What is Ichthyophobia?

Approximately 10 million people across the UK experience phobias. There are currently more than 400 recognised phobias, with some more well-known than others.

Ichthyophobia, an extreme and overwhelming fear of fish, is less well-known than other phobias. However, a phobia of fish can have a significant impact on someone’s life, particularly if they experience fear, anxiety and panic in relation to both dead and alive fish.

Today, we are going to look at ichthyophobia in more detail, including the common causes, triggers, symptoms and treatments.

What is ichthyophobia?

Ichthyophobia is an extreme, overwhelming and irrational fear of fish that are both alive and dead. The fear extends to seeing, smelling, hearing, touching and eating fish. People with ichthyophobia usually fear all species of fish, regardless of how harmless and non-threatening they are. Someone with ichthyophobia will likely experience intense, overwhelming and irrational fear, anxiety or panic when faced with a live or dead fish.

Ichthyophobia can result in avoidance behaviours, whereby a person avoids any place or situation where they could encounter a live or dead fish, including swimming in the ocean and going to aquariums, marinas, seafood restaurants, fish markets and supermarkets.

They may also avoid visiting other people’s homes in case they have pet fish or the person tries to serve them a meal with fish. Avoidance behaviours can negatively impact your ability to carry out everyday tasks, such as going grocery shopping, as well as impacting your social life.

Although many people dislike swimming in the ocean, usually because of the fear of the unknown, or they may feel uncomfortable swimming in an area with lots of fish, someone with ichthyophobia will fear fish even when there is no real risk of coming into direct contact with them. For example, they may fear fish that are enclosed safely in a tank, very tiny fish that cannot harm them and dead fish that are behind a counter in a shop.

This irrational fear of fish can have a significant impact on their day-to-day life and can cause them to experience fear, anxiety and panic even in situations where there is no risk.

Ichthyophobia differs from a general or mild fear of fish.

To classify as a phobia, your fear of fish will include:

• Feelings of intense fear, panic or anxiety that are difficult to manage.
• Fear or anxiety that is out of proportion to the potential danger.
• A fear of fish that lasts for a minimum of six months.
• Avoidance behaviours to prevent encounters with fish.
• A fear of fish that interferes with your day-to-day life, overall wellbeing or sense of safety.

Someone with ichthyophobia may also have difficulty concentrating or functioning in certain situations and find that their fear interferes with their day-to-day life. Some people find that they are consumed by thoughts of fish or the fear that they could encounter a fish; for example, they may feel stressed and anxious in a restaurant in case anyone orders fish.

Some people with ichthyophobia don’t just experience symptoms when they see a fish, but they may also experience symptoms when they think about fish or when they see, hear or smell something that reminds them of a fish.

If you have ichthyophobia, you may be aware that your fear of fish is irrational and disproportionate to the risk and danger. However, you may still be unable to control your fear and prevent or reduce your physiological and psychological responses to fish.

Ichthyophobia is related to and can occur in conjunction with other phobias, including:

• Galeophobia: An extreme fear of sharks.
• Cetaphobia: An extreme fear of whales.
• Thalassophobia: An extreme fear of the ocean.
• Aquaphobia: An extreme fear of water.
• Zoophobia: An extreme fear of animals.
• Megalohydrothalassophobia: An extreme fear of large underwater creatures.

How common is ichthyophobia?

Although animal phobias are one of the most common types of phobias, ichthyophobia is a relatively unknown and rare condition.

A phobia is a type of anxiety disorder, with an estimated 10 million people in the UK having a phobia. However, many phobias, including ichthyophobia, go undiagnosed.

This could be for a number of reasons, including:

• People have never heard of the phobia so are unaware they are experiencing a medical condition.
• People are not aware that their fear of fish is extreme.
• Avoidance behaviours reduce a person’s encounters with the feared object.
• People are not aware that there are effective treatments for phobias.
• People are aware that their fear is irrational and find this embarrassing.

