Psy-Q: Can unconscious exposure to a phobia reduce phobia symptoms and/or improve treatment adherence?

Bradley S. Peterson, MD

Bradley S. Peterson, MD

Answer: If a person with arachnophobia, for example, does not realize they have seen images of spiders, that unconscious experience could possibly reduce their fear of spiders, according to a study by Siegel et al published in Lancet Psychiatry. The researchers found that non-conscious exposure to a feared stimulus reduced fear in people with specific phobia.

Bradley S. Peterson, MD, co-author of the study, discussed the research with Psycom Pro. Dr. Peterson is a professor and vice chair for Research and chief of Child & Adolescent Psychiatry at the Keck School of Medicine at USC, and division chief of psychiatry at Children’s Hospital of Los Angeles.

The research team recruited participants with spider phobia who were exposed to masked images of spiders via very brief exposure (VBE). Spider images appeared for 30 milliseconds, and the participants were not conscious of having seen them. After VBE, participants reported reduced fear of spiders and about half of them were able to move closer to a live tarantula.

Exposure therapy, which can range in length from a single intensive hours-long session to multiple sessions spread over several weeks or months, can be too stressful for some people because they are afraid to confront the subject of their specific phobia, even in controlled therapeutic conditions. Dr. Peterson and his team envision VBE being used as a pretreatment or adjunctive treatment to exposure therapy because it “potentially could desensitize or habituate patients to their feared stimuli to a sufficient degree to allow them either to initiate traditional exposure therapy or to remain in it longer, thereby benefitting more people with the therapeutic effects of exposure.”

This is important, added Dr. Peterson, “because patient refusal to enter or remain in exposure therapy is currently among the greatest obstacles to treatment effectiveness. Because VBE does not induce distress, it may be more acceptable to a wider range of patients who are not currently accessing traditional exposure treatments.”

“The anticipation of fear induced by exposure is often worse than the actual fear itself,” Dr. Peterson explains. “Skilled and experienced therapists are able to introduce exposures gradually and gently, in ways that build confidence and a sense of accomplishment that permit continuing gains in tolerating the object of one’s fears. We urge people suffering from fear-related conditions not to allow their anticipatory worry to allow themselves to defer or refuse the treatment they need.”

It is possible that VBE might be suitable as a stand-alone treatment, notes Dr. Peterson, but more research must be done to establish the parameters that would make it an effective treatment.

He added said that VBE has the potential to be applied to other fear-based disorders such as PTSD, social phobia, and OCD, adding that his team has studies underway for each of these conditions.

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Last Updated: Apr 21, 2021