Among phobias, the most common is social anxiety phobia. The vast majority of contemporary people have a psychological state of rejecting the outside world to a greater or lesser extent. They would rather pick up their phones and pretend they don't exist, put on headphones and pretend they can't hear everything around them, rather than talk to people, and avoid relationships unless necessary.

Social phenomena cause individual phenomena, and individual phenomena are earlier group social phenomena, which is a mutually derived relationship. Unless it is severe enough to interfere with normal life and work, this mental illness is generally described as "introverted".

In addition to this common psychological disorder, there are many, many kinds of phobias, including the specific fear that Chen Xiaoya just talked about the bell.

Specific fear refers to the fact that the patient's irrational fear is confined to a specific object, situation, or certain activity. In terms of the clinical manifestations that Xu Jianan understands, it can be roughly divided into three stages: anticipatory anxiety before facing the fear stimulus. Fear when you really face it. and avoidance behaviors to reduce anxiety.

However, what these patients are afraid of is usually not the specific thing itself, but the consequences of those things.

For example, in deep-sea fear, the patient is not afraid of the sea, but of being swallowed by the bottomless sea. Fear of enclosed space is the fear of suffocation. The python is afraid because it is afraid of being swallowed by the python. Fear of driving is due to the fear of getting into a traffic accident. And so on, and so on. But the bell like Chen Xiaoya said made Xu Jiannan a little puzzled. It was hard for her to imagine what the consequences of the bell would be—the end, the beginning? But could these overly general results create such specific fear?

The fear of phobias is excessive, irrational, but persistent. Although patients are willing to admit that there is nothing to fear about what they are afraid of, this sober sanity does not diminish their fears.

This particular fear, which usually appears in childhood or early adulthood, can last for decades or a lifetime if left untreated. Fear of the fear situation is basically stable, and severe cases can lead to functional impairment and disability, depending on the degree of avoidance of the fear situation. The most immediate and universal example is the phobia of blood, needles, injuries, which, unlike other types, causes the patient to faint directly. This is commonly known as "fainting needle" and "fainting blood".

Xu Jiannan has simply conceived the diagnosis and treatment method for Chen Xiaoya in the fastest time. The first thing she had to do was to get a diagnosis. Because patients at this age often have a "self-righteous" situation, they will insist that there is something wrong with their body or mind, and they think that they have depression, cancer, or other diseases.

Therefore, Xu Jiannan must first be diagnosed before solving the problem of bells. Once Chen Xiaoya is diagnosed as indeed a phobia, then psychological treatment will be given for the specific fear of bells. Because there are many causes of social anxiety disorder, it is necessary to understand it slowly, and long-term treatment cannot be solved by a single diagnosis and treatment. But the specific fear is slightly different, and it is targeted, so that the psychologist is also more targeted.

Then, if you want to confirm whether Chen Xiaoya really has a phobia, Xu Jiannan must confirm at least three points. One, her avoidance of the fearful situation must be distinctly prominent. Two. Psychological or autonomic symptoms must be the primary manifestation of anxiety and not secondary to other symptoms, such as delusions and obsessions. Third, anxiety and fear must be confined to a specific situation.

The key also depends on the reasonableness of Chen Xiaoya's fear, the frequency of occurrence and the degree of fear, and to check whether she has autonomic symptoms, whether it obviously affects social functioning, and so on. This inevitably requires Chen Xiaoya to listen to the bell during the diagnosis and treatment, and her reaction can allow Xu Jiannan to determine the severity of the condition.

So, Xu Jiannan first led the conversation from Chen Xiaoya's childhood. She first asked Chen Xiaoya if she felt happy in her childhood. Because there are two main types of social anxiety fears, one is physiological. The size of the amygdala is related to the size and complexity of the social circle, and the medial and dorsolateral frontal lobes of the brain are activated to a lower extent than healthy controls, which can also produce a lot of negative feelings. The second is because of psychological and social factors. Such as neglect, abuse, over-controlled behavior, or over-protection in childhood. Parents have marital discord, don't learn intimacy, poor performance in school, etc. Children who grow up in such an environment often have distorted social cognition. For a long time, they have been accustomed to giving negative explanations to ambiguous events and catastrophic explanations to negative events, and often engage in continuous negative reflection on themselves.

