Phobic anxiety is characterised by an intense, irrational fear of an object, activity, or situation which poses little or no actual danger. There are many specific phobias e.g. agoraphobia (fear of open spaces) and claustrophobia (fear of closed-in spaces). The person will seek to avoid the object, activity, or situation which triggers the phobic response. The person may recognise that the fear is excessive or unreasonable. If the person is unable to get away from the situation they may experience significant anxiety symptoms such as panic, fear, rapid heart rate, shortness of breath and trembling.
Another example of a phobia which occurs relatively commonly 
following a road traffic accident is a specific phobia related to travelling by car/taxi/bus. In this context, high levels of anxiety and panic attacks may be experienced by the person and they may avoid travel by specific forms of transport. Anxiety experienced in this context can be understood as a post-trauma symptom which may develop into a phobia.
Following brain injury, social phobia (social anxiety disorder) is also very common. Being in certain social situations may result in the person experiencing high levels of significant levels of stress and anxiety. Those with cognitive and/or communication difficulties may experience significant levels of stress and anxiety in busy, noisy, over-stimulating environments e.g. family gatherings, shopping centres, cinemas and pubs.
Communication and cognitive impairments may adversely affect the brain injured person’s ability to communicate in these social situations. These difficulties may contribute to the development of a social phobia.
The person may lack insight into their anxiety symptoms in social situations, may deny feeling anxious but strongly express the desire to leave the situation (social withdrawal). The anxiety may be expressed in an atypical manner e.g. irritability, agitation and occasionally aggression.
Successful, appropriate communication in a social situation requires the capacity to:
- Pay attention to the relevant environmental information e.g. people present, events occurring, rapidly changing situations.
- Screen out irrelevant sensory input (background noise, other people etc).
- Understand the situation and language used within the context.
- Control verbal expression and communication style.
- Monitor and adapt communication as the situation requires.
Damage to the frontal lobes and associated networks may impair the skills required for successful communication (as described above) and may lead to problems with emotional and behavioural regulation. This may result in a reduction in the ability to regulate one’s verbal output or social behaviour in challenging social situations.
Emotion can have a significant impact upon communication in any environment. Therefore inappropriate behaviour in social settings may result from anxiety and feelings of being overwhelmed. Inappropriate behaviour may occur even when there appears to be little or no provocation. These problems are generally worse when the person is stressed due to environmental factors or other stressors e.g. confusion, anxiety/social phobia.