People with phobias are often curious about how they came to develop their intense fears, especially when they can't pin their terror to a particular memory-such as being bitten by a spider, says Richard Zinbarg, PhD, a psychology professor at Northwestern University and co-director of the university's anxiety and panic treatment program. As a result, Zinbarg often tells his phobic clients about research by fellow Northwestern University psychology professor Susan Mineka, PhD, who has found that monkeys can learn fear simply by watching other monkeys act fearfully.
He also explains to clients who question why they developed post-traumatic stress disorder Mineka's research showing that uncontrollable and unpredictable events tend to engender especially intense and long-lasting fear. However, when Zinbarg shares such findings with his clients, he tends to gloss over the fact that much of the research was conducted with rats and monkeys.
"I have learned the hard way not to focus so much on the animal aspect of the research," he says. "I have had a patient or two tell me that it was not applicable to them, that they were somehow insulted by [my] likening them to animals."
With no insult intended, Zinbarg does believe that mechanisms of anxiety and fear in nonhuman animals are very like those in humans. In fact, the prevailing treatment for anxiety disorders-exposure therapy-came directly from classical conditioning experiments with rats, he notes. Many studies have shown that conditioned fear-such as fear of a tone previously paired with a shock-can be reversed merely through repeated exposure to the tone without the shock. Research by Mineka expanded upon such observations, showing that giving an animal the ability to turn off the shock greatly reduces the amount the animal learns to fear the tone.
Moreover, research by Mineka has shown that baby monkeys reared in environments where they can control access to food, water and treats later show less fear in several different anxiety-producing situations than monkeys reared in uncontrollable environments.
This insight-that a sense of control can reduce fear-has refined the theory of how anxiety disorders develop and has helped researchers put a new twist on an old intervention for earthquake survivors with post-traumatic stress disorder. Work by Mineka has also contributed to therapies for survivors of other kinds of traumatic stress, says Metin Basoglu, MD, PhD, head of trauma studies at the Institute of Psychiatry of King's College London.
"Over the years we have demonstrated that this therapy works with torture survivors, war survivors and earthquake survivors," says Basoglu, who has created a short-term therapy based, in part, on Mineka's findings.
Fear of fear
On Aug. 17, 1999, a major earthquake hit Turkey, toppling buildings in the cities of Izmit and Istanbul and killing about 18,000 people. About 43 percent of those who survived developed the vivid nightmares and paralyzing anxiety characteristic of post-traumatic stress disorder, says Basoglu.
"A lot of people fear particular situations that remind them of the earthquake experience," he explains. "They are unable to go back into their homes, they are unable to sleep in the dark with their door closed, they are unable to take showers. They don't have control over their fear and ultimately they lose control over their lives."
With tens of thousands of people experiencing such debilitating fear, Basoglu and his colleagues set out to develop a fast-acting intervention based, in part, on Mineka's findings on the power of uncontrollable, unpredictable events. One such classic finding was reported in a 1984 issue of Journal of Experimental Psychology: Animal Behavior Processes (Vol. 10, No. 3, pages 307-323). In this study, Mineka and her colleagues played a tone and then shocked the feet of 16 rats. Half of the rats could stop the shock after one second by stepping on a ledge in their cage, while the other half had no control over the shock. The group with no control over the shock was yoked to other group, so that both groups received the same amount of shock.
The researchers then played the tone a number of times without pairing it with a shock, and observed the animals, which show fear by freezing in place. Rats that had control over the shock learned more quickly to stop freezing in fear than those that did not have control over the shock, the researchers found.
In a second experiment, Mineka and her colleagues found that animals that saw a "safety signal,"in the form of a light that flashed before the shock stopped, also showed less conditioned fear of the tone.
These results can be extended to people's responses to traumatic events, such as earthquakes, that happen with little warning and that people have little control over, says Mineka. It's no surprise such events can lead to intense and long-lasting anxiety, including panic attacks, she notes. What's more, these and other findings suggest that the resulting panic attacks-which also occur at random, and which people feel little control over-can serve as scary, unpredictable events in and of themselves, she says.
"Pointing out to people how they are feeling a lack of control and how those feelings can, in fact, be illusory, can help them if they are dealing with an anxiety disorder," says Mineka.
An earthquake's aftershock
Basoglu and his colleagues are setting out to do just that for survivors of Turkey's 1999 earthquake. However, with many thousands of people to help, the psychologists aim to distill traditional cognitive behavior therapy into a single 60-minute session. Doing so requires them to focus in on Mineka's idea of prediction and control, says Basoglu.
The clinicians start by talking with earthquake survivors about their fears, and working with them to list the situations they find scary. They then instruct their clients to go into those situations and tolerate whatever anxiety they feel-a staple of traditional exposure therapy.
Where the intervention differs from traditional exposure therapy is the focus on regaining a sense of a control rather than just alleviating anxiety, Basoglu says. Rather than telling clients they have succeeded when they can enter into buildings without fear, for example, the researchers tell them that the goal is simply to regain a feeling of control over their fear. Merely walking into a feared building is an important part of the treatment, says Basoglu.
Additionally, Basoglu encourages earthquake survivors to think of their fear as an opponent, with knowable patterns and actions, rather than something that happens to them without cause or reason.
Results recently published in the Journal of Traumatic Stress (Vol. 18, No. 1, pages 1-11) suggests that this approach works. Six weeks after treatment, 55 percent of participants showed fewer post-traumatic stress symptoms, as compared with 14 percent of people in a control group. What's more, the participants continued practicing the skills they learned during the single session, and many continued to improve-with about 85 percent of participants showing abated symptoms six months after the session.
Giving people a sense that they can control their own fears is a staple of Zinbarg's practice as well, he says. Another treatment route is to help people feel that anxiety is something they can tolerate without fighting against, he notes.
"If we can succeed in helping people to get the sense they can do something about it, at that point 99 percent of the battle is won," he says. In fact, sharing the findings of Mineka's animal studies-if not details of the participants-is an important way to help people see their fears as understandable and therefore controllable, says Zinbarg.
Mineka, S., & Zinbarg, R. (2006). A contemporary learning theory perspective on the etiology of anxiety disorders: It's not what you thought it was. American Psychologist, 61, 10-26.
Mineka, S., Gunnar, M., & Champoux, M. (1986). Control and early socioemotional development: Infant rhesus monkeys reared in controllable versus uncontrollable environments. Child Development, 57, 1241-1256.