I think it’s so interesting when someone says that.

Every so often I hear or read a confident claim from someone saying that desensitization/counterconditioning (DS/CC) wouldn’t work on them.  They seem offended at the very idea that food would help them overcome their fear. The nerve of anyone to even mention it!

Actually, I can relate just a little. Maybe the idea is a tiny bit threatening. So many of us hold our individuality near and dear.  Americans especially, I suspect, are taught (conditioned, hah!) to view conditioning as some kind of mechanistic insult to our personhood. It evokes scary thoughts of self-serving mind control as in Brave New World.

But could any of us really be immune from associative learning and respondent conditioning? Do the processes of learning apply to us or not? Are we really such exceptional super-humans that we know in advance that a method that operates in a fairly predictable psychological and physiological manner just….won’t?

What’s wrong with this picture?

Shoving Cookies

To start with, the phrase about “shoving cookies” signals either a basic misunderstanding or a deliberate misrepresentation of the process of counterconditioning/desensitization. The claim usually goes something like this:

You could shove all the cookies at me you want but it wouldn’t make me feel any better if I were trapped in a room full of [spiders, clowns, snakes, etc.]

I could end the post right here and just say that’s a straw man argument, because it is. But I’m interested in what’s behind it, so I’ll keep going.

Desensitization consists of exposing a subject to the thing they fear in graded exposures, starting with a form that is dilute and nonthreatening, and working up to full exposure to the scary thing. Counterconditioning consists of changing an emotional response (usually from fear to neutrality or to a positive response), by pairing the trigger of the undesired response with something that evokes desired emotional response. Combining these two methods creates a non-threatening but very effective way to alter phobic fear responses.

So of course if the process were started with a full-blown exposure to the scary thing, those cookies probably wouldn’t do much. Cookies wouldn’t help a person who is already scared out of their wits. However, that scenario is not DS/CC. The desensitization component ensures that we never start at such an over-the-top exposure.

What’s This About Starting with a Low-Grade Exposure?

Performing desensitization/counterconditioning when addressing fears ensures that we start with a low intensity, manageable form of the scary stimulus. This is done for at least two reasons. One is ethics, and the other is efficacy. I have discussed the ethics issue in my publications on thresholds. Since we can’t explain to animals what we are doing or get their “buy-in,” there are issues of consent that are not present with humans. It is more ethical to start with a non-traumatic exposure to the scary thing.

But the second reason, efficacy, applies to humans as well as other animals, and this is why the quote above about creepy things vs. cookies doesn’t cut it. We start with a tiny, controlled exposure to the scary thing precisely so that the emotional reaction to it doesn’t overpower the positive response to the pleasant stimulus we will use for our counterconditioning.

The anxiety-producing stimulus must be presented at a low enough level that the parasympathetic nervous system response to food (or specifically for humans, the practice of trained relaxation or other internal technique) is stronger than that of the sympathetic nervous system’s fear response. (See Behavior Therapy Techniques: A Guide to the Treatment of Neuroses, by Joseph Wolpe.)

Pavlov’s Work as an Example

Let’s compare classical conditioning, which doesn’t usually necessitate desensitization, and counterconditioning, which usually does. We can use Pavlov’s work with salivating dogs as a starting point.

Pavlov’s dogs learned via respondent conditioning to salivate when a sound, probably a bell, immediately preceded the delivery of food. They most likely did not have any negative association with the bell to begin with; it was probably a neutral stimulus. Because of the bell being paired as a temporal precursor to food, the dogs’ physiological response to food (including salivation and other internal preparation of the GI system) transferred to the sound of the bell. This straightforward classical pairing changed the dogs’ simple auditory response to the bell to an appetitive one, apparently without a hitch.

But what if there had been a dog who was deathly afraid of the sound of a bell beforehand? When the bell rang, the dog’s sympathetic nervous system would have kicked in, with a cascade of biochemicals and physiological responses. Just like for the person in the room full of spiders, snakes, or clowns, that situation would have provided a strong competing response that would inhibit the ability to relax or respond to even the yummiest food.

