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Posted March 3, 2009 | Copyright © The Northern Virginia Daily
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Overcoming fear

Fears and phobias
Fears and phobias can be real obstacles in life, often requiring counseling and sometimes medication. Rich Cooley/Daily

Dr. Fred Sabia
Dr. Fred Sabia demonstrates a hand technique called eye movement integration he uses to help patients deal with fears and phobias. Dennis Grundman/Daily

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By Josette Keelor -- Daily Staff Writer

Dreams seem to bring out the worst fears in each of us, magnifying them into unrealistic proportions, from an army of invading spiders to a long fall from an airplane.

Upon waking the dreamer is comforted in knowing the images cannot cause harm, no matter how frightening they might be.

What would happen, though, if one could not escape the fear simply by waking but instead experiences that intense anxiety and dread all the time? For someone who suffers from a debilitating fear or anxiety disorder, the dream could quickly turn everyday life into a nightmare, from which he or she cannot wake.

The terror of unknown possibilities is the driving force behind most of what scares people. President Franklin Roosevelt's well-known statement, "The only thing we have to fear is fear itself," may be true, but for many, fear itself is a very real obstacle in their lives, according to local professional counselors.

Fear vs. phobia

"Fears are an awareness of wanting to avoid something that's perceived as dangerous," says Donna van Horn, a licensed clinical social worker with Valley Behavioral Health Associates in Woodstock.

"Anxiety is normal and natural," says Matt Bruffey, a clinical psychologist and head of the anxiety disorder track at New Lifestyles in Winchester. When it becomes excessive is when it becomes a problem, he says.

"Anxiety disorders are the most common mental disorders in the U.S.," Bruffey says.

According to the Web site for the Anxiety Disorders Association of America, www.adaa.org, specific phobias, a type of anxiety disorder, affect 19 million or 8.7 percent of the population.

The differences between fears and phobias can be minimal, but in general, phobias are less rational and more debilitating than fears.

"Where a fear goes into phobia is its intensity, its disruptions of people's functioning," says Fred Sabia, a licensed professional counselor with Lighthouse Counseling in Winchester.

"The differentiation is how it interferes with a person's day-to- day functioning," he says. Avoidance does not help, he says, even though the natural response to something scary is to avoid it altogether.

"The more I avoid it, the more it [can become] an inner reality," Sabia says.

Which lifestyle changes to make depend on the type of fear, van Horn says.

"[It] has to do with intensity of the fear and then the intensity of the response," she says. Overtime the fear can become worse, thus leading to harsher reactions to things that might not actually pose a danger.

Mind over matter

Whether or not a fear is rational, the treatment can still be the same.

"Exposure and response prevention is the most successful," Sabia says of the treatment methods he uses. One form of treatment is to determine the hierarchy of fear, says Sabia.

Make a list from one to 10, beginning with the least fearful aspect of the scary object or subject matter and ending with the most frightening part about it. Someone who fears snakes might select talking about snakes in the No.1 position on the hierarchy, and list actually holding a snake at No. 10.

Sabia then helps his clients overcome their fears by working their way up through the list. Though sufferers need to face their fears to overcome them, they probably should not choose to skip right to No. 10, he says. But instead ease their way into confronting what they fear.

The result of counseling will depend on the patient, says van Horn.

The fear might always be there, but clients will be able to remain in the scary situation rather than running away screaming.

"Don't expect to be fearless about that which you're phobic about," Sabia says.

If a fear does not conflict with a person's every day life, that person might do very well choosing to ignore it.

"You don't have to use elevators," van Horn says of people who fear enclosed spaces or elevators in particular. If their job does not require them to use one, they might choose to simply use the stairs instead.

They might instead choose to treat fear on their own, but Sabia cautions, "You'd have to be pretty self-motivated to do that."

Behind the fear

"Public speaking fears and social anxiety disorders are among the most common [fears]," Bruffey says. For the general public the fear of speaking to others can easily be overcome, but for others treatment is more complicated.

"Very frequently there is some basis to the fear," Sabia says. He uses a psychological technique called eye movement integration in the treatment of those who have experienced traumatic events that triggered a fear in them.

The treatment begins with the client making a anchor statement.

"It would help them to feel safe, secure, confident" -- the complete opposite of how the fear makes them feel, Sabia says

Next the client pictures the traumatic event or the source of anxiety, but as if he is a spectator, not a participant. Sabia asks the client to follow the path of his fingers through the air, back and forth horizontally before asking the client to mentally revisit the scene of anxiety.

"It always changes. ... What's different is what changes. Some people say the movie is moving slower," he says. "Some even say, 'I can't conjure up the image.'"

The process continues, with the eye movement path moving to a vertical platform, and later a circular one over the course of the treatment.

Another form of treatment is hypnosis.

"Basically all hypnosis is deep relaxation," says Gwen Corley, a licensed clinical social worker with New Dawn counseling service in Winchester, who uses hypnosis among other treatments in her practice. It is most useful in the case of something that triggered a specific fear in a patient, she says.

"It takes the emotional punch out of [the memory]," she says of hypnosis.

"There's a lot of use for hypnosis in treating phobias," Sabia says; however, "There's a lot of misunderstanding with that."

A misconception of hypnosis is that it draws forgotten memories out of patients or that it helps them forget traumatic events. Corley says she does not do memory retrieval because the memories can be unreliable.

"What I have found the most successful is taping the session," she says. This way patients can take the tape with them and practice self-hypnosis at home when they need it, she says.

She also uses eye movement desensitization and reprocessing to treat fear, a treatment similar to eye movement integration, but much more well-known, Sabia says. He prefers eye movement integration because he says it helps treat patients without forcing them to relive the traumatic experience.

Corley uses eye movement desensitization and reprocessing in order to allow the client to "free-associate," talking about whatever comes to mind during the session. The treatments she uses gradually expose the patients to their fear, which she says helps prevent them from becoming overwhelmed by the memories.

"We take baby steps," she says. "Usually it's very successful."

Medication could be another treatment, if anxiety is too much, Sabia says.

Support groups also exist for those suffering from fear or phobias as well as those living with a family member or friend suffering from anxiety. The National Alliance on Mental Illness offers support groups in Winchester. A free 12-week course for family and friends of those suffering from anxiety disorders will begin on Wednesday through NAMI.

"It's multifaceted ... very educational for people who don't understand mental illness," Brooke Taylor, president of the NAMI Winchester, says of the class.

"One in four families are affected by mental illness," she says, "which is huge."

The 12-week course will offer information for those wanting to learn more about mental illness.

The free Family to Family class begins Wednesday at 6:30 p.m. Preregistration is required. To register or for more information about NAMI or support groups, call 533-1832 or e-mail namiwinchester@live.com.

Contact Josette Keelor at jkeelor@nvdaily.com

Defining phobias

"A specific phobia is an intense fear of something that poses little or no actual danger. ... Such phobias aren't just extreme fear; they are irrational fear of a particular thing," according to the Web site for the National Institute of Mental Health, www.nimh.nih.gov.

Types of anxiety disorders:

* Panic disorder

* Generalized anxiety disorder

* Obsessive-compulsive disorder (OCD)

* Post-traumatic stress disorder (PTSD)

* Social phobia (or social anxiety disorder)

* Specific phobias

Some of the more common specific phobias include fear of:

* Closed-in places

* Heights

* Escalators/elevators

* Tunnels

* Highway driving

* Water

* Lying

* Dogs

* Injuries involving blood

-- Source: The National Institute of Mental Health

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