Agoraphobia, bacteriophobia, claustrophobia, dentophobia, aquaphobia, febriphobia –there's a whole alphabet of fears and phobias and many ways to treat them. The traditional approaches, such as cognitive behavioural therapy and pharmaceuticals, are being bolstered by holistic and innovative treatments – and according to these experts, they're gaining momentum and achieving lasting success. 

So, what's involved in the making of a phobia, and how do we break the fear cycle?

Virtual reality (VR)

Corrie Ackland, a clinical psychologist at Sydney's Phobia Clinic, says phobias can develop about absolutely anything – even puppies – and virtual reality is a valuable addition to cognitive behavioural therapy. 

Diagnostically a phobia is marked by persistent fear, which elicits worry and physiological symptoms of anxiety that causes outright avoidance or induces significant dread and distress, explains Ms Ackland.

"It becomes clinically significant, or worthy of treatment, when the distress or avoidance behaviours, which can be obvious or subtle, begins to impair an individual's functioning.

"It's fascinating that we can develop a phobia about anything even though the fear response evolved to keep us safe against real threats to our survival.

"That's how irrational things like puppies, small spaces and foods can be the subject of phobia for many people."

Virtual reality helps people address specific phobias through exposure in a controlled environment and is especially useful for phobias that are hard to confront regularly, explains Ms Ackland.

"The crucial component of treatment is exposure, which exposes people to the situations they fear and have been avoiding, to facilitate new, helpful learnings about the situation and their ability to cope."

Ideally, fear exposure is structured, prolonged and repeated, often following a scaffolded or hierarchical approach – ordered from easiest to most difficult. But what if this is not practical in reality? That's where virtual reality makes all the difference, says Ms Ackland.

"The best applications are fears that have a practical limitation to practice, such as flying and medical procedures, but VR is useful in all cases of phobia.

"A common presenting concern, especially now, is the fear of needles. It's hard for a client to enter a pathologist's office and manage themselves for a brief procedure."

In this situation, treatment involves helping clients understand the fear, learning coping techniques and developing a virtual reality exposure plan.

"Typically, this will start with looking at photos, reading about needle procedures, looking at videos and watching others have injections.

"The VR will start with observing injections and blood tests in virtual reality and then experiencing injections and blood tests in virtual reality."

Virtual reality exposure will be repeated for as long as necessary until the client is ready for a real-life procedure.

"Most of my clients have had successful injections or blood tests through the course of the five-sessions programmes. In many cases, I accompany them to their procedure in the final session."


EFT (tapping)

Social worker Khadine Aharon specialises in treating phobias and trauma using emotional freedom techniques (EFT), also known as tapping. She says phobias can be learned in childhood through observing a fear response in others.

"I find that many phobias have an underlying trauma. It makes working with phobias incredibly interesting.

"Often in my work, underlying a phobia is trauma, which they may not associate with the phobia.

"It is sometimes a trauma they have forgotten. It's like the phobia has become a Band-Aid, which keeps the deeper trauma contained."

The recent pandemic will likely impact this generation of children, explains Ms Aharon, with mask mandates, hand sanitising and social distancing becoming the norm.

"It will be interesting to see if more children develop germ phobias or need to wash their hands compulsively."

EFT (tapping) is a simple stress-reducing technique that focuses on uncomfortable emotions and body sensations while tapping on specific meridian points.

"It allows the body's fight-flight-freeze response to relax.

"When EFT is applied well, the trigger for the phobia soften stops being a trigger, and the phobia frequently disappears."

People are unique, and each phobia is different, so the treatment will vary. But generally, a practitioner will demonstrate the basic techniques so clients can treat their anxiety at home as it arises, says Ms Aharon.

EFT practitioners also test the severity of a phobia to gauge their response to treatment.

"Does the person feel anxious just thinking about spiders? Or do they need to see one to feel anxious?

"We focus on any initial discomfort thinking about the phobia, triggers and when the phobia began.

"At the end of a session, we re-test the level of discomfort to assess whether a shift or improvement has occurred."

A fear of sharks masked a long-forgotten childhood trauma for one of Ms Aharon's clients, which was overcome using EFT.

"My client couldn't go into the ocean beyond her knees due to a fear of sharks.

"When we explored the fear, she expressed her fear was being pulled under the water by a shark and not being able to breathe.

