Can Phobia be Treated in One Session?
Can a phobia be treated in one session? Often, yes. Gentle brain-based therapies like MEMI and Brain-Switch 2.0 can update fear responses and neutralize phobia triggers in as few as 1 to 3 sessions.
Why skip exposure therapy? Standard exposure therapy requires repeatedly confronting fears over 6 to 12 sessions, which may be too distressing for some clients.
How my approach works: By using guided eye movements and the principles of memory reconsolidation, we safely de-link emotional panic from phobia memories without forcing you to confront the phobia.
Phobia noun /ˈfəʊ.bi.ə/ An extreme fear or dislike of a particular thing or situation, especially one that is not reasonable.
According to a global review published in The Lancet Psychiatry in 2018, around 3% to 15% of a population will have a phobia at some point in their life.
(Based on a 2019 YouGov survey, Singaporeans’ four greatest fears are drowning, fire, reptiles and cockroaches.)
However, why is it that only around 10% to 25% of people with phobias seek treatment?
One reason is that most people can manage their phobia by avoiding or reducing contact with the feared object or situation. And in most cases, this is sufficient.
Another reason is that the treatment of choice for phobia, exposure therapy, has some limitations.
The Limitations of Exposure Therapy
Exposure therapy starts by asking the client to imagine, or exposing them to, a low-intensity version of the phobia trigger itself (e.g. a drawing of the object). The client uses relaxation techniques to manage the feelings of panic or anxiety.
Once the anxiety subsides to a tolerable level, the client is exposed to the next level of intensity (e.g. a photo of the trigger, or the trigger itself).
This repeated exposure over several sessions builds the client’s tolerance to distress and slowly teaches the nervous system that it need not fear the phobia trigger.
While exposure therapy has a high success rate for those who manage to complete the treatment, it has some limitations.
Treatment Refusal: Some clients understandably feel afraid of being repeatedly exposed to the phobia trigger and never start treatment.
Dropout Rate: Some clients start the treatment but drop out because they’re unable to tolerate the distress as the intensity increases.
Retraumatisation: Some clients who drop out may even be retraumatised by the exposure therapy, leaving them worse off than when they began.
Time and Cost: Exposure therapy can take 6 to 12 sessions, or more for complex phobias. Not all clients can afford the time and expense to complete the therapy.
Risk of Relapse: Exposure therapy works on the principle of extinction learning - it creates a new, competing memory of safety on top of the old memory. There’s a higher risk of relapse (e.g. due to stress or a change in environment) as the old memory is still intact.
The problem when people leave phobia untreated is that it can increase the risk of their developing other anxiety, mood and substance-use disorders.
Fortunately, there’s a gentler and quicker alternative to exposure therapy.
An Alternative Approach to Treating Phobia
Credit: Andy Roberts / Getty Images
I use a three-step approach to treating phobia that does not require repeated exposure to the triggering object or situation, and can usually be completed in one to three sessions.
Step 1: Identify the Anchor Memory
People with phobias usually have an anchor memory associated with the phobia.
This could be your earliest encounter with the feared object or situation, or your most distressing encounter with it. You will not need to relive or describe this memory in detail.
Once identified, I use MEMI to gently neutralise this anchor memory (see my post, What Happens During MEMI?).
Instead of focusing on the phobia trigger, you’ll follow my pen as I guide you through a series of eye movements.
If you don’t have an anchor memory, we move on to Step 2.
Step 2: Neutralise Related Memories
Even when the anchor memory has been neutralised, there will be related memories of other encounters with the distressing object or situation.
I then use Brain-Switch 2.0 to quickly process these related memories - the feelings, thoughts and body sensations (see my post, What Happens During Brain-Switch 2.0?).
Most of my clients generally report feeling “lighter” after this step. They feel more neutral when they recall the anchor and related memories.
You’ll then visualise how you would like to think, feel and behave instead when you encounter the object or situation you used to fear.
Step 3: Self-therapy
If you’ve been carrying this phobia for years, it may take some time for your brain and body to adjust to the changes.
If you’re open to it, I’ll teach you how to do MEMI and/or Brain-Switch 2.0 on your own so that you can continue to quickly process any residual memories or future encounters with the object or situation.
Having these tools helps my client feel more confident that they can manage potential triggers. As their brain and body adjust to the new normal and they gain confidence, my clients find they no longer need to use the tools.
Do I Need to Treat My Phobia?
You may not need to treat your phobia if:
It only makes you mildly anxious;
You rarely encounter the triggering object or situation; or
It has little to no impact on your day-to-day life.
However, studies have shown that phobias can persist for years. They also tend to be linked to and increase your risk of anxiety and mood disorders.
If your phobia causes you significant distress and stops you from living a free and full life, then you may want to consider getting professional help.
Get in touch with me to book a session or find out more.
FAQs
-
My three-step approach to treating phobia can usually be done in one session.
However, I recommend planning for three sessions over three weeks (see my Phobia Processing Intensive under “Fees”).
Session 1 will be for me to understand the background to your phobia and the impact it’s having on your life.
Session 2 will be the main session for treating the phobia.
Session 3 will be for any further treatment and integration of the changes.
-
No therapist can guarantee results as every client is unique.
But I would say that my approach works well for most clients, and I will do my utmost to help you feel emotionally safe and comfortable throughout the process.
-
For the vast majority of my clients, the changes of the phobia treatment are permanent.
Once the brain and body lose the fear of the phobia trigger, it’s hard to reaquire it!
Clients also benefit from diligently using MEMI and/or Brain-Switch 2.0 on their own after the treatment.
-
1. MEMI and Brain-Switch 2.0 can be content-free, which means clients don’t have to describe their phobia experiences in detail in order for the therapies to work. This reduces distress for the client and the number of sessions required.
2. I work with the memories relating to the phobia, rather than the phobia trigger itself.
This makes the process much less threatening and distressing for the client as there’s no repeated exposure to the trigger.
Also, if we update the memories that are driving the fear, the fear itself naturally reduces (see more about memory reconsolidation below).
3. I also limit exposure to the memories relating to the phobia, which makes the process emotionally safer for the client.
For MEMI, the client “projects” the memory onto a wall, creating distance and giving new perspective.
For Brain-Switch 2.0, the client only visualises each memory for a split second before “dumping” it away.
4. Guided eye movements, like those used in MEMI, create relaxation by deactivating the amygdala (which triggers the fight, flight or freeze response).
This keeps the client calmer when recalling the memories relating to the phobia.
5. I introduce multiple prediction errors to enhance the memory reconsolidation process.
Memory reconsolidation is the process whereby recalling a memory makes it temporarily unstable and open to change. Introducing new information (prediction errors) during this window can rewrite the emotional meaning of the memory before it’s re-stored.
Prediction errors are a mismatch between what your brain expects will happen and what actually happens. By introducing new or surprising elements when you recall a memory, your feeling about it tends to shift.
For example, in MEMI we change the perspective and position of the memory, we talk about technical elements of the memory (e.g. Is it in colour or black and white? Is the sound far or near?), we use eye movements across the full visual field (not just bilateral/horizontal), and we use verbal cues to create safety and move you towards how you wish to feel instead.
And in Brain-Switch 2.0, we “move” memories around, we “throw away” memories, and we “extract” unpleasant body sensations. We use the client’s own creativity to change how they feel about the memories.
5. My own style is also to introduce elements of humour. It’s hard to feel afraid when you’re laughing!
Eunice Tan
Trauma & Attachment Psychotherapist
Exposure therapy isn't the only option for treating a phobia. Here's a gentler, three-step approach that works with the memories driving your fear, without repeated exposure to the trigger, often in just one to three sessions.