Halloween is a holiday that revels in our deepest, darkest fears, whether that's spiders, dark, confined spaces or gore galore. For many, confronting these fears by, for instance, visiting a haunted house can be thrilling. But for anyone with a real, life-altering phobia, sudden exposure can be debilitating, terrifying and deeply anxiety-triggering.
But what separates a fear from a serious phobia, a type of anxiety disorder that typically requires mental health support? Is an aversion to eight-legged creatures that could be poisonous simply common sense, or arachnophobia? Do you have aviophobia, or are you just a nervous flier? Few would lay claim to liking needles, but is feeling skittish or squeamish around them on par with trypanophobia?
"Many, if not most, people experience some anxiety or discomfort with spiders, heights, confined spaces, etc.," acknowledges Simon Rego, a licensed clinical psychologist and chief of psychology at Montefiore Medical Center and the Albert Einstein College of Medicine. "In fact, from an evolutionary perspective, many researchers think this type of reaction was actually adaptive and helped us to survive as species."
Whereas it's reasonable to be wary of or feel anxious around certain triggers, someone with a phobia would have a more extreme, instantaneous and constant reaction to that trigger, explains Rego, who says he has most commonly encountered phobias of heights, animals, insects, needles and situations such as crossing bridges, riding elevators or flying.
In the case of a phobia, the trigger "almost always provokes fear or anxiety immediately and often pushes the person to try to do anything they can to actively avoid coming into contact with it — or if it must be faced, they endure it with intense fear or anxiety each time," he tells Yahoo Life. "The most important thing to note is that the fear or anxiety must be out of proportion to the actual danger posed by the object or situation and context (i.e., using the person’s community as the standard, the phobic reacts in a manner that is different or more extreme than the average person in the community)."
It is also worth factoring in how long those feelings have lasted; Rego cites symptoms persisting for a minimum of six months. How a fear might be affecting a person's life is also considered when determining whether it rises to the level of a phobia.
"[We would look] to see if the fear/avoidance is causing significant distress or impairment in the person’s ability to function — socially, at work or school, or in some other important area of functioning," Rego notes, adding that research suggests that women experience phobias more than men by a ratio of about 2:1, though he has treated patients of either gender.
If someone does have a phobia, one option is to vigilantly avoid triggers — for instance, by driving rather than flying to a destination, or staying home. But avoidance — which he calls the "single most common way that people tend to manage their phobias" — is "only a short-term solution" that doesn't tackle the underlying fear, Rego says.
"By avoiding [a trigger] today, you should feel your anxiety decrease," he says. "However, there’s a price to pay for the avoidance: 1) you don’t get to find out whether your feared predictions would have actually come true; 2) you get out of practice with facing your fears and so you start to feel more anxiety ahead of time when you think you may need to face them down the road; and 3) they can start to generalize to other, similar triggers over time."
A better approach is to see a licensed mental health professional — such as a social worker, psychiatrist or psychologist — with experience assessing and treating anxiety disorders. That professional can build a comprehensive patient history, assess, diagnose as needed and recommend a treatment plan. That plan is likely to include cognitive behavioral therapy (CBT), which Rego has 25 years of experience using to treat anxiety disorders and other psychological disorders such as depression, insomnia and body-focused repetitive disorders.
"In essence, the [CBT] treatment uses something called 'exposure' to have the phobic patient gradually and systematically face their fears, often first while accompanied by the therapist and eventually on their own," he explains. "Along the way, some techniques are taught that help people to identify, challenge and change any thoughts they have that may be influencing their fears, [such as] predicting catastrophes, overestimating negative outcomes, underestimating their ability to cope, etc.
"This treatment can be delivered in a relatively short amount of time — often weeks, not months or years — and people who benefit from the treatment tend to maintain their gains long after the treatment ends, because it teaches people skills," he adds.
The principles of CBT can also help treat fears that aren't quite at a phobic level — say, for the person who dreads flying but still does so — though Rego points out that a fully fear-free existence is unrealistic.
"Not all fear is inappropriate — we need it sometimes to keep us safe in life," he says. "And therefore while we can eliminate a phobia, we can’t really eliminate fear per se."
Someone with a phobia will likely also benefit from communicating that issue to the people in their life.
"It’s important for people to recognize that while often appearing quirky, specific phobias are very common and in fact impact many people," Rego says. "So, it’s important to let people know when you’re struggling. Remind them that while they may not share the same fear, that does not mean it can’t impact others significantly. Remind yourself that it’s not 'all in your head,' and be sure to try to get help."
That's particularly true if Halloween is a time that causes more distress than usual. Rego says that by seeking treatment — whether it's CBT or newer techniques involving virtual reality or augmented reality — a person with a phobia can typically expect to "get back to functioning in life quickly and leave treatment with the skills to maintain their gains."
And who knows? "They may even start to enjoy the season and feel excited instead of scared," he suggests. "Just remember: The best way out is always through."
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