EMDR for Phobias

A phobia is defined as an intense fear of a specific object or situation that is out of proportion to the actual risks posed by the object or situation (DSM V, 2013). People with phobias tend to avoid the source of their phobia, which provokes immediate and intense fear or anxiety in them. The avoidance, the fear or the anxiety causes significant disruption to them on a social, occupational or other functional level.

Phobias are grouped by the source of the phobia into:

• Animal phobias (e.g. snakes, spiders, insects, dogs)
• Natural Environment phobias (e.g. heights, storms, water)
• Blood-injection-injury phobias (e.g. needles, going to the dentist, blood)
• Situational phobia (e.g. airplanes, elevators, enclosed spaces)
• Other phobias (e.g. choking, vomiting, loud sounds, etc...)

Avoidance of the phobic stimulus tends to worsen the anxiety, as depicted in the graph below. Imagine that each time you see a spider, your anxiety rises to a 10/10, and you run away. Your body learns that a spider is a 10/10 of anxiety, and remembers that for the future. If, on the other hand, you stick around and see that the spider does not actually pose any risk to you, your anxiety might go down to a 5/10, and your body would store anxiety associated with spiders at this lower level, making your next encounter with a spider a little easier.

Something would not be considered a phobia if most reasonable people would be afraid of it, for instance, most people would experience intense fear at the prospect of swimming in a river known to have salt water crocodiles in it, and this would not be a candidate for psychological treatment, as this fear may save your life.

How Are Phobias Treated?

EMDR is not the only therapy with empirical evidence showing it to be effective in treating phobias. Cognitive behaviour therapy (CBT) enjoys a solid evidence-base in phobia treatment. In CBT the participant would generate a list of potentially disturbing experiences involving their phobic object, say spiders, and order it from least frightening to most frightening. For example, the participant may say that watching films of spiders walking around would be least disturbing, followed by having a live spider in a jar in the consulting room, to having an actual spider walking freely around the consulting room.

CBT works on the principle of graduated exposure, in which the participant actively counters their tendency to avoid the phobic stimulus by putting themselves in its presence. The therapist or the participant produce each situation from the participant's list, and the participant focuses on the spider and notices their physiological responses to it. The participant rates their subjective sense of distress until, gradually, their distress settles. This settling is called habituation.

In order to achieve a full habituation, the participant often has to go a bit farther than most people would with a spider, for instance, having the spider walk on them, or capturing it in their hand, to ensure that their level of distress settles down to 0 or very close to 0. This method is very effective in the treatment of phobias, and is based on sound neurological and cognitive principles.

Why EMDR?

EMDR works a little differently, and I prefer to treat phobias with EMDR because it requires less equipment, takes less time, and is easier to do when the phobia involves something difficult to generate in the consulting room, like an airplane flight, a public speaking engagement, or a large animal. It also seems to generalise better than CBT because it works by transforming dysfunctional schemas into healthy ones, rather than focusing on sensory information, which is farther down the processing stream, from a neurological perspective.

Instead of having the actual phobic stimulus in the room, the participant focuses on their memories of phobic responses, and the feelings that those memories provoke; the therapist doesn't need to produce an actual version of the phobic object, your memory and the memory's associations are the targets of the work. Like CBT, your therapist ensures that you are not avoiding any aspect of the phobic stimulus in your memory, and gets you to engage in exposure to the event in your imagination.

EMDR treats the events in which you have encountered phobic objects or situations as unprocessed traumas, and you work through your memories to achieve an adaptive resolution (link to my Evidence Base page). You work through your feelings of distress until you come to a realisation that the phobic stimulus is not in fact as risky as you felt it was, and the distressing memories of the phobia are no longer distressing.

If your therapist suggests EMDR to treat a phobia, she will ask you to identify the first time you had an encounter with the phobic object or situation, as well as the worst time, and the most recent time. You will work through each of these situations, and an imagined situation in which you encounter it in the future. After this, you will be given an opportunity to test the resolution by engaging with the phobic object outside of the session to ensure that your phobia is resolved.

Academic References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Doering S , Ohlmeier MC , deJongh A , Hofmann A and Bisping V (2013) Efficacy of a trauma-focused treatment approach for dental phobia: a randomized clinical trial. European Journal of Oral Sciences, 121(6), 584.

de Jongh A, van den Oord, HJM, & Ten Broeke, E (2002) Efficacy of Eye Movement Desensitization and Reprocessing (EMDR) in the treatment of specific phobias: Four single-case studies on dental phobia. Journal of Clinical Psychology, 58, 1489-1503.

de Roos, Carlijn & de Jongh, Ad (2008) EMDR treatment of children and adolescents with a choking phobia. Journal of EMDR Practice and Research, Vol 2(3), 2008, 201-211.

Muris P, Merckelbach H, Van HH and Mayer B (1997) Eye movement desensitisation and reprocessing versus exposure in vivo. A single-session crossover study of spider-phobic children. British Journal of Psychiatry, 170(JULY), 82.

Schurmans, Karen A clinical vignette: EMDR treatment of choking phobia. Journal of EMDR Practice and Research, Vol 1(2), 2007, 118-121.