category. In descending order of frequency,
it goes animals like insects, reptiles, dogs and cats, storms,
(02:52):
than heights, than illness, than injury, and actually even death. Yes,
death can be a phobi Yeah, it should last more
than six months, that's part of the criteria, and it
should cause symptoms of high anxiety or panic when exposed
to the phobia itself. The object, like the things that
(03:15):
you're phobic about, often start in early childhood. While situational fears,
so not an object but a place or a situation
like flying, can often develop later in the teens or
even in young adulthood. If you have a simple phobia,
it may have begun when you faced a risk that
(03:37):
provoked anxiety in your life. For example, you were thrown
in a pool and had to learn to swim. It's
understandable you might develop a fear of water, but if
you continue to avoid even shallow water, then your anxiety
can become excessive. Simple phobias, especially animal phobia is, are
(04:00):
very common with children, and in fact they occur at
all different childhood ages. On the other hand, there may
be absolutely no experience of fear paired with the object
that you end up being phobic about. Specific phobias do
run in families, interestingly, with as high as seventy of
(04:21):
affected people having a first degree relative with the same
exact phobia. Summertime can be especially difficult for adults and
kids with specific phobias because the most common ones, like bugs, snakes, dogs, understorms, heights,
(04:41):
are things that you are going to be exposed to
much more often in the summer while outside and having recreation.
This causes some people to greatly alter their lives to
avoid the feared thing, and it compromises their pleasure, and
oftentimes it compromises their family's pleasure because they can't join
(05:04):
the family as they're busy trying to avoid their feared things.
If one has an intense thunderstorm phobia, for example, one
may watch the weather and avoid going out any day
there could be a storm, which in the summer is
many days, and a person might avoid a walk in
the woods, or even fear being outside at all lest
(05:28):
you run into your feared objects. The problem with phobias
is that the more that you avoid the thing and
feel relief at having avoided your fear, that serves as
positive reinforcement, which then continues to perpetuate your phobia, and
your world grows smaller and smaller as you avoid more
(05:52):
and more. Children exhibiting a phobia need both understanding, in
other words, empathy not dismissal, but then help to recognize
it as a phobia and to conquer it. Parents exhibiting
a phobia increase the likelihood that their child will develop
(06:12):
the same phobia because they witness their parents terror and avoidance.
So with that, right after the break, we'll get to
my listeners question. Welcome back. Let's get to my listeners
(06:40):
question and see how can I help Dear Doctor songs.
For years now, I've been very scared of spiders. I know,
for the most part, many people don't like spiders, so
I've just thought, Okay, I too don't like spiders. But
this year has been very stressful for me in general,
(07:01):
due to stuff from the pandemic, money worries, and some
job issues, and I've been thinking that I am looking
forward to summer coming and making some plans this summer
to do some fun things. I've been thinking about planning
a hiking trip or maybe a beach trip, and as
I start to look around, I find myself really anxious
(07:22):
that I might see a spider on my trip and
then be totally panicked. This has gotten to the point
where I don't want to plan an outdoors trip, which
is making me sad, because other than spiders, I love
being outside. The fear of spiders has only gotten worse
over the years. It used to be that I didn't
(07:44):
like spiders, that I thought they were gross and didn't
want to see or be around one, But each year
I become more fearful to the point that if I
see a spider, even one on TV or in a
book let alone one walking on the ground, I feel panicked,
like I can't control my breathing, and I start sweating,
(08:06):
and I feel nauseous, and I can only think about
running away. I realized at this point it seems pretty
weird to anyone I'm with. I can't even tell you
what I'm so afraid of. I mean, yes, they are
yucky looking, but my dread of seeing one would be
more appropriate for, say, a venomous rattlesnake than a tiny spider.
(08:30):
I would really go out of my way to avoid
one at all costs, and I think if one crawled
on me, I might have a heart attack. Mostly, I
have just dealt with this, and because spiders aren't everywhere,
it hasn't really interrupted my life too much. But now
I'd really like to plan and enjoy some fun outdoor
(08:53):
summer trip, and to be honest, my fear of spiders
is robbing me of doing this. Is there anything I
can do from a psychological perspective to decrease this sphere
that won't take too long because time is short and
I'd really like to go ahead and enjoy my summertime outdoors. Arachnophobia,
(09:15):
where the intense, persistent, and irrational fear of spiders, is
actually one of the most common simple phobias. Close to
thirty of Americans have some form of fear of spiders.
