Health A to Z: Treatment - Phobias

Many people with a phobia don't need treatment and avoiding the object of their fear is enough to control the problem.

However, it may not always be possible to avoid certain phobias, such as a fear of flying. In this instance, you may decide to get professional help and advice to find out about treatment options.

Most phobias are treatable, but no single treatment is guaranteed to work for all phobias. In some cases, a combination of different treatments may be recommended.

The main treatment types are:

• self-help techniques
• talking treatments
• medication

You can refer yourself directly to an NHS talking therapies service without a referral from a GP.

Find an NHS talking therapies service

Talking treatments, such as counselling, are often very effective at treating phobias. In particular, cognitive behavioural therapy (CBT) has been found to be very effective for treating phobias.

Cognitive behavioural therapy (CBT)

CBT is a type of counselling that can help you manage your problems by changing the way you think and behave. It can be used to develop practical ways of dealing with your phobia.

One part of the CBT treatment process that's often used to treat simple phobias involves gradual exposure to your fear, so you feel less anxious about it. This is known as desensitisation or exposure therapy.

For example, if you have a fear of snakes (ophidiophobia), your therapist may start by asking you to read about snakes. They may later show you a picture of a snake. They may then arrange for you to visit the reptile house of your local zoo to look at some real snakes. The final step would be for you to hold a snake.

Exposure therapy works by gradually increasing the level of exposure to your fear, which allows you to gain control over your phobia. As the treatment progresses, you should begin to feel less anxious about your phobia.

The National Institute for Health and Care Excellence (NICE) doesn't recommend the use of computerised CBT to treat specific phobias in adults.

Medication isn't usually recommended for treating phobias, because talking therapies are usually effective and don't have any side effects. However, medication may sometimes be prescribed to treat the effects of phobias, such as anxiety.

There are different types of medication that may be prescribed.

Antidepressants

Antidepressants are often prescribed to help reduce anxiety. Selective serotonin reuptake inhibitors (SSRIs) are most often prescribed to treat anxiety, social phobia or panic disorder. These can include:

• escitalopram (Cipralex)
• sertraline (Lustral)
• paroxetine (Seroxat)

Venlafaxine (Efexor), a serotonin and noradrenaline reuptake inhibitor (SNRI) may also be prescribed for anxiety.

Common side effects of these treatments include:

• nausea
• headaches
• sleep problems (insomnia)
• upset stomach

They may also, initially, make your anxiety worse and can cause sexual problems.

Clomipramine (Anafranil) is a type of tricyclic antidepressant (TCA) that's licensed to treat some phobias. Side effects include:

• dry mouth
• drowsiness
• blurred vision
• tremors (shaking)
• heart palpitations
• constipation
• difficulty urinating

Moclobemide (Manerix) is a type of antidepressant from the monoamine oxidase inhibitor (MAOI) group of antidepressants. It's sometimes prescribed to treat social phobia.

Moclobemide interacts with certain types of food, so if you're prescribed this medication, read the information leaflet that comes with it to find out which foods to avoid.

Other possible side effects of moclobemide include:

• sleep problems
• dizziness
• stomach problems
• headaches
• restlessness

If you're prescribed antidepressants, it's very important that you don't suddenly stop taking them. Suddenly stopping can cause withdrawal symptoms. See your GP, who can gradually lower your dose.

Tranquillisers 

Benzodiazepines are a group of medicines that are categorised as minor tranquillisers. They include medicines such as diazepam (Valium) and are sometimes used on a short-term basis at the lowest possible dose to treat severe anxiety. 

Like antidepressants, benzodiazepines should be stopped gradually to avoid withdrawal symptoms.

Beta blockers

Beta blockers are often used to treat cardiovascular conditions, such as heart problems and high blood pressure (hypertension). They are also sometimes prescribed to help reduce the symptoms of anxiety, such as heart palpitations.

Beta blockers slow down your heart rate and decrease your blood pressure. Propranolol (Inderal) is a beta blocker that's commonly used to treat anxiety.

Possible side effects include:

• stomach problems
• cold fingers
• tiredness
• sleep problems