Fri May 25, 2012
Breaking Out Of A Web Of Fear
Originally published on Fri May 25, 2012 4:16 pm
JOHN DANKOSKY, HOST:
So if tiny ticks carrying Lyme disease weren't scary enough for you, how about something even creepier and crawlier? What happens when you see a spider in the sink? Do you panic? Do you shriek? Do you call in someone else to squash it?
For arachnophobes, the fear is more intense. They might break out in a sweat, have difficulty breathing, and maybe even have to leave the room. I'm getting panicked just thinking about it. A new study in the Proceedings of the National Academy of Sciences showed that therapy can tame those spider fears.
How about you? Are you scared of spiders? Give us a call. Our number is 1-800-989-8255. That's 1-800-989-TALK. You can also tweet us @scifri. We'll be talking about fears for the rest of this hour.
Let me bring in our next guest. Katherina Hauner is a postdoctoral fellow in neurology at Northwestern University Feinberg School of Medicine. She was lead author of a study that used a tarantula named Florence to help people face and even overcome their fears. She joins us from Evanston, Illinois. Welcome to SCIENCE FRIDAY.
KATHERINA HAUNER: Thanks so much.
DANKOSKY: Florence, huh?
HAUNER: Yes. That was her name.
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DANKOSKY: So tell us about the study.
HAUNER: So we were interested in seeing how the brain changes after a person who has a phobia has been treated for it. And because we were able to use a therapy that works extremely effectively and extremely efficiently - it's just two hours long - we were able to look at changes in the brain that happen within just minutes after the therapy had been completed.
And we were also interested in seeing how these changes develop over time. So we took the same individuals and looked at their brain activity six months after the initial study. And they hadn't had any additional intervention or treatment within that time, but because the therapy worked so well, they were still phobia-free six months later.
DANKOSKY: OK. So how did you pick these people to be part of your study?
HAUNER: So these were individuals that were recruited from around the campus area. They were young adults. And we posted signs and advertisements, asking if people were interested in overcoming their fear of spiders, and we got quite a few responses.
DANKOSKY: So you picked people who are afraid of spiders. Were you showing them pictures of spiders at first? How did you get them acclimated to this entire idea?
HAUNER: Well, they did see pictures of spiders in the scan, in the MRI scanner. That was part of the study. What do you mean acclimated to the idea?
DANKOSKY: Well, over time you eventually get them to touch Florence the spider.
HAUNER: Oh, I see. So the therapy involved - yeah. Eventually they touched the spider after about two hours of this particular therapy called exposure therapy. But they didn't start off anywhere near the spider. These were people who were very terrified. So the way we did this is by a hierarchy of steps, each of which was first demonstrated by me, the therapist in the study. And the participant would follow along when they felt ready.
So we started off, for example, about 10 feet away from the spider. The spider was in an enclosed terrarium. It was quite far from them. They couldn't really see it. That's where we started. And then eventually we'd get closer and closer to touching the terrarium, and then eventually I would remove the spider from the terrarium to an open container.
I think this is where the change really takes place because that's where they learn that the spider's movements, the spider's behavior is predictable and controllable. So we would learn to first touch it a little bit with a paintbrush and observe its movements, and then with a thick glove, then with a thinner glove, and finally with just the bare hand.
DANKOSKY: I'm John Dankosky, and this is SCIENCE FRIDAY from NPR. So what did the scan show after this therapy? How is it different from what you observed later? This is - there's an amazing change in people after just a couple hours.
HAUNER: It was amazing to see even just, behaviorally, even just to observe them afterwards holding or touching the tarantula with their bare hands. And it was amazing for them as well. They just - they couldn't believe it. But in terms of what the brain showed, one of the most interesting findings is at an area of the brain that is part of the prefrontal cortex.
So this is an area that's associated with inhibition, of fear or emotions or effortful control of fear. This region showed increased activity immediately after the therapy, hadn't been active prior to the therapy. So within minutes there's this change. And then six months later, actually, the same region showed a decrease in activity, even though the participants were still phobia-free six months later.
DANKOSKY: We have a caller here from Phil in Boise. Hi, Phil.
DANKOSKY: So what's your question?
