NLP and The Neurology of Phobia
The Amygdala and When to Swish
Most therapists that have worked with people with phobias will probably have noticed that these clients do seem to enjoy talking about them. This is possibly due to the lateralisation of the phobia to either one of the amygdala. For example, brain injured patients with damage to the left amygdala demonstrate difficulty recalling emotionally verbal material ("the story") and damage to the amygdala on the right impairs recall of 'emotional' pictures.
On a neurological level phobia's are similar in structure to PTSD (where sufferers definitely don't like to talk about there experience) but have a few important differences. In common with PTSD phobias can be a chronic and grossly disabling problem that have surprisingly quick and simple 'cure'. However, selling this quick and simple cure to a phobic can be a tricky affair as the phobic starts to attempt to convince the NLPerson that their phobia is far worse than the therapist could possibly imagine. The phobic will often claim that their phobia is the exception to the rule and will never be able to be cured and the therapist simply doesn't understand how serious this phobia really is.
This is the pattern that seems to occur with most phobics I have seen. Maybe that's just me.
For many NLPractitioners, the "fast phobia cure" and "double dissociation" are among the first techniques that are learned and have been well written up in many of the early books. However, it is also important to understand just what the technique is achieving on a psycho-neurological level, because not every "phobia" reported by a client follows the specific psychological structure that is prerequisite for the fast phobia cures to work.
For example, it is not unusual for people to report a "phobia" of "chatting up" members of the opposite sex (I am yet to meet a homosexual with this problem). And yet on enquiry the person will most likely report that they have never actually chatted anyone "up" - thus they will not possess the vital referential experience to qualify for phobia. This can prove to be a problem when the NLPerson attempts to apply the double dissociation technique - just what are they dissociating the client from?
Much of the problem with this lies in the practitioner playing the game of diagnostics without understanding the underlying psycho-neurological structure of just what they are dealing with. For example, consider the following reports from clients:
1. "I have a phobia of spiders ever since I was six when my bother put one down my shirt."
2. "I'm terrified of dogs because one bit me when I was 13 on my paper-round."
We can see the similarities to the way they are structured (cause and effect) in that both people have a definitive referential experience in order to let them know to be frightened. As a generaLIEsation, we can expect the submodalities of such memories to be quite vivid and, more often than not, associated. But what of the client who reports a phobia complete with referential experience who turns out to already be dissociated from their imprinting experience? For example, consider the following two examples:
1. "I'm terrified of flying, all I can think of is seeing myself in that plane as it bounces around in the turbulence telling myself that I'm going to crash."
2. "Whenever I think about going and talking to a girl, I see myself making a complete fool of myself."
With these two examples that may be reported as being a "phobia", we can see that not only the modalities are different (note the additional verbal auditory component), but they are dissociated and more importantly, anticipatory.
However, all too often it is the failure to spot the linguistic distinctions that leads to a failure to achieve a rapid resolution to the fear. For example, a simple phobia of spiders might have the same structure as a simple phobia of wasps or moths, but is highly unlikely to be in anyway related to the structure demonstrated by someone reporting "agoraphobia". Agoraphobia has an entirely different set of internal behaviours and will be covered in a different page on this site.
A simple phobia is also going to have a simple rule structure (see/hear wasp then freak out! - A/V-K) with a very simple and concise TOTE, whereas a flying phobia is likely to be far more complex. For example, it is a very simple experience for a bee to fly into one's ear canal or for a large spider to drop onto you from the ceiling whilst you sleep, but catching a ride in an airliner is a much more complex experience.
An important test for a phobia is too see if you can induce it. This will give you a lot of information about the way the person enters the phobic strategy and subsequently exits from it. Most of the time, this won't be difficult, since almost every phobic I have met has an expectation that the only way to have the phobia removed is for a therapist to throw a spider at them, or lock them in a room full of snakes in that favorite game of "flood therapy" or "systematic desensitization". Most clients enter the office already in the phobic state.
