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A person came to me who was planning to visit his college friend of many years, but he had a dog phobia and a sense of dread that had nothing to do with their friendship. He told me that his friend had recently bought a dog -- a reportedly sweet old dog from the pound who was gentle and had never bitten anyone. Terror dominated this patient's thinking, however, so we decided to tackle the issue together.
Unlike other phobias, such as a fear of elevators or fear of flying, dog phobia is one that a motivated person may be able to efficiently self-treat at little or no expense. This patient told me he had even considered one day getting a dog, but his phobia was too overwhelming to go through with it. That seed of a desire provided an incentive for him to seek help for a fear he now believed was irrational.
On our first and only visit, the patient recalled that his memory of fearing dogs appeared directly related to being told repeatedly by his mother and grandmother that dogs can hurt people and their bites can result in rabies. Based on what he had been taught for years, it seemed natural that he would develop a fear of these animals.
My work with these types of phobias is behavioral, aiming for as rapid a resolution as possible. In this case, I accepted the patient's theory in much the same way that we in medicine accept a patient's theories about how they reactivated an old shoulder injury.
I used my learning, philosophizing, and action (LPA) treatment method. The learning phase was simple, as the patient clearly explained his history. For the philosophizing phase, we briefly discussed his mother and grandmother's perhaps overblown anxieties about death and danger. And we discussed the concept of "possibilities vs. probabilities." That is, it's possible that a dog might bite you, and it's also possible you might get rabies, but what are the probabilities? This patient accepted the probabilities' message.
The next phase -- action -- was a step-by-step behavior modification program I designed to desensitize the patient through safe exposure to a dog. The idea was to help him gradually face his fear. First, I recommended that he purchase a good book on dog breeds that describes their different traits, training challenges, and personalities. (The American Kennel Club has a great book to help future owners learn about breeds, called The Complete Dog Book.) I instructed him to pore through it every night for a week. Then came his real-life exposure to a dog. He was to choose an understanding friend -- someone he truly trusted -- who owned a dog and would be willing to meet with him a half hour every day for a week or so. During each meeting, the phobic patient was instructed to stand a distance away from the friend and her leashed dog. On each subsequent day he could move a few feet closer, until the day that he would finally be close and calm enough to pet the dog.
A critical element of this strategy is that the person conquering the phobia controls the situation. The trusted friend keeps the dog leashed and close by, and the patient always knows that he is the one approaching the feared animal, for as long as the strategy progresses, with no exceptions. This level of trust assures the patient that nothing unexpected will happen during the desensitization program.
My LPA strategy was highly successful in this case, and the expense for the patient was a single 90-minute session. This type of strategy can be modified depending on the origins and depth of the phobic response, as well as the patient's motivation for problem resolution.
In the end, the patient was very grateful, having spent more than a year in traditional talk therapy before he had come to see me. When I initially described my method to him, he was a doubter. But after it worked -- and in such a short time frame -- he opined that the previous theoretical approaches had been "harebrained techniques" to deal with what he had come to understand as a simple phobia. A month later, after he got home from visiting his college friend, he sent me a thank-you card with a photo of him sitting with his friend's dog. At the bottom he wrote, "P.S. I understand now why they're called man's best friend. I think I'm about ready to get a pal for myself now."
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This blog aims to present psychiatric/psychological information to a general readership, offering insights into a variety of emotional disorders, as well as social issues that affect our emotional well-being. It includes the ideas and opinions of Dr. London and other leading experts. This blog does not provide psychotherapy or personal advice, which should only be done by a mental health care professional during a personal evaluation.
