New phobias have emerged with the Covid: nosophobia, fear of falling ill, or haptophobia, the fear of touching or being touched. We are also talking more and more about the “cabin syndrome”, which is the difficulty of leaving your home after confinement. “The crisis we have just gone through has imposed a whole set of stress factors on us: limited access to resources at the start of the pandemic (masks, gowns, etc.), fear linked to contamination, for us as for our loved ones, the feeling of isolation, the often vague or even contradictory information, the consequences on the economic level… Moreover, due to the long and uncertain duration of the containment measures, a new balance has been formed, indicates Dr Bourgognon, psychiatrist. We had to adapt to this reality in which nothing worked as before, and where we had to keep a distance from each other. For more than a year now, we have been severely limited in our social interactions.
The problem ? These additional stressors forced us to draw on our resources and generated anxiety, even trauma in some. In addition, social distancing has somehow “disadapted” us to being in direct relationship with others. “The fact of communicating by interposed screens and wearing a mask protects from the gaze of the other, further notes Dr. Bourgognon, which can be reassuring in people who suffer from social phobia, but tends to reinforce the dynamic of avoidance. . »
The different types of phobias
Certain phobias are certainly inherited from evolution. They then have an adaptive value, as phobias of certain animals. Other phobias (we speak of specific phobias) are often the expression of a traumatic imprint. One can develop a phobia of an ordinary place, even though it presents no danger, after feeling unwell in this place for example. But in reality, almost anything can be a phobia : storm, height, insects, injection, blood, tunnel, elevator… “Agoraphobia, which corresponds to the fear of finding oneself in places where it would be difficult to escape in the event of symptoms of panic (transport by common, shopping centers, queues…) is apart insofar as it is not specific to a single situation”, explains Dr Bourgognon. Finally, social phobia, which is characterized by an excessive fear of being confronted with the gaze of others (beyond simple shyness) is a fairly common anxiety disorder and can prove to be very disabling (we also speak of social anxiety).
Is any fear a phobia? No, specifies the psychiatrist, because one element is decisive for us to speak of a phobia: the fear must be irrational, disproportionate to the real danger of the situation. The fear is also so intense that it can cause a real panic attack, with the impression that one is going to die.
Who are the people at risk?
Are some people more at risk of developing a phobia during their lifetime (often during a period when one is more vulnerable)? An anxious terrain, the affective environment in childhood, education, each person’s history, the occurrence of traumatic events are all elements that come into play.
“Growing up in a family withdrawn into itself, not encouraging self-assertion, and in which the judgment of others occupies an excessive place, can induce social phobia, notes the psychiatrist. Finally , regarding specific phobias and agoraphobia, women are more often affected.”
How does this manifest?
Beyond the irrational fear itself, phobia has physical manifestations. One can feel paralyzed in front of the phobic object. “It’s a bit like if you wanted to go to a place and your car no longer started “intellectually” since it becomes impossible to turn the key”, explains psychotherapist Rodolphe Oppenheimer.
To this can be added tremors, palpitations, excessive sweating, hot flashes… all manifestations of an anxiety attack. However, Rodolphe Oppenheimer also observes, “phobias are increasingly accompanied by panic attacks due to the feeling of an ‘endless day’. “
How is it treated?
The immediate solution to the real suffering of the phobia and the panic attack is to remove the object of the phobia from your life. “Phobias always work the same way: I feel anxiety about an object (which is objectively not dangerous) so I avoid it,” explains Dr. Bourgognon. Each phobic person must therefore ask themselves whether or not they can live normally with their phobia, and what they are losing. In most cases, avoidance triggers a veritable vicious circle: not only does it prevent us from experiencing the fact that it is not dangerous, but it relieves, and therefore reinforces the idea that we have done the right thing. ‘to avoid. Which is a mistake.
In addition, an abnormally shy person, who has difficulty interacting socially, and who finds himself in a situation that prevents him from meeting other people (such as during confinement) maintains in spite of himself, without necessarily being aware of it, his phobia. Avoidance cannot be satisfying in the long term. This is especially true for a disorder like social phobia which can interfere with work or school activities, relationships with others, etc.
A phobia never disappears spontaneously and tends, on the contrary, to increase over time if nothing is done. Rapid treatment is undoubtedly the best option, especially since today’s techniques (cognitive-behavioral therapies, virtual reality, self-affirmation groups, etc.) give good results.
- Therapies (CBT and ACT) : Dr. Bourgognon often uses a metaphor with his patients, which explains the method well: we imagine that we are a mountaineer and that we want to climb to the top of a mountain, it is the dream of our life, we have been preparing for this for years. Unfortunately, the day we arrive at the foot of the mountain we find that it is surrounded by swamps, the object of the phobia. In TCC, you gradually enter the swamps to get used to it and better control your fear. With the ACT, we accept to cross the swamps, and all the discomfort that goes with it, because they are inevitable if we want to make this ascent which gives meaning to our life. “In some patients, this mental orientation is much more effective.”
- Self-affirmation groups. “In all the socially anxious people we receive in our groups, especially adolescents and young adults, we find this excessive and paralyzing fear of the judgment of others: fear of being observed, evaluated, badly judged, fear of appearing ridiculous, uninteresting, zero, etc. “, explain Blandine Schnepp and Catherine Sargueil, founders of one of these groups. This fear, which is manifested by physiological symptoms (dry throat, sweating, tremors, palpitations, blushing, headaches, feeling of suffocation…), can lead to real panic attacks in the face of situations of confrontation with others. “The group allows you to gradually confront anxiety-provoking situations in a climate of listening and benevolence: everyone reports the difficult situations that he encounters, we discuss them together, everyone proposes solutions, the situations are played and replayed with feedback from the group until everyone feels comfortable in his we role”.
- Virtual reality. It is a support used in the context of behavioral and cognitive therapies. The virtual reality helmet faithfully reproduces the object of the phobia (more realistic than a film), but we feel safe. As with other supports, habituation is gradual and must be supervised. It is not a question of using this type of device alone, at the risk of aggravating the symptoms. This type of support is also not recommended for people with epilepsy.
Our Experts:
- Dr François Bourgognon, psychiatrist, co-author of The Therapy of Acceptance and Commitment (Que sais-je?)
- Rodolphe Oppenheimer, psychotherapist-psychoanalyst, co-author of Freedom from anxiety disorders through virtual reality (ed. Eyrolles)
- Blandine Schnepp and Catherine Sargueil, clinical psychologists, founders of the assertiveness group
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Virtual reality at the service of health
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