Spiders, lifts and flying: How to treat a phobia.

I enter the dark, marbled foyer of the heritage-listed Trust Building in Sydney's CBD and walk past three sets of brass lift doors, old-fashioned enough to have the levels numbered above each frame, which light up as the carriage ascends and descends. 

Instead of stepping into one, I climb five flights of stairs, hauling myself up by the brass bannister. By the time I wind my way past a corridor of wooden office doors and find my destination, my lungs are searing because I'm so puffed by the climb. 

I pick up a clipboard and some papers to fill out as the receptionist greets me and says cheerfully, "I can always tell who the claustrophobics are – they're always out of breath by the time they get in here."

This is Sydney Phobia Clinic, a place where people can find specialised treatment designed to tackle their fears and phobias in controlled ways. In fact, when they opened their doors in 2016, they were the first clinic in Australia that was designed specifically to treat phobias. 

When I pick up the handbook for my treatment course, titled 'Claustrophobia', I note that the cover includes a photograph of lift buttons, which genuinely surprises me because, with all of my years having lived with this phobia and speaking to various people about it, I assumed it was relatively rare – at least, in no way common enough for it to be part of the graphic design. 

And yet, sitting down for my first session with the clinical director and founder of Sydney Phobia Clinic, Dr Corrie Ackland, I quickly discover how completely predictable my fear is. Dr Ackland is clearly well accustomed to talking to people with claustrophobia and quickly uncovers terrors that I think about so regularly I'd almost forgotten they were abnormal at all. 

Lifts? Yes, terrifying. 

Fire escapes? Oh yep, absolutely despise them.

Enclosed public bathrooms? Yes, horrible. 

MRI machines? No, thank you. 

Would you ever get into, say, an isolation tank? I would much rather be dead. 

Throughout this introduction with Dr Ackland, as she runs through all of the facets of my fears and behaviours around those fears like a checklist, I can't help but reflect on one of the most fascinating parts of how we live with phobias: they are incredibly common, they can often present in much the same ways for many people, and yet... we don't really take them very seriously.

So, how common are phobias exactly?

Dr Ackland explains that around 12 to 20 per cent of the population live with a phobia – but that's not even the whole story. 

"When you're looking at some phobias at a subclinical level – so, not meeting full criteria (which is basically the daily impairment or quite significant regular distress), things like fear of medical procedures, fear of needles, or fear of flying – then the rates go up something closer to 40 per cent of people," she says. 

When I ask the Mamamia team if anybody experiences a phobia, I'm met with an onslaught of responses, ranging from the commonly recognised (heights, the dark, small spaces, birds, needles) to the slightly more unusual (submarines, mannequins, the middle of the ocean, clusters of small holes, sloths, whales – "really big whales"). 

Regardless of the object of each person's fear, they all note that they can experience genuine distress being confronted with it or even thinking about it at all. Talissa, an executive producer of podcasts, tells me that her mannequin phobia can easily make her panic. 

"I have this irrational fear that they are going to come to life or are real people pretending to be mannequins that will attack me. I feel silly even saying this but it's this moment of panic that makes me freeze and stays with me for hours." 

In telling me this, Talissa touches on a truly under-discussed aspect of living with a phobia, which is how embarrassing they can feel. Most of the people that I chat to about their fears remark in some way about this feeling of humiliation and the ridicule they receive: "Yes, it sounds weird", "I also make fun of myself because I know it's so ridiculous", "It's always judgement and people reminding me of my age." 

Phobias are also often treated in popular culture as a source of comedy and I have done enough Good Weekend Saturday quizzes to recognise that phobias such as arachibutyrophobia (fear of peanut butter sticking to the roof of your mouth) or xanthophobia (fear of the colour yellow) are also often regarded as simple curiosities. Dr Ackland tells me many of her clients will report that friends, no matter how well-meaning, can demean their phobias or play pranks, like throwing rubber spiders at people with arachnophobia. 

Watch: The Anxiety Course on phobias below. Article continues after video. 

When I ask her why, despite our increasing literacy around mental health conditions and anxiety, phobias are seen as fair game, she has an interesting theory. Dr Ackland believes that because people are, in large part, willing to disclose their phobias to others and talk about them, they're often perceived as not particularly serious forms of distress and therefore something that we can poke fun at.