Fewer of these actually are, in reality a phobia, and
what you describe actually does sound like a true phobia.
(09:39):
For most people, arachnophobia does not interfere with everyday life.
In most natural habitats, however, people are usually not farther
than a few feet from a spider. This means that
for some people with arachnophobia, intrusive thoughts of spiders can
become a chronic source of distraction and beer, and this
(10:01):
sounds like the case for you. Like with other specific phobias,
arachnophobia is most commonly treated with therapy, particularly cognitive behavioral techniques.
CBT focuses on stopping the negative automatic thoughts that are
associated with your feared object or situation if it's about
(10:22):
something else, and replacing them with more rational thoughts. Techniques
include something called cognitive reframing, which helps you shift the
way you look at something so you no longer perceive
it as dangerous or stressful and this can eventually change
your physical reaction to the triggering thing, such as, in
(10:44):
your case, the spider, and another technique called systematic desensitization.
In this method, you employ relaxation techniques like deep breathing
and muscle relaxation, and while doing these, confront your fear
from the least fearful up to the most fearful. So,
(11:06):
for example, you might start with only imagining a spider
just in your imagination, and then drawing a spider, and
then looking at a spider in a book before ultimately
looking at the real thing, but all the while you'll
be working with your therapist doing relaxation techniques. Research has
(11:29):
shown that virtual reality therapy, another form, is where the
person with the phobia is exposed to virtual representations of
in your case, spiders, which makes it more realistic, but
there is actually no spider there and it can be
an effective treatment for a rachnophobia. A therapist will be
(11:50):
with you while you're wearing a headset where you look
at the spiders, but the therapist is talking you through
the therapy. Another option, according to a study that was
published in Biological Psychiatry, actually in like two minutes can
eradicate that fear. Lead researchers at the University of Amsterdam
(12:11):
in the Netherlands wanted to explore whether there's something called
memory reconsolidation, which is a treatment that was originally developed
actually by neuroscientists Joseph lad at n YU here in
New York City where I am for the treatment of
post traumatic stress disorder, could be used to treat arachnophobia.
(12:32):
The concept behind reconsolidation is to change the way the
brain processes memories that could be upsetting and thereby altering
trauma related thoughts and behaviors. So they put together forty
five subjects with arachnophobia. Each group was exposed to a
tarantula for two minutes, resulting in a predicted fearful response
(12:58):
after being exposed to that spider. Half of the people
received a forty milligram dose of a medication called propranolol.
Propranolol is actually not usually used for this purpose, but
it slows down the physiologic reaction to anxiety, like a
rapid heartbeat. The other half received placebo, So proplanolol is
(13:23):
what's called a beta blocker, but it's been shown to
in addition to its usual slowing down heart rate, lowering
bread pressure have what are called amnestic properties, meaning DU's
idea of reconsolidation was that fearful memories require something that's
(13:44):
called protein synthesis in the brains amygdala. The amygdala is
actually a part of the brain that houses fear and anxiety,
so after these memories are retrieved, this protein synthesis makes
the memories more susceptible to change, but only for a
few hours. Thus, the treatment that occurs immediately after triggering
(14:08):
the fear, as was the case with the people exposed
to the tarantula, could help extinguish it, and in fact,
as predicted, participants who received the beta blocker experienced significant
reduction in fear related avoidance behavior, and they were more
willing to approach the spiders up to even a year
(14:30):
after the study. Most people don't do this treatment because
it's not available everywhere, so most people do exposure therapy
and you can get a lot of relief in only
eight to ten sessions. Exposure therapy is, as I said,
this CBT form of exposing yourself to the feared object
(14:53):
in a very mild form like a book, and working
your way up while doing relaxation and therapeutic techniqu weeks.
I would suggest that you start your treatment now so
as to plan and enjoy your outdoor trip and stop
dreading some are fun. In the future you could be
feeling a whole lot better and as short as eight weeks.
(15:18):
I hope that was helpful. The good news is that
phobias are very treatable. The most common treatment used and
effective is exposure therapy, which is a type of behavioral therapy.
