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Many treatment options are available for those suffering from it. Cognitive behavioral therapy is one form of therapy for people who suffer from certain phobias. It focuses on one's fears and the reason they exist. It tries to change and challenge the thought processes behind one's fear. Studies have shown that it has been effective in treating people with equinophobia. Another treatment option is systematic desensitization, which focuses on gradually acclimating patients to their phobias. The first step in this process may involve thinking about horses, followed by looking at pictures of horses. Once the patient is comfortable with the images, they may proceed to meeting a horse, touching a horse, and finally riding a horse. For extreme cases, it may also be necessary to use medication, even though its effects are only short term.
Like many other phobias, lilapsophobia can often be treated using cognitive-behavioral therapy, but if it stems from post-traumatic stress disorder, then alternative therapy may be more recommended.
As with most phobias this fear could be cured with therapy. Relaxation techniques or support groups could also be effective.
The fear of spiders can be treated by any of the general techniques suggested for specific phobias. The first line of treatment is systematic desensitization – also known as exposure therapy – which was first described by South African psychiatrist Joseph Wolpe. Before engaging in systematic desensitization it is common to train the individual with arachnophobia in relaxation techniques, which will help keep the patient calm. Systematic desensitization can be done in vivo (with live spiders) or by getting the individual to imagine situations involving spiders, then modelling interaction with spiders for the person affected and eventually interacting with real spiders. This technique can be effective in just one session.
Recent advances in technology have enabled the use of virtual or augmented reality spiders for use in therapy. These techniques have proven to be effective.
Flight experience with the use of anti-anxiety medications like benzodiazepines or other relaxant/depressant drugs varies from person to person. Medication decreases the person's reflective function. Though this may reduce anxiety caused by inner conflict, reduced reflective function can cause the anxious flier to believe what they are afraid will happen is actually happening.
A double-blind clinical study at the Stanford University School of Medicine suggests that anti-anxiety medication can keep a person from becoming accustomed to flight. In the research, two flights were conducted. In the first flight, though patients given alprazolam (Xanax) reported less anxiety than those receiving a placebo, their measurable stress increased. The heart rate in the alprazolam group was 114 versus 105 beats per minute in the placebo group. Those who received alprazolam also had increased respiration rates (22.7 vs 18.3 breaths/min).
On the second flight, no medication was given. Seventy-one percent of those who received alprazolam on the first flight experienced panic as compared with only 29% of those who received a placebo on the first flight. This suggests that the participants who were not medicated on the first flight benefited from the experience via some degree of desensitization.
Typical pharmacologic therapy is 0.5 or 1.0 mg of alprazolam about an hour before every flight, with an additional 0.5-1.0 mg if anxiety remains high during the flight. The alternative is to advise patients not to take medication, but encourage them to fly without it, instructing them in the principles of self-exposure.
The most common methods for the treatment of specific phobias are systematic desensitization and in vivo or exposure therapy.
Scientists have developed medications that can be taken to reduce patients' fears. This medication is known as anti-anxiety medication. However, medications may have side-effects or withdrawal symptoms that can be severe. The most popular form of treatment is visiting a cognitive behavioral therapist, psychologist, psychiatrist, hypnotherapist, or hypnotist. These therapies are also used to help patients forget what they are afraid of. Some basic therapy sessions involve making the patient stand in front of a fan, or making the patient face their fears in a safe environment. With the use of hypnotherapy, the subconscious mind of a person can be reached, potentially eliminating those fears.
Exposure therapy has been proven as an effective treatment for people who have a fear of bees. It is recommended that people place themselves in a comfortable open environment, such as a park or garden, and gradually over a prolonged period of time move closer to the bees. This process should not be rushed, it may take many months spent watching bees before people feel comfortable in their presence.
Apiphobia is one of the zoophobias prevalent in young children and may prevent them from taking part in any outdoor activities. Older people control the natural fear of bees more easily. However, some adults face hardships of controlling the fear of bees.
A recommended way of overcoming child's fear of bees is training to face fears (a common approach for treating specific phobias). Programs vary.
There have been a number of studies into using virtual reality therapy for acrophobia.
Many different types of medications are used in the treatment of phobias like fear of heights, including traditional anti-anxiety drugs such as benzodiazepines, and newer options like antidepressants and beta-blockers.
