Phobia Therapy Ineffective For People With Negative Attitudes
February 27, 2013

Nothing To Fear But Fear Itself, And A Bad Attitude

Jedidiah Becker for — Your Universe Online

Putting aside pop-psychology adages that claim the contrary, simply confronting our fears isn´t always the most effective way of defeating them. Instead, researchers now say that to gain lasting freedom from our deep-seated phobias, we have to change our attitudes towards the objects and experiences in which those fears are rooted.

A team of Ohio State University psychologists recently found that among two groups of people who were treated with exposure therapy — for which individuals must confront their fears in a non-threatening environment — those individuals who had a negative attitude toward public speaking were more likely to relapse into their phobia than those who had developed a positive attitude.

What´s more, by devising a new method to evaluate each individual´s attitude immediately following exposure therapy, the researchers believe that they have given therapists a new tool for determining whether or not a patient might need to undergo a few more treatment sessions.

Their research was recently published in the journal Behaviour Research and Therapy.

Psychologists have long known that a large percentage of patients relapse into their phobias even after they have successfully completed intense therapy programs. The Ohio State team suspects that this return of fear may be related to the fact that most therapies tend to focus on equipping the patient with tools for fighting against their fears while leaving their fundamental negative attitude towards the source of the fear unchanged and unchallenged.

These negative attitudes arise because of a deeply anchored psychological association between the object of fear — whether it´s public speaking or poisonous snakes — and a powerful negative feeling that is usually rooted in a negative experience or memory. The result is that a person with a phobia typically can´t even see or think about the object of their fear without experiencing an automatic negative reaction.

According the National Institute of Mental Health, almost 9 percent of Americans, or about 20 million people, live with phobias.

“In exposure therapy, people can learn some skills to control the negativity and fear that got automatically activated and be able to perform well despite that activation. But if that´s all that happens, then the person may still very likely have a problem because there will be situations where their confidence will end up being eroded, they won´t be able to manage their fear and they will have a failure experience,” explained Russell Fazio, Ohio State psychology professor and senior author of the study.

“The other thing treatment can do is actually change the likelihood that that negativity or fear is automatically activated when one is placed in that situation. We argue that treatment will provide more persistent improvement if it succeeds in changing that attitude representation,” he continued.

“Overall, we´d like to see if clinicians can get people to view success in therapy not as a limited experience, but instead as an opportunity to really learn something about themselves. To the extent that we promote that generalization, we´re going to promote attitude change.”

The researchers studied 40 people between the ages of 18 and 46 who had been diagnosed as having an anxiety disorder related to public speaking. The team measured the participants´ phobias and attitudes using a combination of questionnaires, heart-rate recordings and subjective units of distress — a scale that allowed the subjects to rate their anxiety level while they gave a speech.

As part of the exposure therapy, the participants were each given three minutes to prepare a five-minute speech on two topics that had been randomly selected for them. The participants were then asked to give the speeches in front of an audience and camera without using notes. Each person delivered four of these speeches during the course of the therapy.

Finally, the test subjects were asked to complete a modified version of a popular critical assessment tool known as the Personalized Implicit Association Test.

The combined results of the study showed that all of the participants´ phobias were reduced after their treatment. However, after one month, almost half of the participants had experienced a full return of their fear. Looking at the results of the association test, Fazio´s team found that those people who had persistent negative attitudes towards public speaking were by far the most likely to see their public speaking phobia return. This relapse into their phobia was evidenced by an elevated heart rate and high levels of anticipatory anxiety.

Fazio believes that these post-therapy follow-ups are important to assess whether the treatments are really working or not. The reasons, he says, are that people want to believe that their therapy was effective and they want to make their therapists happy.

“There is a lot of pressure to believe and to report that it is going well,” he says. “Another part is people are not very well calibrated at reporting the extent to which they´ve improved. So there´s value in having another way of getting inside the person´s head.”

One remaining question not addressed by the study is how and why some people retain their negative attitudes after treatment while others do not. In the future, Fazio and his colleagues would like work on creating new tools that can help therapists and clinicians pinpoint and treat the negative attitudes that lie behind phobias.