In absence of other knowledge, desensitization techniques kind of make sense. After all, the "successful phobic" manages to always avoid any situation whereby he may experience the threat. For example, one of the most common phobias I see in clinical practice is that of a fear of vomiting in public. This is by no means the most common phobia but given the extremes the person has to go through to avoid any situation where he may have to eat/drink in public etc, this phobia rapidly becomes an entire lifestyle. I am reminded of the story of the horse that is given a severe electric shock, via one of it's hoofs, two seconds after a bell rings. After a while, the horse gets fed up with this and naturally raises it's hoof every time it hears the bell. If the bell still rings but the electricity is disconnected, how will the horse ever discover that this is the case, unless he risks a further shock?
Whilst there is little doubt that most true phobias are a learned phenomena from an effective single trial learning (an "anchor"), a phobic response can be demonstrated in monkeys raised in zoo's when exposed to snakes for the first ever time. For those monkeys lacking this innate response, the reaction is soon cued by the behaviour of the other monkeys that are already reacting.
Recently in the city park, I was feeding a family of water voles by the pond when a small and curious child wandered over to see what I was doing. At that instant, a fatherly hand snatched said child away, as he exclaimed, "Euch! RATS!!!" in a disgusted tone, thus cueing the child to cry and become frightened.
A future client in the making!
What is curious is that in the UK, where toxic spiders and snakes are exceptionally rare, phobias of snakes and spiders are very common and yet phobias of far more commonly dangerous objects such as cars and politicians are virtually unheard of. Small creeping hairy things and long thing slithery things appear to form a blueprint in the genetic ability for phobia, although others can be learned or induced.
Neurologically speaking, there are two primary pathways that mediate the phobic response. Rather inevitably, both these pathways lead the information into the amygdala, a region discussed elsewhere in this site. Pathway one takes input visual information to the visual cortex where the visual recognition process takes place. Once categorized as dog/snake/threat, information about this category is retrieved from the hippocampus before being passed to the amygdala.
- Pathway 1: Visual Input - Thalamus (relay station) - Visual cortex (recognition) - Hippocampus ("Oh Shit!") - Amygdala ("Panic!!!!!!!")
The second pathway is more direct and involves activation of the "fight or flight" system mediated by the hypothalamus and triggers the physiological reactions that occur with true phobia via the sympathetic nervous system.
- Pathway 2: Visual input - Thalamus (relay station) - hypothalamus - amygdala
What is curious for many people is just how such severe reactions can be produced by seemingly innocuous stimuli. For example, in my practice, as well as the usual suspects I have seen people with a phobia's of wings (any wing, sanitary towel, bird, plane, bee, etc), a phobia of jelly pudding, a phobia of bare feet; and, my all time favorite - a man who complained that his life was "utterly ruined" by a phobia of "ships in a bottle" (a phobia that was, bizarrely, shared by his sister, mother and stepfather). Psychiatry likes to speak of genetic predisposition to phobia, but what I have often been curious about is that people rarely report ever having more than one phobia. They often can have a collection of fears, but rarely ever possess more than a single true phobia at any one time.
One fun thing that I like to do to demonstrate submodalities is to switch phobias around. For example, one lady brought to me by a psychiatrist for a "pathological phobia of spiders" (!!!??) sat in my office hyperventilating whilst the psychiatrist told me how resistant she was (despite the ridiculous quantity of psychiatric drugs in her system - thus anchoring the symptoms to a medicated state and then experiencing that medicated state every day). Her representation of spiders involved making a moving 3 dimensional, 30 foot spider in full techno-color with surround sound, before freaking out and screaming her way up the street. It was quite straightforward to anchor this response to the carton of Thorazine before taking the representation of the spider and reducing it down in size.
This unfortunate woman had been seeing the psychiatrist for "systematic desensitization" for 11 months without success and had been subjected to SEVENTEEN different psychiatric medications.