Cognitive therapy is a widely accepted form of treatment for most anxiety disorders. It is also thought to be particularly effective in combating disorders where the patient doesn't actually fear a situation but, rather, fears what could result from being in such a situation. The ultimate goal of cognitive therapy is to modify distorted thoughts or misconceptions associated with whatever is being feared; the theory is that modifying these thoughts will decrease anxiety and avoidance of certain situations. For example, cognitive therapy would attempt to convince a claustrophobic patient that elevators are not dangerous but are, in fact, very useful in getting you where you would like to go faster. A study conducted by S.J. Rachman shows that cognitive therapy decreased fear and negative thoughts/connotations by an average of around 30% in claustrophobic patients tested, proving it to be a reasonably effective method.
The medical literature suggests a number of treatments that have been proven effective for specific cases of needle phobia, but provides very little guidance to predict which treatment may be effective for any specific case. The following are some of the treatments that have been shown to be effective in some specific cases.
- Ethyl Chloride Spray (and other freezing agents). Easily administered, but provides only superficial pain control.
- Jet Injectors. Jet Injectors work by introducing substances into the body through a jet of high pressure gas as opposed to by a needle. Though these eliminate the needle, some people report that they cause more pain. Also, they are only helpful in a very limited number of situations involving needles i.e. insulin and some inoculations.
- Iontophoresis. Iontophoresis drives anesthetic through the skin by using an electric current. It provides effective anesthesia, but is generally unavailable to consumers on the commercial market and some regard it as inconvenient to use.
- EMLA. EMLA is a topical anesthetic cream that is a eutectic mixture of lidocaine and prilocaine. It is a prescription cream in the United States, and is available without prescription in some other countries. Although not as effective as iontophoresis, since EMLA does not penetrate as deeply as iontophoresis-driven anesthetics, EMLA provides a simpler application than iontophoresis. EMLA penetrates much more deeply than ordinary topical anesthetics, and it works adequately for many individuals.
- Ametop. Ametop gel appears to be more effective than EMLA for eliminating pain during venepuncture.
- Lidocaine/tetracaine patch. A self-heating patch containing a eutectic mixture of lidocaine and tetracaine is available in several countries, and has been specifically approved by government agencies for use in needle procedures. The patch is sold under the trade name "Synera" in the United States and "Rapydan" in European Union. Each patch is packaged in an air-tight pouch. It begins to heat up slightly when the patch is removed from the packaging and exposed to the air. The patch requires 20 to 30 minutes to achieve full anesthetic effect. The Synera patch was approved by the United States Food and Drug Administration on 23 June 2005.
- Behavioral therapy. Effectiveness of this varies greatly depending on the person and the severity of the condition. There is some debate as to the effectiveness of behavioral treatments for specific phobias (like blood, injection, injury type phobias), though some data are available to support the efficacy of approaches like exposure therapy. Any therapy that endorses relaxation methods may be contraindicated for the treatment of fear of needles as this approach encourages a drop in blood pressure that only enhances the vasovagal reflex. In response to this, graded exposure approaches can include a coping component relying on applied tension as a way to prevent complications associated with the vasovagal response to specific blood, injury, injection type stimulus.
- Nitrous Oxide (Laughing Gas). This will provide sedation and reduce anxiety for the patient, along with some mild analgesic effects.
- Inhalation General Anesthesia. This will eliminate all pain and also all memory of any needle procedure. On the other hand, it is often regarded as a very extreme solution. It is not covered by insurance in most cases, and most physicians will not order it. It can be risky and expensive and may require a hospital stay.
- Benzodiazepines, such as diazepam (Valium) or lorazepam, may help alleviate the anxiety of needle phobics, according to Dr. James Hamilton. These medications have an onset of action within 5 to 15 minutes from ingestion. A relatively large oral dose may be necessary.
This method forces patients to face their fears by complete exposure to whatever fear they are experiencing. This is usually done in a progressive manner starting with lesser exposures and moving upward towards severe exposures. For example, a claustrophobic patient would start by going into an elevator and work up to an MRI. Several studies have proven this to be an effective method in combating various phobias, claustrophobia included. S.J. Rachman has also tested the effectiveness of this method in treating claustrophobia and found it to decrease fear and negative thoughts/connotations by an average of nearly 75% in his patients. Of the methods he tested in this particular study, this was by far the most significant reduction.
