Rachel Wynn, a 31-year-old D.C. entrepreneur, is terrified of the impending cicada invasion in May.
“I am extremely afraid that they’ll touch me, get on my hair or near my face,” she said. “Or that my dog will try to eat them.”
Her concerns are not rare.
As a clinical psychologist in the D.C. area, I have heard many of my patients — especially the ones prone to anxiety in general — talk about dreading the arrival of cicadas. Almost a quarter of the U.S. population fears one or more animals, higher than any other feared object or situation.
But for many, their fear is out of proportion with the real danger, persists over time, and leads to avoidance and other behaviors that affect the person’s functioning — conditions that define it as a phobia. Estimates of lifetime prevalence of animal fears range from 12.6 to 22.2 percent, and animal phobias from 3.3 to 5.7 percent.
Phobias of creepy, crawly animals such as insects, snakes and mice are higher than for other types of animals. This does not surprise Abir Syed, 33, an e-commerce consultant from Montreal: His anxiety went into overdrive when his office moved to the same building as the research-and-development department of the Austin start-up he worked for that farmed insects for human consumption.
“I compulsively checked under my desk every few minutes for any crawling crickets and would get upset when I found one,” he said.
Insect phobia is also called entomophobia or insectophobia and is a type of specific phobia in the American Psychiatric Association’s manual of mental disorders (DSM-V). As with other phobias, women are more likely to suffer from it. The gender difference might exist because natural selection has favored females who were most avoidant of danger, especially during their child-rearing years, or because of socialization that teaches women, but not men, that it is acceptable to fear things and show your fear.
For most people, insect fears and phobias start in childhood.
“I grew up in Miami, where I developed a deep fear of palmetto bugs and cockroaches,” Wynn said. “One day, when I was young, a cockroach skittered across my feet while I was doing laundry, causing me to scream, drop the laundry, and run for help.”
Why do some people develop insect or other phobias? Studies suggest that genetics, parenting and life events combine to make a person susceptible. People who suffer from other anxiety disorders such as panic disorder or social anxiety disorder are more likely to have phobias.
When confronted with a feared object or situation, people with phobias commonly experience uncomfortable physical symptoms such as rapid and shallow breathing, tightness in the chest, pounding heart, dry throat, sweating and an uneasy stomach. These sensations are part of the “fight-or-flight” response, which was useful when fighting dangers in our evolutionary past, but now flares up like a fire alarm going off when you are cooking.
Other reactions to encountering what you fear include paralysis and disgust.
When Wynn would see a cockroach in her apartment, she often stayed frozen until her partner could come and kill it. She described being “grossed out” by the bugs and fears even stronger reactions with cicadas.
Tamar E. Chansky, a clinical psychologist in Philadelphia and the author of “Freeing Yourself From Anxiety” and “Freeing Your Child From Anxiety,” strives to normalize the anxious reactions when working with patients: “We’re wired to stay safe, and that part of the brain is always ready. But sometimes it misfires in response to a nondangerous situation, and we have to learn to distinguish when the brain’s reaction is helpful and when it’s not.”
Avoidance breeds anxiety
The natural reaction to feeling fear and disgust is to avoid bugs, spiders or anything else we are scared of. If that is impossible, people might escape anxious thoughts and feelings by drinking alcohol or distracting themselves with technology, among other tactics.
But avoidance works only temporarily. Even if the anxiety decreases by running away from a swarm of cicadas, for example, it will come back later and be stronger. And by avoiding more and more situations where anxiety might show up, lives end up shrinking.
Syed said he remembers dreading family trips to his parents’ native Pakistan because he would have to deal with insects and children teasing him for being afraid.
“At night, I would run away from lit areas where beetles would congregate, and miss much of the fun,” he said. “But even if I managed to escape from some of the bugs, anxiety would keep me up at night.”
As the emergence of the cicadas nears, Wynn said she is concerned that her usual precautions whenever she goes to Rock Creek Park in Northwest Washington or similar places — a sturdy hat, long pants, boots, being constantly on the lookout — won’t be enough.
“Even thinking about them makes me anxious,” she said. “I already scan my environment for anything small and dark. Even the smallest thing can freak me out.”
Michael Stein, a clinical psychologist and the founder of Anxiety Solutions of Denver, said he treated a patient who had a phobia of grasshoppers. “It got so bad that he couldn’t step on a lawn or walk in any grassy area,” Stein said. “He sought help because his life was so strongly affected by the phobia.”
The most effective treatment
Reviews of randomized control trials for more than 50 years have shown that cognitive behavior therapy (CBT) works well for most anxiety problems and disorders and is the most effective treatment for phobias. Although CBT has been around since the 1960s, it remains poorly understood by the general public and even by patients seeking psychological help.
The main component of CBT for phobias (and other anxiety problems and disorders) is exposure therapy — learning to approach rather than avoid insects, for example, and other feared objects or situations. Patients progress through imagining insects, watching images of them, playing with toy insects, visiting areas with a lot of insects and finally touching the insects.
