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None of this is remotely easy for the phobic person, and the body's anxiety Klaxons may go off the instant the therapy begins. Gradually, however, as each exposure level is reached, the alarms start to quiet; they sound again only when the intensity of the exposure is turned up. "Just as people become habituated to the noise of traffic or background chatter, so too can phobics become nonresponsive to the thing that once frightened them," says Phillipson.
With that habituation comes profound recovery. In studies recently conducted by Lars Goran Ost, a psychology professor at Stockholm University and one of the pioneers of one-day phobia treatments, a staggering 80% to 95% of patients get their phobias under control after just one session. And when symptoms disappear, they usually stay gone. Patients, he says, rarely experience a significant phobic relapse, and almost never replace the thing they no longer fear with a fresher phobia object.
Given the apparent simplicity of exposure therapy, phobics may be tempted to try it themselves. That can be a mistake. It is important that exposure take place under the care of a professional, since it takes a trained person to know when patients are being pushed too far and when it's safe to go further. For some situations impossible to re-create in a doctor's office--like heights and flying in airplanes--virtual-reality programs are available to provide simulated exposure under professional supervision. Software for other fears is being written all the time. "Not all people respond to virtual reality," says Barlow, "but on average, it's just as effective for treating certain phobias." If specific phobias were the only type of phobias around, things would be decidedly easier for doctors and patients. But the two other members of the phobia troika--social phobias and panic disorders--can be a little trickier.
Of the 50 million Americans who have experienced or will someday suffer from a phobia (and many will have more than one), 35 million will suffer from social phobia, and the battle they fight is a harrowing one. Richard Heimberg at Temple University's Adult Anxiety Clinic often thinks of the 50-year-old patient who talked frequently about getting married and having a family--a reasonable dream, except that his terror of rejection had kept him from ever going out on a date. After much encouragement and counseling, he finally screwed up his courage enough to ask a woman out. The next day, when Heimberg asked him if he'd had a good time, he said yes. But when asked if he were going to invite her out again, the patient slumped and said no. "She's only going to give to charity once," he explained.
For this patient, the problem wasn't mere low self-esteem but outright terror. To a social phobic, the mere prospect of a social encounter is frightening enough to cause sweating, trembling, light-headedness and nausea, accompanied by an overwhelming feeling of inadequacy. For some sufferers, the disorder is comparatively circumscribed--occurring only at large parties, say--making avoidance strategies seem easy. But social phobias can encroach into more and more areas of life, closing more and more doors. As sufferers grow increasingly isolated, they grow increasingly hopeless and risk developing such conditions as depression and alcoholism.