PHIL: Well, as a child I was bit by a black widow, and I suffered some severe trauma. And my current trade is a plumber. I have been a plumber for eight years, and I see spiders, and I really can't move. It's really debilitating. And in my trade it's kind of hard to actually do my job, being as afraid of spiders as I am. As a matter of fact, I have my wife get in crawl spaces sometimes to kill them for me. And I'm wondering how effective this treatment is going to be and how available it's going to be. And you know, I mean, what process is it in currently?
DANKOSKY: Yeah. Can you help out Phil here?
HAUNER: Sure. So that's a really good question. A lot of participants in this study had fears that were equal to that. This therapy has been available for decades, so it's actually very well established. And maybe the only surprising thing is that very few people know about it.
In terms of availability, it's not necessary to seek out a therapist who specializes in spider exposure therapy because exposure therapy for all phobias involves the same procedure, so as long as you can find a therapist who has experience with exposure therapy in general.
And actually, I can give you a website for finding one. A good resource for this is Association of Behavioral and Cognitive Therapies, and the website is A, B as in boy, C as in Charlie, T as in Tree dot org., abct.org. And they have a find a therapist link. And depending on where you live, you might be able to find one very close to you or not. But if they have experience in exposure therapy or CBT in general, actually, because exposure therapy is a component of CBT, you should be fine.
DANKOSKY: We're talking with Katherina Hauner, a post-doctoral fellow in neurology at Northwestern University. We're talking about the fear of spiders, a new way to perhaps overcome this fear. We'll be broadening discussion to all fears, and we want to hear from you: 1-800-989-TALK, 1-800-989-8255. You can tweet us @scifri. What are the things that frighten you? Maybe we can find some help for you, coming up next.
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DANKOSKY: This is SCIENCE FRIDAY, and I'm John Dankosky. We're talking this hour about therapy for people with a phobia of spiders and how the brain processes fear. Katherina Hauner is a post-doctoral fellow in neurology at Northwestern University Feinberg School of Medicine and lead author of a study in the proceedings of the National Academy of Sciences that we've been talking about. This study, though, raises some larger questions: Why are some people scared of spiders while others aren't?
I want to bring in Dr. Todd Farchione, who is director of the Intensive Treatment Program at the Center for Anxiety and Related Disorders and a research assistant professor of psychology at Boston University. Dr. Farchione, welcome to SCIENCE FRIDAY.
TODD FARCHIONE: Thanks, John. I'm glad to be here.
DANKOSKY: So why are some people so scared of spiders?
FARCHIONE: Well, you know, there's a few things. First, let me say that fears, you know, certain fears are sort of, you know, probably built-in so that from an evolutionary standpoint it's important to be afraid of certain things. And there's research to actually suggest that some fears are easier to learn than others. But it does appear that some people may be more predisposed to develop fears than other people.
DANKOSKY: Fears, anxieties, phobias, what's the difference?
FARCHIONE: Well, fear is more of a - they're just different kind of emotional states. Fear is actually much more of an immediate sort of fight-or-flight reaction, whereas anxiety is - sort of proceeds over a longer period of time and it tends to be more future-focused, involve things like a greater state of hyper-arousal, sort of looking for the threat. And then fear would really be the emotional response that someone would experience in the presence of the situation or object that they're afraid of.
DANKOSKY: And at a certain point, though, this fear, this anxiety, can become actually harmful to us. When does this happen? How do we characterize that harm that fear can cause?
FARCHIONE: Well, I think as far as the - like a diagnosis of a specific phobia, what we look for clinically is an excessive fear that the individual recognizes as being irrational and it also causes interference for the person or is very distressing to the individual. So a lot of people will report fears, again, you know, and I think these are common things to be afraid of, like spiders and snakes and being high up, you know, and - but for some people it becomes very excessive, very intense, and can become interfering for them.
DANKOSKY: Let's go to Rob, who's calling from Grand Rapids, Michigan. Hi there, Rob.
ROB: Hi, guys. It's an interesting conversation because I - I don't know if it's arachnophobia or how you can classify it, but I was never afraid of spiders my whole life until I watched my friend get bit by a recluse - brown recluse and the absolute sickness he went through and all the problems. And ever since then, now any spider I see automatically in my mind is a brown recluse and it bothers me.
DANKOSKY: Wow. Is that part of it, Dr. Farchione? When someone sees a terrible incident maybe as a child or maybe you see a friend get bitten, then all of a sudden you go into being an arachnophobe?