Some desensitization treatments produce short-term improvements in symptoms. Long-term treatment success has been elusive.
There are several options for treatment of scopophobia. With one option, desensitization, the patient is stared at for a prolonged period and then describes their feelings. The hope is that the individual will either be desensitized to being stared at or will discover the root of their scopophobia.
Exposure therapy, another treatment commonly prescribed, has five steps:
- Evaluation
- Feedback
- Developing a fear hierarchy
- Exposure
- Building
In the evaluation stage, the scopophobic individual would describe their fear to the therapist and try to find out when and why this fear developed. The feedback stage is when the therapist offers a way of treating the phobia. A fear hierarchy is then developed, where the individual creates a list of scenarios involving their fear, with each one becoming worse and worse. Exposure involves the individual being exposed to the scenarios and situations in their fear hierarchy. Finally, building is when the patient, comfortable with one step, moves on to the next.
As with many human health problems support groups exist for scopophobic individuals. Being around other people who face the same issues can often create a more comfortable environment.
Other suggested treatments for scopophobia include hypnotherapy, neuro-linguistic programming (NLP), and energy psychology. In extreme cases of scopophobia, it is possible for the subject to be prescribed anti–anxiety medications. Medications may include benzodiazepines, antidepressants, or beta-blockers.
Systematic desensitization therapy was introduced by Joseph Wolpe in 1958 and employs relaxation techniques with imagined situations. In a controlled environment, usually the therapist's office, the patient will be instructed to visualize a threatening situation (i.e., being in the same room with a dog). After determining the patient's anxiety level, the therapist then coaches the patient in breathing exercises and relaxation techniques to reduce their anxiety to a normal level. The therapy continues until the imagined situation no longer provokes an anxious response.
This method was use in the above-mentioned study done by Drs. Hoffmann and Human whereby twelve female students at the Arcadia campus of Technikon Pretoria College in South Africa were found to possess symptoms of cynophobia. These twelve students were provided with systematic desensitization therapy one hour per week for five to seven weeks; after eight months, the students were contacted again to evaluate the effectiveness of the therapy. Final results indicated the study was fairly successful with 75% of the participants showing significant improvement eight months after the study.
However, in his book, "Virtual Reality Therapy for Anxiety Disorders", Dr. Wiederhold questions the effectiveness of systematic desensitization as the intensity of the perceived threat is reliant on the patient's imagination and could therefore produce a false response in regards to the patient's level of anxiety. His research into recent technological developments has made it possible to integrate virtual reality into systematic desensitization therapy in order to accurately recreate the threatening situation. At the time of publication, there had been no studies done to determine its effectiveness.
Autophobia is a form of anxiety that can cause a minor to extreme feeling of danger or fear when alone. There is not a specific treatment to cure autophobia as it affects each person differently. Most sufferers are treated with psychotherapy in which the amount of time that they are alone is slowly increased. There are no conclusive studies currently that support any medications being used as treatment. If the anxiety is too intense medications have been used to aid the patient in a continuation of the therapy.
It is not uncommon for sufferers to be unaware that they have this anxiety and to dismiss the idea of seeking help. Much like substance abuse, autophobia is mental and physical and requires assistance from a medical professional. Medication can be used to stabilize symptoms and inhibit further substance abuse. Group and individual therapy is used to help ease symptoms and treat the phobia.
In mild cases of autophobia, treatment can sometimes be very simple. Therapists recommend many different remedies to make patients feel as though they are not alone even when that is the case, such as listening to music when running errands alone or turning on the television when at home, even if it is just for background noise. Using noise to interrupt the silence of isolated situations can often be a great help for people suffering from autophobia.
However, it is important to remember that just because a person may feel alone at times does not mean that they have autophobia. Most people feel alone and secluded at times; this is not an unusual phenomenon. Only when the fear of being alone beings to interrupt how a person lives their daily life does the idea of being autophobic become a possibility.
There is no universal cure for genophobia. Some ways of coping with or treating anxiety issues is to see a psychiatrist, psychologist, or licensed counselor for therapy. Some people experiencing pain during sex may visit their doctor or gynecologist. Medicine may also be prescribed to treat the anxiety brought on by the phobia.
