Roughly 15 percent of Americans develop phobias.
By Ray Segebrecht The worn yellow page features 13 easy tasks for most teens: eat out, walk the dog, go a day without a panic attack — among 10 others. For Clark Topjon, they were unfathomable.
The 16-year-old jotted them down two years back before beginning exposure therapy for an emetophobia, or severe fear of vomiting. Countless vomit videos and handfuls of fake throw-up later, Topjon just smiles at his shaky, ninth-grade handwriting.
The goal list, now more like a certificate, bears 13 check marks. Every last task is now habitual.
Exposure therapy took only two months and seven sessions to help Clark. Before that, his emetophobia worsened over three years, despite medical, homeopathic and talk treatments.
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Roughly 15 percent of Americans develop phobias, said Thomas Wise, American Psychiatric Association co-chair of the Committee on Adult Psychology. If unaddressed, they can worsen over time and turn serious, even life threatening.
In the U.S., exposure treatment — facing fears — has steadily gained acceptance in the last couple decades, Wise said. For phobias, exposure therapy is the sole proven cure. But still, many people with phobias are slow to seek, and find, it.
“It’s great that it turned out this way,” said Greg Topjon, Clark’s father. “The only regret is the poor kid lost three years of really neat time.”
— — —
By definition, phobias are any anxieties that limit life, like a fear of cars too intense to drive to work or a fear of dogs that keeps someone from walking outdoors. Ashley Smith, psychologist for the Kansas City Center for Anxiety Treatment, likened them to fire alarms that sound with the simple lighting of a candle or stovetop.
“Until you realize it’s a false alarm,” she said, “you’d be running out of the house all the time.”
In Topjon’s case, this meant hours on end in the bathroom, afraid he might vomit. He also started phoning his parents incessantly and skipping breakfast for fear the hungry feeling meant he might get sick.
For Wendy Erickson, of Overland Park, Kan., the limit from her phobia was simply a flat refusal to fly.
Earlier in life, Erickson loved plane trips. She flew for family vacations. She flew to Florida on frequent ocean visits to see her grandparents.
“I was a person who flew all the time and loved it,” Erickson said.
But all her infatuation with flying ended with one broken elevator in 1987, which sparked a case of claustrophobia. She sat, trapped and alone, for 45 minutes, before a fireman eventually pried it open and pulled her free. When she emerged, she wouldn’t visit her grandparents — or the ocean — for 23 years.
“I looked at (flying) as being up in the air 30,000 feet in a tube,” Erickson said.
Erickson’s phobia lasted longer than Topjon’s because, for decades, she didn’t see it as a treatable illness. She and her family just accepted that every family trip would be by car — to Wisconsin, to Colorado. The times her two daughters, Libby and Annie, or her husband, David, did fly, she simply stayed home.
Topjon said he tried to be proactive with his phobia. He went to his primary care doctor, who started him on Zoloft, an antidepressant. He also tried numerous talk and homeopathic therapists. Sometimes, he improved. But the progress was always precarious and short-lived. Another incident would send him straight back into instability.
“What we got from every place we went to before the Kansas City Center for Anxiety Treatment was coping stuff,” Greg Topjon said. “It was all just tools and props to cope, to just make it through the day, and it had nothing to do with curing it.”
In the end, Erickson only changed her attitude toward treatment because her eldest daughter moved to Chicago last spring. With Libby in a medical residency there, she couldn’t bear not visiting.
Libby suggested exposure therapy at the Kansas City Center for Anxiety treatment as her top choice.
Topjon turned there in a more desperate state. The week before, he had dipped into depression and even spoke of suicide. After numerous other centers, it was a last resort.
“It literally saved his life,” his mother, Di Topjon, said.
The Kansas City Center for Anxiety Treatment keeps an assortment of potentially fearful sights. The ones prescribed commonly include clown figures, hypodermic needles, fake blood and cages of spiders and snakes.
The staff also takes patients with embarrassment fears to supermarkets to have them clap in public. For a fear of speeches, the staff poses as inattentive students, throwing paper planes and talking as the patients present a topic.