FARCHIONE: Yes. Yeah, that does that happen sometimes. So there's a few different ways that we can learn to be afraid of things. One is to actually experience the trauma ourselves. Then there's a couple other ways. One is sort of just information that we pick up along the way. So a lot of times the media, you know, has a role on that. And then finally sort of vicarious learning, seeing somebody else be afraid of something, and it's sort of - we can pick up fears like that as well.
DANKOSKY: Let's go to Karen in Morgan Hill, California. Hi there, Karen. Go ahead. Karen, go ahead.
KAREN: I'm curious because I am definitely afraid of spiders. I'm curious if there are people who went through your study who were not successful.
DANKOSKY: Ah, Katherina Hauner, anybody who just couldn't make it, touching the tarantula there?
HAUNER: No. All 12 made it. And actually, that's not surprising, given the numbers. Between 95 to 98 percent of people are successful using this two to three-hour therapy.
DANKOSKY: Why is that? Why is it so successful?
HAUNER: Well, overcoming fear is really about prediction and control. And so the therapy - during the therapy, one learns how to approach the feared object or situation - in this case, a spider - so that it is no longer unpredictable or uncontrollable, which makes the object or situation less threatening. And with spiders, this is quite easy to facilitate because their movements - or at least with tarantulas, they're quite slow, it makes them very easy to predict and to control oneself.
DANKOSKY: But I can only assume, Dr. Farchione, that not everything is so easy to control. I mean, if you have a fear of flying, you can't just get up in planes all the time for exposure therapy.
HAUNER: Oh, I'm sorry. The same treatment has been used two to three hours successfully for flying as well.
DANKOSKY: It has been?
DANKOSKY: How does that work?
HAUNER: Well, often a flight simulator is used.
DANKOSKY: Ah, OK. So...
FARCHIONE: Virtual reality. A lot of - there is some virtual reality programs that can be useful for flying in particular, because it is sort of hard to recreate repeatedly.
DANKOSKY: Well - and I assume, Dr. Farchione, that there are other things - other phobias that people can have that might be very, very difficult to treat through exposure therapy. Or is there a way to treat everything?
FARCHIONE: I mean, exposure tends to be an essential component of treatments across the different anxiety disorders. And I would say with the specific phobias, it is at the heart of any good treatment for specific phobias.
DANKOSKY: If you have questions about your fears, your phobias: 1-800-989-8255, 1-800-989-TALK. You can also tweet us @scifri. Our guests are Dr. Todd Farchione, the director of the intensive treatment program at the Center for Anxiety and Related Disorders and a research assistant professor of psychology at Boston University. Katherina Hauner is post-doctoral fellow in neurology, Northwestern University Feinberg School of Medicine, the lead author in the study and the proceedings of the National Academy of Sciences. Don's on the line from St. Cloud, Minnesota. Hi there, Don.
DON: John, I'm afraid of tiny spiders, but not large ones. I can hold tarantulas and daddy long-legs and house spiders and garden spiders with no problem at all, but the little, tiny ones bother me.
DANKOSKY: OK. Little, tiny - do you have any idea why? Is it because they move so fast, they're unpredictable, unlike these slow-moving tarantulas, Don?
DON: I have no clue. I'm not afraid of anything except bears and tiny spiders.
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DANKOSKY: That's a pretty wide range. Thanks for your phone call. Any thoughts for Don?
FARCHIONE: Yes, if I could. You know, it is interesting. You do see that sometimes with treatment, actually. It's interesting that you can do an exposure treatment with, say, a tarantula. And sometimes what you'll get is that the person will no longer be afraid of the tarantula, but it doesn't always translate over to them not being afraid of other spiders. Now, a lot of times, it does. But, for some people, the fears may be, you know, in such a way that you have to develop other exposures to sort of help them. So the tarantulas do move fairly quickly, whereas the small spiders move pretty quick, you know, pretty - sorry. The tarantulas move fairly slowly. The other ones move faster. So it's interesting.
They've done a lot of research on what's called return of fear. And sometimes what you'll see is somebody could be treated in a laboratory setting, but then you sort of take them out to the real world, and they'll actually get some fear that will come up. And it's sort of the - idea is it's a different context. And the same applies, I think, for the spiders. So with treatments, to make them more effective, you would expose the individual not only to the tarantulas, but also to the little spiders, different colors, different, you know, spiders that move in different ways. And that seems to be most effective, long term.
