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Meet 22-year-old Mariam Doom
from Venezuela,

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clinical psychologist Lars-Göran Öst
from Sweden,

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and Alph--
he's an American corn snake.

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This multinational threesome
is working together.

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

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and Öst helps Mariam
put Alph around her neck.

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

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just three hours ago,

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

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>> I cannot...
(crying)

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Mariam has a specific phobia,
a fear of snakes.

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Other specific phobias include:
claustrophobia and

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a fear of flying and thunder.

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

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>> Since I remember myself,
I remember being afraid of snakes.

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

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>> And the zoo...
>> It's impossible.

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>> And it interferes with her life.

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>> I have friends with snakes..
it's horrible.

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

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>> Mariam is a research technician

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

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Psychologist David Marlow is director
of the center and a pioneer

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in exposure therapy. His research
demonstrates the outstanding success

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

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just one week. Some psychologists at the
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
specific phobias in just 3 hours.

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

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

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

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

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here in the United States.

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

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Exposure therapy requires that patients
gain experience with feared objects.

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

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

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

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>> But some say that this
intense exposure is cruel.

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>> I disagree completely
because everything we do in the

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treatment is decided by the
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
given the suffering that they have endured

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up until this point,
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
you suddenly pick up the animal

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

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

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describes and prepares her for treatment
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
that you're not...

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>> It's critical to determine
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
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
that you might die

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as a consequence of that interaction?

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>> Maybe 70%.
>> 70%? Ok.

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>> No one has ever died
or become ill,

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either with Öst's or Barlow's treatment.

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But Mariam believes her anxiety
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
catastrophe,

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that is what's driving
the avoidance behavior,

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and the avoidance behavior is the directly
maintaining factor for the phobia.

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

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

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>> And importantly, there can be
cognitive changes...

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

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>> Öst does not prepare patients
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
research evaluating this component

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

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

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>> Deep breathing masks anxiety
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
hyperventilates.

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Just prior to exposure she rates her
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 
get the snake.

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Mariam's anxiety soars.

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

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>> Ok.

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>> And then...
>> 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
back towards you..

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

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

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and that it was,
you know, stronger than me.

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>>And what was Öst thinking
about her reaction?

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>> Maybe not the
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
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
minutes.

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

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(Sobbing)

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>> Doing good. Let's try
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
going to get new knowledge.

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It's completely peaceful.

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>> She stands and smiles as her
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
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
eight minutes. She realizes that her

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

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>> I'm not doing that.
>> Ok.

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

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>> Try to breathe slowly and
calmly and with your stomach.

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>> She calms down.

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>> So, what about the name
for it?

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(laughing)

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

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>> Ok. What do you think it
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
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.
(laugh)

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

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

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

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

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

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

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>> There's also positive
reinforcement and modeling.

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What's Öst's assessment so far?

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

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

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>> Certaintly his research
supports his confidence.

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

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over 80% improvement compared
with control groups.

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

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>> The research is actually
very, very strong.

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I would say surprisingly strong

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when you consider the dramatic 
nature of the intense approach.

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

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>> Maybe Alph.
>> 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..
>> Yeah?

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>> After an hour, 
she touches Alph.

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

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

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>> Progress is very uneven
throughout the afternoon, but it

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provides an opportunity to challenge the
catastrophic belief.

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(surprised sound)

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>> Woah... and you died?
>> No...

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(laughter)
>> And you survived... Great!

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>> Alph is placed on Mariam's
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
Mariam's catastrophic belief.

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

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

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>> What about Mariam's
catastrophic belief?

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>> Is it down to 0?
>> Yes.

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>> Good!

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

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

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

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that last part really,
that I was able to do that.

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>> There was time for some
celebration and congratulations.

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>> Did you really think you would
get this far?

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>> No, I didn't.

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>> And reflect on the
implications for treatment.

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

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

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what would the patient choose? There are
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
Mariam engage in maintenance,

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watch nature films, 
go to the park and the zoo.

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

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able to see it and walk away and
not see it and run.

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

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

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I also watch movies with no problems,
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
snake I won't be scared.