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The San Mateo CBT Clinic provides therapy for anxiety disorders in children, teens, and adults. Jonah Lakin PsyD is a licensed clinical psychologist specializing in Cognitive-Behavioral Therapy (CBT) for Obsessive-Compulsive Disorder (OCD), panic disorder, phobia, Generalized Anxiety Disorder (GAD),  social anxiety disorder/social phobia, agorophobia, emetophobia (fear of vomiting), illness anxiety disorder, trichotillomania (hair pulling), & excoriation (skin-picking).

San Mateo CBT Clinic blog about anxiety treatment

Anxiety Blog. Describes CBT principles involved in treatment for anxiety disorders in children and adults. Conditions discussed include: Obsessive-Compulsive Disorder (OCD), panic disorder, phobia, Generalized Anxiety Disorder (GAD),  social anxiety disorder/social phobia, agorophobia, emetophobia (fear of vomiting), illness anxiety disorder, trichotillomania (hair pulling), & excoriation (skin-picking).

Exposure Therapy: How Scary Stimuli Become Neutral

Jonah Lakin

Please note: this is Part II of Understanding Phobias: How Neutral Stimuli Become Scary. You may benefit from reading that post before continuing with this one. 

Remember from Part I that classical conditioning is a type of learning in which associations are made in a person’s mind.  A person learns to associate two things when those two things are repeatedly presented together. Remember how Watson presented the white rat to Little Albert, and then immediately banged two pipes together? After pairing the white rat with the scary, loud noise a few times, Little Albert came to react to the white rat as if it were the loud noise - even when the pipes weren't banged together. He felt fear because he had learned to associate the white rat with loud noise. 

Classical extinction is a type of “unlearning,” in which associations are broken in a person’s mind. The way this type of learning takes place is by repeatedly presenting the neutral stimulus in the absence of a scary one. If Watson went on to repeatedly present the white rat without banging the pipes together, Little Albert would no longer associate the two, and the fear induced by the white rat would be gone. When the association between the white rat and the loud noise was broken, we would say it was “extinguished.”

Unfortunately, as you may already know from personal experience, classical extinction is a much slower process than classical conditioning.  In other words, an association can be learned very quickly, but can only be unlearned very slowly. Little Albert may have learned to fear the white rat after only a few pairings of the white rat with the loud noise. But in order for him to stop fearing it, the white rat would have to be presented over and over and over again before the association extinguished. Although this presents a modern day challenge, there is evolutionary value to this discrepancy. Let's think about it for a moment…

Let’s imagine an ancient ancestor of ours who we will call “Lucy.” Imagine Lucy is walking through the jungle one day and encounters a lion. The lion is hungry and chases her; she is badly wounded but manages to escape. After this, Lucy would be fearful of lions. Through classical conditioning, lions have become associated with serious injury and threat of death. 

Now imagine that a few weeks later, Lucy is in the jungle and once again encounters a lion. This lion has already eaten and is quite sleepy. He wakes up and clearly stares at Lucy, but then returns to sleep as if he didn’t care about her presence. Do you think it would be good for Lucy to stop fearing lions after this one interaction? Certainly not. She's much safer continuing to associate the lion with danger.

If we remember that fear evolved to help us stay alive and avoid dangerous predators, the difficulty of unlearning fear makes sense. If Lucy decides (after just this one incident) that lions are safe and she adopts one as a pet, the result would be quite disastrous. 

Now, what does all of this have to do with real life phobias and treatments?

Classical extinction is the basis of exposure therapy for anxiety disorders. During the course of exposure therapy, the feared stimulus is encountered repeatedly in a safe environment. Over time, the feared stimuli (in the case of Little Albert, the white rat) loses its association with the stimulus that was causing fear (the loud noise), and the anxiety goes away. 

Remember that phobias are the result of neutral stimuli getting linked to scary stimuli in our minds. In the case of Little Albert, there is no great mystery about what the scary stimulus is. The white rat became scary because it was linked with the loud noise that the experimenter created. However, in real life, it’s rarely quite so clear how a phobia developed. You (or your child) may have come to fear various things without knowing how the conditioning took place. Dogs may be terrifying even though you were never bitten by one. Or maybe you are terrified of red cars, but you can’t ever remembering having a bad experience with one. Fortunately, we can effectively treat the anxiety even if we don’t know the full history. 

If Little Albert got a bit older and appeared at my office for treatment, he might not have the faintest idea why he feared white rats. Given that he was only a young child when the initial conditioning took place, he likely wouldn’t remember it at all. Interestingly, the treatment would be the same regardless of his reasons for fearing a white rat: he and I would repeatedly encounter white rats, nothing horrendous would happen, and his fear would go away through classical extinction. Likewise, if you fear germs, dogs, embarrassment, odd numbers, the color red, the smell of flowers, or the dark, the treatments would all be quite similar. We would slowly and repeatedly expose you to these things until the fear extinguishes. Nothing terrible would happen during the exposures, and the association between the dog and the scary stimulus (whatever it was) would eventually be broken. 

But remember, the unlearning process is slower than the learning process. We may need to encounter the feared object repeatedly for prolonged periods (greater than 30 minutes) before the anxiety is eliminated. The good news is that there is usually a significant reduction in fear relatively quickly, with full extinction over a longer period of time. 

- Dr. Lakin