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Reducing Fear Without Fear Itself

A new study finds that it's possible to reduce people's fears by tracking neural activity, as an alternative to the traditional exposure to the feared object, Alva Noe says.
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Nearly 20 million Americans, more women than men, have or have had a specific phobia.

According to the National Institute of Mental Health (NIMH), "a specific phobia is an intense, irrational fear of something that poses little or no actual danger."

Someone afraid of closed places may find it unbearable to take the train during rush hour, or to undergo an examination in the narrow and constraining tube of an MRI. For some, the very thought of being inserted into the magnet would induce panic whereas for others, there's no strong feeling either way. Phobias come in all shapes and sizes: closed places, heights, escalators, tunnels, highway driving, water, flying, dogs, spiders, snakes and the sight of blood are common objects of phobia-like anxiety.

One treatment that's been around for a while — and that is reported to be pretty effective — is so-called "exposure therapy." The idea is to break the link between the feared situation and the panic reaction by carefully controlled exposure. You might start by imagining the object of your horror and then you move up, gradually, to confronting it. The problem, obviously, is that for someone in the grip of a phobia, the very idea of exposure is painful and disturbing. It would obviously be desirable to find a way to overcome the fear without going through the ordeal of exposure.

Enter a remarkable study published Monday by UCLA psychologist Hakwan Lau, and an international team of researchers, titled: "Fear reduction without fear through reinforcement of neural activity that bypasses conscious exposure."

Fear reduction without fear? Sounds great.

For a long time now it has been known that you can perceive unconsciously. For example, you might have been presented with the world "elephant" so quickly that you are unable to identify it. And yet when you are asked, later, to complete the word-fragment "ele__," you are much more likely to complete it "elephant" than, say, "elevator" or "elevate." This shows that you had seen the word, even though it never made it into your awareness. How else could it have influenced your subsequent behavior?

It also has been shown that it is possible to learn to associate two stimuli even though one is unaware of having seen either of them (using what is known as the masking paradigm).

What happens if you try to combine exposure therapy with these sorts of techniques of implicit perception? The possibilities are tantalizing: Perhaps you'd be able to unlearn your fearful response to a stimulus without having to go through the ordeal of experiencing the stimulus. This would be, as in the article's title, fear reduction without fear. And this is what Lau and his colleagues seem to have succeeded in doing (with 17 subjects, 11 male, in their mid-20s in the laboratory).

Their strategy is ingenious. Using new techniques for real-time tracking of neural activity using fMRI, Lau and his colleagues simply wait for the occurrence in the visual areas of the brain of a neural signature that is a bit like the one that would normally be produced by exposure to the troubling stimulus. Then, they give the perceiver a reward. To quote Lau, from an email exchange we had Sunday:

"Essentially, whenever we saw the neural representation happening in early visual areas (ignoring whatever happens in higher brain regions), we just give people a reward. As to how the relevant neural representation happens at all in the first place, that's because neural representations happen from time to time anyway, as a result of spontaneous fluctuation of brain activity. By pairing such occurence with reward, the brain ends up making these spontaneous occurrences more often."

Lau compares their method to B.F. Skinner's behavioral instrumental learning:

"Basically, Skinner taught pigeons to do stuff by pairing spontaneously generated actions with a reward. That tends to make the action, originally performed spontaneously, occur more frequently. So here conceptually we treat the occurrence of the relevant neural representation as an 'action,' but with one crucial difference: The subjects have no idea that they were 'doing' it."

Which is explained, of course, by the fact that they, the subjects, weren't doing anything; the relevant neural events were random fluctuations in the brain.

That's why the overall upshot of the study is all the more remarkable. At the end of the process of spontaneous neural "action" and reward, the association of that neural kind of event with fear has been altered, lessened and, in some subjects, even extinguished (as measured both by galvanic skin response and also activity in neural areas associated with fear, such as the amygdala). And the whole thing happened without the subject having any awareness whatsoever of what occured.

Which is exactly what you would want in a fear-reduction therapy.

Alva Noë is a philosopher at the University of California, Berkeley where he writes and teaches about perception, consciousness and art. He is the author of several books, including his latest, Strange Tools: Art and Human Nature (Farrar, Straus and Giroux, 2015). You can keep up with more of what Alva is thinking on Facebook and on Twitter: @alvanoe

Copyright 2021 NPR. To see more, visit https://www.npr.org.

Alva Noë is a contributor to the NPR blog 13.7: Cosmos and Culture. He is writer and a philosopher who works on the nature of mind and human experience.

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