Treating Trypophobia with Exposure Therapy

Exposure therapy is a subtype of behavioral therapy consisting of various systematic techniques used to help people to overcome mental health issues caused by fear. The techniques are designed to give the patient more experience with the fear stimuli by being gradually exposed to the sounds and sights causing that fear. The end goal is to reduce the feeling of fear and anxiety and improve the patient’s quality of life.

The Important Characteristics Of The Exposure Therapy

The roots of exposure therapy originated in the early 1900s with the works of famous behaviorist, Ivan Pavlov and John Watson, who were the first to introduce the concept of classical conditioning. The process was further improved with behaviorist Mary Cover Jones who introduced counter-conditioning, a process of changing unwanted, learned response to a more desirable one. As a part of cognitive behavioral therapy, the patient is encouraged to identify the unhealthy thoughts and turn them into beneficial through gradual exposure. The therapist’s sessions with the patient must include:

• Graded exposure, starting from an appropriate first step which you will be fairly confident to do it. For example, someone with a dog phobia should consider facing with smaller dogs, which are less threatening than the big ones. Upon completion of the first step, the patient can move to more difficult steps.
• Repeated exposure, which means that you need to confront your fears gradually, as well as regularly. By being constantly exposed to stressful situations, the patient has higher chances to get used to the fearful setting.
• Prolonged exposure, which means that you need to continue facing your fears until the symptoms start to decrease. At this stage, the therapist will explain to the patient that avoidance is never a helpful strategy to overcome fear and that the intensity of symptoms would decrease over time.

Mental Health Issues Treated With Exposure Therapy

Many people with anxiety disorders and trauma-related issues have found this type of therapy as extremely helpful. Applicable mental health issues include:

• General anxiety disorder (GAD)
• Social anxiety (such as fear of public speaking)
• Acute stress or other traumas
• Posttraumatic stress or PTSD
• Obsessive-compulsive disorder
• Different kinds of phobias.

The benefits of exposure therapy are numerous and they have been well documented over the past few years. In many studies, the therapy was used as a first-line treatment for several mental health disorders.

• According to International OCD Foundation, 7 out of 10 people with obsessive-compulsive disorder have reported a 60-80% decrease in symptoms while being treated with exposure therapy. According to the data published in the Psychiatric Times, 90% of patients who underwent treatment reported a reduced level of anxiety and 65% of participants no longer experienced specific phobias.
• According to the data published in the Journal of Rehabilitation Research and Development, exposure therapy proved to be “a gold standard treatment” for PTSD.

Exposure Therapy Treatment for Specific Phobias

Facing your phobias in a gradual and consistent way proved to be the most effective type of treatment in many cases. The process requires courage and determination to expose yourself to the feared object or situation in a controlled environment. By working with your therapist, together you are making a personal training program to follow. For example, if someone is experiencing a panic attack while just looking at a dog, he or she should start with drawing a dog on a piece of paper, reading about them and looking at pictures or videos of dogs, Then the therapist will encourage you to gradually expose yourself to the object while, for example, looking at dogs through a window or from a doorway. Through repeated experience, the patient is able to realize that, no matter how unpleasant the situation might be, it is not harmful. As the symptoms gradually decrease, the patient will no longer react in an uncontrollable matter.

The exposure therapy variations work effectively for specific phobias, but the specific approach depends on the nature of phobia and client’s preferences. Some of them include:

• In vivo exposure which involves a direct, gradual confrontation with the feared object. The treatment usually lasts a number of hours or across multiple sessions. This type of treatment proved to be effective for animal phobias.
• Imaginal exposure, which involves patient vividly imagining the trigger and describing the emotions which happen as a result of these images.
• Virtual reality exposure, which involves the usage of virtual technology, or equipment which produces images and sounds of the feared object or situation.
• Interoceptive exposure, which involves deliberately causing physical sensations, usually harmless, but feared.

