Visit Your Local PBS Station PBS Home PBS Home Programs A-Z TV Schedules Watch Video Donate Shop PBS Search PBS
SAF Archives  search ask the scientists in the classroom cool science
scientists from previous shows
cool careers in science
ask the scientists
SCIENTISTS FROM PREVIOUS SHOWS

Photo of Hunter Hoffman and Al CarlinPhoto of Hunter Hoffman and Al Carlin Hunter Hoffman and Al Carlin as seen on Spiders!: Archnophobia

Click on Hunter or Al's photo to read a brief bio.



q Approximately how many people in the United States have arachnophobia? How many have other phobias? (asked by many viewers)

A (from Hunter Hoffman) Specific phobias involve animals, (particularly dogs, snakes, insects and mice) or involve witnessing blood or tissue injury (blood-injury phobia), closed spaces (claustrophobia), heights (acrophobia) or air travel. Approximately 10 percent of Americans have a specific phobia of some sort at some point during their lifetime The U.S. population is approximately 270 million, so we are talking about 27 million Americans having a specific phobia at some point in their life. Among the specific phobias, it appears that spider phobia is the most common (Ost, 1996). (Sorry I don't have the answer to your exact question, i.e., about the number of spider phobics in the U.S.).



q I, too, suffer a fear of spiders. Even through the safety of viewing them through my TV and watching Alan Alda with the virtual headgear, I still felt anxiety in the pit of my stomach as I watched the black, life-like spider realistically crawl and dangle around in front of him. I want to try VR therapy to get over this anxiety I feel toward spiders, but I do not live near your clinic. Can you recommend other clinics around the country where this treatment is offered? (similar question asked by many viewers)

A (from Al Carlin): The fact that you felt twinges of anxiety while watching the program and continued to watch is a good predictive sign. There is no way to overcome anxiety without experiencing tolerable levels of anxiety along the way.

To the best of my knowledge there are no other VR-based spider phobia treatment programs around. However, desensitization of your phobia can still be successful. I would encourage you to call a psychologist in your area and ask about cognitive behavior therapy for phobias. A nearby University Psychology Department or nearby Medical School would also be a good starting place.




q Are you using this VR therapy to treat other phobias? If so, what are they, and are you having the same level of success we saw on your program? (asked by several viewers)

A (from Al Carlin): At this time spider phobia is the only one we are doing. We are working to create a virtual snake and also hope to eventually create a virtual audience for those with fear of public speaking.



q Will your patient with arachnophobia need follow-up treatments or is she now completely "cured" of her fear of spiders? Jennifer

A (from Al Carlin) It seems as if our patient does not require any follow up treatments for her phobia. She continues to be active in the environment and no longer is vigilant for spiders, nor does she react with excessive anxiety. So long as she does not flee in an effort to reduce her anxiety or engage in active avoidance of spider threat she is not likely to experience a "relapse." Some earlier theories about phobias proposed that phobias were symbolic manifestations of deep unconscious problems that needed to be addressed as part of the treatment. Such theories also speculated that removing the phobia would result in the emergence of new anxiety or new phobias. Those working with a cognitive-behavioral approach to phobias have found that so-called symptom substitution does not happen.



q How do people develop arachnophobia? (asked by many viewers)

A (from Hunter Hoffman) There is little empirical research on this topic, and simply asking the patient how they became phobic may be misleading, since people tend to reconstruct memories for past events and these reconstructions are not always accurate (Loftus and Hoffman, 1989). For some phobics, conditioning appears to play a role (e.g., a person has a direct experience with a spider that causes fear). For example, when 6 years old, one of our patients was trapped in a corner by a relative, who deliberately frightened/tortured her with a live spider. She claims this direct experience was the beginning of her fear of spiders.

Other phobics learn from their parents. A couple of years ago, I asked a colleague about the origins of her phobia. She mentioned that her brother also had a bad case of spider phobia and my question made her curious. When she asked her mother about it, she found out that years ago, her mother was worried that the kids would get bitten by a poisonous spider while playing outside, so the parents deliberately instilled a healthy respect for spiders, which, it turns out lead the two children to both develop bad spider phobia. This is an example of transmission of information and/or instruction as a pathway to phobia.

Similarly, Joanne, the woman interviewed on Scientific American Frontiers, remembers that a slumber party was the beginning of her 20 year phobia. When she was 17 years old, her parents were out of town. Two of Joanna's friends were sleeping over, and her friends freaked out when they saw a spider in Joanna's house (and went through the whole routine again a little later when they found a second spider). At the time, Joanna thought they were over-reacting, and calmly carried the spiders outdoors. But a few days later, after her parents returned, she encountered a spider in the house and displayed the same panicky behavior her friends had modelled for her a few days earlier.