Patients are never forced to do anything they don’t want to do, and their therapist is right there with them, engaging in the same exposures, modeling, coaching, encouraging and cheerleading. Exposure therapy can be accomplished only in the context of a strong, collaborative therapeutic relationship.
Although the exposure principles are conceptually simple, it takes a skilled, experienced therapist to put them into practice, tailoring the approach to each patient’s needs.
“With most people, you have to go gradually,” Stein said. “Once they realize that anxiety eventually subsides even as they’re doing something they couldn’t imagine doing before, they are encouraged and want to continue. And as a therapist, you have to be creative and flexible. When we couldn’t find grasshoppers, my patient and I went to a pet store and bought jars full of crickets, which are very similar.”
Although a lot of exposure therapy can be done in a standard office setting, cognitive-behavioral therapists also conduct sessions out in the world when needed. That might mean going to a park and sitting in the dirt with an insect-phobic patient, visiting a zoo reptile house for snake phobia exposure, or traveling with fearful drivers or fliers. Also, patients are encouraged to practice exposure in between sessions by themselves or with other people. The more contexts the exposure takes place in, the better treatment effects are maintained.
Treatment for phobias typically takes about 10 weekly sessions, but they can be shorter or longer, depending on symptom severity and patient willingness. A single three-hour exposure treatment has also proved effective with spider, snake, needle and other phobias. Newer innovations have shown promising results using either virtual reality or augmented reality exposure therapy. Augmented reality studies that superimposed virtual cockroaches or spiders onto the real environment helped people overcome their insect phobia, for example.
Through exposures, we can also test our irrational or unhelpful thinking patterns that provide fertile ground for anxiety.
For example, becoming aware of our tendency to catastrophize and realizing that the fear that cicadas will get tangled in our hair does not happen can boost recovery from the phobia. And as we wait and imagine how life with cicadas will be, we have the additional opportunity to challenge a common anxious concern of not being able to cope with uncertainty.
“Exposure therapy helps us learn new information in a way that will stay with us. We learn that insects are not as dangerous as we thought and that we can tolerate our anxiety and distress,” said Jonathan S. Abramowitz, a professor of clinical psychology at the University of North Carolina and co-author of “Exposure Therapy for Anxiety: Principles and Practice” “We become better at feeling anxiety and disgust, and realizing that these emotions and the accompanying physical sensations are also not dangerous.”
Finding courage to seek help
Despite the high effectiveness of exposure therapy, many people are reluctant to engage in it because it might seem too scary or overwhelming. You need to ask yourself how motivated you are to go through the process.
Given that everybody has some ambivalence, Abramowitz suggested asking, “How much is this phobia or fear impacting my life, relationships, social activities and leisure?” He also advised asking, “Do you want your life to be about dealing with insects?” and discussing both issues with loved ones and a therapist.
Finding a well-trained therapist with whom you feel comfortable also goes a long way in increasing a person’s willingness to try exposure therapy.
The therapist will be able to provide a detailed rationale for the therapy and explain how the process will unfold, and answer any questions or concerns you might have. High motivation and a sense of self-efficacy are also positive predictors of exposure treatment success.
Helping children with their phobias
Specific phobias, including insectophobia, are common in children and adolescents. Cognitive behavior therapy (CBT) with children is similar to CBT with adults, but there are some differences.
“With children, I start by editing the story that a mind is telling you — that bugs are, for example, our enemies who want to hurt us — to a new story that says that you might not be fond of bugs, but they’re just doing their bug thing, and you can live with them,” said Tamar E. Chansky, a clinical psychologist in Philadelphia and the author of “Freeing Yourself From Anxiety” and “Freeing Your Child From Anxiety.”
“We write down fears and predictions and then fact-check them based on what we learn about bugs. And we always give them silly names,” Chansky said.
Veronica L. Raggi, a clinical psychologist in Chevy Chase, Md., and author of “Exposure Therapy for Treating Anxiety in Children and Adolescents: A Comprehensive Guide,” said, “We make it as fun as possible, doing exposures aided by goal charts, and a salient reward system.”
When children see the exposure treatment as a game, they are more likely to participate, she said. Small successes and positive experiences build over time as children develop confidence and pride. Rewards for accomplishing exposure goals can further increase motivation.
When a child undergoes CBT, parents learn how to encourage the child to try something even if it’s a bit scary in the beginning, and how not to accommodate a child’s anxiety by always giving in to the fears. Raggi has found that the hardest thing for parents is to learn not to immediately come to the rescue. Parental modeling of curiosity, a sense of wonder and exploration and facing whatever feelings come up, lead to less fear and anxiety over time.
“Caregivers sometimes just need permission to nudge — but never force — their kids, to figure out where ‘yes’ is,” Chansky said.
She suggests setting up a courage challenge in May and June: “Let’s see who can get closer to cicadas and discover everything about them!”