"It's about raising awareness that phobias aren't little quirks and they can be quite significant for people. And these kinds of pranks are likely only to put someone in a position where their phobia is reinforced.

"If somebody wants to help, there's probably a supportive and structural way they can go about doing that, but teasing someone for what they've confessed is a difficulty for them is almost never going to be a great idea." 

Relaying my fears to Dr Ackland, I realise, is also probably the first time that I have really explained my phobia to anybody in any great detail. It feels wildly relieving to be taken seriously by somebody who I know will receive this information without any hint of judgement or frustration. 

Where does the fear come from? 

Whenever I reveal to somebody that I have a phobia of lifts the first question they ask – unfailingly – is whether or not it started after I got stuck in a lift. This is usually followed up by a story that they or a family member have of being trapped in one for hours, which is less than helpful (to put it mildly). But the truth is, I've never been stuck in a lift for a significant period of time and I don't know when or why it started to affect my life (the fact that the Mamamia office is in a high-rise is a daily offence to me). 

Throughout our session (the first in a course of five that is apparently extremely effective in reducing phobias), Dr Ackland walks me through how people come to develop these debilitating fears in the first place.

The fear response, she explains, is one of the smartest things that the human brain can do. That feeling of adrenaline pumping through our bodies that sends our hearts racing, our palms sweating and the feeling of our stomachs dropping as we consider whether to fly, fight or freeze, has ensured the survival of our species. 

Phobias, which are persistent or excessive fear reactions, essentially come down to how the brain learns to protect us through fear – often, people with phobias have never actually had a negative experience with the thing that they are afraid of. Having a phobia comes down to cognitive processes that involve our brains getting caught in a loop of assessing something as a threat, experiencing the fear reaction and then surviving. Our brains keep learning again and again that having the fear reaction means that we will ultimately survive (the brain isn't great at registering the idea that we would have likely survived anyway).

There are certainly phobias that hark back to our caveman past and make sense in a way, like a fear of heights, spiders, or flying (what caveman suddenly found themselves at 33,000 feet in the air?) – but Dr Ackland also asserts that the fear reaction can form around pretty much anything. She tells me she has treated clients for phobias of detached hair, belly buttons, and fish, none of which you can pin to any particular logic but all of which caused those particular people immense distress nonetheless. 

Sydney, a growth marketing manager at Mamamia, illustrates how phobias can develop when she tells me about how her phobia of submarines came about. 

"I developed it in high school. I rowed for school and we would go past signs in Sydney Harbour that said 'Submarine cables below', which I genuinely thought meant cables that submarines were attached to for storage.

"I got so scared that the submarines under the water would spontaneously come to the surface and spear the boat as we rowed over them. Many, many hours spent rowing and fixating on this possibility developed into a full-on fear." 

Dr Ackland sees her job as helping people live within what she calls a "normal range of fear", which is to say, having a response proportionate to a threat.

"If you're standing at a sheer height, we would never realistically be able to expect that you would be able to look down a sheer drop, one that would kill you if you fall off, and experience no threat response – because that would be almost abnormal in the other direction. 

"Whereas a phobia of buttons, for example, there is no normal range for. So, we really should be able to expect to get them to a point where it doesn't elicit any threat response." 

The treatment that Sydney Phobia Clinic offers tries to tamp down the fear response that people with phobias experience rapidly after recognising a threat. Dr Ackland aims to establish a cycle of learning in the brain that reduces fear, rather than all of the learning that keeps reinforcing it (phobic habits like avoidance will eventually have to be challenged head-on). 

When is it worth trying to treat a phobia? 

Speaking to others at Mamamia about various phobias, another one of the strangest aspects of living with phobias becomes extremely obvious: we rarely think about doing anything about them. 

When Dr Ackland asks if I've ever attempted to address my phobia of lifts – a clearly inconvenient phobia that affects my day-to-day life – I'm a little baffled to report that no, I haven't even mentioned it to a psychologist before, despite having seen many in the past to address anxiety or depression. 

Listen to the Mamamia Out Loud team discuss phobias below. Article continues after podcast. 

We simply don't tend to think of phobias as having any tangible or serious connection to mental health, despite the fact that they can be intrusive and deeply upsetting to us. Dr Ackland tells me that phobia treatment even falls under the requirements of Medicare's mental health treatment plans but this failure to seriously consider addressing our own phobias is common. 

