Overcoming Phobias with CBT: A Real-Life Case Study of Fear, Healing, and Personal Growth

A 20-year-old client came to me due to an intense, long-standing fear of cockroaches that had been controlling her life for years. It prevented her from leaving the house without someone accompanying her, and she avoided going out in the dark altogether.

Thankfully, with the help of CBT (Cognitive Behavioral Therapy), and some heavenly assistance, this type of phobia can be treated effectively.

One of the first things we addressed was how avoidant behaviors, irrational thoughts, and overwhelming emotions were reinforcing the phobia. I also introduced her to the concept of “attentional bias” which is the idea that when something frightens or preoccupies us, our mind becomes hyper-focused on noticing it. For example, pregnant women often notice more pregnant women around them, simply because it’s on their radar.

As the therapy progressed, I provided psycho-educational explanations about what happens in the body during fear responses (involving the sympathetic and parasympathetic nervous systems). Together, we explored how thoughts trigger emotions, which then activate physical responses and influence behavior.

We worked on the following reframing statement: “Cockroaches are scary, but they are not dangerous”. The client chose a relaxation technique that suited her, and began practicing it during moments of distress or when intrusive thoughts and emotions would arise.

We also worked together to build a graded exposure hierarchy, allowing her to face her fear in manageable steps. The goal was to trigger the fear and gradually build habituation, so that each time she confronted the fear, her reaction would become less intense.

Opening Pandora’s Box

An interesting development occurred through the therapeutic alliance which was the trust built between us. This strong connection allowed us to “open a Pandora’s box,” which revealed a deeper underlying issue behind the cockroach phobia.

Through this safe and supportive relationship, we were able to uncover what I referred to as her “capable part”- the part of her that faces the world. We noticed the silent tension that surrounded her during sessions, and discovered that her fear was rooted in deeper life patterns (schemas).

We found core beliefs such as the need to please others, to appease, to be submissive, and- consciously or not- to draw attention and validation from those around her. This schema played out in many areas of her life.

Together, we mapped the connection between her fear of cockroaches and her behavioral patterns. When basic emotional needs like love are unmet, people often seek attention as a substitute.

We challenged these patterns using Socratic questioning, identifying her inner strengths, and uncovering intermediate beliefs that had been shaping her thinking. She selected a personal affirmation from a list we created together and began repeating it during moments of difficulty.

The Outcome

Gradually, the client regained a sense of control over her life. Her self-confidence improved, and she became happier and more at peace with herself.

Today, she feels increasingly worthy of love and appreciation, not because of what she does or thinks, but simply because of who she is. Her self-worth is no longer dependent on external factors, and her fear of cockroaches is now well managed.

Yaffa Ifergan is a CBT therapist and educator with over 33 years of experience.