How does one become phobic ?

From the thunderstorm to the dogs, from the black to the kiwis, in humans everything can give rise to a phobia ! Trauma and avoidance mechanism are the main ingredients for turning fear into phobia. And after decades of classic therapies, virtual reality may well be the treatment of the future.

Fear is a normal emotion and often necessary for survival. But phobia is defined by ” a clinically significant level of fear, which hinders normal functioning. For example, phobia can lead to avoiding places where spiders can be found, or refusing a promotion that would require flying, ” explains Dr. Stéphane Bouchard, an expert psychologist in anxiety disorders, and Canada Research Chair in Clinical cyberpsychology, to Sciences et Avenir.

The phobia can come from direct or vicarious trauma … or remain unexplained

Phobias can develop in childhood, such as fear of the dark. In general, they fade in adolescence, when new behaviors end the avoidance mechanism that feeds phobias, but sometimes they persist, explains Dr. Bouchard. Women are somewhat more prone to phobias than men, and about 25% of the causes are related to genetic predispositions. There are three profiles among phobics, summarizes Dr. Bouchard. A third of phobics experienced an event that marked them, “like a dog bite, for example,” illustrates Dr. Bouchard. A third witnessed this event, “for example their mother was afraid of cats, or they saw a plane crash on television”. Finally, a third of phobics have no idea where their disorder comes from. “In the end, regardless of the cause, the success rate of cognitive-behavioral treatment will be the same,” says Dr. Bouchard.

Avoidance, the mechanism that turns fear into phobia

It is the avoidance of what is perceived as threatening that can not only maintain it, but above all turn it into a phobia. “If every time I see a spider I move away, I maintain the information stored in my limbic system (brain area) that encodes fear,” explains Dr. Bouchard. In our brain, fear is encoded in the amygdala, the center of emotions, which is part of the limbic system. When it receives a signal from the thalamus, which receives our perceptions, it delivers in just 12 milliseconds a signal of fear, which then rises to the hippocampus-seat of memory. The hippocampus – and other regions associated with information analysis-can in return give a calming signal to the amygdala, if the frightening perception finds a reassuring explanation in logic… But this can only happen 9 to 10 milliseconds after the fear signal. “In the case of phobias, the amygdala reacts so strongly that the correcting signal no longer corrects,” explains Dr. Bouchard.

Exposing oneself to fear to heal

To cure a phobia, only one solution : progressive exposure to the source of fear. “When you are afraid of the dark, you leave a little light first, then you close the door with someone in the room, then with someone in the room next door,” explains Dr. Bouchard.

Professional management will generally use cognitive behavioral therapy (CBT), which aims to replace the maladaptive behavior with another, according to what the patient wants, and thus create a link between the therapist and him. The exhibition will then be gradual, “first we look at a spider image, then a plastic spider, then a stuffed toy, then a real one in a jar, then we open the jar”. This art of treating evil with evil requires to dose well and rely on the good relationship between the therapist and the patient, who will have to be violent. “It has been known since the late 1980s that this technique works in 90% of cases after 10 to 12 weeks of therapy,” says Dr. Bouchard.

Virtual reality, the tool that goes even further

We have new tools, since the 1980s : this is where virtual reality or VR comes in. “It’s exactly the same, except I don’t need to have a real spider in my office,” says Dr. Bouchard, enthusiastic. In virtual reality, the therapist can control all the parameters of the experience : the conformation of the room, the location or the size of the spider, whether it moves or not … But also recreate situations too specific to be reproduced in practice with only imagination, videos and some noises, such as miming turbulence in an airplane or speaking in front of an assembly whose reactions can be controlled. For now, “virtual reality has shown similar effectiveness to conventional CBT,” says Dr. Bouchard, “but I think we haven’t gone far enough with this tool.”

Because by definition, VR allows us to break free from the limits of reality, “but we use it to do the same thing as in normal CBT,” notes Dr. Bouchard. In virtual reality, an arachnophobe can face a spider the size of a table, and a person with a phobia of heights climb up the floors of an imaginary building, and above all… He can jump into the void ! “After 3 or 4 jumps, he will realize that he no longer feels ‘caught’ by the void, that he will only fall if he wants. And that can only be done in virtual reality, ” reveals Dr. Bouchard. If the realism of the decor can be a limit to this technology, it is all relative, because phobics tend to let themselves be much more easily embarked than non-phobics.

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