DANKOSKY: And that context is important. If you find a spider hidden in your basement and it scares you, that's a much different thing than a laboratory setting, isn't it?
FARCHIONE: Right, right. Yeah, that's the basic idea.
DANKOSKY: Well, let's go to Jackie in Pueblo. Hi, Jackie.
DANKOSKY: You're on the air. Go ahead.
JACKIE: I have kind of an opposition to put to this, too. I think you can be trained into the fear, as well as possibly trained out of it. I grew up in and around tarantulas. I have seen them migrate in their thousands across the highways in Southern New Mexico.
FARCHIONE: Oh, God.
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JACKIE: I have been - I mean, you just run over them. We couldn't not run over them. And they're kind of slimy when you do that. And I've been chased down a garden row by one that's hopping at about four-foot length hops. I discovered I could outrun him. And then - and they come in different colors down in New Mexico. Some are brown. Some are with an orange spot on their back, and some are yellow with an orange spot on the back. And right behind all of this, why are people afraid of spiders, but not afraid of ants? And I will turn my radio back up and listen.
DANKOSKY: Oh, my goodness. Well, you just freaked us out, Jackie. I know that...
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DANKOSKY: Any thoughts about what Jackie has to say? I mean, can we be trained into a fear?
HAUNER: I think it's possible as to why someone is afraid of spiders and not ants. I think that goes back to what Dr. Farchione was explaining previously, which is that some spiders are poisonous, and are even deadly, whereas I don't - as far as I know, that's not the case with ants. And this - it's actually, I'm the second author on a study. Dr. Susan Mineka is responsible for some of this.
FARCHIONE: Oh, Sue Mineka. OK.
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HAUNER: She was...
FARCHIONE: All right.
HAUNER: ...yeah, responsible for some of this research showing that non-human primates are...
HAUNER: Yeah, well, are - they learned to be afraid of snake-like objects more quickly than similar objects. And I think the same can be applied to spiders, that it's evolutionary advantageous, potentially, to show more quick learning to an animal that might be deadly.
DANKOSKY: Dr. Farchione, do you want to pick up on that there?
FARCHIONE: No. I mean, Sue Mineka has done a lot of work in how fears are sort of established, and I think that's entirely accurate. You know, it's easier to - like I think there was research, correct me if I'm wrong. But I believe there's research with - that Sue did with monkeys, rhesus monkeys, showing that it was easier to condition a fear of snakes than it was to condition a fear of things such as flowers.
FARCHIONE: So that it sort of, you know, primates and human beings were predisposed to or are prepared to sort of fear certain things, as opposed to other things. So we can learn those much more easily.
HAUNER: Of course, we can't test this directly, but it seems a good explanation, and it seems to hold up with what humans tend to be most afraid of.
DANKOSKY: But fear certain things like snakes, which don't have legs, or things like spiders that have eight legs - I mean, is it just because they're so different than us?
FARCHIONE: No. They can harm us.
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HAUNER: Yes, it could be that. They can - some snake bites...
HAUNER: ...are deadly.
HAUNER: Some spider bites are deadly, whereas ant bites are not.
DANKOSKY: But there's lots of poisonous things in the world that look totally harmless.
HAUNER: And I think, in general, people would develop a phobia to those things more quickly.
DANKOSKY: All right. Well, if you want to join us, 1-800-989-TALK, 1-800-989-2855. I'm John Dankosky, and this is SCIENCE FRIDAY, from NPR. Tom's in Cincinnati. Hey there, Tom. Go ahead. You're on SCIENCE FRIDAY.
TOM: Yeah, my name's Tom. I'm pretty afraid of spiders. And a couple of years ago, I bought a large sailboat, and it seems to be spider magnet. And over the last couple of years, through sort of empirically exposing myself to these spiders and seeing that they control all the other bugs from coming on to the sailboat, I've sort of developed a symbiotic relationship with them and take the broom out and gently place them on the dock and go sail my boat and...
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TOM: ...it's sort of - sounds like I developed this exposure therapy...
TOM: ...you know...
HAUNER: It sounds like...
TOM: ...empirically myself.
