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Not all of us, however, parlay that ancient history into a modern-day phobia. It may be our distant ancestors who predispose us to phobias, but it's our immediate ancestors--specifically our parents--who seal the deal. As many as 40% of all people suffering from a specific phobia have at least one phobic parent, seemingly a clue that phobias could be genetically influenced. In recent years, a number of scientists have claimed to have found the phobia gene, but none of those claims have held up to scrutiny. If phobias are genetically based at all, they almost certainly require a whole tangle of genes to get the process going.
But genetics doesn't even have to be involved as long as learning is. A childhood trauma--a house fire, say, or a dog bite--may be more than enough to seize the brain's attention and serve as a repository for incipient fears. "Temperament also seems to be critical," says Craske. "Two people can go through the exact same traumatic event, but the high-strung, emotionally sensitive person is more vulnerable to the fear." Even secondhand fears--watching Mom or Dad react with exaggerated terror to a cockroach or a drop of blood, for example--may play a role. The journal Nature last week reported a study in which researchers performed scans on the fear centers of volunteers' brains and found that when the subjects were merely told to expect an electric shock, the neurological reaction to the anticipated jolt was as powerful as fears based on actual experience. "There is a lot of legitimacy to the idea that phobias can be learned," says Edna B. Foa, professor of psychology and psychiatry at the University of Pennsylvania. "We respond to what we see or experience."
In many cases, the brain may think it's doing the child's psyche a favor by developing a phobia. The world is a scary place, and young kids are inherently fearful until they start to figure it out. If you are living with a generalized sense of danger, it can be profoundly therapeutic to find a single object on which to deposit all that unformed fear--a snake, a spider, a rat. A specific phobia becomes a sort of backfire for fear, a controlled blaze that prevents other blazes from catching. "The thinking mind seeks out a rationale for the primitive mind's unexplained experiences," says psychologist Steven Phillipson, clinical director of the Center for Cognitive-Behavioral Psychotherapy in New York City.
But a condition that is so easy to pick up is becoming almost as easy to shake, usually without resort to drugs. What turns up the wattage of a phobia the most is the strategy the phobics rely on to ease their discomfort: avoidance. The harder phobics work to avoid the things they fear, the more the brain grows convinced that the threat is real. "The things you do to reduce anxiety just make it worse," says Barlow. "We have to strip those things away."
And that's what doctors do. A patient visiting Barlow's Boston clinic is first assessed for the presence of a specific phobia and then guided through an intensive day or two of graduated exposure. People who are afraid of syringes and blood, for example, may first be shown a magazine photo with a trace of blood depicted in it. Innocuous photos give way to graphic ones, and graphic ones to a display of a real, empty syringe. Over time, the syringe is brought closer, and the patient learns to hold it and even tolerate having blood drawn.