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The specific phobias, such as animal phobias, or the fear of lightning, are easier, in general, to treat than agoraphobia. Agoraphobia spreads from place to place because the basic fear is not of that place or set of circumstances, but of the feeling the phobic person has in those situations. If agoraphobics are afraid of getting panicky and losing control of themselves, as they are, they will have that fear in any place from which they cannot quickly, and easily, extricate themselves. On the other hand, the fear of dogs, for example, is not likely to spread to other places and things. Just avoiding dogs will usually be enough to allow people afraid of dogs to live their lives comfortably. But not always.
A woman who had a singularly disruptive fear of snakes came for treatment to our Anxiety and Phobia Center. Usually, avoiding snakes is much easier than avoiding dogs. I live in Westchester County, as she did, and I haven’t seen a snake outside of a nature center or pet store in the last forty years. She was so afraid of snakes, however, that she had not left her house alone for over ten years—on the odd chance that she would encounter a snake. That was her only fear. She felt at ease in those places—elevators, theaters, restaurants, and so on—that agoraphobics typically avoid. She entered an eight week treatment program along with other more typical phobics and, of course, the trained Phobia Aides we use, almost all of whom had been phobic, themselves, in the past.
During out first group session, she asked me if she would be able to recover completely.
“Sure,” I told her. “But to recover completely, you will have to confront snakes closely. In the end, you will have to hold them in your hands.”
She began to cry.
After the meeting, the Aides complained to me that I should not have, in this very first meeting, confronted her with what she obviously thought was impossible. I think they were right. If I had scared her too much, she might have left treatment. I wish I were sensitive and adroit enough to say the right thing reliably; but I cannot. I tend to say what I think. I can no more pretend to be circumspect than I can pretend to be neat, rather than messy. I would not be able to pull it off. On the other hand, there are some advantages to being outspoken. The patients always know exactly what I think. In any case, this particular patient was not dissuaded from continuing in treatment.
Besides the weekly group meetings, where progress and difficulties are reported, treatment involves the patient exposing herself, with the help of the Aides, to snakes—the idea of snakes, the fact of snakes--in a series of experiences of graduated difficulty, starting with:
- Reading about snakes. I like phobics to become very knowledgeable, if possible an expert, about whatever they fear, in the case of snakes, their habits and habitats, whether they are poisonous or not, what they like to eat, how they have evolved. The more the patient knows, the better.
- Looking at pictures of snakes. Not easy. Even a drawing of a snake could elicit a gut-wrenching feeling at first. But with more pictures and photographs, this became less and less upsetting.
- Holding a toy snake. Still difficult. The patient had to get used to a stuffed snake first, then a toy snake that squiggled at the end of a stick.
- Getting a snake skin, and keeping it in different places around the house.
- Looking at a snake in a pet store, first from a distance, then closer and closer. It turns out a snake in a glass cage is very boring. It doesn’t snap or snarl. It sleeps most of the time.
- Going to a nature center where non-poisonous snakes slither around the floor.
- Holding a snake.
By the end of eight weeks, this patient was holding, and demonstrating, snakes in the nature center. One of the unexpected things she discovered, she told me, was that the snake always slithered away from her when she inadvertently dropped it.
Months later she was still fine. Her husband, however, was complaining about all the snake skins he found around the house. (c) Fredric Neuman 2012 Follow Dr. Neuman's blog on fredricneumanmd.com/blog