"I asked if she could identify another time in her life when she felt this way.

"A memory came up of being a child with a serious lung condition. If she got a cold, her lungs would fill up with fluid, and she likened it to feeling like drowning.

"We used EFT to release the childhood trauma, and now she loves swimming in the ocean, and she doesn't think about sharks."


Hypnotherapy and NLP

Riannah Roach, a hypnotherapist and NLP (neurolinguistic programming) practitioner, has successfully treated fears and phobias through hypnosis and timeline therapy.

"In my experience, persistent fear or phobia starts from one experience, which is often considered traumatic or intense…is linked to a meaning in the person's unconscious mind.

"The experience is then often replayed over and over again–they may re-live the experience many times until the fear or phobia is well and truly in place.

"It's almost like PTSD because the mind cannot tell the difference between what's real and what's not. The fear or phobia is then reinforced and strengthened over time."

Hypnotherapy helps a person relax and access memories that may have created the fear or phobia, explains Ms Roach.

"They can go back to the very first time the fear or phobia started even if they can't remember it consciously.

"Once back in the memory, as a hypnotherapist, I guide them to find the learnings from the memory and plant positive suggestions that help them to release the fear or phobia.

"A suggestion or learning may be as simple as 'everything is going to be okay because at that moment in time they may not have known that, but now they do."

NLP is a system that provides tools and techniques to understand the language of the mind to create change, explains Ms Roach.

"It allows us to access the unconscious mind, which holds infinite memories, emotions and resources, to reframe our internal dialogue and how we see the world and ourselves.

"It can bring about change in someone's thoughts and behaviours."

A typical session involves identifying the problem and uncovering the root cause of a fear or phobia, which is not always the surface problem presented, says Ms Roach.

"Once we uncover the root cause, we then use an NLP tool, such as timeline therapy, which can quickly and powerfully release negative emotions or limiting beliefs at an unconscious level."

A fear of heights was unconsciously connected to a childhood memory of climbing trees for one of Ms Roach's clients.

"Through a combination of hypnotherapy and timeline therapy, she went back to the very first time she experienced a fear of heights.

"It was a memory that involved climbing trees as a kid and her brother getting hurt.

"While consciously, this memory had no linkages to a fear of heights, the link was there at an unconscious level.

"At that moment in time, she thought her brother might not survive and linked the height of the trees to the problem, and the fear was formed.

"The fear was strengthened over time with continuous reinforcement.

"Through the session, she was able to realise that the height of the trees was not the reason her brother was hurt. Her brother was okay, and she can be safe even up high."

Yoga and meditation 

Camille Woods, yoga therapist and mental health first aid instructor, says while yoga can't 'cure' phobias, it can bring the confidence to help a person confront their fears more peacefully.

A typical yoga therapy session for fears and phobia includes a grounding breathing exercise, coping strategies, gentle warm-up, yoga poses, cool down and meditation.

"Yoga means union and can bring a sense of peacefulness to a person as they synch their body, breath and mind into the present moment.

"Extreme fears and phobias limit a person's ease of living, and by doing yoga, they may build up the confidence to move their body in new movements, creating a little less resistance to staying the same.

"A yoga therapist can work to complement the treatments recommended by a client's doctor and mental health professional to bring a sense of peacefulness."

Yoga for fears or phobia focuses on breathing and movement to ground the client in the present moment.

"Breathe in to raise the hands to the sky…breathe out to bring the hands down towards the ground and repeat.

"What this does is bring the mind and the body to sync with the breath, which has the effect of focusing on the present moment.

"If a yoga pose reminds them of something that makes them fearful, the client may choose to walk along the yoga mat instead.

"We want the client to build on their inner resource so they can feel safe, calm and at ease.

"The yoga therapist will emphasise being in the 'here and now' throughout the session; this is to help the client not think about fears of the future or fears from the past."

Cross patterning yoga techniques are important in yoga to relieve feelings of fear, explains Ms Wood, and involve moving one limb to meet the other or performing figure eights with the hands.

"These movements bring a light, child-like play and allows the brain to take a break from the heaviness of fear.

"By working with clients who are going through exposure therapy for their phobia, yoga can help in-between … to celebrate their wins and consolidate the new experience as they move through their yoga practice."