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Meet 22-year-old Mariam Doom[br]from Venezuela,

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clinical psychologist Lars-Göran Öst[br]from Sweden,

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and Alph--[br]he's an American corn snake.

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This multinational threesome[br]is working together.

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Mariam helps out when Alph gets[br]tangled in Öst's belt loops

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and Öst helps Mariam[br]put Alph around her neck.

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The picture looks simple enough[br]unless you go back in time,

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just three hours ago,

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as Mariam was preparing to[br]meet Alph for the first time.

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>> I cannot...[br](crying)

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Mariam has a specific phobia,[br]a fear of snakes.

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Other specific phobias include:[br]claustrophobia and

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a fear of flying and thunder.

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Mariam's had almÖst no contact with[br]snakes and doesn't know why she's afraid.

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>> Since I remember myself,[br]I remember being afraid of snakes.

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>> She has trouble with movies...[br]>> I have to close my eyes - always.

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>> And the zoo...[br]>> It's impossible.

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>> And it interferes with her life.

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>> I have friends with snakes..[br]it's horrible.

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I like to scuba dive and there's snake[br]gills and other things.

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>> Mariam is a research technician

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here at BÖston University's[br]Center for Anxiety and Related Disorders.

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Psychologist David Marlow is director[br]of the center and a pioneer

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in exposure therapy. His research[br]demonstrates the outstanding success

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that's been achieved in treating phobias[br]in a very brief time period--

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just one week. Some psychologists at the[br]center use virtual reality to gradually

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introduce a patient to a feared situation,

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But Öst bypasses all that. He treats[br]specific phobias in just 3 hours.

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>> What's he's done though over[br]the years and he leads, in some ways,

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leads the world in this, is, strip the[br]program down to its essence.

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>> Barlow invited Öst from Sweden[br]to demonstrate brief exposure therapy.

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>> In the hopes that we will be[br]better able to apply it

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here in the United States.

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>> And Mariam has agreed to be[br]treated in front of her colleagues.

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Exposure therapy requires that patients[br]gain experience with feared objects.

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>> Unless one is willing to[br]experience one's own negative emotions,

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and expose them as not dangerous,[br]overwhelming or threatening, then they

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probably will not be able to overcome[br]their anxiety and phobia.

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>> But some say that this[br]intense exposure is cruel.

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>> I disagree completely[br]because everything we do in the

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treatment is decided by the[br]patient and it is within this

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time limit a very gradual approach.

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>> There are surprisingly few people[br]given the suffering that they have endured

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up until this point,[br]who aren't willing to take that plunge

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and see if they can overcome it.

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>> People have this idea that[br]you suddenly pick up the animal

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and throw it in the lab or at the person,[br]that will never happen.

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>> It's teamwork. Öst interviews[br]Mariam for 45 minutes and then

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describes and prepares her for treatment[br]in an additional 15 minutes.

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>> I will challenge you to try things,

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but I will never force you to do anything[br]that you're not...

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>> It's critical to determine[br]Mariam's worst fear,

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what's called her "catastrophic belief."

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Her catastrophic belief is that if a[br]snake is loose and she can't escape,

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she'll have heart failure.

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>> How certain are you[br]that you might die

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as a consequence of that interaction?

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>> Maybe 70%.[br]>> 70%? Ok.

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>> No one has ever died[br]or become ill,

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either with Öst's or Barlow's treatment.

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But Mariam believes her anxiety[br]won't diminish and she'll escape.

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>> Like, run away from the room.

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>> The strong belief in the[br]catastrophe,

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that is what's driving[br]the avoidance behavior,

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and the avoidance behavior is the directly[br]maintaining factor for the phobia.

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>> But if Miriam doesn't escape,[br]Öst predicts her anxiety...

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>> ...will then gradually diminish as we[br]go along in the treatment.

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>> And importantly, there can be[br]cognitive changes...

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>> ...to help you get new information[br]about that catastrophic belief.

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>> Öst does not prepare patients[br]with relaxation or deep breathing.

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>> I don't think it's necessary at all.

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>> We discovered through systematic[br]research evaluating this component

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that patients receiving these skills were[br]trained in these skills, who then use them

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to cope with their anxiety or fear,[br]actually did not do as well.

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>> Deep breathing masks anxiety[br]and the patient doesn't learn

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anxiety isn't dangerous.

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Here it will be used only if Mariam[br]hyperventilates.

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Just prior to exposure she rates her[br]anxiety on a scale of 0 to 100.

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>> 70 or 80.

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>> Now, it's time to go [br]get the snake.

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Mariam's anxiety soars.

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>> I can stand with my back[br]towards you if you want me to.

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>> Ok.

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>> And then...[br]>> Can I close my eyes?

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>> Then I can gradually turn..

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>> No!

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>> I'm standing here now with my[br]back towards you..

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>> Öst does that for two[br]minutes. What is Mariam thinking?