People with spider phobia all have one thing in common: they avoid spiders. When they encounter a spider, they usually leave the room (if possible). When they have left the room, their anxiety/panic attack is greatly reduced, and this makes them feel better, which encourages them to avoid spiders even faster in the future. Dr. Carlin and I think that this avoidance behavior contributes to the development of phobia. Little by little, with each avoidance, phobics become less confident in their ability to deal with spiders and/or their panic reaction to the spider. Gradually, in a sense, the spider gains control over the person, since the person's behavior is controlled by the spiders appearance (although the loss of control over the situation is only in the person's mind). Phobics also develop rather exaggerated ideas about the spiders powers and intentions. Systematic desensitization/exposure therapy reverses this process. The phobic slowly approaches the object of their fear, little by little they become more confident of their ability to deal with the spider, and the spider loses its magic power over the patient. Evidence that the therapy is starting to work is often obvious after only a couple of hours of treatment. Patients are already able to get much closer to the spider (with comfort) than before therapy. Patients are often amazed at how quickly the therapy is working, and this helps keep them motivated to return for additional treatments. The positive ripple effects of getting rid of a phobia can be quite impressive. In one extreme case (the woman interviewed on Scientific American Frontiers), the person can now go camping, has an increased self-esteem, and less depression. Prior to treatment, her anxiety/stress about spiders also interfered with her reproductive system. After getting cured, she has finally been able to get pregnant and have a child!




q I've hated spiders ever since I was 5! Are there any practical ways for me to lose my fear without VR treatment (not available where I live) or by spending thousands of dollars on therapy? (similar question asked by several viewers.)

A (from Hunter Hoffman) Most people with arachnophobia started fearing spiders when they were a kid. For some people, this fear goes away as they kids get older, but for the rest, the fear is likely to persist for years without therapy.

Many patients could get cured in a few hours for less than $1000. The number of treatments required to cure a phobia depends on how motivated/brave the patient is (i.e., how quickly they approach the spider during desensitization, within reason). It also depends on how phobic the patient is to begin with. Our most phobic patient (the woman interviewed on Scientific American Frontiers) required only 12, one hour therapy sessions over a period of 3 months. Many or most highly motivated patients can be cured with only 6 therapy session. Typical cognitive-behavioral desensitization therapy using real spiders to evoke the anxiety (not VR therapy) at the U.W. typically costs about $150.00 an hour.

For someone who is truly phobic, having a trained, experienced therapist involved in treatment is important. The therapist helps reassure the patient that they can do it, and helps the patient progress at the right pace. It is also important that the anxiety level be kept fairly high, but also that it is allowed to drop noticeably before the patient progresses closer, so the patient can see that their anxiety is getting lower and they are making progress. Self-treatment is possible with instruction, but studies have shown it to be less effective than sessions guided by a therapist. My guess is that most phobics would not continue very far into the therapy without a therapist. For people who with very mild phobias, just squish em dead every time you see one (Dr. Carlin doesn't like that, but that's my advice, a quick merciful death). Or at least, don't avoid them.

While they are getting professional therapy, the patient can speed up the process (and thus reduce the cost) by encounters with spiders at home in between treatments (in consultation with their therapist).

Some forms of clinical therapy for disorders other than phobias (e.g., for drug addiction) can be extremely expensive, and last for years (e.g., Freudian therapy). In comparison, if you are phobic, you are lucky! Cognitive-behavioral therapy for systematic desensitization is remarkably quick for most phobia patients (e.g., only a few hours of therapy). It is arguably the most effective clinical technique in the history of clinical psychology.

Learning more about spiders will also help, since some of spider phobia is cognitive (e.g., has to do with thoughts about the spiders you have). Many zoos have programs (e.g., talks in the spider section) to inform the public about misconceptions about spiders and other insects. Most spiders are frail timid little creatures (contrary to some of the species seen on Scientific American Frontiers, SPIDERS! which focused on the most interesting spiders). The first couple of times I petted my pet tarantula, it acted tough, but once it figured out I was the boss, even this huge spider quickly became submissive and scared of me. Another misconception about spiders is that they have complex inner thoughts. A spider's brain is very small. Most of their behaviors are not thought out like ours, but are merely reflexive kneejerk instincts they do without thinking. In other words, they are really stupid in comparison to a human, and they are not over there having complicated thoughts.




q Since using virtual reality to overcome phobias is a relatively new area of study, I'd be interested in your thoughts about the future applications of this treatment. Michael

A (from Hunter Hoffman) VR researchers are actively exploring the use of VR exposure therapy for treating a number of different types of phobias. One of my favorites is the shrinking room.

Clinical Psychologists in Spain (and elsewhere) have successfully treated patients for claustrophobia (fear of closed places like elevators, airplanes, tunnels, booths etc.). Claustrophobics have an abnormal dread of being in closed or narrow spaces. The idea of systematic desensitization is to gradually get people used to being in an enclosed area, and to help them learn how to deal with their reactions to being enclosed.