One thing of curiosity is that true phobias are a particularly visual phenomena. Show the phobic the dreaded stimuli (like a bee) and they will immediately freak out. But when they hear the buzzing, in neurological terms the response might be delayed or inhibited until they actually see it or vividly visualize it.
Joseph LeDoux writes:
...when rats are exposed to a cat, they give off calls, sounds that warn other rats to stay clear of where the sounds are coming from. These sounds, it turns out, are in the ultrasonic range (the range beyond human hearing). Since cats can't hear in this range, the calls are like secret encrypted messages that pass undetected through enemy lines. In recent experiments Fabio Bordi and I found some neurons in the rat amygdala that responded especially briskly to ultrasounds similar to warning calls. The rat amygdala may be evolutionary prepared to respond to these sounds and to learn about them. In fact, the amygdala of all creatures may be prepared to respond to species-relevant cues. For example, faces are important emotional signals in the lives of primates, and neurons in the monkey amygdala respond briskly to the sight of monkey faces.
LeDoux goes on to speculate about the differences between phobics who can vividly remember the imprinting event (formed in the temporal lobe memory system) thus remembering that they are supposed to be a phobic and the phobics who do not remember the imprinting event.
The brain's ability to generalize phobia's leads to two interesting distinctions between phobic clients. Those phobics who vividly remember the imprinting experience will hold a specific phobia - ie a wasp crawled into their ear when they were 5 years old and they now have a specific phobia of wasps. The client who does not remember the imprinting experience, will more likely possess a generalized phobia to all small flying things that resemble wasps.
Broadly speaking, cultural expectation may also play an important role in the generalization of phobic response. As my colleague Dr. Mike Jones points out, a phobia is socially acceptable. For example, it is acceptable to announce that one might be a "social phobic", but it might not be so easy to say, "I lack the skills and experience for social interaction." The main descriptive differential lying between an identity level statement and a capability level statement, where stating an inadequacy as "I am..." is culturally preferable to stating it as, "I cannot..."; a phenomena I believe to be a tragic hangover from our debacle of an education system.
Broadly speaking, phobics who have a definite 'cause and effect' relationship to the referential experience, (ie, "I am phobic because a dog bit when I was 6") will respond very quickly to even a clumsy, technique orientated "double dissociation" technique. Next time you work with a phobic client who does not know why they have the phobia (ie they have deleted the referential experience) listen carefully when you ask them how they do the phobia. The answers typically take the form of:
"I just look at the wasp and go 'ahhhhhhhhhhhh' and freak out."
"I just see the dog and go 'SHIIIIIIIIT!' and have a panic attack."
"I just watch the thing getting closer and just start screaming."
Listen closely for the sequence that the modalities occur (V-A-K). If it is this auditory component that is the link between the visual stimuli and the kinesthetic reaction, then the NLPerson can begin to understand different ways of approaching the problem that don't depend on the diagnostic-technique approach.
But then, if we followed the psychoanalytical literature, we'd be focusing on the size of horses penis's and "oedipal complexes". Whilst demonstrating a particularly effective (I was so pleased), thirty second "fast phobia cure" to a herd of clinical psychologists, I was collectively criticized for failing to administer a "real cure". Despite the fact that sat before them was a lifelong phobic now happily handling a dead tarantula (the pet shop wouldn't trust me with a live one and I only knew at the last minute what sort of client they would provide me with). The criticism revolved around the fact that the true "internal conflict" had not been resolved and that I had only provided a "gimmick" - and besides, the spider was dead.
It was during this time that a truly fantastic moment in history occurred as the taratantula, right on cue, gave a slight twitch of the leg and began to revive. This occurred much to the delight of the client who by this time was getting as annoyed as myself and who promptly gave a whoop of glee as he plonked Lazarus down on the lap of the psychologist who surprisingly didn't look at all comfortable with the idea. That night we certainly found one of the fastest ways of clearing a room of all it's clinical psychologists.
Curiously, they didn't invite me back.