In some cases, education can considerably diminish concern about physical safety. Learning how aircraft fly, how airliners are flown in practice, and other aspects of aviation can reduce anxiety. Many people have dealt with the problem by learning to fly or skydive, effectively removing their fear of the unknown. Some educate themselves; others attend courses offered by pilots or airlines.
Though education plays an important role, the knowledge that turbulence will not destroy the aircraft does not stop the amygdala - the part of the brain responsible for generating most emotional responses, and via the Hypothalamic–pituitary–adrenal axis, the release of stress hormones - from reacting. In turbulence, repeated downward movements of the plane trigger one release of stress hormones after another. A build-up of stress hormones can cause a person to be terrified despite having every reason to know logically that the plane is not in danger. In such cases, therapy — in addition to education — is needed to prevent the release of stress hormones so that the anxious flier may gain relief.
Behavioral therapies such as systematic desensitization developed by Joseph Wolpe and cognitive behavior therapy developed by Aaron Beck rest on the theory that an initial sensitizing event (ISE) has created the phobia. The gradually increased exposure needed for systematic desensitization is difficult to produce in actual flight. Desensitization using virtual flight has been disappointing. Clients report that simulated flight using computer-generated images does not desensitize them to risk because throughout the virtual flight they were aware they were in an office. Research shows Virtual Reality Exposure Therapy (VRET) to be no more effective than sitting on a parked airplane. As a practical substitute for systematic desensitization, the amygdala can be taught to regard a stimulus as benign by linking it to an experience already regarded by the amygdala as benign. This alternative has been termed systematic inhibition of the amygdala.
Hypnotherapy generally involves regression to the ISE, uncovering the event, the emotions around the event, and helping the client understand the source of their fear. It is sometimes the case that the ISE has nothing to do with flying at all.
Neurological research by Allan Schore and others using EEG-fMRI neuroimaging suggests that though it may first be manifest following a turbulent flight, fear of flying is not the result of a sensitizing event. The underlying problem is inadequate development of ability to regulate emotion when facing uncertainty, except through feeling in control or able to escape. According to Schore, the ability to adequately regulate emotion fails to develop when relationship with caregivers is not characterized by attunement and empathy. "Because these mothers are unable to regulate their own distress, they cannot regulate their infant's distress." Chronic stress and emotional dysregulation during the first two years of life inhibits development of the right prefrontal orbito cortex, and hinders the integration of the emotional control system. This renders the right prefrontal orbito cortex incapable of carrying out its executive role in the regulation of emotion. Some who disagree with the importance of early experience regard this view point as contentious. However, Harvard University and the National Scientific Council on the Developing Child state, "Genes provide the basic blueprint, but experiences influence how or whether genes are expressed. Together, they shape the quality of brain architecture and establish either a sturdy or a fragile foundation for all of the learning, health, and behavior that follow."
When it senses anything unfamiliar or unexpected, the amygdala releases stress hormones. In humans, stress hormones activate both the sympathetic nervous system and executive function. The sympathetic nervous system produces an urge to mobilize. Initially, to assess the situation, executive function overrides the urge to mobilize. If assessment reveals no threat, executive function dismisses the matter, and signals the amygdala to end stress hormone release. If risk is apparent, executive function considers what can be done to deal with the risk. Upon commitment to a plan, either of action or of inaction, executive function signals the amygdala to end stress hormone release.
In a non-phobic person, the arousal caused by the release of stress hormones results in a sense of curiosity, not a sense of emergency. Phobic response is significantly different. The phobic person equates arousal with fear, and fear as proof that there is danger. Upon arousal, the person's executive function is called upon not merely to assess the situation, but - if stress hormones are to be regulated - to prove no danger exists. If danger cannot be ruled out, executive function can no longer inhibit the urge to mobilize. Though phobics regard control as the antidote to fear, it is commitment to a plan - not control alone that ends the release of stress hormones. If a person has control but cannot commit to a plan, fear persists. It is interesting to note that commitment to any action - even unwise action - provides relief, and signals the amygdala to terminate stress hormone release.
If a phobic flier were able to fly in the cockpit, the pilot's facial response to an unexpected noise or motion would adequately prove the absence of danger. But with information in the cabin limited, it is impossible to prove no danger exists. Stress hormones continue to be released. As levels rise, anxiety increases and the urge to escape becomes paramount. Since physical escape is impossible, panic may result unless the person can escape psychologically through denial, dissociation, or distraction.