Unlike other well-known phobias, such as arachnophobia, an extreme fear of spiders, aerophobia, an extreme fear of flying, and claustrophobia, an extreme fear of confined spaces, very few people have heard of ichthyophobia, which can make it more difficult to diagnose. There are no accurate statistics available for how many people are experiencing ichthyophobia.

Many people dislike fish, stating their sliminess, the bad smell of them and their dislike of not being able to see fish swimming near them in the ocean. However, negative thoughts and reactions to fish can occur on a spectrum, ranging from low levels of fear and anxiety to severe fear, panic and anxiety that can impact your ability to function in your day-to-day life and can impact your decision-making and result in avoidance behaviours of certain places, situations or objects.

It can be difficult to determine how many people are scared of or dislike fish and how many are experiencing a true phobia.

Who is at risk of ichthyophobia?

Although anyone can experience an extreme fear of fish, there are certain risk factors that can increase the likelihood of you developing ichthyophobia, including:

• Having another related phobia, such as galeophobia or thalassophobia.
• Having a previous traumatic experience with fish, whether dead or alive.
• Having a close family member, such as a parent or sibling, with ichthyophobia.
• Having a close family member, such as a parent or sibling, with another phobia.
• Being exposed to the fear of fish during childhood or adolescence.
• Belonging to a culture, tribe or religion that portrays fish negatively or dislikes fish, such as the Navajo tribe.
• Living inland and spending little time near the ocean or having little or no contact with fish.
• Having a history of anxiety, depression, panic attacks or another mental health condition.
• Being a naturally more anxious or fearful person.
• Going through a significant life event or stressor or having higher than usual stress levels (particularly if you are exposed to a fear of fish or having a negative experience with fish during this time).
• Having a substance use disorder, such as an addiction to drugs or alcohol.

Although ichthyophobia can develop at any age, the majority of phobias are diagnosed during childhood and adolescence. Because many phobias develop during childhood and adolescence, a traumatic, negative or stressful event during this time can trigger ichthyophobia, even if the event was unrelated to fish. This is because stress and trauma can cause feelings of anxiety and fear and can reduce your ability to cope with certain situations.

For example, ichthyophobia can be triggered by:

• Experiencing physical, sexual or emotional abuse or violence during childhood or adolescence.
• Experiencing the loss of a parent or close family member or parental separation during childhood or adolescence.

There are other factors that could increase the likelihood of someone developing ichthyophobia. The majority of people diagnosed with ichthyophobia identify as female, with twice as many females being diagnosed with the condition compared to males. However, it is unknown whether these figures represent a true gender disparity or whether other factors affect diagnostic statistics.

Although the above risk factors can increase the chances of you developing ichthyophobia, it is important to keep in mind that someone with no risk factors can also develop the condition. Additionally, someone with several of the above risk factors may never develop ichthyophobia. For example, if you have a parent with ichthyophobia, you rarely encountered fish during your childhood and you have a history of anxiety, this doesn’t mean you will necessarily develop ichthyophobia at any point in your life.

How to deal with ichthyophobia

Some people never seek a diagnosis for ichthyophobia because they learn coping and calming strategies that enable them to deal with their phobia. Learning how to deal with your phobia enables you to reduce and alleviate your symptoms and reduce the impact your phobia has on your day-to-day life and your overall wellbeing.

You can learn and implement both long-term and short-term coping and calming strategies to help you manage your phobia more effectively, including strategies that you can utilise when faced with your triggers and strategies that you can engage in on a daily basis to help reduce the likelihood of your phobic symptoms occurring and reduce the frequency and severity of your symptoms.

You may think that the easiest way to deal with your phobia is to avoid fish and any places or situations where you could encounter fish. However, although avoidance behaviours may seem like they are effective in preventing a phobic response, they can actually have a significant impact on your life, particularly if they cause you to avoid social situations or impact on your wellbeing.

Failure to deal with your phobia can also cause you to experience more severe symptoms when faced with fish in the future. It can be very difficult for you to completely avoid fish and an unexpected trigger with no coping strategies can result in more severe symptoms in the future, such as experiencing a panic attack.

