Snake Phobia Behavioral (Exposure) Therapy

>>Narrator: Meet 22-year-old Mariam Dum from Venezuela, clinical psychologist, Lars-Göran Öst from Sweden, and Elf. He’s an American corn snake. This multinational threesome is working together. Mariam helps out when Elf gets tangled in Öst’s belt loops, and Öst helps Mariam put Elf around her neck. The picture looks simple enough, unless you go back in time, just three hours ago, as Mariam was preparing to meet Elf for the first time.>>Mariam: [Crying]>>Narrator: Mariam has a specific phobia– a fear of snakes. Other specific phobias include claustrophobia and a fear of flying and thunder. Mariam’s had almost no contact with snakes and doesn’t know why she’s afraid.>>Mariam: Since I remember myself, I remember being afraid of snakes.>>Narrator: She has trouble with movies.>>Mariam: I have to close my eyes, always.>>Narrator: At the zoo.>>Mariam: It’s impossible.>>Narrator: And it interferes with her life.>>Mariam: I have dreams of snakes. It’s horrible. I think I like [inaudible] without, and there’s snakes in some other things. >>Narrator: Mariam is a research technician here at Boston University’s Center for Anxiety and Related Disorders. Psychologist, David Barlow, 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 three hours.>>Barlow: What he’s done though, over the years, and he leads . . . in some way, he leads the world in this . . . is stripted . . strip the program down to its essence.>>Narrator: Barlow invited Öst from Sweden to demonstrate brief exposure therapy.>>Barlow: In the hopes that we will be better able to apply it here in the United States.>>Narrator: And Mariam has agreed to be treated in front of her colleagues. Exposure therapy requires that patients gain experience with the feared object.>>Barlow: Unless one is willing to experience one’s own negative emotions, and expose them as not dangerous and overwhelming or threatening, then they probably will not be able to overcome their anxiety and phobia.>>Narrator: But some say this intense exposure is cruel.>>Öst: 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.>>Barlow: 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.>>Öst: People have this idea that you suddenly pick out the animal and throw it in the lab toward the patient. That will never happen.>>Narrator: It’s teamwork. Öst interviews Mariam for 45 minutes, and then describes and prepares her for treatment in an additional 15 minutes.>>Öst: So I will challenge you to try things. But I will never force you to do anything that . . . >>Narrator: 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.>>Öst: How certain are you then, that you might die as a consequence of that interaction?>>Mariam: Maybe 70 percent.>>Öst: Seventy percent. Okay.>>Narrator: 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.>>Mariam: They can run away from the room.>>Öst: The strong belief in the catastrophe, that is what’s driving the avoidance behavior and the avoidance behavior is the direct maintaining factor for the phobia.>>Narrator: But if Mariam doesn’t escape, Öst predicts her anxiety . . .>>Öst: Will then gradually diminish as we go along in the treatment.>>Narrator: An important way there can be cognitive changes.>>Öst: To help you get new information about that catastrophic belief.>>Narrator: Öst does not prepare patients with relaxation or deep breathing.>>Öst: I don’t think it’s necessary at all.>>Barlow: What we discovered through systematic research evaluating this component, that patients receiving these skills, were trained in these skills, who then used them to cope with their anxiety or fear actually did not do as well.>>Narrator: Deep breathing masks anxiety and the patient doesn’t learn anxiety isn’t dangerous. Here is will be used only if Mariam hyperventilates. Just prior to exposure, she rates her anxiety on a scale of 0 to 100.>>Mariam: Seventy or 80.>>Narrator: Now, it’s time to go get the snake. Mariam’s anxiety sores.>>Öst: I can stand with my back towards you, if you want to.>>Mariam: Okay. [Crying]>>Öst: And then I can . . .>>Mariam: Wait. Can I close my eyes?>>Öst: And then I can gradually turn.>>Mariam: [Crying].>>Öst: Standing here now with my back towards you.>>Narrator: Öst does that for two minutes. What is Mariam thinking?>>Mariam: It was horrible. I felt like I was going to leave the room. and that it was, you know, stronger than me.>>Narrator: And what was Öst thinking about her reaction?>>Öst: It’s maybe not the strongest I’ve seen, but up there among the 25 percent strongest.