Exposure therapy can also be paced in different ways such as graded exposure (from mildly to moderately difficult exposures), flooding (exposure fear hierarchy) and systematic desensitization (exposure combined with relaxation techniques).

As reported by the authors of the clinical study Intensive Treatment of Specific Phobias in Children and Adolescents, Davis, Olendick and Ost, the hierarchical exposure, then, serves to elicit the fear and allows the clinician to implement one or more techniques to address the nuances of a phobic emotional response. As a result, adequate assessment and knowing as much as possible about the fear and reactions to exposure beforehand are crucial.  

Treating Trypophobia Symptoms with Exposure Therapy

Trypophobia, or fear of clusters of holes, has numerous, common triggers including lotus seed pods, honeycombs, bubbles, mango worms, skin diseases, animal patterns, etc. Though it is not yet officially recognized as a mental disorder, there are numerous patients claiming to experience fear while looking at these clusters of holes. The patients are usually treated with several types of behavioral therapy, including some medications like sertraline. Though their first reaction may be to run away or shut their eyes, with this type of therapy they are forced to undergo repeated exposure, becoming less sensitive to the usual triggers. They are encouraged to take a deep breath and question themselves like: What does the object make you want to do? How does it make you feel? What is irrational about your feelings? The concept of facing up the fear of cluster of holes and recognizing the thoughts as irrational and unproductive will eventually cause the decrease of symptoms. The therapist’s mission is to challenge the patient by facing the fears though imaginal exposure (imagining different clusters of holes) or in vivo exposure (going outside and confronting with the triggers directly).

Exposure therapy also proved to be working by breaking into a vicious cycle. The anxiety symptoms can reduce by at least 50%. This process is also called habituation and it involves four stages: graded, prolonged, repeated and the stage without distraction.

During the first stage, Trypophobe would make a list of triggers, from the easier things like strawberry pattern up to more difficult like Surinam toad giving birth. When the exercise is done repeatedly with at least 40% of anxiety symptoms, the patient is ready to move to the next phase. The second stage includes the repetition of exposure until the anxiety drops and no longer gets above the 40% as it was at the start of the exercise. The phase of repetition involves doing these exercises until they no longer make the Trypophobe anxious. It is also important to try to reduce any kind of distraction while exposing yourself to the hierarchy of feared objects.

A research study published in 2015 by An Trong Dinh Le, An Exploration of Trypophobia, from the University of Essex, has shown the effects of graded exposure therapy conducted on Trypophobic patients. The objective of exposure therapy was to produce more realistic behavior in relation to the phobic stimuli. By going through the step-by-step phases, the patients should eventually habituate to the Trypophobic stimuli, due to the fact that many research studies have shown the exposure therapy is the most successful in treating phobias.

A total number of 36 patients, from the age of 26 to 68, were asked to try to respond to the treatment procedure, and the research was done anonymously, by each Trypophobe provided with a random participant number. The treatment procedure consisted of twenty sessions, with each session consisting of four sets of images including a random set of small clusters, a random set of large clusters and two sets of Trypophobic images. The images were manipulated in terms of contrast, using grey levels. The first ten sessions with the sequence of Trypophobic images was repeated throughout the last ten sessions. The research data showed that, after going through the ten initial sessions of exposure therapy, the participants were less affected by being gradually exposed to the Trypophobic stimuli. They were also less affected by the increase of contrast level in the last stage, which was one of the most important signs that exposure therapy had a positive impact. By manipulating the contrast level of the pictures, they started with the so-called graded exposure, which means that they were fairly confident while facing the first step. During the next sessions, they underwent repeated exposure which lasted up to twenty sessions, in order to be exposed to the Trypophobia stimuli gradually and also regularly. The aversion and discomfort were decreasing due to the established fear hierarchies (manipulating the images in terms of contrast).

References

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http://www.psychiatrictimes.com/anxiety/exposure-therapy-anxiety-disorders
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https://www.tandfonline.com/doi/full/10.1080/17470218.2015.1013970?src=recsys
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