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Rädslor och fobier
Vid rädslor och fobier upplever man ångest som är knuten till bestämda situationer.

Specifika fobier är väl avgränsade till en enda typ av föremål eller situationer. Det kan vara ormar, spindlar, blod eller höga höjder. Denna form av stark rädsla kan ofta botas med korta och intensiva behandlingsinsatser.

Principen för behandlingen är att klienten måste möta det som skapar rädslan. Det sker i små steg, i takt med förbättringen, och leder till upplevelsen att man klarar konfrontationen bättre än man trodde. Det kallas gradvis exponering. Resultatet blir att klienten utvecklar mer verklighetsförankrade föreställningar om både situationen och om den egna förmågan att hantera den.

Agorafobi är en mer komplicerad störning. Men även här har Kognitiv Terapi visat sig vara den mest effektiva behandlingen. En agorafobiker är rädd för allmänna platser som är svåra att fly från och där ingen hjälp står att få om man drabbas av en panikattack.

Den som lider av denna torgskräck undviker folksamlingar, tunnlar, broar, bussar. Den bästa behandlingen är också här gradvis exponering. Terapeuten hjälper klienten att stegvis mobilisera modet att utsätta sig för "faran " och att hålla ut, tills ångesten släpper. I terapeutens närvaro får klienten en ny tro på sin egen förmåga att hantera situationen. Som en följd minskar också själva rädslan.

Social fobi är en rädsla för att bli bedömd och granskad av andra människor. En rädsla för att bli förödmjukad och generad, kanske göra bort sig genom att rodna. Undvikande är en vanlig strategi om man har social fobi. Om man inte kan undvika sociala situationer helt och hållet utan tvingas att vara i dem, kanske man utvecklar beteenden och strategier som döljer rädslan och som gör att man känner sig säkrare, s.k. säkerhetsbeteenden. Dessa säkerhetsbeteenden är också ett slags undvikande. Exempel på säkerhetsbeteenden är: att spänna sig hårt för att förhindrar skakningar, att klä sig ljust för att dölja svett, att bara dricka när andra har uppmärksamhet på annat vid middagsbordet, att repetera meningar utantill innan man säger dem, osv.

I behandlingen får man tillsammans med terapeuten ta reda på mer om sina säkerhets-beteenden och hur dessa kan upprätthålla rädslan för sociala situationer. För att övervinna rädslan och känna sig mer avslappnad i sådana situationer får man göra experiment med sina säkerhetsbeteenden på ett sådant sätt att det ger en chans att utmana de negativa tankarna. Rollspel och videoinspelningar kan användas som verktyg i terapin.


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