>>Narrator: But he knows that initial anxiety is not the best predictor of success. It’s a motivation to succeed. She lets him turn around after three minutes.>>Mariam: Okay. I’m going to close my eyes. Okay? But don’t count.>>Öst: No. [Mariam Crying]>>Öst: You’re doing good. Elf’s tried to watch it. It’s in my hands. [Mariam continues crying]>>Narrator: She looks for the first time.>>Öst: That’s the only way you are going to get new knowledge.>>Mariam: Okay [Crying]>>Öst: It’s completely peaceful.>>Narrator: She stands and smiles as her anxiety level comes down.>>Mariam: Fifty.>>Narrator: She’s learning.>>Öst: But if you stay exposed to the situation long enough, you see that the anxiety level goes down.>>Narrator: She lets him enter after eight minutes. She realizes that her catastrophic belief can’t occur unless Öst releases the snake.>>Öst: I’m not doing that.>>Narrator: After 15 minutes, Öst sits down. Some anxiety returns.>>Öst: Try to breathe slowly and calmly and with your stomach.>>Narrator: She calms down.>>Öst: So what about a name for it? [Mariam and Öst laugh]>>Öst: And where are you going?>>Mariam: I’m going to move here.>>Öst: Okay. What do you think it feels like?>>Mariam: This is a . . . it’s a nice snake.>>Narrator: Her anxiety is down.>>Öst: Perfect. Great. You’re sitting about, what is this? Three meters away?>>Narrator: She decides to approach.>>Mariam: Okay. I’m going to approach you. I’m going to approach you.>>Öst: Yeah? Good. >>Mariam: But hold it [Chuckles].>>Öst: Yeah?>>Narrator: What psychological principles might account for the improvement so far?>>Öst: It might be that you have a happy situation going on which leads to extinction of the anxiety reaction. You could say that the confidence is increasing. specific [inaudible] ideas come in to play here from a committed 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.>>Narrator: There is also positive reinforcement in modeling. What’s Öst’s assessment so far?>>Öst: 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.>>Narrator: Certainly his research supports his confidence. Across several types of specific phobias, even with children, Öst’s research shows over 80 percent improvement compared with controlled groups, and the results are maintained at a one-year followup.>>Barlow: Well, the research is actually very, very strong. I’m going to say, surprisingly strong, when you consider the kind of traumatic nature of the intense approach.>>Narrator: It’s close to one hour now, and she decides to name the snake.>>Mariam: Maybe Elf.>>Öst: Elf!>>Mariam: Yeah.>>Öst: Okay. Elf. That’s a nice name. What would it feel like touching it?>>Mariam: I’m thinking about it.>>Öst: Yeah?>>Narrator: After an hour, she touches Elf.>>Öst: Good. Did you touch it?>>Mariam: A little bit.>>Öst: A little bit. Yeah.>>Mariam: I can’t believe I’m touching a snake.>>Öst: You are touching the snake.>>Narrator: Progress is very uneven throughout the afternoon, but it provides an opportunity to challenge the catastrophic belief. [Mariam crying]>>Öst: No. And you died.>>Mariam: No.>>Öst: Nooo. You survived! Great!>>Narrator: Elf is placed on Mariam’s lap. But again, progress is uneven. Elf’s on her lap now alone. >>Mariam: One more time.>>Öst: One more time?>>Narrator: And finally, it’s time to test Mariam’s catastrophic belief, but Elf’s more interested in the radiator and warmth.>>Öst: The snake, it didn’t do a lot of things that she predicted it would do.>>Narrator: What about Mariam’s catastrophic belief?>>Öst: Is it down to 0?>>Mariam: Yes.>>Öst: Good.>>Narrator: Now, it’s time to pose.>>Mariam: A picture. [Laughter]>>Narrator: And then, help untangle Elf. As for her anxiety . . . >>Mariam: Yeah. And at the end, when I was helping him, with the . . . It was zero. That impressed me, the last part, really, that I was able to do that.>>Narrator: There was time for some celebration and congratulations.>>Barlow: Did you really think you could deal with it this way?>>Mariam: No.>>Narrator: And reflect on implications for treatment.>>Barlow: 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, you know, what would the patient choose? There are many patients who really don’t have the time to take a week out of their lives.>>Narrator: The recommendation is that Mariam engage in maintenance, watch nature films, go to the park and the zoo.>>Mariam: If I see a snake on the street, at least I’m going to be able to see it and walk and not see it and run.>>Narrator: And two months after treatment, we spoke with Mariam by phone. [Mariam speaking]

