In the middle of a session, Sarah, a client suffering from claustrophobia, begins to show visible signs of panic: her breathing quickens, her hands become clammy, and she suddenly asks to leave the room. As a massage therapist, you’re faced with a situation that requires not only an understanding of phobias, but also the ability to adapt your approach to help your client regain her composure. Phobias, belonging to the world of anxiety disorders, can have a direct impact on your practice.
| Contents: Diagnosis and types of phobias The vicious circle of phobias Treatments for phobias Supporting a client suffering from a phobia Conclusion |
Diagnosis and types of phobias
It is one of the most widespread mental health disorders with a prevalence of 7 to 12.5% and an age of onset around 7 years, they differ from simple fears by several criteria:
- A marked and disproportionate fear of an object or situation.
- A systematic fear reaction to the object or situation.
- Active avoidance or endurance of the situation with marked anxiety.
- Significant impact on daily life (social, occupational and professional functioning).
- Persistence of symptoms for at least six months.
- Lack of alternative explanation by other mental disorders.
There are five main categories of specific phobias:
- Animal-related phobias: fear of dogs, spiders or snakes.
- Phobias of the natural environment: fear of thunderstorms, heights or water depths (thalassophobia).
- Blood-injection-injury phobias: fear of injections, seeing blood or medical procedures.
- Situational phobias: fear of confined spaces (claustrophobia) or air travel.
- Other phobias: various fears, such as the fear of vomiting (emetophobia) or contamination (mysophobia).
Some phobias can be traumatic in origin, such as a dog bite, or the result of observation, for example if a parent shows intense fear in a given situation. They may appear spontaneously, and refer to archaic fears that helped us survive in ancient times.
The vicious circle of phobias
Phobias are often part of a vicious circle that reinforces and perpetuates fear. It all starts with a feeling of danger, whether real or imagined, in a specific situation. This feeling triggers an intense emotion, generally marked by anxiety or anguish. To alleviate this distress, the person adopts an avoidance strategy, which, in the short term, reduces the unpleasant emotion. This immediate relief consolidates the idea that avoidance is the solution to escape anxiety, thus reinforcing this behavior. However, by systematically avoiding the situation, the person fails to develop the skills needed to manage their anxiety, making each potential confrontation even more difficult. This self-reinforcing mechanism feeds the vicious circle, which always returns to its starting point.
Phobia treatments
Cognitive-behavioural therapy (CBT) is currently the most validated treatment method for phobias. It aims to reduce or eliminate symptoms by gradually exposing the patient to the source of their anxiety, while learning to manage the anxiety it provokes. This desensitization process is based on gradual exposure, from imagination to real-life confrontation, accompanied by breathing and relaxation techniques. These tools help the body to regulate its state of stress and return to a state of calm.
Hypnotherapy is also gaining recognition in this field. Although promising, its efficacy still needs further study before it can be fully validated.
The use of medication remains limited: in the case of social phobias, in-depth treatment can sometimes be envisaged, and for other specific phobias, anxiolytics or antidepressants are used on an ad hoc basis. For example, to cope with an unavoidable situation such as flying. However, these treatments do not tackle the root cause of the phobia, and should be used sparingly as a back-up solution.
Supporting a customer suffering from phobia
It’s not the massage therapist’s job to diagnose or treat phobias directly, but he or she can play a key role in providing an environment where the client feels safe and can relax. To do this, it’s essential to listen and empathize, taking the time to understand the client’s specific fears. For example, someone with a phobia of needles might be apprehensive about any sensation reminiscent of a prick.
Environmental design also plays a crucial role. A welcoming room, with subdued lighting and soothing music, can help reduce feelings of oppression or discomfort. In addition, teaching the client breathing or relaxation exercises can be very helpful in regulating emotions during the session. A client suffering from mysophobia (fear of germs) may be reassured by strict visible hygiene measures, such as wearing gloves or using disinfectant wipes.
Finally, it’s important to adopt a progressive, transparent approach. Explaining each step of the process helps to create a climate of trust and reduce anxiety about the unknown. This open communication helps to establish a reassuring framework that respects the customer’s needs.
It’s essential to encourage clients to discuss the issue with their GP, psychiatrist or psychologist, especially if the phobia has a significant impact on their daily life, such as social isolation.
Conclusion
By recognizing phobias and adapting your sessions, you contribute not only to your clients’ relaxation, but also to their overall mental well-being. This sensitivity reinforces your posture as a caring and competent practitioner, able to adapt to diverse needs and sensitivities.
To remember:
- Phobias are common anxiety disorders characterized by intense, disproportionate fear. They often form part of a vicious circle in which avoidance reinforces anxiety in the long term.
- Cognitive-behavioural therapy (CBT) is the most effective treatment method, combining gradual exposure and relaxation techniques. Medication is used only in exceptional cases, as a one-off solution.
- Providing a safe, soothing environment, listening with empathy and offering relaxation techniques are all essential in supporting customers suffering from phobias.
- It is important to advise customers to consult a healthcare professional (doctor, psychologist or psychiatrist) if the phobia has a strong impact on their daily life.
Sources :
- American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR.
- Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in Clinical Neuroscience, 17(3), 337-346. https://doi.org/10.31887/dcns.2015.17.3/akaczkurkin
- Millard, E. (2022, January 12). DSM-5 Phobia Types, Diagnosis, and Treatment. MedCentral. https://www.medcentral.com/behavioral-mental/anxiety/assessment-diagnosis-adherence-phobia
- Wolf, T. G., Schläppi, S., Benz, C. I., & Campus, G. (2022). Efficacy of Hypnosis on Dental Anxiety and Phobia: A Systematic Review and Meta-Analysis. Brain Sciences, 12(5), 521. https://doi.org/10.3390/brainsci12050521
