Imagine that: To conquer your fear you can use your head
'Unlearning' is a highly effective way of banishing anxiety and fear-related disorders, say scientists
Your imagination can help you “unlearn” fear, a new study, which measures brain and skin responses to threats, has found.
This type of therapy could help to overcome anxiety and fear-related disorders, including phobias, without people being exposed to the threat or danger that originally triggered the fear.
Researchers from New York’s Mount Sinai School of Medicine tested whether “imagining a threat” could help people conquer fear – focusing on how fear is learnt and unlearnt.
Daniela Schiller, an associate professor in Neuroscience and Psychiatry at the Icahn School of Medicine at Mount Sinai, said: “People quickly learn to fear a threatening or unpleasant experience, and the fear will recur when cues, like sights or sounds, associated with the bad experience are sensed.
“This can negatively impact quality of life and underlie emotional disorders like post-traumatic stress disorder, phobias, and anxiety.”
Being exposed to threatening cues without having a bad experience – known as threat extinction or extinction learning – is one of the most effective ways to eliminate fear.
This method is the most prescribed way of treating these disorders.
But senior co-author Schiller said: “This type of therapy is impractical in some cases because the cues associated with a traumatic event may be difficult or unethical to reconstruct (for example, a war zone) or because the intensity of re-exposure is overwhelming for the patient.”
Using imaginative therapy to simulate real events or cues is a common way of treating fear-related disorders in these cases in the clinic. Until now, however, it has not been studied widely by neuroscientists.
The new research, published in the journal Neuron, sheds light on the neural processes through which imagination affects behaviour.
To test its efficacy, scientists exposed 68 people to “auditory threat conditioning”, training them to pair a high-pitch or low-pitch sound with an uncomfortable electric shock.
Then volunteers were randomised into three groups: One group practised “imagined extinction” by “playing the conditioned tones in their heads” as best they could (the threatening and non-threatening sound cues);
Another group had “real extinction”, listening to the two sounds;
The control group had no extinction and were told “to imagine two neutrals sounds from nature (birds singing and rain falling). Then all the volunteers were given four “unsignalled shocks to reinstate the threat memory”. This was followed by re-exposure to the two sounds.
In each phase scientists conducted functional MRI imaging, and they continuously recorded skin conductance responses.
Imagined extinction activated “a network of threat suppression” in the brain, in the same way that actual threat cues did, the neuroimaging showed.
Senior co-author Professor Tor Wager from the University of Colorado said: “It’s exciting to me that you can do something with your imagination and it has an impact we can see in the brain.”
Imagining specific sounds related to threats activated the same neural circuits in the volunteers as actually hearing the cues.
Schiller said: “In many cases, when we study how we react to important stimuli, we use actual cues in the environment and then measure our responses to them. But at the same time many internal processes happen in our brains: We imagine, we plan, we ruminate, we have expectations, we make predictions.”
The group who listened to bird calls and rain falling did not experience the same subjugation of threat in their brains.
Schiller said their results showed that simulating real-world experiences with the imagination could “alter the way one responds to that situation in the future”.
The research shows how mental conditioning can influence the brain’s basic neural circuits, she said.
Cognitive behaviour therapy (modifying habitual thoughts and behaviours to improve people’s coping skills) has increased in popularity over the past decade, particularly for anxiety-related disorders.
Professional CBT-trained therapists help patients to work out alternative beliefs and reactions to triggers or cues in their lives.
Professor Stefan Hofmann of Boston University, the former president of the International Association of Cognitive Psychotherapy, described it as “a here-and-now-focused approach on what the problem is and how to help. What we care about is the factors and triggers for behaviours. We don’t care much about the past.”
He said short-term therapy was more affordable than other treatments, and was the first option in developed countries for many mental health disorders.
“We judge ourselves and base our success on whether [patients] feel better. Insight is not enough,” Hoffman said.
Roughly one in five South Africans is, or will be, living with depression, anxiety or other mental illnesses.