Phobias are thought to be the most common of all the Anxiety Disorders, affecting approximately 12.5% of Americans, and women are more then twice as likely to suffer from this condition, in comparison to men. However, this figure may be grossly overestimated, due to the difficulty in distinguishing between  "phobias" vs. "disgust". For example, when an individual who resides in Incline Village says they have a "fear of rats", what they may mean is that they feel that rats are "disgusting" (well OK, Mark Twain felt that Washoe County had a lot of rats, but that was only his opinion!). Thus, the person may scream, and then run from the sight of a rat; starting in Incline Village and ending up in Tahoe City!!  This is particularly true of women, which may be a reason why women are over reported in the literature concerning the prevalence of phobias.  So, what are the diagnostic features required for being diagnosed with a phobia, whether you live in Incline Village or Tahoe City, Nevada? In general, they would include the following:

  • Experience intense fear nearly every time he/she encounters the phobic stimulus/situation (panic attack, freezing, etc.)
  • Recognize that the fear is unresonable (have insight)
  • Avoid the stimulus/situation, or endure extreme emotional distress when needing to interact with the feared situation
  • Experience significant impairment in social functioning

There are four (4) main types of Phobias, which is why we now refer to Phobias as "Specific Phobias": Animal Type (spiders, snakes, dogs, etc.); Natural Environment Type (heights, water, storms, darkness), Blood-Injection-Injury Type (sight of blood, receiving an injection, seeing needles), and Situational Type (bridges, tunnels, flying, driving, enclosed places).  Note that it is very easy to confuse "Situational Type", with another type of phobia, such as a fear of heights (Natural Environment Type), or another Anxiety Disorder such as Panic Disorder, when working with someone who states that they have a "fear of flying", for example. In other words, the question the person suffering from Panic Attacks, a fear of heights, claustrophobia, or some other condition? Thus, the need for a very thorough assessment. In general, the most common phobias involve animals and heights, with a mean age of onset typically around the age of 16 years.  It should also be kept in mind that the term, "Agoraphobia", used to be classified as a type of Phobia.  However, this term is now better associated with a diagnosis of "Panic Disorder with Agoraphobic Avoidance". That is, those who suffer from a diagnosis of Panic Disorder may ALSO display avoidance of specific environmental situations such as movie theaters, sporting events, etc. Their avoidance of these situations is not because they are "phobic" of movie theaters, etc., but is instead because of their fear of having a Panic Attack while in these particular environmental settings.

As was mentioned above, once an individual comes into contact with a feared object or situation, the most common reaction involves a Panic Attack.  Although the symptoms of a Panic Attack are primarily physical in nature, they also include cognitive components, that is, specific thought patterns associated with these attacks. The primary physical symptoms of a Panic Attack would include: rapid heart rate, a feeling of suffocation, a feeling of choking, chest pain, sweating, nausea or abdominal distress, chills or hot flashes, dizziness, and a feeling of disorientation or detachment from one's body. Not all of these symptoms need to occur during a Panic Attack. Some attacks include only a handful of these symptoms, and a person may experience different physical sensations from one attack to another.  In addition to these physical sensations, Panic Attacks also involves thoughts related to the attacks themselves, such as persistent concerns about having additional attacks in the near future, and thoughts about the possible consequences of the attacks themselves (e.g., experiencing heart failure, loosing all control and "going crazy"). These anxiety attacks represent the basic emotion of terror, or "false alarms" firing off at times when there is no true emergency at hand.

What is the difference between normal anxiety concerning interacting (or the thought of encountering) with a trigger (e.g., a dog), and having a phobic reaction? Normal anxiety would involve simple feeling worried about the need to go over to a neighbor's house for dinner, knowing that the person owns a dog. Having an animal phobia (in this case, regarding dogs), would result in avoidance behavior such as turning down the invitation to have dinner at your neighbor's home. In addition, should avoidance become impossible, and the person found themselves in contact with the neighbor's dog, it is very possible that a Panic Attack would occur.

Types of Phobias

Phobias & Panic Symptoms

Cognitive-Behavior Therapy & Exposure Response Prevention (ERP)


937 Tahoe Blvd. Ste. 205

Incline Village, NV. 89451

Phone:  775.831.2436


In terms of treatment for Specific Phobias, the research literature consistently demonstrates that the most effective intervention for any type of Phobia is Cognitive-Behavior Therapy (CBT), with a strong emphasis on Exposure & Response Prevention (ERP). My therapeutic approach depends heavily on the use of Cognitive Therapy treatment strategies which first involve helping the patient to become more aware of, and subsequently change, perceptions and typical interpretations of daily events in their lives (e.g., "the dog will attack me and I will require emergency room treatment"), which create behavioral or emotional discomfort. That is, I first help the patient to better understand their current thought patterns which they frequently use to predict specific outcomes, as well as how these outcomes are often catastrophized. I then help patients to explore other possible interpretations/predictions regarding these outcomes; interpretations that they may not be accustomed to thinking about. In other words, encouraging my patients to widen their "perspective lens" by getting into the habit of saying..."wait a minute, is there another way that I can view this situation, a way that is different than my typical manner of explaining to myself why something just happened, or may occur in the near future".

Once this goal has been accomplished, I then begin the Behavior Therapy component of the treatment program for Specific Phobias, which incorporates the use of Exposure and Response Prevention (ERP) strategies, while at all times working together with the patient, at his or her own pace. As a result of these goals, it is common to assign weekly out-of-office planned exposure exercises to perform, in addition to various "behavioral experiments", related to the phobic object or situation, thus allowing for the practice of newly learned skills acquired during each therapy session for the purpose of enhancing and maintaining skills learned within the treatment setting, to the individual’s home, school, community or work environments. Yes, the Center for Anxiety  p& Chronic Worry performs short-term Cognitive-Behavior Therapy (CBT) services for the treatment of Specific Phobias and Related Anxiety Disorders, I always have my patients' best interests in mind, realizing that everyone is unique, and thus my short-term Cognitive-Behavior Therapy treatment protocols are always individually based. I "take what the patient  gives me" during session #1 (i.e., their initial skill level, readiness level, etc.), and then teach additional skills needed to obtain treatment goals, one Cognitive-Behavioral step at a time. For more information on Phobias, please visit the Obsessive-Compulsive Foundation and the  Anxiety & Depression Association of America web sites.

Copyright © 2014-2021:  Center for Anxiety & Chronic Worry

All rights reserved:  Barry C. Barmann, Ph.D.

937 Tahoe Blvd. Ste. 205  Incline Village, NV. 89451

Tel.  775.831.2436