Online Mindfulness Psychotherapy For Treating Phobias. Boulder, Colorado

A phobia, from the Greek phobos, meaning to fear, is a recurrent irrational emotional and physiological reaction to an object or situation. Phobias are actually one of the most common forms of anxiety disorder and the National Institute of Mental Health estimates that as many as 10% of Americans suffer from phobias. The most well known phobias are the Specific Phobias produced in reaction to animate objects, such as spiders, cats, dogs and moths or inanimate objects such as needles. This class also includes fear of enclosed spaces, high places, dark places, dirt, the fear of injury or activities such as driving a car. Some of these specific phobias may have had evolutionary origins as defence reactions against real threats, but most have no clear explanation. Another major group of phobias are the Social Phobias. Most of us feel a degree of fear if we are called on to give a presentation, but for a social phobic the fear reaction takes the form of panic, accompanied by an elevation in heart rate, rapid breathing, sweating and blurred vision and an uncontrollable urge to flee the situation. This class of phobias also includes fear of crowds, parties and social gatherings and is often accompanied by extreme self-consciousness and embarrassment. Agoraphobia is perhaps the most disabling phobia in which there is a generalized fear of a wide range of stimuli associated with being outside of a defined safe space such as home.

Phobias have a major impact on the quality of life and can cause a great deal of stress. They cause embarrassment and lead to all manner of conscious and unconscious avoidance reactions that limit choices and freedom. Phobias can have a major influence on self-esteem and self-confidence.

What causes phobias to arise is far from clear. However, it is well known that emotional trauma in which the individual is confronted with an overpowering sense of helplessness may manifest as a phobia long after the event and it is not unreasonable to assume that phobias contain a core of unresolved emotional conflict. The treatment options for phobias are varied, but the general consensus is that effective psychotherapy must involve some form of desensitization protocol coupled with controlled exposure to the phobic trigger. Clients are taught a relaxation response to use whenever they encounter the stimulus. They are gradually introduced to the stimulus, learn to monitor their stress response and respond with the relaxation technique. This is repeated many times until the client can encounter the object without having the phobic reaction.

Neuro-Linguistic Programming has attracted considerable attention as a treatment for phobias and claims many success stories. The central premise in NLP is that an emotional reaction is built around an internal mental representation. This Structural Theory of Emotions is a useful concept when working with intense emotional reactions such as phobias or past-traumatic stress reactions. Basically, the theory states that an emotional reaction has an internal structure built around sensory modalities. The principle modalities are visual, auditory and psychophysical sensations. Of these, the visual modality of inner imagery is usually dominant. In effect, when an arachnophobe encounters a spider, what he sees is not the actual animal, but an internal image, his internal representation of spiders. Most likely this will consist of a very large, very vivid in-your-face image that is in color and probably moves in a particular way. The emotional fear is encoded in these various sub-modalities of size, position, color and movement. This is the internal structure of the emotion and this structure encodes the feelings that form the emotional reaction. The external object seen through the eyes is simply a stimulus that evokes this internal representation and it is the internal representation generates the fear.

            During MMT, the client learns how to establish a safe and non-reactive relationship, the Mindfulness Based Relationship, with the core internal representation of a phobia. There are a number of techniques that he can experiment with to create this safety, such as making the image very small and distant. He might imagine looking at the spider through a thick glass window. The therapist and client engage their creativity to find what works for the client. In MMT, the emphasis is always on helping the client form a non-reactive relationship with his or her inner representation of emotions and when working with a phobia much time is spent on establishing a mindful relationship. This is called the RELATIONSHIP PHASE of Mindfulness Meditation Therapy. This in itself can be highly transformative, because as the client learns not to react to his internal representation he will find that he will be les reactive when he encounters the actual object or situation.

The next phase of MMT is the TRANSFORMATIONAL PHASE. Now that you are able to relate to the inner imagery with mindfulness, continue to observe and investigate the imagery, to become more familiar with its structure and all the various feeling sensations associated with the color, size and other sub-modalities. There is no attempt to analyze or interpret, only to fully observe and know what is being experienced, like a scientist observing an experiment as it unfolds, or a fisherman observing the river for subtle features and changes that indicate where the fish are to be found. As this wealth of subtle details begins to unfold, you will simultaneously become aware of what needs to happen next. The psyche naturally looks for changes at the experiential level that reduce suffering and when you remain mindful and present with the unfolding experience of inner imagery, it will present changes to you. You may discover that placing the spider in a glass jar and putting the jar on a shelf is sufficient to completely neutralize the fear reaction or that changing its color from blood red to pale pink does the job. What is important is that you experiment for your self and find what works for you. But, rather than stopping there, you stay with the inner experience and continue to sense what needs to happen next. Perhaps you sense a need to take the spider jar and take it to a place where you can release the spider or you may discover some other thing that needs to happen. The important thing is to allow these solutions to arise experientially and that they feel right.

Next is the RE-EXPOSURE PHASE. You deliberately imagine seeing a spider in your home or other environment. Start with the least difficult encounter and progress to the most difficult encounter of all, such as imagining the spider crawling on your hand. Check the feeling response in each case and repeat the visualization many times. If the emotional reaction is still too intense, then return to the Relationship phase and continue working with the sub-modalities. If you can successfully manage all the different imaginary situations, then you are ready to try exposure to a real spider. Do this gradually, first observing the spider at a distance, then move closer and finally place the spider on your hand. If the reactions are too intense, then return to the visualization phase. It may take many repetitions of the process, from the relationship phase through to re-exposure, but you now have a strategy for working with your inner experience of a phobia at the experiential level and eventually this will lead to the desired results.