As is typical, patients in the Spanish VR exposure study start with relatively easy scenarios, which make patients anxious and emotional. For example, patients start in a large virtual room with a balcony and big window. After they desensitize or get used to this larger room, they go to a medium sized virtual room. At first, this medium sized room makes them very nervous and afraid, but gradually they get used to it and are ready to endure even smaller rooms without becoming overly frightened. The third virtual room is very scary like an Edgar Allen Poe story. It is a small room with a wall that closes in on the patient (under the patient's control). As the wall closes in, they get scary sound effects. The wall makes a scraping sound, like the wall is scraping against the concrete floor as the room shrinks! Patients control how much the room shrinks. If they get too afraid, they can make the room get a little bigger again if necessary. They shrink the room a little, pause and relax, control their breathing until their fear goes down, and when they are ready, the can shrink the room a little more. After slowly going through this therapy, patients are less afraid of enclosed spaces in the real world. They know they can deal with it if they get locked in an elevator since they have now survived a similar experience in the virtual world. As one of the Spanish patients said If I can do it here (in VR), I can do it anywhere.

VR is being explored for treating other phobias such as fear of public speaking (e.g., giving a talk to the school in the auditorium), fear of heights (e.g., going on a chairlift at a ski resort), fear of flying in airplanes, fear of driving, etc. VR is being used at Georgia Tech to treat Post-Traumatic Stress Disorder in Vietnam Veterans. These soldiers have mental problems as a result of their combat experiences (e.g., flying around in helicopters shooting at people and getting return fire). Recreating similar VR experiences for patients may help them.

One fascinating future direction for psychological applications of immersive virtual reality is for treating pain of severe burn patients (especially children and teenagers). Severe burn patients often have to have their bandages changed and their wounds cleaned every day. Although morphine-related pain medication generally works well while the patients are resting, wound care is much more painful. Most burn patients experience severe to excruciating pain during wound care even when given strong pharmacologic analgesics. In an NIH funded study, my colleagues at Harborview Burn Center and I are using virtual reality IN ADDITION TO morphine-related drugs. Virtual reality draws patients away from their pain, and patients typically report a dramatic reduction in how much pain they felt while they were in virtual reality. This is related to phobia desensitization, because wound care makes patients anxious, and anxiety makes pain worse. VR reduces anxiety, and distracts the patients. My colleagues Dave Patterson, Gretchen Carrougher, Tom Furness and I see pain control for relatively short medical procedures such as wound care as a very promising direction for future medical virtual reality applications in practice.




q How many VR sessions did it take for the Seattle women to overcome her fear of spiders? Is her amazing progress typical of someone undergoing this therapy? (asked by several viewers)

A (from Hunter Hoffman) Our first patient, nicknamed Miss Muffet, underwent approximately 12, one hour VR exposure therapy sessions. She came in for VR treatment one hour a week for about 3 months. For each hour she was here, she only spent about 25 minutes in SpiderWorld. She would go into SpiderWorld for 5 minutes, and then get a 5 minute break, go back in etc. The progress she experienced is in fact typical, except her phobia was more extreme than usual. Approximately 90% of our patients have shown dramatic reductions in their fear of spiders. Some phobics were largely cured after only 4 one hour sessions. The number of sessions they need varies. Usually the more phobic they are to start with, the slower they go with their therapy. The technique we are using has a cognitive or thinking component. Patients learn to be more aware of their own bodily sensations such as sweating, heart rate, tensed muscles etc., and Dr. Carlin teaches them how to relax their muscles, take deep breaths, to stay calm in the presence of the virtual spider. So part of the therapy is for patients to learn how to control their own anxiety reaction. The other part of the therapy is stimulus-response training. Patients unlearn the connection between fear and the object or situation they are afraid of. Combining these two types of therapy, cognitive therapy and behavioral therapy leads to a very powerful and effective clinical treatment: cognitive-behavioral therapy.

When phobics have had it with being afraid, and set their minds to getting cured, systematic desensitization for specific phobias is perhaps the most effective clinical treatment in the history of clinical psychology. Nobody should have to live in fear like that. VR helps them confront their fear, deal with it, and move on, typically with higher self esteem and less depression!

In vivo exposure therapy uses the same technique, but patients are exposed to real spiders rather than virtual spiders to elicit the anxiety during therapy. Like VR exposure therapy, in vivo therapy with live spiders is also extremely effective for those who complete the therapy. There are a number of important advantages to using VR over in vivo therapy.








 

Scientific American Frontiers
Fall 1990 to Spring 2000
Sponsored by GTE Corporation,
now a part of Verizon Communications Inc.