Needles, heights, cockroaches: Why do you have phobias and how can you overcome them?

What are Singaporeans most afraid of? No, it's not the ERP 2.0 system or next year's GST rate change, although some individuals may beg to differ.

What are likely to raise our heart rate, get us breaking out in cold sweat and take our breath away, at least according to the experts I asked, range from germs and needles to situational fears such as social anxiety, heights, confined spaces and flying in a plane. 

And for some of us who grew up in the 1980s, it may also include a strange irrational fear of butterflies – no thanks to the first short story in the retro Channel 8 drama series Mystery or Mi Li Ye (it's like M Night Shyamalan's Old but with mutated butterflies that cause accelerated ageing).

Not that we lack other sources of urban terror growing up… house lizards that dart out of nowhere, the smack on the venetian blinds that means uh-oh, you have a beetle to handle. And the ultimate: Flying cockroaches and the ear-tunnelling antics they get up to. Enough said.

WHY DO WE EXPERIENCE FEAR?

It doesn’t matter what age you are at. Irrational fears or what the psychologist’s handbook Diagnostic And Statistical Manual Of Mental Disorders defines as phobias, can feel so real that your heart feels like it’s going to beat itself out of your ribcage. These irrational fears can also make you behave, well, irrationally.

A fully grown man I know, for instance, is so terrified of dolls (from Polly Pocket to Barbie) that he refuses to enter Toys R Us. An ex-colleague of mine will break out in cold sweat at the mere sight of a snake, even when it’s just an online picture. And I once made my partner come home in the middle of the work day to evict a praying mantis.

The risk of getting your partner fired is just one of the potential consequences; other trouble your phobia could get you into can be more far-reaching. “Needle phobia can be a huge problem for patients who need to undergo chemotherapy or COVID-19 vaccinations,” said Koh Xin Yu, a senior psychologist with National University Hospital’s Department of Psychological Medicine, Psychology Team.

“Claustrophobia affects patients who need MRI scans for diagnosis and treatment as well as their transport options. People with social anxiety often become very depressed when they are not able to make presentations or speak up at meetings.”

But I can also see why fear is important. It keeps us from getting unalived by a predator or from letting gravity pull us to an untimely death. “Normal fear is a universal experience. Humans have evolved to react with fear when confronted with danger as this fear helps to keep us safe,” said Dr Lim Boon Leng, a psychiatrist with Gleneagles Hospital.

“In contrast, a phobia is a type of anxiety disorder in which one has an irrational and extreme fear of a situation or an object. The affected person will go to great lengths to avoid the phobic stimulus. When exposed to the situation or object, the person will react with severe anxiety and a strong desire to escape,” said Dr Lim.

WHY ARE WE TERRIFIED OF CERTAIN THINGS BUT NOT OTHERS?

I am always in awe of people who can grab a live adult cockroach with their bare hands – disregarding its wriggling legs, twitching antennae, flicking wings and all – and just fling it away. Once, during a conversation with an editor, such an abomination landed and entangled itself in her long hair. She nonchalantly picked it out as if it were a split end and continued talking without skipping a beat. I, on the other hand, almost passed out.

Am I lacking something in my brain or DNA? “Phobias are complex and deeply ingrained irrational fears that are likely due to a combination of factors, including strong automatic brain responses, conditioned response due to trauma, error in thinking, one's genetics and cultural influences,” said Dr Lim.

Like learning multiplication tables, most phobias are acquired, said Koh. “Some may identify a particularly traumatic event that triggers the development of the phobia. There are also those who report developing a phobia through vicariously learning from the traumatic experiences of others.”

For instance, said Dr Lim, when a person experiences a near-death situation in a crowded area, he might subsequently develop a phobia of crowded places. “A child observing adults displaying fear toward insects may mistakenly learn that insects are dangerous, leading to the development of a phobia.”

CAN WE RATIONALISE PHOBIAS AWAY?

Most individuals with phobias are aware that their fears are irrational, said Dr Lim. And there’s more.

“Specific phobias are highly co-morbid with other mental health illnesses,” he said. “About 60 per cent of individuals with lifelong phobias have other mental illnesses such as depression, other anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder.”

So, it’s not as simple as rationalising the fear away, said Dr Lim. “It often requires effective treatment tailored to the individual’s specific needs and circumstances.” If your phobia has taken a hold of your life, best to see a doctor for help. 

Generally, said Koh, the therapy recommended is exposure therapy, which could involve gradually exposing you to your feared object or situation in a safe and controlled manner. “This helps patients learn that the feared object or situation is not as scary as they thought, and can help them to overcome their fears,” she said.

For example, if you're afraid of getting into a lift, you could start off by simply thinking about getting into one. Next, you look at pictures of lifts and progress to going near one to actually stepping into a lift. When you’re comfortable with all that, you may ride the lift for one floor, then several floors and finally, ride in a crowded lift.

In some cases, medications like selective serotonin reuptake inhibitors may also be prescribed to help manage symptoms, said Dr Lim.