Snake Phobia Behavioral Therapy

Meet 22-year-old Mariam Doom
from Venezuela,

clinical psychologist Lars-Göran Öst
from Sweden,

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

This multinational threesome
is working together.

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

and Öst helps Mariam
put Alph around her neck.

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

just three hours ago,

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

>> I cannot...
(crying)

Mariam has a specific phobia,
a fear of snakes.

Other specific phobias include:
claustrophobia and

a fear of flying and thunder.

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

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

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

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

>> And it interferes with her life.

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

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

>> Mariam is a research technician

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

Psychologist David Marlow is director
of the center and a pioneer

in exposure therapy. His research
demonstrates the outstanding success

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

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

introduce a patient to a feared situation,

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

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

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

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

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

here in the United States.

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

Exposure therapy requires that patients
gain experience with feared objects.

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

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

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

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

>> I disagree completely
because everything we do in the

treatment is decided by the
patient and it is within this

time limit a very gradual approach.

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

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

and see if they can overcome it.

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

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

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

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

>> I will challenge you to try things,

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

>> It's critical to determine
Mariam's worst fear,

what's called her "catastrophic belief."

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

she'll have heart failure.

>> How certain are you
that you might die

as a consequence of that interaction?

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

>> No one has ever died
or become ill,

either with Öst's or Barlow's treatment.

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

>> Like, run away from the room.

>> The strong belief in the
catastrophe,

that is what's driving
the avoidance behavior,

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

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

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

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

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

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

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

>> We discovered through systematic
research evaluating this component

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

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

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

anxiety isn't dangerous.

Here it will be used only if Mariam
hyperventilates.

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

>> 70 or 80.

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

Mariam's anxiety soars.

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

>> Ok.

>> And then...
>> Can I close my eyes?

>> Then I can gradually turn..

>> No!

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

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

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

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

>>And what was Öst thinking
about her reaction?

>> Maybe not the
strongest i've seen,

but up there among the 25% strongest.

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

success, it's motivation to succeed.

She lets him turn around after three
minutes.

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

(Sobbing)

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

(Sobbing)

>> She looks for the first time.

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

It's completely peaceful.

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

>> 50.

>> She's learning...

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

that the anxiety level goes down.

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

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

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

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

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

>> She calms down.

>> So, what about the name
for it?

(laughing)

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

>> Ok. What do you think it
feels like?

>> It's a nice snake.

>> Her anxiety is down.

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

>> She decides to approach.

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

>> Yeah? Good.

>> But hold it.
(laugh)

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

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

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

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

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

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

>> There's also positive
reinforcement and modeling.

What's Öst's assessment so far?

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

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

>> Certaintly his research
supports his confidence.

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

over 80% improvement compared
with control groups.

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

>> The research is actually
very, very strong.

I would say surprisingly strong

when you consider the dramatic
nature of the intense approach.

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

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

What would it feel like touching it?

>> I'm thinking about it..
>> Yeah?

>> After an hour,
she touches Alph.

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

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

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

provides an opportunity to challenge the
catastrophic belief.

(surprised sound)

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

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

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

Alph is on her lap now alone.

>> One more time.

>> One more time?

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

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

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

>> What about Mariam's
catastrophic belief?

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

>> Good!

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

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

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

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

>> There was time for some
celebration and congratulations.

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

>> No, I didn't.

>> And reflect on the
implications for treatment.

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

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

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

time to take a week out of their lives.

>> The recommendation is that
Mariam engage in maintenance,

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

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

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

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

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

I also watch movies with no problems,
and pictures.

So I think that I'm doing great.

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