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What Keeps Fears And Phobias Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, they provide an easy way for clients to understand at a glance why their disorders persist, and how they might be interrupted. What Keeps Fears And Phobias Going? is designed to help clients with fears and phobias understand more about their condition.

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A PDF of the resource, theoretical background, suggested therapist questions and prompts.

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A PDF of the resource plus client-friendly instructions where appropriate.

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An editable Microsoft PowerPoint version of the resource.

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Languages this resource is available in

  • Chinese (Simplified)
  • English (GB)
  • English (US)

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Introduction & Theoretical Background

Everyone feels afraid sometimes. Uncomfortable as it is, fear is an unavoidable part of life. In fact, a little fear can help you stay safe and avoid danger.

However, fear can become so intense, or trouble you so often, that it leads to serious problems. When specific objects, animals, or situations cause intense feelings of fear that are out of proportion to the actual danger, psychologists call it a ‘phobia’. Common symptoms of a phobia include:

  • Feeling extremely scared of something specific.
  • Experiencing immediate and intense fear.
  • Trying to avoid the thing that scares you, or enduring it with dread.
  • Worrying about encountering the scary thing in the future.
  • Being much more scared of something than most people are.

Research studies have shown that cognitive behavior therapy (CBT) is one of the most effective treatments for overcoming phobias and extreme fears (Hofmann & Smits, 2008). CBT therapists work a bit like firefighters: while a fire is burning, they’re not so interested in what started it, but in what is keeping it going and what they can do to put it out. If they can work out what is maintaining a problem, they can address it by interrupting the cycles that fuel it.

CBT models of extreme fears and phobias suggest that several things keep them going once they start. The What Keeps Fears and Phobias Going? information handout describes some of these maintaining factors, and illustrates them in a vicious flower format, in which each ‘petal’ represents a separate maintenance cycle. Helping clients to formulate a model of their experiences is an essential part of cognitive behavioral therapy for extreme fears and phobias. Therapists can use this handout as a focus for discussion, or as a template from which to formulate an idiosyncratic model of a client’s experiences.

Therapist Guidance

“One interesting way of thinking about extreme fears and phobias is to look at why, for some people, they don’t get better by themselves. This handout shows some of the most common reasons why some people’s fears persist. I wonder if we could look at it together and think about whether it describes what is happening for you?”

References And Further Reading

  • Eaton, W. W., Bienvenu, O. J., & Miloyan, B. (2018). Specific phobias. The Lancet Psychiatry, 5, 678-686. DOI: 10.1016/S2215-0366(18)30169-X.
  • Hofmann, S. G., & Smits, J. A. J. (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychology, 69, 621– 632.