fear with fear
For patients with anxiety disorders,
intense and frequent exposure may help wear down apprehensions
By Shari Roan
LA Times Staff Writer
July 26, 2004
When people become intensely anxious, the
body responds with an adrenaline rush that increases heart
and respiration rates — that sweaty, heart-thumping,
gasping-for-air feeling. For the estimated 19 million
Americans with anxiety disorders, however, this sensation
occurs frequently, often without warning and can interfere
with normal activities.
Treatment for anxiety disorders usually
is designed to erode that response, either through medications
or gentle, gradual exposure to the object or situation
causing fear. Dr. Mark Barad of UCLA's Neuropsychiatric
Institute is among a group of doctors who are turning
the traditional treatment paradigm on its head. Barad,
an assistant professor of psychiatry and biobehavioral
sciences, says that people can learn more quickly to overcome
these disorders by intense, frequent exposure to a fear
during behavioral therapy. He describes his research,
which has been conducted primarily in animals but is moving
into human studies.
* Question: How has anxiety been treated
Answer: The older kinds of treatments were
psychotherapy, where people talked about their fears….
In the 1950s and '60s, a man named Joseph Wolpe [a Temple
University psychiatry professor who died in 1997] devised
a technique called gradual desensitization, which is exposing
the person, little by little, to the fear so that they
get over it. More recently, people have used medications,
particularly antidepressants. But nobody really knows
how they work.
* Q: How is your approach different?
A: We're looking at ways to improve behavioral
therapy. We take two approaches. One is to improve the
ways in which people get exposed to their fears. And the
other is to understand the molecular mechanisms for how
people develop fear. This could then lead to drugs that
make behavioral therapies work better.
* Q: What are you doing to make behavioral
therapies more successful?
A: One of the big problems with behavioral
therapy is it takes a very long time. Gradual desensitization
is a bit-by-bit approach in which you expose the patients
gradually to the fear. We actually started out trying
to figure out if we can make the process go faster.
* Q: How did you go about that?
A: What we did was to test to see if mice
got over their fears faster if they were exposed to their
fears gradually or all at once…. This is called
massed versus spaced. We gave mice 20 exposures to something
they were afraid of. These were things we made them afraid
of. We gave them the exposures with different spacing
(ranging from six seconds to 600 seconds). We found, much
to our surprise, that the less space there was between
exposures, the faster the animals got over their fear
and the more they got over their fear. This is the opposite
from what we expected.
* Q: Why do you think frequent exposure
A: What we believe is that the brain does
not allow you to learn to forget your fear unless it's
absolutely sure you're safe. You have to overcome that
with a critical mass of exposure, then the learning starts.
But the proof of that, in terms of head-to-head studies,
hasn't been done yet. I just received funding to do that
kind of study [in humans], and we'll be starting that
* Q: How could medications help facilitate
A: We have one published study and have
another that looks … at a substance called yohimbine.
Yohimbine is a natural herbal medication derived from
a tree bark. It was [and still is] used for sexual disorders
in men. It's a stimulant. By itself, yohimbine has been
shown to increase anxiety in people who are prone to panic
disorder. But we find that if we combine it with this
model of therapy [in mice] that it really facilitates
extinction [the erasure of fear]. We get extinction faster
with massed exposures and yohimbine. Most interesting
of all, even when we do spaced exposures — which
usually doesn't work — we now get extinction when
we add yohimbine. It allows the animal to learn to overcome
* Q: But people with anxiety shouldn't take
yohimbine on their own, should they?
A: It's probably actually bad for anxiety.
It needs to be taken in conjunction with psychotherapy.
* Q: So, overall, you're suggesting that
the best way to overcome anxiety is to face — head-on
— the thing that's making you anxious?
A: I think that is the emerging message.
In fact, there is a hypothesis that the more afraid you
are during extinction learning, the more you'll extinguish.
But it's really important to experience the anxiety under
circumstances in which you are safe.
disorders are the most common of emotional disorders,
affecting about one in nine people.
Symptoms include overwhelming feelings of panic and fear;
uncontrollable obsessive thoughts; intrusive memories
or recurring nightmares; physical symptoms, including
nausea, sweating and muscle tension.
Various anxiety disorders include panic disorder, phobias,
obsessive-compulsive disorder, post-traumatic stress disorder
and generalized anxiety disorder.
Most anxiety disorders respond well to treatments, such
as medication and psychotherapy.
Source: American Psychiatric Assn.
Original source: http://www.latimes.com