UAB Medicine News


Cognitive Behavioral Therapy Offers Relief from Phobias and Anxiety

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“The Wizard of Oz” tells the story of a young girl who befriends three sidekicks while traveling a yellow brick road to find her way home. Dig a little deeper into the 1939 classic, though, and it quickly becomes clear that Dorothy and the gang suffer from bouts of anxiety. There’s the Scarecrow’s dislike of crows, the Wicked Witch’s terror around water, and the Cowardly Lion’s instinct to flee from perceived danger. The crew experiences near-constant jitters about what might lurk around the next bend.

Dorothy and her friends aren’t the only ones who anticipate danger, feel nervous, or sense impending doom. According to the National Institute of Mental Health (NIMH), anxiety or phobias affect 20% of adults in the United States. “Anxiety disorders fall into three categories,” says Tiffany Nowell, PhD, a clinical psychologist and assistant professor at UAB Medicine. “Phobias, generalized anxiety disorders, and panic disorders are all types of anxiety disorders.”


Dr. Nowell says a phobia is a fear that doesn’t match the threat that an object or situation actually poses. “Between seven and nine percent of people in the U.S. experience fear of a specific object,” she says. Examples of specific phobias include:

  • Animals, such as spiders, dogs, or snakes
  • Environmental, such as heights or storms
  • Situational, such as enclosed spaces or elevators
  • Miscellaneous, such as needles or vomiting

There are two types of non-specific phobias that can create anxiety:

  • Agoraphobia, the fear of open spaces or being in public
  • Social phobia, which creates anxiety in a number of social settings. “Social phobia can involve fears of being judged by others,” Dr. Nowell says. “It can make people afraid of public speaking, eating in front of other people, shopping at a mall, or going into a grocery store.”

Anxiety and Panic

Generalized anxiety isn’t triggered by a specific object or event, but the symptoms are similar. “You can feel nervous, irritable, or have difficulty concentrating or sleeping, and you may sweat or hyperventilate,” Dr. Nowell says.

Those who have a phobia typically experience symptoms when confronted with a specific trigger. If you have generalized anxiety, however, you may feel on edge every day. “Anxiety happens more frequently than not and may be related to money, your health, or your job,” she says.

Panic disorder is in a category all its own. An episode can be triggered by something specific or occur randomly. “It’s anxiety symptoms on steroids,” Dr. Nowell says. “At its peak, it’s uncontrollable panic, but it usually subsides after about 15 minutes.”

What’s the Impact?

Your decision whether or not to seek treatment for a phobia or anxiety disorder can depend on the impact it’s having on your life. The NIMH reports that 43% of adults with anxiety experience mild impairment, 34% experience moderate impairment, and 23% experience serious impairment.

  • Mild impairment: You have symptoms like worry, increased heart rate, or gastrointestinal distress, but the discomfort doesn’t interrupt your life.
  • Moderate impairment: “You might not be able to push through the discomfort all of the time,” Dr. Nowell says. “You are able to keep your job or have food in the fridge most of the time, but sometimes the stress levels are higher and your life is impacted.”
  • Serious impairment: “Your anxiety levels can mean that you’re unable to go to work, that you’re at risk of losing your job, or that you’ve lost your job,” Dr. Nowell says. “You may be worried about relationships with friends or loved ones because you’ve completely withdrawn.”

The earlier treatment begins, the better the results in most cases. “If you can catch these symptoms before they impact your functioning, your chances are better than for those who have been struggling for years and years,” Dr. Nowell says.

The Gold Standard in Treatment

According to Dr. Nowell, cognitive behavioral therapy (CBT) is the gold standard for treating phobias and anxiety. “It’s a type of psychotherapy that helps people modify their thinking and behavioral patterns,” she says.

In the case of social phobia, therapy might look like this:

  1. Coping strategies: “We practice relaxation and deep breathing techniques,” Dr. Nowell says. “These are tools the person can use in the real world.”
  2. Functional analysis: Understand the events and circumstances that are triggering the anxiety, such as going to the grocery store.
  3. New cognitive strategies: “Together, we examine the evidence with questioning,” Dr. Nowell says. “If someone is avoiding the grocery store because they’re worried that people will stare, I might ask, ‘Do you stare at people when you go to the grocery store?’” Likely, the answer is no.
  4. Behavioral strategies: Encourage the person to engage in those behaviors that cause them distress. “I’ll encourage them to go to the grocery store on a Sunday afternoon, during the busiest time,” Dr. Nowell says. “They can check in with themselves about their symptoms of distress and use their coping strategies to relieve those symptoms.”

Someone who has a phobia or anxiety may believe that they won’t be able to tolerate the experience. “Some think they will vomit or pass out but then discover that their worst fears didn’t happen and that they were able to push through their discomfort,” Dr. Nowell says. “Over time, their anxiety will decrease to a tolerable level.”

According to the Anxiety and Depression Association of America, it can take 12-16 sessions to successfully treat anxiety disorder with CBT. “Depending upon impairment of functioning, you may respond to treatment more quickly,” Dr. Nowell says. “If impairment is mild, you might only need five to eight sessions, but if it’s severe, you’re probably looking at 16 sessions.”

You’re Not Alone

While the causes of phobias and anxiety can be complicated – ranging from genetics to the trauma of bullying – the treatment is straightforward and effective. “Anxiety is treatable,” Dr. Nowell says. “You don’t have to suffer alone.”

If you wish to explore treatment for anxiety or a phobia, please either speak with your primary care physician for a referral or call 205-934-7008. After providing some basic information, you’ll be matched with a clinician who can help.

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