This article was a front-page feature on Medium.

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Many people live with fear. Chronic fear: phobias, anxieties, and PTSD. Conditions like these can be debilitating and difficult to treat. Many treatment options cause painful physical and psychological side-effects. New and promising treatments, however, use advances in brain scans and neurofeedback to revolutionize the way science helps us overcome our fears.

The problem with drug-based treatments will always be their side effects and wide targets. There’s no drug to specifically cure a fear of snakes or fear of flying, for example; medications only dampen a generalized level of anxiety (sometimes, they even knock people out completely).

Medications can only dampen the general level of anxiety or perhaps even knock people out completely.

One of the best available treatments for a specific anxiety? Exposure therapy. In a controlled environment, participants are trained to relax and face their fears. If they have a phobia of snakes, for instance, they might be asked to imagine a snake in the first session, then look at a picture of a snake in the second, then watch a video in the third, then see a real snake in the fourth. If they make it through the therapy, they might successfully reduce their level of fear in the real world. The problem, as you might expect, is that dropout rates during this type of therapy are high. Repeated exposure to your deepest fears is a painful process.

Parallel to exposure therapy runs another stream of scientific research looking at a method known as neurofeedback. Through manipulating brain patterns, this technique trains people to shift their behavior in specific directions. If you were undergoing neurofeedback, the procedure might go something like this:

You sit and look at a circular disc on a computer screen while researchers measure your brain activity. You see that the size of the circular disc changes, and you know that its size is somehow linked to a target pattern of brain activity in your head. When that pattern is more active, the disc grows. When it’s less active, it shrinks. Over time, you begin to learn how to consistently make the disc bigger. But, strangely enough, you don’t always know exactly how you’re managing to control your brain activity in order to accomplish this. The learning process is implicit and outside your awareness.

Neurofeedback shows some potential as a tool for treating neurological or psychiatric disorders. The logic is that if doctors can identify a particular signature of activity in the brain that characterizes a patient’s symptoms, they might be able to use neurofeedback training to reduce that activity. If the activity is shown to have a meaningful role in causing their symptoms, then the hope is those symptoms will also decrease.

Emerging evidence supports these benefits for disorders, including ADHD and stroke recovery. Of course, there are still questions around the practicality and efficacy of this treatment. But the evidence, so far, is promising.

Repeated exposure to your deepest fears is a painful process.

Building on the potential of this research, a new study published in March 2018 by labs at UCLA and in Japan brings together the worlds of exposure therapy and neurofeedback. The study’s ambition was to expose participants not to their fears themselves (like in exposure therapy), but to the unconscious activity representing those fears in their brains (neurofeedback). By rewarding participants when their brains showed that unconscious activity, they tried to create a positive rather than negative emotional association with the feared object.

Critically, this method avoids the need to directly present the fear to participants, minimizing the chance they’ll drop out of therapy (a common problem with exposure techniques).

Surrogate volunteers with no phobias were shown the fear-based objects (e.g., spiders and snakes) and their brain activity was scanned. Researchers used these patterns to infer what fearful activity would look like in the brains of people with phobias toward those objects. Then they used neurofeedback training to reward participants whenever their brain activity looked like it represented the unseen feared object. Amazingly, neither researchers nor participants knew the fear that was being targeted: The computer randomly selected neurofeedback for each participant, automatically using an object they didn’t fear as a control.

If doctors can identify a particular activity signature in the brain that characterizes a patient’s symptoms, they might be able to use neurofeedback training to reduce that activity.

At the end of the experiment, participants’ physiological fear levels (skin conductance responses and brain activity in their amygdala) were reduced when looking at images of the object they feared. Fear responses to the control object, which was not targeted in the neurofeedback training, remained the same as before the experiment.

It’s amazing to consider what this kind of neurofeedback could do for people in the future. Imagine the benefits for those with chronic anxieties, phobias, or conditions such as PTSD. Could their symptoms one day be treated without ever exposing them to the terrors they suffer from?

When phobias are overwhelming enough that they take over our lives, we may be able to defeat them without ever directly facing them.