Tim Ervin, LCPC, BCC, CH

A phobia is defined as an intense fear of a specific object or situation that is out of proportion to the actual risks posed by the object or situation (DSM V, 2013). People with phobias tend to avoid the source of their phobia, which provokes immediate and intense fear or anxiety in them. The avoidance, the fear or the anxiety causes significant disruption to them on a social, occupational, or other functional level.
Phobias are grouped by the source of the phobia into:
• Animal phobias (e.g., snakes, spiders, insects, dogs)
• Natural Environment phobias (e.g., heights, storms, water)
• Blood-injection-injury phobias (e.g., needles, going to the dentist, blood)
• Situational phobia (e.g., airplanes, elevators, enclosed spaces)
• Other phobias (e.g., choking, vomiting, loud sounds, etc...)
Avoidance of the phobic stimulus tends to worsen the anxiety, as depicted in the graph below. Imagine that each time you see a spider, your anxiety rises to a 10/10, and you run away. Your body learns that a spider is a 10/10 of anxiety and remembers that for the future. If, on the other hand, you stick around and see that the spider does not actually pose any risk to you, your anxiety might go down to a 5/10, and your body would store anxiety associated with spiders at this lower level, making your next encounter with a spider a little easier.

EMDR works a little differently, and I prefer to treat phobias with EMDR because it requires less equipment, takes less time, and is easier to do when the phobia involves something difficult to generate in the consulting room, like an airplane flight, a public speaking engagement, or a large animal. It also seems to generalize better than CBT because it works by transforming dysfunctional schemas into healthy ones, rather than focusing on sensory information, which is farther down the processing stream, from a neurological perspective.
Instead of having the actual phobic stimulus in the room, the participant focuses on their memories of phobic responses, and the feelings that those memories provoke; the therapist doesn't need to produce an actual version of the phobic object, your memory and the memory's associations are the targets of the work. Like CBT, your therapist ensures that you are not avoiding any aspect of the phobic stimulus in your memory and gets you to engage in exposure to the event in your imagination.