Michael Martin

36 Responses

  1. The therapist's accent sounded a lot like Darth Sidious. I kinda pictured in my head that she was being seduced by him. LOL 

  2. Phobia is unreasonable fear of something how in hell being afraid of snakes is unreasonable -__- they have poison that'll kill you. You'll be an idiot if you're not afraid of snakes.

  3. I too have snake phobia.And I understand what many of are saying that it is normal to be scared of snakes.But phobias are fears that may be irrational.At one stage even someone talking of snakes made me cringe and I would block my ears and lift my feet up on a chair .
    Through self implied graduated exposure via digital media, I am now open to sharing my phobia and doing something about it.I think it will better prepare me to deal with a confrontation, if ever.

  4. i even couldn't watch that guy tying to show/give her snake…so I don't know if i could handle the treatment..Now i have Phobia for treatment.

  5. That's pretty interesting how it all works. It makes sense. You cannot overcome an irrational fear if you've never truly experienced the irrational fear face-to-face. I was referred to this video for further study in my psych 102 course and I'm glad I watched it. We, and by we I mean normal people who have not studied psychology, look at irrational fears people have as funny, stupid, sad etc. and normally people would use this against someone, whether for amusement or otherwise. For example, if there are two friends and one has a phobia of snakes the other friend may put a rubber snake somewhere to scare them. It's very similar to this except in this exposure therapy the woman had full control of the situation. I had actually guided my girlfriend through a very similar process and had no idea that I was using exposure therapy. She would tell me that when she is home, alone or with family, she would avoid their sliding glass back door at all costs at night. I asked her why and she could not give me a rational reason. She would tell me that she feels like if she looks someone will be there and would hurt her. At first, I asked her if she had any prior life experiences of that nature and she told me no so over a course of a couple of weeks I kept urging her to take small steps to try to counter her fear. At first I urged her to not avoid the door, to go into the room once or twice at night and walk out. Then when she responded positively to that I urged her to stay in the room longer, maybe sit down and read a book, she did and responded positively. Then I urged her to approach the door at night, with the blinds closed and stand there for a moment, she did this a couple of times and once again responded positively. Then I told her to go into the room, approach the door and open the blinds – that's when I hopped out with a chainsaw… Just kidding, no really she did it and responded positively. Lastly I convinced her to go into the room, approach the door, open the blinds, open the door and walk outside. Ever since then she hasn't had an issue with her phobia. It's amazing to study psychology and the way the mind works and be able to apply it back to life experiences when you didn't even know you were performing a type of therapy on yourself or others.

  6. I fear that if that poor man walked up to me that snake I would punch him in the throat and run like I was on fire until I found a safe place to crap myself and pass out. I love animals, but I have always been pathetically afraid of snakes. 🙁

  7. I think she din't have a problem with snakes compared to me. I am still unable to approach snakes a few meters apart even if they are in one's hand. And if dome one try to put it around my neck either I die or the guy! My case is hopless I think.

  8. Everyone is like "Well duh it makes sense to be afraid of snakes". No it doesn't, not all snakes are venomous and not all snakes are big enough to constrict you. I dislike spiders, but I know not all of them have the ability to kill me.

  9. I have a fear of going outside and have this kind of therapy coming up in 2 weeks. I'm really scared. Can I name the outdoors Alf? I don't know….

  10. I have an extreme fight or flight response to even images of snakes. My heart is beating like hell and I am sweating just from watching the fist 30 seconds of this. I will kill any snake I see or run away. Fuck snakes

  11. It's intresting how phobias make people react.
    Me myself have a phobia of rats and mice, but i have no problem seeing them on TV or pictures for example or even in the wild. I do however freak out if i see them indoors or hear them inside the walls and last but not least if they are in traps.
    I don't get panic attacks and start crying like her if i see someone with a rat in their hand, but i would feel very uncomfortable if i had to touch them.
    When it comes to snakes, the people fearing them can't even see a picture of them without freaking out.

    That's why i think that fear of snakes and spiders could be cured easiley with exposure therapy like this, but i'm not sure about rats since it's a diffrent kind of fear. People who fear snakes fear that they will die or be attacked by them, that's why she cries initially from just seeing it, but they seldom see snakes in the wild and see them on pictures now and then.
    With mice and rats and i speak for myself it's more a fear rather than panic, but you constantly have that fear. I can't throw stuff in the trash bin, i can't go down to the cellar or up the attic, i can't walk through a dark room and i have nightmares and see or hear rats in everything. If i see something blink, i think it's a rat, if i hear something make a sound, i think it's a rat and so on. It disturbs my everyday life in winters and i feel surrounded. Exposure of live animals would probably only make it worse, but exposure to dead animals could work since i must get used to taking them out of traps or seeing them in traps without shitting myself.

  12. This treatment might have helped physically but, snakes in dream is a sexual idea, depending on what is going on

  13. I dont believe in exposure therapy. I have been around snakes for 17 years. Have handled fed, and been struck at. My fear has never lessened. We have had sand boas, retail boas, rainbow boa, balls pythons, rock python, cornsnakes, a couple years ago my husband got into venomous, copperheads, blacktail rattles snakes, western diamond back rattlesnake, gaboon vipers and monocled cobras. I live with 35 snakes right now mostly venomous. I don't remember when my fear of snakes started or why. In my situation now I feel my fears Justified but before I still was scared

  14. Im not afraid of snakes but im very impressionable so being around this girl would make me very afraid of snakes. Especially if shes acting like that..

  15. I overcame fear of snakes by buying one. 25 years living in fear, not going to the woods, zoos, it's all gone and he's my best friend now. Best feeling in the world. I have won this battle

  16. Exposure therapy is tough, but the key is to focus on the outcome that you want for yourself– to be able to fly again, go camping with the family, etc.

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