Dr. Gail Saltz outlines new ways to treat phobias -- persistent and irrational fears of objects, such as snakes or spiders, or situations, such as flying or public speaking. New treatments include virtual reality therapy.
New Ways to Treat Phobias
CAMPBELL BROWN, anchor:
This morning on TODAY'S HEALTH, new ways to treat phobias, whether you suffer from a fear of flying or a fear of heights or even bugs, Dr. Gail Saltz is a psychiatrist and TODAY contributor. Dr. Saltz, good morning.
Dr. GAIL SALTZ (New York Presbyterian Hospital): Good morning.
BROWN: So, basically there are three kinds of phobias that most people experience. Break it down for us.
Dr. SALTZ: Correct. A phobia overall is a persistent and irrational fear of an object or situation. The three types of the specific phobias which is some specific object or situation like a bug, a cat, a dog as an object or even blood, something like that, or a situation like being in an elevator, flying in a plane, heights, as opposed to a social phobia which is a fear of being in a humiliating or embarrassing situation. So, it might be public speaking, it might just be walking into a party, it could even be meeting anyone new. And that can be really crippling. And agoraphobia, the last one, a fear of being in a place where you can't get help. That sounds kind of, you know, vague but it is vague for people. And some people are afraid of even leaving their home.
BROWN: That's the one that I was thinking keeps people indoors.
Dr. SALTZ: It keeps people indoors, and it's associated with panic attacks, but it's a really separate kind of phobia.
BROWN: Cause. Is it similar for all of them or is there something?
Dr. SALTZ: You know, we don't know exactly, but what we--our best thought right now is a combination of a biologic or genetic cause, meaning, it is--it does run in families. And so maybe a child is born with a certain kind of temperament where unfamiliar things are uncomfortable for them. That's a biologic given.
Dr. SALTZ: Then you add a stress, perhaps a car accident.
BROWN: Something happens. Right.
Dr. SALTZ: It can be not just the car accident and they're afraid of cars, but a car accident where they saw a cat run across the street, and it gets displaced onto this other object. They don't fear the car. They have to get in a car and keep riding in a car. They displace it onto a cat so it can be something like that.
BROWN: We're going to get into the treatments, and some of them are just fascinating, the new stuff. But how debilitating can it really be if you have one of these phobias and you don't get treatment?
Dr. SALTZ: Extremely. And a lot of people don't get treatment. They don't realize that they can get treatment. And some people can avoid things. I mean, you can avoid a cat for the rest of your life, basically, but you can't avoid a thunderstorm.
Dr. SALTZ: And if you're a businessperson who needs to travel, you might not be able to avoid flying. And it can really be crippling. People lose their jobs or they become actually hermits, unable to leave their home or fearful about the weather all the time or what might be out there.
BROWN: Let's go through the treatments. The first is the one we're all most familiar with, just basic psychotherapy.
Dr. SALTZ: Yes. And what I do want to say about psychotherapy is that it used to be thought that could be helpful to understand what your phobia is about. And while that could be helpful to you, it probably won't cure your phobia. We've come to understand that actually cognitive behavioral treatments are much more effective like exposure and flooding.
BROWN: That's the next one.
Dr. SALTZ: The next one.
BROWN: Which I didn't--until I read it, didn't understand what that meant.
Dr. SALTZ: Flooding is a kind of cognitive behavioral treatment where you literally flood the person with the stimulus. So if they're afraid of heights, you take them to the top of the building all at once, you the therapist, and sort of desensitize them in this rapid fashion. That isn't used so much anymore.
BROWN: That--that sounds a little extreme.
Dr. SALTZ: It is kind of extreme. It does work sometimes. Exposure is the slow method of doing the same sort of thing. So maybe if you're afraid of spiders, I would show you a picture of a little teeny spider.
BROWN: Gradually, right.
Dr. SALTZ: Then I would show you a picture of a bigger spider and so on until you were able to be with a spider while we did the cognitive talk about not being afraid.
BROWN: Let's talk about this next one, virtual reality technology.
Dr. SALTZ: It's amazing.
BROWN: I couldn't believe it when I read about this.
Dr. SALTZ: It is amazing.
BROWN: Explain it. And we’re going to show some pictures, and we should point out that that's actually you that's demonstrating that we're going to see in the video.
Dr. SALTZ: That's right. Exactly. At Cornell Medical Center. But, originally, it was developed at Emory by two doctors. And it is a combination, sort of, of exposure and flooding in the sense that you have the intense stimulus of what you're seeing. So I was doing the flying one, which has been very effective. Eight treatments, 100 percent response, which is quite incredible.
Dr. SALTZ: But you feel like you are on the plane. It feels like the plane. You see the plane. And meanwhile, the therapist is telling you, though, that you are in a safe situation, and you know you are. As opposed to people might say `Why can't I just keep getting on a plane and get rid of it?' Because then you're actually re-traumatizing yourself.
Dr. SALTZ: So it's a combination of more intense exposure, but--but--but still knowing you're safe and gradually working your way up with the therapist. It's been quite effective.
BROWN: Well, this is great news for a lot of people. Dr. Gail Saltz, thank you as always.
Dr. SALTZ: It's a pleasure.
SAN JOSE, Calif. — Last year, a popular and talented student at Los Altos High School collapsed. She suffered an emotional breakdown after reading her parent's text message asking her to come home to talk about her grades. The girl, a star athlete and generally straight-A student, had received a D.
Fear, Phobias, Flying, Snakes, Spiders, Heights, Elevators, Dogs, Cats, Blood, Thunderstorms, Public Speaking, Agoraphobia, Panic Attacks, Debilitating, Disability, Hermit, Cause, Biologic, Genetic, Stress, Trauma, Treatment, Help, Cure, Psychotherapy, Exposure, De-Sensitizing, Virtual Reality, Safe, Cornell Medical Center, Emory University