Some long-term and short-term coping strategies that can help you deal with your ichthyophobia are:

• Learn about your phobia – Consider what initially caused your phobia to develop and what happened when you first experienced an onset of symptoms. This allows you to address the root cause of your phobia. Additionally, consider what your triggers are and which of your triggers result in more severe symptoms. Learning about your phobia can help you to understand your fear of fish and rationalise your thoughts and emotions. This can help you to manage your symptoms more effectively in the future and address any negative patterns of thought that exist around fish.
• Create a fear ladder – A fear ladder can help you to analyse and understand your fear of fish and determine which triggers create more severe fear, anxiety and panic than others. A fear ladder allows you to organise your triggers from least severe to most severe.
  For example, your fear ladder can look like this:
  – 1 = Swimming in the ocean with fish.
  – 2 = Eating fish.
  – 3 = Feeding a fish.
  – 4 = Seeing a dead fish in a fish market or supermarket.
  – 5 = Seeing a live fish in an aquarium, fish tank or pond.
  – 6 = Watching a video of people swimming with fish.
  Once you have created your fear ladder, you can then confront your fears one at a time, starting at the bottom of the ladder (the trigger that results in the least phobic response). This can help you to build up your tolerance of your triggers gradually and reduce your fear of fish.
• Educate yourself – Ichthyophobia can worsen because of a lack of knowledge about fish or because you begin to view fish as being much more dangerous than they actually are. Learning facts and information about fish, such as how vital they are to the Earth’s ecosystem and how harmless the vast majority of fish are to humans, can help you to view them as less dangerous. If you think of fish as being weird or disgusting, learning about why they are slimy or why they don’t blink can help to normalise fish and remove some of the weirdness that you associate with them. Learning about fish can help you to rationalise your thoughts and feelings and disrupt any negative patterns of thought.
• Challenge negative thoughts and feelings – Challenging negative thoughts, feelings, stories and memories surrounding fish can help you to manage your phobia more effectively. Try and disrupt negative thoughts and try not to recap any negative memories you have surrounding fish. Remind yourself that the risks to your health and wellbeing from fish are minimal and that you are not in danger. If you begin to experience symptoms of ichthyophobia, remind yourself that the feelings will soon pass and that your fear is irrational, and that fish aren’t going to hurt you.
• Avoid negative stories or depictions of fish – Hearing negative stories about fish or watching a film or TV show where they are depicted negatively can validate your thoughts, increase your fear or anxiety responses and worsen your phobia. Inform your family and friends of your phobia so they can be more mindful in the future, and don’t watch films or TV shows where fish are depicted negatively, such as Jaws or Piranha. Remove yourself from certain situations if necessary, for example, by leaving the room if mercury poisoning from fish is being discussed.
• Practise yoga, meditation or mindfulness – Yoga, meditation and mindfulness can all be implemented as long-term coping and calming strategies that teach you how to control your breathing and manage your body’s response to your triggers. Practising yoga, meditation or mindfulness can help you to feel more in control and calm and reduce the physiological and psychological responses you may have when faced with fish in the future. By practising yoga, meditation or mindfulness every day, this can help to improve the symptoms of ichthyophobia over time and reduce the likelihood of you experiencing a phobia response.
• Practise deep breathing techniques – Deep breathing is another long-term strategy that can help you to reduce the impact your phobia of fish has on your life. Deep breathing has been shown to be an effective way of lowering your stress levels, relieving tension in your body and reducing anxiety and panic. Deep breathing sends a message to your brain to relax and calm down. It can also help you to control your central nervous system, which is central to your phobic responses. Practise deep breathing regularly, as part of your daily routine, and implement the strategies you have learnt if you encounter a trigger in the future.
• Implement lifestyle changes – There are several lifestyle factors that can worsen the symptoms of phobias, including ichthyophobia. For example, lack of sleep and high stress levels can worsen anxiety and make your symptoms more likely to occur. Implementing a successful sleep routine and taking steps to reduce your everyday stress can help to reduce the severity of your phobia both short term and long term. Other lifestyle factors that could help you deal with your phobia include eating a healthy, balanced diet and increasing the amount of exercise you do. If you are expecting to face a trigger, for example if you are going on a family trip to the zoo, avoid alcohol, caffeine, sugar and other stimulants in the lead-up, as they can all increase your heart rate and blood pressure, resulting in a more severe phobic response.
• Implement distraction techniques – Distraction techniques are short-term coping strategies that can help you to reduce your physiological and psychological response to your triggers and keep you calm in triggering situations. Distraction techniques should be implemented if you encounter fish or another trigger, or if you feel symptoms of your phobia developing. Some distraction techniques you could implement include listening to music, reading, playing a game, watching a video or talking to someone you trust.
• Implement visualisation techniques – Visualisation techniques are another short-term coping and calming strategy that can help you to reduce the symptoms of your phobia or prevent a phobic response from occurring. When faced with your triggers, visualise a place or memory that keeps you calm or elicits positive emotions to help you to alleviate your symptoms. Successful visualisation techniques include recalling some of your favourite memories or visualising yourself in your favourite place or a calming environment.