Depending on the order of events, the dog could even get reverse conditioned, and the fear triggered by the bell could get associated with the food. Likewise, the person in the room full of spiders being showered with cookies may not want a cookie again for a long time.

So for the bell-fearing dog and the spider-fearing person, we would use desensitization in addition to the counterconditioning. We would start with a very dilute, weak exposure to the scary thing. Then the seesaw would drop on the side of response to the conditioning stimulus being the more powerful process at work.

This is also why we use something like steak and not kibble when doing counterconditioning on dogs. We take every opportunity to get the strongest positive response possible.

So again, our people with their off-the-cuff denials are not describing DS/CC at all.

Let’s explore how DS/CC is typically done with a human.  I’ll volunteer for the thought experiment.

My Phobia: Crawdads

I spent a lot of time playing in a murky creek as a kid. Crawdads creeped me out.  I was afraid of being pinched by one, underwater where I couldn’t see it. I felt like they were ugly and sneaky. And I was also really, really grossed out by the dead ones I would see sometimes. They would be in the still, shallow water, and have algae and murk on them. I would think they were alive, just lurking, until I moved the water around them and they would slowly disintegrate. Ewww!

However, crawdads are just not all that dangerous. They generally are not going hurt you very badly, especially if you leave them alone. Certainly, they are not as potentially harmful as bumblebees (which I don’t fear abnormally) or the non-poisonous snakes I had as pets. I believe I was pinched by a crawdad one time. It was completely underwhelming. I felt this little pinch on my big toe, and then it was gone.

The comparative harmlessness of crawdads makes my little phobia a perfect candidate for DS/CC. There is no ethical problem with making me comfortable around crawdads, as there would be, for example, with escaped convicts or bears.

Let’s Make a Plan

So how would we really go about addressing my irrational fear of crawdads with desensitization/counterconditioning?

First of all, we have many more options with humans than with animals (on this page is just a sampling of the many things that have worked with humans). We don’t have to use “cookies,” although we certainly could. With humans, we can often evoke a competing emotional state by using imagination/cognition or a physical activity. There are lots of things one can use.

Now, the idea of cookies (especially chocolate ones) is enticing, but what if I got full too fast? Satiation can indeed be a problem. And all that imagining or virtual reality described in the resource list sounds like more work than I feel like doing. So, my first choice for a tool to use for my own counterconditioning is that potent secondary reinforcer for humans: money!  How about if some rich person funded my DS/CC by arranging for me to be paid $50 every time I perceived a crawdad in any form, proceeding up a desensitization hierarchy? (I’m actually already thinking about how I would go around looking for crawdads.)

To do it properly I would need to establish a hierarchy of exposures, so here is what I came up with. In real life, I would do this in consultation with a knowledgeable psychotherapist, who would also monitor the sessions to gauge the exposure levels and my response.

Steps of Graded Exposure to Crawdads

Each iteration of each step will pay $50, with the option of adjustments by the supervising psychologist.