In the cognitive approach, the passenger learns to separate arousal from fear, and fear from danger. Cognitive therapy is most useful when there is no history of panic. But since in-flight panic develops rapidly, often through processes which the person has no awareness of, conscious measures may neither connect with - nor match the speed of - the unconscious processes that cause panic.
In another approach, emotion is regulated by what neuroscientist Stephen Porges calls neuroception. In social situations, arousal is powerfully regulated by signals people unconsciously send, receive, and process. For example, when encountering a stranger, stress hormone release increases the heart rate. But if the stranger's signals indicate trustworthiness, these signals override the effect of stress hormones, slow the heart, calm the person, and allow social interaction to take place. Because neuroception can completely override the effect of stress hormones, can be controlled by linking the noises and motions of flight to neuroceptive signals that calm the person.
Lastly, frequent flyer experts at Flightfox suggest that fear of flying is a reaction caused by the panic and tension of so many travellers in close quarters - once one person is uneasy the rest soon feel uncomfortable as well. Their solution, odd as it may seem, is to fly in premium class to experience flying in a comfortable and relaxed setting, so as to avoid the tension and anxiety of coach.
Education is the most common treatment, although psychotherapy, including cognitive-behavioral therapy, is indicated when the fear becomes so severe as to cause dysfunction for the individual who suffers from the phobia.
Fear of surgery or other invasive medical procedure may be known as tomophobia. Fear of surgery is not a fear experienced often, but is still just as harmful as those that are more common. Since surgery is not a common occurrence, the fear is more based on inexperience or something that is out of the ordinary. This fear is one of those categorized under all fears of medical procedures that can be experienced by anyone, all ages, and have little need for actual psychological treatment, unless it is uncharacteristically causing the patient to react in a way that would be harmful to his or her health.
Medications can help regulate the apprehension and fear that come from thinking about or being exposed to a particular fearful object or situation. Antidepressant medications such as SSRIs or MAOIs may be helpful in some cases of phobia. SSRIs (antidepressants) act on serotonin, a neurotransmitter in the brain. Since serotonin impacts mood, patients may be prescribed an antidepressant. Sedatives such as benzodiazepines may also be prescribed, which can help patients relax by reducing the amount of anxiety they feel. Benzodiazepines may be useful in acute treatment of severe symptoms, but the risk-benefit ratio is against their long-term use in phobic disorders. This class of medication has recently been shown as effective if used with negative behaviors such as alcohol abuse. Despite this positive finding, benzodiazepines should be used with caution. Beta blockers are another medicinal option as they may stop the stimulating effects of adrenaline, such as sweating, increased heart rate, elevated blood pressure, tremors and the feeling of a pounding heart. By taking beta blockers before a phobic event, these symptoms are decreased, causing the event to be less frightening.
As is common with specific phobias, an occasional fright may give rise to abnormal anxiety that requires treatment. An abnormal fear of bats may be treated by any standard treatment for specific phobias. Due to the fact that the fear is not life altering, it can usually just be left untreated.
The most common treatment for serious cases is behavior therapy—specifically, systematic desensitization.
Several other self-help treatments exist, mainly involving exposure therapy and relaxation techniques while driving. Additional driving training and practice with a certified teacher also help many to become more confident and less likely to suffer from anxiety.
One of the emerging methods of treating this fear is through the use of virtual therapy.
With repeated exposure, all of the subjects displayed significantly less variance from normal in heart rate acceleration, depression readings, subjective distress, and post-traumatic stress disorder ratings.
Lilapsophobes spend a lot of time watching the weather or checking weather online to keep an eye out for oncoming storms. When a storm hits, sufferers either watch for severe weather alerts constantly or take cover, like under the bed or in the windowless room. In the extreme cases, sufferers take tornado shelter as soon as rain starts falling, usually in the basement or storm shelter. Sufferers who have weather radio or mobile phones can watch the radar and alerts using it while hiding.
Heliophobia can be treated using talk therapy, exposure therapy, self-help techniques, support groups, cognitive-behavioral therapy, and relaxation techniques. For people who are severely heliophobic, anti-anxiety meditation is a recommended mode of treatment.