BMJ 2013;347:f6652 doi: 10.1136/bmj.f6652 (Published 5 November 2013)
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Views & Reviews
VIEWS & REVIEWS NOTHING’S SACRED
Balloon phobia Colin Brewer writer, researcher, and former psychiatrist, London Ultimately, it is the exploding that constitutes the fundamental but irrational fear.
Phobia of balloons (the party, not hot air, variety) may seem a reason for mirth rather than serious attention but can need surprisingly urgent intervention. Its prevalence is not easy to discover but, among cases of which I’ve heard, the presenting circumstances were identical.
After being sensitised in childhood by exploding balloons, patients tend to avoid proximity to balloons. For most that’s not difficult. Many with flying phobia simply don’t fly, but, just as this can become a big problem when a job or relationship is at stake, so fear of balloons (globophobia) can also cause crises. This is because balloon-phobics usually marry and have children, who soon start having birthday parties, which means balloons. That’s when mother or father takes her or his shameful secret to the general practitioner to ask for help.
Freudians may have fun speculating on the sexual significance of particular balloon shapes and colours, but most patients are uninterested. Their problem is that little Jake is having a birthday party in three weeks, and they just want to avoid creating embarrassing scenes that Jake’s friends will tease him about for years afterwards. Cognitive behavioural treatments for isolated, uncomplicated phobias are simple and effective, and patients’ motivation is usually high.1 2 Balloon-phobics tend not to be interested in the possibility of defeat. Patients can often handle uninflated balloons without anxiety, so what exactly frightens them? Is it the sight of shiny, transparent, maximally inflated balloons, or is it the squeaky balloon noises that suggest imminent explosion?
Progressive exposure with “response prevention” shouldn’t take more than an hour. (Fleeing is the response to be prevented.) One long session is better than two shorter ones. Start by slightly inflating a balloon. Show that it can be quite roughly handled without exploding. Once patients can consistently handle limp balloons, introduce progressively more inflated ones, and start making squeaky noises with them. When the time comes for popping a balloon, distance makes it less frightening. Don’t explode a balloon sneakily before the patient is ready because that destroys trust.
Pop a small, barely inflated balloon first. It sounds unthreatening. Repeat a bit nearer the patient, and then with bigger and tenser balloons. Patients don’t flee and soon hardly flinch. Eventually, they usually manage to puncture a balloon that the doctor is holding and tolerate proximity. Get the family to do further sessions at home. The party, when it happens, is almost an anticlimax. GPs with time and interest can easily perform this simple and satisfying service. Unless they’re phobic about balloons, of course. Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I have given some unpaid advice about oral and implanted naltrexone and have, on one occasion, received travel expenses from GoMedical Australia, who are developing naltrexone and other implants. Provenance and peer review: Commissioned; not externally peer reviewed. Patient consent not required (patient anonymised, dead, or hypothetical). 1 2
Ougrin D. Efficacy of exposure versus cognitive therapy in anxiety disorders: systematic review and meta-analysis. BMC Psychiatry 2011;11:200. Johnston L, Titov N, Andrews G, Spence J, Dear BF. A RCT of a transdiagnostic internet-delivered treatment for three anxiety disorders: examination of support roles and disorder-specific outcomes. PLoS One 2011;6:e28079.
Cite this as: BMJ 2013;347:f6652 © BMJ Publishing Group Ltd 2013
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Views & Reviews
VIEWS & REVIEWS NOTHING’S SACRED
Balloon phobia Colin Brewer writer, researcher, and former psychiatrist, London Ultimately, it is the exploding that constitutes the fundamental but irrational fear.
Phobia of balloons (the party, not hot air, variety) may seem a reason for mirth rather than serious attention but can need surprisingly urgent intervention. Its prevalence is not easy to discover but, among cases of which I’ve heard, the presenting circumstances were identical.
After being sensitised in childhood by exploding balloons, patients tend to avoid proximity to balloons. For most that’s not difficult. Many with flying phobia simply don’t fly, but, just as this can become a big problem when a job or relationship is at stake, so fear of balloons (globophobia) can also cause crises. This is because balloon-phobics usually marry and have children, who soon start having birthday parties, which means balloons. That’s when mother or father takes her or his shameful secret to the general practitioner to ask for help.
Freudians may have fun speculating on the sexual significance of particular balloon shapes and colours, but most patients are uninterested. Their problem is that little Jake is having a birthday party in three weeks, and they just want to avoid creating embarrassing scenes that Jake’s friends will tease him about for years afterwards. Cognitive behavioural treatments for isolated, uncomplicated phobias are simple and effective, and patients’ motivation is usually high.1 2 Balloon-phobics tend not to be interested in the possibility of defeat. Patients can often handle uninflated balloons without anxiety, so what exactly frightens them? Is it the sight of shiny, transparent, maximally inflated balloons, or is it the squeaky balloon noises that suggest imminent explosion?
Progressive exposure with “response prevention” shouldn’t take more than an hour. (Fleeing is the response to be prevented.) One long session is better than two shorter ones. Start by slightly inflating a balloon. Show that it can be quite roughly handled without exploding. Once patients can consistently handle limp balloons, introduce progressively more inflated ones, and start making squeaky noises with them. When the time comes for popping a balloon, distance makes it less frightening. Don’t explode a balloon sneakily before the patient is ready because that destroys trust.
Pop a small, barely inflated balloon first. It sounds unthreatening. Repeat a bit nearer the patient, and then with bigger and tenser balloons. Patients don’t flee and soon hardly flinch. Eventually, they usually manage to puncture a balloon that the doctor is holding and tolerate proximity. Get the family to do further sessions at home. The party, when it happens, is almost an anticlimax. GPs with time and interest can easily perform this simple and satisfying service. Unless they’re phobic about balloons, of course. Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I have given some unpaid advice about oral and implanted naltrexone and have, on one occasion, received travel expenses from GoMedical Australia, who are developing naltrexone and other implants. Provenance and peer review: Commissioned; not externally peer reviewed. Patient consent not required (patient anonymised, dead, or hypothetical). 1 2
Ougrin D. Efficacy of exposure versus cognitive therapy in anxiety disorders: systematic review and meta-analysis. BMC Psychiatry 2011;11:200. Johnston L, Titov N, Andrews G, Spence J, Dear BF. A RCT of a transdiagnostic internet-delivered treatment for three anxiety disorders: examination of support roles and disorder-specific outcomes. PLoS One 2011;6:e28079.
Cite this as: BMJ 2013;347:f6652 © BMJ Publishing Group Ltd 2013
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
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