The child or adult is desensitized by gradually exposing them
to the feared object, while at the same time using
(15:39):
techniques to decrease anxiety, such as breathing, relaxation methods, and
cognitive restructuring, which is the discussion that the object is
not in fact dangerous. This can be used with any
type of simple phobia, not just spiders. It can be
done very slowly, starting for just think about the object,
(16:01):
working your way up to maybe drawing a picture of
the object and then seeing the actual object, and in
fact you can work your way up, for example with
a spider, to even touching a spider. Some phobias can
be treated using virtual reality simulation of the feared object.
This is the case I've seen programs myself, such as
(16:24):
flying while a therapist does therapy with you, or even
public speaking social anxiety, and of course the feared object
like a spider. If panic symptoms are overwhelming, then sometimes
adding medication either a benzodae zepine or what's called a
selective serotonin reuptake inhibitor can be helpful. But note these
(16:49):
medications are not treating the phobia, so they cannot be
used alone. They are just facilitating the therapy you are
doing that is treating the phobia in order to be
able to complete the treatment. Sometimes medication is needed if
anxiety is so high so that you can learn the
(17:10):
therapy and do it. Many people do not come to
treatment because the phobia does not really bother them or
interfere with their lives, but others will avoid travel, stay
home during storms, and live in fear of dogs. If
this is you, I strongly urge you to seek treatment,
(17:31):
as it is really time limited and highly effective. Oftentimes
a phobia, any phobia, can be treated in eight to
ten sessions or less. Do you have a problem I
can help with? If so, email me yet? How can
I help? At Seneca women dot Com All centers remain
(17:53):
anonymous and listen every Friday too. How can I help
with me Dr Gail's
These are challenging times, but you don't have to navigate
them alone. Welcome to how can I help? I'm Dr
Gail Salt. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:33):
hopefully with understanding, insight and advice. Summer is coming, and
with it an uptick in patients who are struggling with
a simple phobia to the things that summertime makes them
confront or try to avoid, such as spiders and other insects,
(00:55):
snakes and other outdoor reptiles, dogs and cats wandering around,
and a big one thunderstorms, and actually even water in general,
like oceans, lakes, or ponds. Also common in terms of
phobias is the fear of flying, which can limit travel
for vacations, but also needed travel for work. So today
(01:18):
I'm answering a question from someone struggling with an intense
fear of spiders. A specific phobia is an irrational fear
that causes you to consciously avoid the feared object, activity,
or situation. The person with a phobia knows their reaction
(01:39):
is excessive, and yet they cannot stop feeling very distressed
when in the situation or in anticipation of the situation. Generally,
this fear causes them to avoid anything having to do
with their phobia and often interferes with the person's overall
function in life. Specific phobias are actually the most common
(02:05):
mental health disorder in women and the second most common
one in men, second only to substance abuse. It affects
women to men two to one, and overall affects eleven
of the population. A simple or common phobia is an
(02:27):
unreasonable fear of animals, insects, and natural elements like thunderstorms
or water, heights and closed spaces. Even germs, odors, or
illnesses fall into this category. In descending order of frequency,
it goes animals like insects, reptiles, dogs and cats, storms,
(02:52):
than heights, than illness, than injury, and actually even death. Yes,
death can be a phobi Yeah, it should last more
than six months, that's part of the criteria, and it
should cause symptoms of high anxiety or panic when exposed
to the phobia itself. The object, like the things that
(03:15):
you're phobic about, often start in early childhood. While situational fears,
so not an object but a place or a situation
like flying, can often develop later in the teens or
even in young adulthood. If you have a simple phobia,
it may have begun when you faced a risk that
(03:37):
provoked anxiety in your life. For example, you were thrown
in a pool and had to learn to swim. It's
understandable you might develop a fear of water, but if
you continue to avoid even shallow water, then your anxiety
can become excessive. Simple phobias, especially animal phobia is, are
(04:00):
very common with children, and in fact they occur at
all different childhood ages. On the other hand, there may
be absolutely no experience of fear paired with the object
that you end up being phobic about. Specific phobias do
run in families, interestingly, with as high as seventy of
(04:21):
affected people having a first degree relative with the same
exact phobia. Summertime can be especially difficult for adults and
kids with specific phobias because the most common ones, like bugs, snakes, dogs, understorms, heights,
(04:41):
are things that you are going to be exposed to
much more often in the summer while outside and having recreation.
This causes some people to greatly alter their lives to
avoid the feared thing, and it compromises their pleasure, and
oftentimes it compromises their family's pleasure because they can't join
(05:04):
the family as they're busy trying to avoid their feared things.