What triggers ichthyophobia?

There are many different things that can trigger the symptoms of ichthyophobia. Different people with the condition often have different triggers and your triggers can vary, depending on what initially caused you to develop a fear of fish, your perception of danger, the severity of your symptoms and your current mental health and mindset.

It may be that multiple things trigger your phobia. However, some triggers can result in more severe symptoms than others.

Some of the most common triggers of ichthyophobia are:

• Seeing a live fish swimming in the ocean, a tank, a pond or another body of water.
• Seeing a dead fish, for example, at a fish market or washed up on a beach.
• Seeing a cooked fish, for example, in a restaurant.
• Smelling raw or cooked fish.
• Touching a fish or something slimy that reminds you of a fish.
• Seeing bubbles or movement in a body of water.
• Going to a zoo, aquarium, pet shop, the beach or another place where there is a possibility you could see a live fish.
• Going to a fish market, a supermarket, a seafood restaurant or another place where there is a possibility you could see a dead fish.
• Seeing an object that reminds you of fish, such as a fishing net.
• Thinking of fish or remembering a previous encounter with fish.
• Watching a video or seeing a picture of fish.
• Being in close proximity to fish, even if you can’t see them.

What are the symptoms of ichthyophobia?

You can experience the symptoms of ichthyophobia when exposed to fish, when thinking or talking about fish or when exposed to a sight, sound or smell that reminds you of fish. The symptoms of ichthyophobia can vary significantly in their severity, their manifestation and their frequency. Symptoms can differ from person to person and from situation to situation.

This disparity can occur because of different triggers, the perceived risk and threat of danger, your current mental and emotional health and wellbeing and any treatments you are undergoing or coping strategies you have implemented.

Symptoms can range from mild to severe. Some people with ichthyophobia experience more severe symptoms than others. It could also be that your symptoms are more severe when faced with some triggers, compared to others.

The symptoms of ichthyophobia can be similar to the symptoms of anxiety and panic attacks. Some people with severe ichthyophobia can experience a full panic attack when faced with their triggers.

The symptoms of ichthyophobia can be both physiological and psychological and can include:

Physiological Symptoms

• Dizziness or light-headedness.
• Breathing difficulties, such as rapid breathing, shortness of breath, hyperventilating or feeling like you cannot breathe.
• A rapid heart rate, heart palpitations or feeling like your heart is pounding.
• Tightness in your chest, chest pain or feeling like something is stuck in your chest.
• Elevated blood pressure (hypertension).
• A choking sensation, difficulty swallowing or feeling like something is stuck in your throat.
• A dry mouth.
• Unusual or excessive sweating.
• Shaking or trembling.
• Nausea, vomiting or an upset stomach.
• Chills, hot flushes or unusual paleness, particularly in the face.
• Unusual or severe headaches.
• Muscle tension.
• Feeling like you are extremely hot or cold or having an unusual sensitivity to temperature.
• Feeling confused or disorientated.
• Numbness or tingling, particularly in your hands or feet.
• Unusual fatigue or tiredness.
• A lack of appetite when in triggering situations.