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>> It was horrible, I felt that I[br]was going to leave the room

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and that it was,[br]you know, stronger than me.

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>>And what was Öst thinking[br]about her reaction?

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>> Maybe not the[br]strongest i've seen,

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but up there among the 25% strongest.

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>> But he knows that the initial[br]anxiety is not the best predictor of

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success, it's motivation to succeed.

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She lets him turn around after three[br]minutes.

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>> Ok, I’m going to close my[br]eyes, ok? But don't come...

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(Sobbing)

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>> Doing good. Let's try[br]to watch it. It's in my hands.

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(Sobbing)

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>> She looks for the first time.

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>> That's the only way you are[br]going to get new knowledge.

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It's completely peaceful.

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>> She stands and smiles as her[br]anxiety level comes down.

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>> 50.

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>> She's learning...

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>> .. that if you stay exposed[br]to the situation long enough you'll see

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that the anxiety level goes down.

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>> She lets him enter after[br]eight minutes. She realizes that her

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catastrophic belief can't occur unless[br]Öst releases the snake.

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>> I'm not doing that.[br]>> Ok.

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>> After 15 minutes, Öst sits down.[br]Some anxiety returns.

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>> Try to breathe slowly and[br]calmly and with your stomach.

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>> She calms down.

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>> So, what about the name[br]for it?

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(laughing)

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>> And where are you going?[br]>> I'm gonna move here.

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>> Ok. What do you think it[br]feels like?

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>> It's a nice snake.

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>> Her anxiety is down.

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>> Great! You're sitting about[br]what is this... three meters away?

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>> She decides to approach.

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>> Ok, I'm going to approach you.

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>> Yeah? Good.

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>> But hold it.[br](laugh)

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>> What psychological principles[br]might account for the improvement so far?

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>> It might be that you have[br]habituation going on-- which leads

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to extinction of the anxiety reaction.[br]You could say that the confidence

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is increasing. Self efficacy, Bandura's[br]ideas come in to play here from a

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cognitive point of view. I think what is[br]happening here is that the patient is,

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with the help of the therapist, accepting[br]to take in new information.

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>> There's also positive[br]reinforcement and modeling.

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What's Öst's assessment so far?

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>> Deep in my mind [br]I know it's going to work.

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That means that I don't have [br]to be impatient, I can be calm.

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>> Certaintly his research[br]supports his confidence.

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Across several types of specific phobias,[br]even with children, Öst's research shows

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over 80% improvement compared[br]with control groups.

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And the results are maintained at[br]a one-year follow-up.

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>> The research is actually[br]very, very strong.

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I would say surprisingly strong

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when you consider the dramatic [br]nature of the intense approach.

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>> It's close to one hour now[br]and she decides to name the snake.

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>> Maybe Alph.[br]>> Alph? OK. That's a nice name.

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What would it feel like touching it?

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>> I'm thinking about it..[br]>> Yeah?

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>> After an hour, [br]she touches Alph.

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>> Good! Did you touch him?[br]>> A little bit...

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I can't believe I'm touching a snake.[br]>> You are touching the snake.

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>> Progress is very uneven[br]throughout the afternoon, but it

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provides an opportunity to challenge the[br]catastrophic belief.

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(surprised sound)

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>> Woah... and you died?[br]>> No...

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(laughter)[br]>> And you survived... Great!

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>> Alph is placed on Mariam's[br]lap, but again, progress is uneven.

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Alph is on her lap now alone.

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>> One more time.

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>> One more time?

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>> And finally it's time to test[br]Mariam's catastrophic belief.

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But Alph's more interested in the[br]radiator and warmth.

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>> The snake didn't do a lot of[br]things that she predicted it would do.

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>> What about Mariam's[br]catastrophic belief?

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>> Is it down to 0?[br]>> Yes.

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>> Good!

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>> Now it's time to pose...[br]>> A picture. (laughs)

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>> ...and then help untangle Alph.[br]As for her anxiety?

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>> At the end when I was helping[br]here, it was zero. That impressed me,

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that last part really,[br]that I was able to do that.

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>> There was time for some[br]celebration and congratulations.

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>> Did you really think you would[br]get this far?

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>> No, I didn't.

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>> And reflect on the[br]implications for treatment.

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>> We have no reason to believe[br]that the three hour program would be

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any less effective than the one week[br]program. So, then it becomes an issue of

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what would the patient choose? There are[br]many patients who really don't have the

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time to take a week out of their lives.

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>> The recommendation is that[br]Mariam engage in maintenance,

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watch nature films, [br]go to the park and the zoo.

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>> It is alright if I see a snake[br]on the street at least I'm gonna be

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able to see it and walk away and[br]not see it and run.

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>> And two months after treatment,[br]we spoke to Mariam by phone.

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>> I have dream with snakes but[br]I didn't have any anxiety.

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I also watch movies with no problems,[br]and pictures.

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So I think that I'm doing great.

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I really feel confident that if I see a[br]snake I won't be scared.