If one has an intense thunderstorm phobia, for example, one
may watch the weather and avoid going out any day
there could be a storm, which in the summer is
many days, and a person might avoid a walk in
the woods, or even fear being outside at all lest
(05:28):
you run into your feared objects. The problem with phobias
is that the more that you avoid the thing and
feel relief at having avoided your fear, that serves as
positive reinforcement, which then continues to perpetuate your phobia, and
your world grows smaller and smaller as you avoid more
(05:52):
and more. Children exhibiting a phobia need both understanding, in
other words, empathy not dismissal, but then help to recognize
it as a phobia and to conquer it. Parents exhibiting
a phobia increase the likelihood that their child will develop
(06:12):
the same phobia because they witness their parents terror and avoidance.
So with that, right after the break, we'll get to
my listeners question. Welcome back. Let's get to my listeners
(06:40):
question and see how can I help Dear Doctor songs.
For years now, I've been very scared of spiders. I know,
for the most part, many people don't like spiders, so
I've just thought, Okay, I too don't like spiders. But
this year has been very stressful for me in general,
(07:01):
due to stuff from the pandemic, money worries, and some
job issues, and I've been thinking that I am looking
forward to summer coming and making some plans this summer
to do some fun things. I've been thinking about planning
a hiking trip or maybe a beach trip, and as
I start to look around, I find myself really anxious
(07:22):
that I might see a spider on my trip and
then be totally panicked. This has gotten to the point
where I don't want to plan an outdoors trip, which
is making me sad, because other than spiders, I love
being outside. The fear of spiders has only gotten worse
over the years. It used to be that I didn't
(07:44):
like spiders, that I thought they were gross and didn't
want to see or be around one, But each year
I become more fearful to the point that if I
see a spider, even one on TV or in a
book let alone one walking on the ground, I feel panicked,
like I can't control my breathing, and I start sweating,
(08:06):
and I feel nauseous, and I can only think about
running away. I realized at this point it seems pretty
weird to anyone I'm with. I can't even tell you
what I'm so afraid of. I mean, yes, they are
yucky looking, but my dread of seeing one would be
more appropriate for, say, a venomous rattlesnake than a tiny spider.
(08:30):
I would really go out of my way to avoid
one at all costs, and I think if one crawled
on me, I might have a heart attack. Mostly, I
have just dealt with this, and because spiders aren't everywhere,
it hasn't really interrupted my life too much. But now
I'd really like to plan and enjoy some fun outdoor
(08:53):
summer trip, and to be honest, my fear of spiders
is robbing me of doing this. Is there anything I
can do from a psychological perspective to decrease this sphere
that won't take too long because time is short and
I'd really like to go ahead and enjoy my summertime outdoors. Arachnophobia,
(09:15):
where the intense, persistent, and irrational fear of spiders, is
actually one of the most common simple phobias. Close to
thirty of Americans have some form of fear of spiders.
Fewer of these actually are, in reality a phobia, and
what you describe actually does sound like a true phobia.
(09:39):
For most people, arachnophobia does not interfere with everyday life.
In most natural habitats, however, people are usually not farther
than a few feet from a spider. This means that
for some people with arachnophobia, intrusive thoughts of spiders can
become a chronic source of distraction and beer, and this
(10:01):
sounds like the case for you. Like with other specific phobias,
arachnophobia is most commonly treated with therapy, particularly cognitive behavioral techniques.
CBT focuses on stopping the negative automatic thoughts that are
associated with your feared object or situation if it's about
(10:22):
something else, and replacing them with more rational thoughts. Techniques
include something called cognitive reframing, which helps you shift the
way you look at something so you no longer perceive
it as dangerous or stressful and this can eventually change
your physical reaction to the triggering thing, such as, in
(10:44):
your case, the spider, and another technique called systematic desensitization.