Psychological Symptoms

• Overwhelming fear, anxiety or panic when faced with a fish or another trigger.
• Feelings of fear, anxiety or panic that are out of proportion to the risks.
• Being unable to control your negative thoughts or feelings, even if you are aware that they are out of proportion to the true danger.
• Feeling like you are out of control of the situation or fearing losing control.
• Anticipatory anxiety in the lead-up to encountering your triggers.
• Engaging in avoidance behaviours, such as avoiding places, situations or social events where you might encounter fish or other triggers.
• Difficulties concentrating or functioning normally in triggering situations.
• Experiencing frequent or distressing nightmares about fish.
• Feeling defenceless or vulnerable when faced with a trigger.
• Having a sense of impending doom.
• Feeling like you are going to die.

Symptoms of Ichthyophobia in Children

The symptoms of a phobia can differ in children compared to adults. This is because a child may not understand what is happening to them or may not be able to articulate or explain their feelings. Children are also usually less constrained by societal expectations so may not try to hide their fear, panic or anxiety.

Some symptoms of ichthyophobia in children can include:

• Crying or screaming.
• Having a tantrum or trying to lash out (the fight or flight response).
• Trying to run away or hide (the fight or flight response).
• Clinging to a parent, guardian or another safe person.
• Shaking or trembling.
• Showing extreme anxiety, fear or panic.

What causes ichthyophobia?

Ichthyophobia can have many possible causes. Similarly to other phobias and anxiety disorders, ichthyophobia could be caused by a combination of genetic, physiological and environmental factors.

Different people have different experiences of what caused their phobia of fish to develop. It could be that your phobia has one clear cause that you can pinpoint. For other people, multiple factors contributed together, meaning their phobia has several causes.

Some people find it difficult to pinpoint what caused their phobia of fish to develop. Being aware of the root cause or causes of your phobia can help you to address the initial trigger and any negative patterns of thought or negative feelings that are attached to the initial onset of your phobia. This can make it easier to treat your phobia and for you to develop coping strategies. Being aware of the cause of your ichthyophobia can make your phobia easier to manage.

Some of the most common causes of ichthyophobia are:

• A negative or traumatic experience involving fish – An intense fear of fish usually stems from previous negative or traumatic experiences involving fish. This negative experience is known as a direct learning experience or traumatic conditioning. The event that caused the traumatic conditioning may not actually have involved real danger or real risk. However, as long as the individual experiences significant fear, distress or trauma, this can lead to the development of a phobia. A traumatic experience may include being bitten, stung or spiked by a fish, seeing a dead fish on a plate and finding this traumatic, or seeing a large or threatening fish when swimming in the ocean and feeling like you were unable to escape. Following the negative event, you may experience intrusive and negative thoughts or memories of the trauma and begin to avoid trauma-related triggers, for example, by avoiding all fish. This can cause the fear or anxiety you felt at the time of the experience to linger or worsen.
• Thinking of fish as smelly or dirty – Ichthyophobia can be caused by the perception of fish as being smelly, slimy and unclean. This can lead to you not wanting to eat fish or be in close proximity to them. Some people can also begin to associate fish with mercury poisoning, which can be fatal. Things that we perceive as unclean generally cause avoidance behaviours, which can develop into a phobia.
• Negative media depictions of fish – In films and TV shows, we often see fish, such as sharks and piranhas, attacking and killing people, which can cause people to view fish as being dangerous. We may also see pictures and videos of chopped-off fish heads or the insides of a fish, which can result in fish being viewed as disgusting or repellent. Media reports of mercury poisoning in fish, food poisoning and toxins that are specific to fish and seafood can also cause you to view fish as being dangerous or disgusting. In some people, this will result in them stopping eating fish, whereas in others, their response may be more severe and could develop into a phobia.
• Negative cultural depictions of fish – Ichthyophobia has been found to be more prevalent in cultures that fear fish, portray them negatively or don’t eat them. For example, the Navajo tribes in North America historically do not eat or touch fish. Ichthyophobia is more prevalent in cultures such as these, compared to cultures where people spend a lot of time around fish and eat them frequently. Cultural attitudes can have a significant impact on the development of a phobia.
• Fear rumination – Fear rumination is when you engage in a repetitive negative thought process and persistently and repetitively recap a traumatic, scary or negative experience involving fish. Over time, these thoughts and memories can become increasingly upsetting and intrusive and can make you remember the experience as being more traumatic, painful or scary than it was in reality. Fear rumination reinforces your natural fear responses and can result in you developing a phobia of fish.
• An informational learning experience – Being exposed to information that scares you or creates feelings of anxiety can result in you developing a phobia. For example, learning about dangerous and toxic fish, such as stonefish, lionfish and pufferfish which can be venomous and fatal to humans, and candiru fish which can swim into the urethra of humans and feed on their blood, can result in your developing a fear of all fish, even though dangerous or fatal encounters with these fish are extremely rare.
• A learned phobia – Phobias can develop because of an observational learning experience, meaning you observed a fear of fish in another person and learnt to associate fish with fear or danger yourself. You are more likely to learn a phobia if you are exposed to it during childhood or adolescence. In fact, children who grow up with a close family member, such as a parent or sibling, with ichthyophobia are more likely to develop the condition themselves.
• Experiencing significant stress – Significant, long-term stress can result in a disproportionate fear response or an inability to manage intense situations, which can make it more likely that you will develop a phobia. A stressful and distressing event, such as a death or a sudden loss of stability in your life, can also trigger a phobia, as it can result in some people being less able to manage their emotions and thought processes when experiencing stress. If you are exposed to a fear of fish or have a negative experience with fish while experiencing significant stress, this is more likely to develop into a phobia.