"We've had a lot of clients in here that have been in therapy for a long time and have also just never considered it relevant... It's so interesting because when we train as psychologists, phobias are often our case studies because it's the most straightforward application of what we do in psychological treatment. It's a super-straightforward one to manage – although that doesn't mean it's easy," she says with a warm laugh. 

Claire Murphy, host of The Quicky, has a phobia of heights that she finds hard to deal with. 

"I can't watch anything where height is involved. I had to cover my eyes while watching Extraction 2 on the weekend because there's a scene where they fight on the edge of a high-rise building and it makes me feel like I can't breathe. 

"I also avoid anything touristy that requires a walk near the edge of anything like a cliff or a very high balcony. I often have dreams about being close to the edge and nearly falling, the anxiety levels spiking through the roof," she says. 

Despite these obvious impact on her life that as a direct result of a height phobia she developed in her 20s, Claire says she has never considered seeking treatment, or even really thought about it as something she could be treated for. And neither had Talissa... or Sydney.

I ask Dr Ackland when she believes people should seek professional help. 

"Take intuitive steps and try to get practice to improve it. And if that doesn't improve it or if you're finding it too difficult to take any intuitive step, that's when to come in. 

When people do tend to come in, it's usually when something in their life has increased a conflict with their phobia. They're usually happy to avoid, dodge, and weave it to a point – but then something happens that makes them go 'Enough is enough.'" 

For example, a fear of flying might be easy enough to avoid day-to-day but when a family member like a child moves overseas, then people may try to address the issue.

Phobias can be treated in range of psychology practices but having a purpose-built clinic can be useful and work better for the consumer. Professor Melissa Norberg, an anxiety and phobia researcher, tells Mamamia that this is partly because people with phobias can be assured that they will have access to effective exposure therapy and partly because phobia clinics can provide treatment that is less costly and more convenient. 

"Perhaps you are afraid of spiders or snakes. It can be surprisingly difficult to find a spider or a snaked when you need one. A phobia clinic is likely to house spiders and snakes, so that they are always available. 

Alternatively, you may be afraid of dogs. On top of paying for your therapist, you might have to pay $100 or more an hour to an external company to use a therapy dog during your treatment sessions. A phobia clinic may have their own therapy dog," Professor Norberg says. 

Dr Ackland herself has a psychology background in treating a range of conditions, such as severe anxiety and obsessive-compulsive disorder (OCD) and she says that one of the reasons she decided to establish Sydney Phobia Clinic was because she could choose the office space specifically and stock it with a range of tools for treating phobias. 

I ask her what kind of resources she's talking about that can help this process of dissolving phobias and she begins to list them.

"I've got tubs of rubber spiders and snakes and cockroaches out there," she says gesturing towards the foyer. "I've got the VR too, which is expensive to develop and maintain," she says, referring to the VR headsets that can be used to simulate flight or height scenarios. 

"I've got a real spider that we keep in here..." 

"Wait, sorry, what? Did you just say you have a real spider?" I interrupt. 

This was how I came to meet Stripes, the banded huntsman spider that lives (contained, thankfully) in the clinic's lobby. At one point, Dr Ackland herself had arachnophobia but now she comfortably holds the box up for me to inspect Stripes – although, admittedly, she does refer to him as "horrible" and "ghoulish" several times (he is, a bit).

Stripes the huntsman. Image: Supplied.

When I ask her if she is satisfied with the work she does in this clinic, Dr Ackland beams. 

"It's a cool job because it's so varied. I'll be doing a session with Stripes or I'll be in the VR, or Hyde Park for birds, or Centre Point Tower... Every week I'm in a flight simulator.

"But also, the outcomes are super powerful. I get emails every week from all around the world from people who didn't think they were going to be able to get on a plane. I get pictures of babies sent to me from clients who had a needle phobia or emetophobia [phobia of vomiting], who never thought they'd ever be able to become parents. 

"It's an amazing thing to watch someone go through that work... what comes from it is amazing." 

Elfy Scott is an executive editor at Mamamia. 

Sydney Phobia Clinic gifted Elfy her first session.

This article was amended to include quotes from Professor Melissa Norberg. 

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