In this method, you employ relaxation techniques like deep breathing
and muscle relaxation, and while doing these, confront your fear
from the least fearful up to the most fearful. So,
(11:06):
for example, you might start with only imagining a spider
just in your imagination, and then drawing a spider, and
then looking at a spider in a book before ultimately
looking at the real thing, but all the while you'll
be working with your therapist doing relaxation techniques. Research has
(11:29):
shown that virtual reality therapy, another form, is where the
person with the phobia is exposed to virtual representations of
in your case, spiders, which makes it more realistic, but
there is actually no spider there and it can be
an effective treatment for a rachnophobia. A therapist will be
(11:50):
with you while you're wearing a headset where you look
at the spiders, but the therapist is talking you through
the therapy. Another option, according to a study that was
published in Biological Psychiatry, actually in like two minutes can
eradicate that fear. Lead researchers at the University of Amsterdam
(12:11):
in the Netherlands wanted to explore whether there's something called
memory reconsolidation, which is a treatment that was originally developed
actually by neuroscientists Joseph lad at n YU here in
New York City where I am for the treatment of
post traumatic stress disorder, could be used to treat arachnophobia.
(12:32):
The concept behind reconsolidation is to change the way the
brain processes memories that could be upsetting and thereby altering
trauma related thoughts and behaviors. So they put together forty
five subjects with arachnophobia. Each group was exposed to a
tarantula for two minutes, resulting in a predicted fearful response
(12:58):
after being exposed to that spider. Half of the people
received a forty milligram dose of a medication called propranolol.
Propranolol is actually not usually used for this purpose, but
it slows down the physiologic reaction to anxiety, like a
rapid heartbeat. The other half received placebo, So proplanolol is
(13:23):
what's called a beta blocker, but it's been shown to
in addition to its usual slowing down heart rate, lowering
bread pressure have what are called amnestic properties, meaning DU's
idea of reconsolidation was that fearful memories require something that's
(13:44):
called protein synthesis in the brains amygdala. The amygdala is
actually a part of the brain that houses fear and anxiety,
so after these memories are retrieved, this protein synthesis makes
the memories more susceptible to change, but only for a
few hours. Thus, the treatment that occurs immediately after triggering
(14:08):
the fear, as was the case with the people exposed
to the tarantula, could help extinguish it, and in fact,
as predicted, participants who received the beta blocker experienced significant
reduction in fear related avoidance behavior, and they were more
willing to approach the spiders up to even a year
(14:30):
after the study. Most people don't do this treatment because
it's not available everywhere, so most people do exposure therapy
and you can get a lot of relief in only
eight to ten sessions. Exposure therapy is, as I said,
this CBT form of exposing yourself to the feared object
(14:53):
in a very mild form like a book, and working
your way up while doing relaxation and therapeutic techniqu weeks.
I would suggest that you start your treatment now so
as to plan and enjoy your outdoor trip and stop
dreading some are fun. In the future you could be
feeling a whole lot better and as short as eight weeks.
(15:18):
I hope that was helpful. The good news is that
phobias are very treatable. The most common treatment used and
effective is exposure therapy, which is a type of behavioral therapy.
The child or adult is desensitized by gradually exposing them
to the feared object, while at the same time using
(15:39):
techniques to decrease anxiety, such as breathing, relaxation methods, and
cognitive restructuring, which is the discussion that the object is
not in fact dangerous. This can be used with any
type of simple phobia, not just spiders. It can be
done very slowly, starting for just think about the object,
(16:01):
working your way up to maybe drawing a picture of
the object and then seeing the actual object, and in
fact you can work your way up, for example with
a spider, to even touching a spider. Some phobias can
be treated using virtual reality simulation of the feared object.
This is the case I've seen programs myself, such as
(16:24):
flying while a therapist does therapy with you, or even
public speaking social anxiety, and of course the feared object
like a spider. If panic symptoms are overwhelming, then sometimes
adding medication either a benzodae zepine or what's called a
selective serotonin reuptake inhibitor can be helpful. But note these
(16:49):
medications are not treating the phobia, so they cannot be
used alone. They are just facilitating the therapy you are
doing that is treating the phobia in order to be
able to complete the treatment. Sometimes medication is needed if
anxiety is so high so that you can learn the
(17:10):
therapy and do it. Many people do not come to
treatment because the phobia does not really bother them or
interfere with their lives, but others will avoid travel, stay
home during storms, and live in fear of dogs. If
this is you, I strongly urge you to seek treatment,
(17:31):
as it is really time limited and highly effective. Oftentimes
a phobia, any phobia, can be treated in eight to
ten sessions or less. Do you have a problem I
can help with? If so, email me yet? How can
I help? At Seneca women dot Com All centers remain
(17:53):
anonymous and listen every Friday too. How can I help
with me Dr Gail's
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