Treating Phobias with Imagination

A big, fat, furry spider. The dart of a snake’s tongue. A vertiginous view. Whatever the phobia, there’s an interesting new theory on how to treat it: Use your imagination.

In a new study published in the journal Neuron, researchers at the University of Colorado Boulder and Icahn School of Medicine suggest that imagination be used to treat people with fear and anxiety disorders. For about 60 years, exposure therapy has been used to treat many phobias. That is, someone is asked to face their fears, but in a controlled, safe way, and gradually they become less afraid due to this exposure. For example: One might see pictures of a spider, then sit next to a terrarium with a spider in it, then work up to holding a spider. But no one really knew how this method worked within the brain, and whether or not imagining a spider would work as well as seeing a spider.

For this study, 68 healthy participants were first trained to associate a sound cue with receiving a small shock (nothing painful). Then, they were divided into three groups and heard either the sound cue, or were asked to think about the sound cue, or were asked to imagine pleasant sounds, like birds in a rainforest. Using fMRI images of the participants’ brains, the researchers were able to see that whether people heard the sound or imagined the sound, their brains responded in much the same way. “Statistically, real and imagined exposure to the threat were not different at the whole brain level, and imagination worked just as well,” wrote Marianne Cumella Reddan, the study’s lead author.

Moreover, after repeated exposure to the sound, without the electric zap, the group with the sound cue could learn to not be afraid. Interestingly, the group imagining bird sounds did not unlearn their fear.

“I think a lot of people assume that the way to reduce fear or negative emotion is to imagine something good. In fact, what might be more effective is exactly the opposite: imagining the threat, but without the negative consequences,” wrote Tor Wager, co-senior author of the paper. Wager is the director of the Cognitive and Affective Neuroscience Laboratory at CU Boulder.

Their study suggests that imagination may be a tool we can harness for overcoming phobias. “You can use imagination to tap into it, change it and re-consolidate it, updating the way you think about and experience something,” wrote Reddan.