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FARCHIONE: Yeah. You do what you needed to do there, Tom.
DANKOSKY: I'm wondering, Katherina Hauner, if you can talk a bit more about what happens next with some of this research that you're doing. Is there a next step for you?
HAUNER: Well, for me, the next step would be applying these procedures to other disorders, other anxiety disorders that don't respond quite as well to treatment.
FARCHIONE: Like what?
HAUNER: These would be anxiety disorders like social anxiety, or obsessive-compulsive disorder or post-traumatic stress disorder.
DANKOSKY: And, Dr. Farchione, how much more difficult for some of these other disorders to conquer?
FARCHIONE: Well, the rates of improvements, you know, the number of individuals that show sort of clinically significant change tends to be less than it is with the specific phobias, and it's not entirely clear why that is. It may be that, in part, with the specific phobias in conducting the exposure, it's just - it's less complicated. It's more direct, and you have more control over certain factors. There may be less of a cognitive component, perhaps, with the specific phobias, but - than there with the other disorders. But, you know, we've been applying exposure treatment to the other disorders for some time, and they - the treatment, again, it's not as effective as what you see with the specific phobias. But a lot of the disorders, it's actually pretty good for the anxiety disorders.
HAUNER: Yeah, and I think that's important to emphasize, that the treatments are effective, but the - you might not see improvement in the two to three hours that you do...
FARCHIONE: Right, right.
HAUNER: ...with something like spider phobia.
FARCHIONE: Right. That's right.
DANKOSKY: Is there anything that we can learn from this to help people with post-traumatic stress disorder coming back from a war, something that we hear so much about, people who are afraid of so many things in their own surroundings once they get back from a dangerous place?
HAUNER: I think with post-traumatic stress disorder, it's a bit more complicated, because you have these immediate fears, as you would with a specific phobia. But then on top of that, you have additional symptoms that are unrelated to specific phobias, such as these flashbacks and hallucinations and recurrent thoughts and dreams. It's far more complex. And this disorder is also associated with the different - different regions of the brain are active when people with post-traumatic stress disorder are experiencing these symptoms. So it's a bit more complex.
FARCHIONE: That said, there is a considerable amount of data to suggest that exposure therapy, what's called prolonged exposure, can be effective for post-traumatic stress disorder. The work of Patricia Resick and Enda Foa comes to mind. But there is data for the efficacy of an exposure-based treatment for post-traumatic stress disorder, as well, although it is more complicated.
DANKOSKY: Just a last thing for you, Dr. Farchione. Is there something that people can do, some specific place you'd tell them to look if they feel as though they have a debilitating phobia, just an overwhelming fear in their lives?
FARCHIONE: Yeah. I mean, I think the resource that was provided to the Association for Behavioral and Cognitive Therapy is actually - is a very good resource, abct.org. There are also some self-help treatments out there. There's one published by Oxford University Press that is very good for specific phobias, and other anxiety disorders, as well.
HAUNER: Is "The Mastery of Your Specific Phobia" book that you're thinking of?
FARCHIONE: That's the one. That's the one I'm thinking of. Yes.
HAUNER: Yeah. So the authors for that book Antony, Craske and Barlow, and it's available on Amazon. I just think it's helpful for people to know that, actually, specifically for specific phobias, there's evidence to show that treating yourself can actually be almost as effective as seeing a therapist. So...
FARCHIONE: Good point. That's a good point. And where people run into problems, I think, with think the treatments is they start the treatments and they expose themselves to the thing that they're afraid of. And sometimes they'll escape or they'll run away at the point that the fear becomes very intense. And that's actually not what they want to be doing. It can, in fact, sort of backfire on them and sensitize them a little bit more to the thing that they're afraid of. So it is important to either, you know, look at self-help books or to talk with somebody if the fear is very intense, if it's at the level of what you would see with the phobia, to talk with a therapist to get that assistance.
HAUNER: And then it's OK...
DANKOSKY: Well - and I have to jump in, because I just about have run out of time, but I want to thank Doctor Todd Farchione from Boston University and Katherina Hauner from Northwestern University for allying some of our fears. Thank you so much for joining us today.
HAUNER: Thank you.
FARCHIONE: You're very welcome. Thank you very much. Transcript provided by NPR, Copyright National Public Radio.