How is ichthyophobia diagnosed?

Because ichthyophobia is not a well-known phobia, it is thought to be significantly underdiagnosed, with the number of people who currently have a diagnosis being far below the true figures.

Ichthyophobia is a specific phobia, which means it is a lasting, overwhelming and unreasonable fear of a specific object, situation, activity or person; in this situation, an overwhelming fear of fish. Because ichthyophobia is not specifically included in the diagnostic criteria for phobias, to receive a diagnosis, your symptoms will be compared to the diagnostic criteria for specific phobias.

Many people with ichthyophobia have never heard of the condition so do not seek a diagnosis. They may also not realise their symptoms are severe enough to qualify as a phobia.

If you are unsure if you are experiencing a true phobia, consider whether your symptoms include:

• Fear, anxiety or panic that are out of proportion to the actual risks.
• Fear that impacts your ability to function in your everyday life or in certain situations.
• Thoughts and feelings surrounding fish that negatively impact your quality of life, your mental health or your wellbeing.
• Symptoms that occur when faced with your triggers or when thinking about fish.
• Fear or anxiety that results in avoidance behaviours.

If you think you could be experiencing ichthyophobia, your first step will be to visit your GP. Although your GP is unlikely to be the one to make a formal diagnosis, they will still ask about your symptoms and other factors before they make a referral to a phobia specialist.

Your GP will likely ask about a variety of things, including:

• Your symptoms, including what your symptoms are, how frequently they occur and how severe they are.
• Your medical history, including any anxiety disorders, panic disorders, phobias or other mental health conditions you have experienced.
• Any medication or supplements you take.
• Whether you have a family history of phobias.

You will then be referred to a psychologist or mental health professional. The psychologist will likely conduct a phobia questionnaire. As well as asking similar questions to your GP, the psychologist will also look at when your symptoms began, what caused the initial onset and how much your fear interferes with your everyday life or your decision-making.

To confirm a diagnosis of ichthyophobia, your symptoms will be compared to the diagnostic criteria for specific phobias.