1. Read a story in which crawdads are peripherally mentioned.
2. Write the word “crawdad” myself on a piece of paper. Note that this might be a good first step for the people who write posts about how DS/CC couldn’t work for their fear, since they have already shown that they can write about it. In contrast, there are people with phobias so severe (emetophobes come to mind) that they can’t even stand to see the word that is associated with their phobia.
3. View a cartoonish picture of a happy crawdad.
4. Look at these silly crawfish guys at Mardi Gras.
5. Play with this adorable plush crawfish. (I actually want one!)
7. View a realistic still photo of a small, clean crawdad (remember the part about murk—I’m trying to avoid that).
8. Read an educational piece about crawdads and their importance in the environment like this one (it has one photo).
9. (Steps 9a, 9b, 9c, etc) View a variety of photos, gradually including bigger crawdads and murkier environments. No movement yet.
10. Watch a video like this one that shows a small crawdad moving around in a crystal clear tank.
11. Watch more videos, gradually increasing numbers of crawdads, movement, size, and murk.
12. View, in person, a single crawdad in a tank, such as in the setup in Step 9.
13. View more crawdads in tanks, raising criteria with movement, numbers, and intensity as with the photos and videos.
14. Put my hand in a tank with a baby crawdad for it to investigate.
15. Do the same in a tank with several babies.
16. [I’m leaving out steps of deliberating touching juvenile or adult crawdads because going that far is not necessary for my needs and could hurt the crawdads.]
17. Listen to the song, “Crawdad Hole.” I originally had this as an early step, since it’s a very pleasant tune, but then I actually listened to the lyrics, which include a whole bag of crawdads breaking and the crawdads were “back to back.” Oops! Imagining multiple moving crawdads was too intense for an early exposure, but is probably okay about now.
18. Go explore a creek (something I love to do, by the way) where there are known to be crawdads, but stay on the bank.
19. Go back to the creek and actively look for crawdads (probably won’t find any). Just for fun, the fee has just gone up and I will get $200 if I see a real crawdad in the wild.
20. Sit by the creek with my feet dangling in the water. Still paying $2o0 for crawdad sightings.
21. Wade in the creek (with footwear if appropriate). Still paying $2o0 for crawdad sightings.

I would get paid for each iteration of any one of these tasks. Under the care of the psychotherapist, I could repeat tasks, or add interim steps as needed. (In case the potency of the $50 tempted me to linger unnecessarily on a particular step, the psychotherapist would observe me for possible “fake” responses, and would be free to make alterations in the protocol accordingly.)

For the sake of thoroughness, I added more steps to the list than would probably be necessary for me. You might want to note how many steps there were before the real-life crawdad made an appearance. That is the beauty of desensitization, and why it’s really a shame that people misrepresent it.

If anybody wants to fund my project, please let me know!

Would it Work?

There’s the question. If I went through standard DS/CC of my crawdad phobia, would it work? Probably! Claiming to be exempt from this well-documented process, whether happening naturally in life or in a protocol, is what’s pretty hard to defend.

Our bodies are wired to make associations. If we didn’t build these associations, we wouldn’t have many of the pleasures in life that we do. We do have to be a bit more creative and work a bit longer if we are “rehabbing” a stimulus with negative associations rather than a neutral one. Yeah, it seems kind of silly for the sight of a crawdad to predict $50, but if it did, I bet my feelings about them would change.  And with a bit of finesse, the added pleasure from mucking about in creeks without fear–access to pleasurable activities–would kick in as I weaned off the money.

To make one comment about dogs: I have watched that exact process with my feral dog Clara, and it is thrilling. For a long time, strangers predicted spray cheese. Now they predict comfortably hanging out with her dog and human friends, being able to walk up and give interesting people a good sniff, being able to go in completely new environments and explore without worry, and of course being able to sniff good pee-mail. She actually chooses these activities rather than hanging around for the food. She is free to choose environmental reinforcers. She was formerly prevented from that by her fears.

So I bet I could go from cartoons to plush toys to photos of itty bitty cute (really?) ones all the way up to the gnarly crusty crawdads hiding in the mud. This is not some kind of faith on my part. It’s in keeping with what I have learned that science says about the process, creating a protocol that is in keeping with what we know, and personal observations that are in concert with that knowledge.

Can One Resist?

You do kind of have to wonder whether the people who are adamant that it wouldn’t work would actually cooperate. Could one actually resist counterconditioning?

Stay tuned for a future blog on trying to resist respondent conditioning. There is an interesting story in the literature. But in the meantime, let me leave with some words by Dr. William Mikulas, a behavioral psychologist and also the author of this cool book:

Counterconditioning of fear/anxiety takes place outside of cognitive control, so does not require cognitive acceptance or beliefs. But, of course, cognitive co-operation makes it much easier!!

Dr. William Mikulas, excerpt from personal email, August 2014

*There are also issues of order and timing that would affect which response would “win.” We’re leaving them aside for now.

Copyright Eileen Anderson 2014