The embarrassment of having a phobia as an adult

People describing a phobia to me almost always apologise partway through. I know it's silly. I feel ridiculous saying this. It's such a stupid thing to be scared of. They have often built a whole life around not meeting the thing, and told nobody the real reason, because a grown adult afraid of a dog, a needle, a lift or a bird sounds, to them, like a child who never grew up.

The embarrassment is often the thing that has stopped someone asking for help, and it is entirely misplaced.

It is not childish

Phobias are among the most common anxiety problems there are. Most adults with one acquired it in childhood, which is not the same as it being childish; childhood is simply when alarms get laid down most easily. Fear of blood, needles, animals, heights, flying, enclosed spaces, vomiting, the dentist: these are ordinary human fears, wired into an alarm system that everyone has and that occasionally attaches itself to the wrong thing.

The people who do not have a phobia are no braver; their alarm did not happen to get connected to that trigger.

It has nothing to do with courage

A phobia is a learned alarm, firing in response to a trigger, faster than thought. Courage is what you do in the presence of fear, and most people with phobias show a good deal of it every day: getting through the blood test shaking, sitting on the plane rigid, walking past the dog with their heart pounding. What they cannot do by willpower is switch off the alarm, and nobody can. Willpower is the wrong tool. The fear does not respond to it, and the failure of willpower gets read as weakness when it is nothing of the kind.

Why the embarrassment makes it worse

The shame keeps the phobia private, and a private phobia is a maintained one. If nobody knows, nobody can help you approach the thing. The avoidance stays invisible, so it never gets challenged. And the fear itself gets an extra layer: fear of the thing, plus fear of being seen to be afraid of it, which makes any encounter twice as loaded.

Most people I see have been carrying a phobia for decades before mentioning it to anyone. The length of time is no barrier to treatment; what matters is how much of your life the fear currently governs, and that is measurable and changeable.

What happens when you say it

When you describe the fear to me, what you get is recognition of a familiar picture. I have heard versions of it many times, and the version you are apologising for is one I will recognise. Then we get on with the work, which is practical and short.

The work

Specific phobias have one of the strongest evidence bases of anything I treat, and graded exposure is the heart of it. We build a ladder together, from something you could do today up to the thing you want back, and work up it step by step, staying with each step long enough for your body to learn something new. Around it sits the CBT: the prediction you are making, the images that come with it, the safety behaviours that keep the fear intact.

Nobody is asked to do anything they have not agreed to. You choose every step, because exposure that is forced does not work; the learning depends on you deciding to stay. After an assessment session, most people need 6 to 10 weekly sessions, sometimes fewer.

Where the phobia is affecting your medical care or your work, needle fear that stops treatment, driving fear that threatens a job, dentist fear that has kept you away for years, it is worth prioritising, and it responds well.

Blood and needles

One phobia deserves a note, because it is the one people are most embarrassed by and it is genuinely different. Fear of blood, injections and injury involves a real drop in blood pressure, which is why people faint. It is a reflex. The treatment adds applied tension, a technique that keeps your blood pressure up during exposure, and it works.

If you have been apologising for a fear for years, you can stop, and there is more on how I treat phobias.