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For adults and parents
Specific phobias
Specific phobia is among the most treatable of all anxiety presentations. Many people who have avoided something for twenty years find it shifts in a small number of sessions.
What a specific phobia is
A specific phobia is an intense, persistent fear of a particular thing or situation, out of proportion to the danger, which you either avoid or endure with real distress. The narrow definition is useful: unlike generalised anxiety, the fear has an address.
The ones I see most often are needles and blood tests, vomiting, dogs, flying, heights, choking, enclosed spaces, motorway driving, dentists, thunderstorms, spiders and other insects, and in children the dark, loud noises, hand dryers, toilets away from home, and costumed characters.
Almost everybody with a phobia already knows the fear does not match the risk. Being told the statistics on aeroplanes does not help, and by the time people reach me they have heard them several times. The fear is not stored as an argument, so it cannot be dismantled with one.
The most treatable thing I see
Specific phobia is the most reliably treatable presentation in the anxiety field. A single well-defined phobia in someone who is otherwise well frequently responds in a small number of sessions.
That is not a promise about any individual case. But if you have avoided something for decades and assumed it was permanent, this is usually short work.
How avoidance keeps it going
Every phobia runs on the same mechanism. You avoid the thing, the fear drops immediately, and your brain records two lessons: the situation was dangerous, and you escaped in time. Repeat that a few hundred times and the fear grows, because it is never contradicted.
Avoidance is rarely total, and the partial versions do the same damage. Flying only with a drink and a particular seat. Looking away during the blood test and gripping someone’s hand. Walking the long way round the park in case of dogs. Cutting food into pieces so small that choking feels impossible. These safety behaviours get you through while preventing you from learning anything. When somebody flies regularly and is still terrified, this is why.
Around the fear, life quietly reorganises: the job involving travel is not applied for, the friend with the dog is seen less, the holiday is driven rather than flown, the smear test is postponed again. The cost of a phobia is not the panic. It is the accumulated absence.
What treatment involves
The treatment is graded exposure. It is the principle that underpins exposure and response prevention and sits within cognitive behavioural therapy. NICE recommends CBT-based treatment as a first-line approach for anxiety disorders.
First we take the fear apart. Not “dogs”, but the sudden movement, the noise, being jumped at, the teeth, not knowing what it will do. Not “flying”, but turbulence, being unable to leave, or the sensations in your body at altitude. The exposure has to target the actual prediction.
Then we build a ladder, from something you could do today to the thing you cannot imagine, and work up it. You stay in each situation long enough to learn something and drop the safety behaviours as you go. Doing the thing while gripping the armrest teaches your brain that the armrest saved you.
The aim is not to make the fear go down during the session, though it usually does. It is to violate the prediction. You expected to faint, be bitten or be sick, and you were not. That mismatch changes the fear, and it is why varied exposure works better than a rigid sequence.
Needles, blood and the fainting problem
Blood-injection-injury phobia is the one real exception to the usual physiology. Most anxiety raises heart rate and blood pressure; this one produces a drop, which is why people faint at the sight of blood and why the fear is justified by experience. Treatment includes applied tension, tensing the large muscle groups to raise blood pressure and prevent fainting, alongside graded practice with the equipment.
Phobias in children
Children develop fears as a matter of course and most fade. What turns a normal fear into a problem is the scaffolding around it: the route changed, the birthday party skipped, the parent who checks the room first, the reassurance given nightly. As with other childhood anxiety, much of treatment is coaching parents out of the accommodation and towards supporting approach. With younger children exposure is built as a game with a reward structure. With teenagers it looks like adult work.
When it is not a simple phobia
Some presentations wear a phobia’s clothes but behave differently. Fear of vomiting spreads across food, travel, alcohol and other people. Fear of choking narrows the diet until it becomes ARFID. Fear of enclosed spaces is usually panic and agoraphobia.
These are treatable, but they take longer and need a different sequence. Getting the formulation right at assessment stops treatment stalling later.
Working with me
I am a clinical psychologist and have worked in psychology since 2008. I trained at the University of Washington, completed my internship at Seattle Children’s Hospital and Harborview Medical Center, and a postdoctoral fellowship at the Evidence-Based Treatment Centers of Seattle, where I was Director of Training and Education and later Assistant Director of the Child Anxiety Center. I am board certified in Behavioral and Cognitive Psychology by the American Board of Professional Psychology, HCPC-registered, and chartered with the British Psychological Society.
I work with adults, children and teenagers online across the UK and in person near Ravenshead, Nottingham and Mansfield, weekdays from 9am to 9pm. I do not prescribe, but I work alongside GPs and psychiatrists. Fees and insurance are on the fees page. The first step is a free 30-minute call. For a straightforward phobia, that call is often enough for me to tell you roughly how much work it will take.
Common questions
How many sessions does a specific phobia usually take?
Fewer than most people expect. A single, well-defined phobia in someone who is otherwise well often resolves in a handful of sessions after the assessment, and some of that work can be done in longer appointments rather than spread over months. Phobias present for decades, involving several feared situations, or sitting alongside panic or depression take longer. I will give you an estimate after the assessment, and I would rather discharge you early than keep you coming.
Will you make me do something I have not agreed to?
No. Exposure works because you choose to approach the thing, not because you are ambushed into it. We build the ladder of steps together, you know what each session involves before it starts, and you decide when to move up. Surprises are also counterproductive: they teach your nervous system that the situation is unpredictable. The discomfort in treatment is real, but it is planned, time-limited and yours to control.
Can a phobia be treated online?
Most can, and often more easily than people assume. Much of the work happens between sessions in your own environment, and video sessions let me see the actual staircase, the actual dog, the actual needle kit on your kitchen table rather than a description. Some phobias need in-person work at some stage, including driving, certain animal phobias and some medical procedures, and I will say so if yours does. I see people near Ravenshead, Nottingham and Mansfield as well as online.
My child is terrified of needles and has vaccinations coming up. Can you help in time?
Often yes, and this is a situation where a short, focused piece of work pays off quickly. Needle fear responds well to graded practice with the actual equipment, and blood-injection-injury fear may need a technique called applied tension, which raises blood pressure briefly to prevent fainting. If there is a deadline, tell me at the free call and we will plan around it. It is worth acting rather than hoping the appointment goes well.
What is emetophobia and why is it harder?
Emetophobia is fear of vomiting, your own or other people’s. It is technically a specific phobia but behaves more broadly, because the feared event can happen anywhere. People avoid particular foods, restaurants, alcohol, public transport, illness in others, pregnancy and sometimes their own children being sick. Treatment follows the same logic but takes longer and needs careful sequencing, and it involves reducing a long list of safety behaviours as well as approaching the feared situations.
Is it too late if I have had this since childhood?
Length of history matters much less for phobias than for other presentations. People routinely arrive having avoided flying or dogs or dentists for thirty years, and the fear responds to the same treatment it would have responded to at twelve. What a long history changes is the amount of life arranged around the avoidance, such as jobs not taken and holidays not booked. Unpicking those habits sometimes takes longer than treating the fear itself.
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