Dr. Amy Jacobson resorted to vomit-flavored jelly beans and home-cooked fake vomit — favorites for emetophobia — to treat Topjon. She flew on a plane with Erickson to St. Louis.
But she saved all this at the start. Most professionals, Smith said, use a “graduated” approach which, albeit slower than “flooding,” is milder and less traumatic.
So, at first, Topjon merely thought of vomiting, then looked at pictures and watched movies of people throwing up. Only later did he eat the jelly beans; hold a hand in fake vomit, which he then thought was real; and gag himself — all with Jacobson telling him he was going to vomit.
Erickson, for a long time, just watched movie after movie of planes — inside and outside the cabin — taking off and landing.
Not until May 9, more than a month after beginning, did Erickson board a St. Louis-bound plane with her doctor.
The wait helped.
Early on, Erickson expected a week of sleepless nights before that inevitable flight came. But even the night before, she slept like a baby.
She also had predicted protesting in panic over sitting in a separate row from Jacobson on the return flight. Instead, upon arriving in St. Louis, she calmly faced her doctor and requested a much bolder revision to their itinerary.
“Is it OK if I fly on to Chicago?” she asked; later on, Libby had a flight to Kansas City.
Jacobson smiled. It was great.
“I flew home that night with my daughter,” Erickson said, proudly.
Smith compared the gradual approach in exposure therapy to acclimating to a cold pool by entering one limb at a time.
But even gradual exposure with phobias — spread over four to 10 sessions instead of just one or a few — isn’t easy. The Kansas City Center for Anxiety Treatment uses a stress scale from one to 10, with level 10 being total panic, for patients to self-monitor their anxiety.
“The first couple of times, I was 9, 10 the whole time,” Topjon said.
The anxiety often weighs on the therapists, too.
“The hardest part is tolerating their distress,” Smith said, of her patients. “I certainly would do it a different way if other ways worked.”
But Smith says it helps to know that even the panic attacks are harmless and that her patients need her help.
“People can actually strengthen their symptoms by trying and not being successful,” she said. “If people could do this on their own, they would.”
She also reminds herself that the reward is well worth the struggle — something Topjon hopes everyone with a phobia will realize.
“You can’t give up,” he said. “There’s always something that can fix it. You just have to have faith in that.”
… afflict one in every 7 to 10 people (10 to 15 percent of the population).
… are more common in women than in men.
… worsen in time without treatment.
… should be treated professionally. (Unsuccessful exposure makes them worse.)
… can be treated in patients as young as age 1.
… typically take 4 to 10 sessions of professional behavioral therapy, or cognitive behavioral therapy, to cure. 10 warning signs of phobias in kids:
1. Increased clinginess
2. More frequent nervous movement or twitches
3. Impulsive behavior
4. Distracted behavior
5. Difficulty sleeping
6. Sweaty hands
7. Faster resting heart rate
OTHER COMMON PHOBIAS AND TREATMENTS
1. Animal phobias, such as arachnophobia (of spiders), ophidiophobia (of snakes) and cynophobia (of dogs)
Treatment: (gradual exposure) Start with imagining the creatures and build to pictures and videos of them as anxiety decreases at each stage. Eventual visual and then, hands-on exposure with live creatures should also be scaled, like starting with a puppy and then switching to a grown dog and a room of dogs.
2. Social phobias, such as glossophobia (of public speaking or “stage fright”) and more general social anxiety
Treatment: Clap out loud in a busy supermarket or carry on a conversation with someone who intentionally creates an awkward silence. For a fear of speeches, give a presentation while others (such as mental health counselors) pose as disruptive students throwing paper planes, talking and ignoring you.
1. Separation anxiety, such as a fear of overnights
Treatment: Don’t console the kids before leaving, but rather act as though leaving isn’t a big deal, saying goodbye and exiting with confidence the child will be OK. For sleepovers, have kids stay increasingly later (until they eventually stay the night) or increasingly further away (like from a neighbor’s to across town to summer camp).
2. Scary movies
Treatment: Address the behavior the child limits after seeing the film, like exiting the front door or going out at night. More exposure to the movie or unrealistic fear, like Freddie Kruger, is unhelpful and counterproductive; the fear will fade in time as long as it no longer limits daily life.