Your symptoms will need to correspond to the seven key criteria listed below:

1. The fear must be persistent, excessive and unreasonable. It can occur either when fish are present or when they are not present.
2. Exposure to fish or another trigger leads to an immediate anxiety response in the majority of situations.
3. The fear is excessive and disproportionate to the threat, and this is recognised by the individual.
4. The individual avoids places or situations where fish could be present. If a fish is present, the individual will experience extreme fear, anxiety or distress.
5. The anticipation of fish and the avoidance behaviours associated with avoiding their triggers can have a significant impact on the individual’s day-to-day life.
6. The fear has lasted for a minimum of six months.
7. The phobia is not associated with another disorder or mental health condition.

If your symptoms fit the diagnostic criteria, you will receive a diagnosis of ichthyophobia. Depending on the severity of your phobia, you may be offered treatment.

How is ichthyophobia treated?

There are multiple treatment options available for ichthyophobia. However, not every person with a phobia requires treatment. If the symptoms of your phobia are mild, you have implemented successful coping strategies or your phobia doesn’t impact your day-to-day life or wellbeing, you may not require treatment.

However, if the symptoms of your phobia occur frequently or are severe, if your phobia results in avoidance behaviours or your phobia is impacting on your daily life, treatment will be recommended.

Because multiple treatment options are available, your psychologist will create a personalised treatment plan that is designed to effectively treat the cause and symptoms of your phobia.

When creating your treatment plan, your psychologist will consider:

• How severe your symptoms are.
• How frequently your symptoms occur.
• What the root cause of your phobia is.
• How significantly your phobia impacts your life.
• Your overall health and wellbeing, including your mental health.

The most common treatment options for ichthyophobia are:

Exposure Therapy

Also known as systematic desensitisation, exposure therapy is when you are gradually exposed to your triggers in a safe, controlled environment. This gradual and repeated exposure is designed to eliminate the fear and risk you have associated with fish and to reduce your fear and anxiety responses so that you can eventually be around fish, either dead or alive, without experiencing symptoms.

The psychologist will assess your phobia and create a fear ladder of scenarios and situations that are the least to the most triggering. To ensure you are in a relaxed and comfortable state, you will first utilise calming and relaxation techniques. Your exposure will then begin gradually, with a situation that creates the least phobic response, such as watching a video of a fish.

Once you are comfortable with this level of exposure, you will move on to the next level, for example, going to a beach. The aim is that through systematic desensitisation, you will eventually be comfortable with the most triggering situations, such as swimming with fish or touching a fish.

Cognitive Behavioural Therapy (CBT)

Cognitive behavioural therapy is a type of psychotherapy that is effective in treating a range of phobias. It focuses on existing negative thought patterns and any harmful thoughts, feelings and behaviours related to fish. CBT can also help you to address the root cause of your phobia and reduce your physiological and psychological responses to your triggers.

CBT sessions can be conducted individually or as part of a group with other people with ichthyophobia. The sessions aim to reduce your physiological and psychological responses to your triggers.

 During your sessions, you will:

• Discuss your triggers and symptoms.
• Explore what caused your fear of fish.
• Explore your fears in more detail.
• Learn how to recognise your negative thoughts and change the way you are thinking.
• Learn coping strategies and calming strategies, such as deep breathing exercises, distraction techniques and coping statements.

Clinical Hypnotherapy

Clinical hypnotherapy uses a combination of guided relaxation techniques and focused attention to help you reduce your stress, fear and anxiety responses. This is done by putting you in a deeply relaxed state while you discuss your phobia and your triggers.

Hypnotherapy sessions use a combination of guided relaxation techniques and focused attention. They can help you to identify the root cause of your fear and help you change your thought patterns and any negative feelings you have about fish. Hypnotherapy helps you to change your perception of fish and reduce your phobic response.

The sessions also aim to repattern your thoughts, memories and feelings towards fish. They can also teach you calming strategies, such as deep breathing and relaxation techniques which can help you to reduce your symptoms in the future.

Medication

Medication is not a common treatment choice for phobias and will likely only be used if you are also experiencing anxiety, depression or another mental health difficulty alongside your phobia.

In this case, some of the medications you may be offered include:

• Beta-blockers.
• Selective serotonin reuptake inhibitors (SSRIs).
• Sedatives.
• Anti-anxiety medication.