Chen Xiaoya's answer met these criteria, her mother died when she was eight years old, and her father brought her up, but when she was ten years old, her father also remarried. Although her stepmother has not abused her, her feelings are not very close. Chen Xiaoya's family outlook is a little weak, which is normal. Because she didn't feel too much family warmth, even if she had it when she was very young, the memories of that age were not enough to support her experience.

found the suspicious cause of Chen Xiaoya's social anxiety, and Xu Jiannan began to ask her about her experience after school. Xu Jianan's voice was low and soft, and he smiled very cheerfully, which made Chen Xiaoya relax and narrate the experience a lot easier. They're like friends chatting about the past, talking about school.

School is the first "social environment" that a person comes into contact with from birth and growth. This first time, it is very important, and even at a certain age, the influence of the school will completely exceed that of the parents. Because children spend more time at school than at home, the scope of communication at school exceeds that of communication at home. What happens in school will affect the person's social outlook, future outlook on love, and the fundamental personality that determines life.

For example, if you encounter an obscene teacher or a teacher who abuses and scolds you when you go to school, then it may be difficult for this injured child to face anyone who is a "role model" in this life. They will decide from the bottom of their hearts that all teachers are not good people.

At the same time, it is also a common scene for schools to listen to class bells and bells. Xu Jiannan also tried to find out the root cause of Chen Xiaoya's fear of the bell from here.

However, although Chen Xiaoya said a lot of incidents that happened at school, none of them were related to the bell. Most of them are ordinary school bullying, she lost her mother at a young age, she is not very gregarious, cowardly, and has become the target of bullying by those little bullies.

This can once again deepen the explanation of Chen Xiaoya's social fear, but it still cannot explain the reason for the fear of the bell.

Xu Jiannan listened patiently and gave some encouragement and affirmation from time to time. Although Chen Xiaoya has said a lot, at most this can only explain social fear. She didn't grow up in a good environment for mental health, but when compared to a tragic childhood of real abuse, her experience doesn't seem like much.

Xu Jianan asked Chen Xiaoya: "Among all the things you are afraid of, what is the one that scares you the most? We have been chatting for a long time, are you still so afraid of me?" Xu Jianan smiled slightly.

Chen Xiaoya seemed to like Xu Jianan's smile very much, and she also shook her head with a shy smile and said, "Don't be afraid." ”

"That'...... What's the most unacceptable thing to you?"

"The bell ......" Chen Xiaoya thought for a while, and finally answered in the affirmative, but her expression was also very blank. Just like all phobias, they know everything in their hearts, and they know very well that there is nothing to be afraid of, so they themselves are at a loss, what are they afraid of? Chen Xiaoya's expression now seems to be racking her brains to know what is terrible about the bell.

Xu Jianan asked: "If you hear the bell, what kind of reaction will you have? avoid, run away, scream, or feel that your heart beats abnormally and your breathing is miserable?"

Chen Xiaoya replied: "There have been, but the most serious one, probably just a few months ago, I ...... I was stunned. ”

Xu Jiannan didn't think about such an autonomic reaction, because there are very few specific fears that are really avoided by syncope.

Then he asked, "Does a particular sound of a bell cause such an out-of-control behavior, or does any similar sound cause such a consequence?" For example, if someone verbally simulates a bell, or if there is a sound of a clock moving in a certain piece of music, does it make you so scared?"

Chen Xiaoya thought for a while and said, "That...... Probably not, I don't know, anyway, whether it's a big bell, a small bell, or the clock of the New Year's countdown on TV, it can make me scared...... Not very sober. ”

"How long has this been fearful?"

Chen Xiaoya thought about it for a while and said, "I can't remember clearly...... It's been many years. ”

"Then, is it after the death of his mother? or before?" Xu Jiannan felt that the loss of his mother at an early age was a relatively big blow to a child. Especially at the age of eight, she is not like a one- or two-year-old child, she has no sense of sadness of life and death, and she is not reluctant to control her mother. She is not like an adult who can rationally look at birth, old age, sickness and death. At that age, consciousness is unstable, memory is clear, self-awareness is self-aware, but it is not mature at all. So when she lost her mother at that time, she should have had a hard time.

Sure enough, Chen Xiaoya frowned and said, "It was after my mother died." ”

determined the time period of the onset of the disease, and Xu Jiannan basically understood the source of this terrifying "bell", which was mostly related to the death of Chen Xiaoya's mother. That emotional shock caused her to manifest her phobias later on.