What You Can Change _. And What You Can't - Martin E. Seligman [39]
“Don’t let Boycat in!” Susan, four years old, shrieked to her mother, pointing to the kitchen door. Outside sat the proud family cat, covered in rabbit blood and gnawing a partly eaten bunny. Susan cried hysterically for an hour. After this she would never again stay in the same room with Boycat or any other feline.
As she grew up, her aversion to cats intensified. But this fall, at age thirty-one, it climaxed. She can’t leave the house. The house next door was vacant for the summer, and Susan glimpsed a cat in the unmown grass. She now fears that if she goes out, she will be attacked and mauled by a cat. Her first thought on waking is of what cats she might meet today. Every sudden noise and movement in the house startles her—it might be a cat. Her last thought as she falls asleep, exhausted, is dread—of the cats she will meet in her nightmares.
Successful therapy. It is normal for four-and five-year-old children to “break out” in strong object fears, particularly of animals. Ninety-five percent of these fears simply disappear as the child grows up. A few, like Susan’s, persist into adulthood, and when they do, they are unremitting and will not wane of their own accord. But there is one brand of therapy for phobias that works reliably: behavior therapy. Here is the theory of why it works:
A phobia is an instance of ordinary conditioning with a particularly traumatic UR (unconditional response). Some neutral object, like a cat, happens to be around when a trauma, like Susan’s terror on seeing a mangled bunny, occurs. The cat is the CS (conditional stimulus), and Susan’s trauma is the UR. By virtue of this pairing, the CS becomes terrifying.
If phobias are simply Pavlovian conditioning, it should be easy to eliminate them. Therapy needs only to accomplish Pavlovian extinction—by getting the patient to stay in the presence of the CS, but arranging to have no UR occur. Until Joseph Wolpe came along in the 1950s, no one had ever tried this straightforward approach. Psychotherapy at that time was dominated by psychoanalysis, whose practitioners tried, without success, to get phobics to gain insight into the sexual and aggressive conflicts that allegedly caused their phobias. By the mid-1960s, however, psychoanalysts knew that insight therapy on phobias was “never easy.”6
Two behavior therapies, both of which are forms of extinction, are now used with success on phobias.
The first, systematic desensitization, is Wolpe’s original. In it, the patient first learns progressive relaxation. The patient then constructs a fear hierarchy, with the worst, full-blown phobic situation at the top, and a situation that produces only the slightest phobic fear at the bottom. Susan, for example, picked meeting someone named Katz for the bottom rung, and seeing cat in the word catsup on a label on the next rung. At the top was having a real cat sit on her lap—her worst-imaginable situation.
Next, the patient goes into her practiced state of relaxation and imagines vividly the situation on the bottom rung. So Susan lay there flaccidly and imagined being introduced to an Ada Katz. She repeated this until she felt no fear at all while visualizing this. In the subsequent session, the patient once again relaxes and imagines the next-most-fearsome scene—seeing the word cat, in Susan’s case. She visualizes this, while relaxing, until she feels no fear at all. In about a dozen sessions, the patient will have reached the top of the hierarchy—in her imagination—without feeling fear. Once the top rung is achieved, most cat phobics find they can go from imagining cats fearlessly to actually facing real cats with little fear.
What has happened here is Pavlovian extinction. Susan repeatedly imagined the feared CS in the absence of the UR (the bodily state of relaxation precludes fear). This broke the association between cats and fear.
The other therapy, flooding, uses this same extinction principle. Flooding is more dramatic, but briefer. Here the phobic is thrown into the phobic situation: A claustrophobe will agree to be