Quote from AStubbs on April 19, 2021, 7:19 pm

How might the information shared regarding fear conditioning vs fear extinction impact my interventions with my clients psychotherapeutically to facilitate the tasks of memory processing, desensitization, new learning and reconsolidation?

Quote from nkeeter on April 19, 2021, 8:32 pm

Fear conditioning creates ever more efficient neural pathways that reinforce the notion that "fear is a real thing that controls me." Disrupting that vicious cycle of fear/response/confirmation bias can allow a client to begin a transition from "my fear manages me" to  "I have the ability (even if only part of the time at first) to manage my fear."

Part of my job as therapist is to make as safe as possible a time and space to reprocess those "fears" and to facilitate, as Irv Yalom puts it, "corrective recapitulation of" experiences. Easing the movement through gradual steps toward an empowered view of self will not make the client forget what happened, but will allow them to see things differently, changing the actual memory of the even subtly changing the client's view of self.

As more gains are made in fear extinction the brain will stay more in the regulated state, where learning can take place, and away from the dysregulated states of either hypoarousal, where "I check out", or hyperarousal,  where "I control everythings," that indicate a client has drifted into "survival brain."

As a virtuous cycle, the more I learn the less I am afraid, seems likely to change the automatic thoughts from fear and negativity  toward empowerment and confidence.

Quote from christyculbreth on April 21, 2021, 7:44 pm

Quote from nkeeter on April 19, 2021, 8:32 pm

Fear conditioning creates ever more efficient neural pathways that reinforce the notion that "fear is a real thing that controls me." Disrupting that vicious cycle of fear/response/confirmation bias can allow a client to begin a transition from "my fear manages me" to  "I have the ability (even if only part of the time at first) to manage my fear."

Part of my job as therapist is to make as safe as possible a time and space to reprocess those "fears" and to facilitate, as Irv Yalom puts it, "corrective recapitulation of" experiences. Easing the movement through gradual steps toward an empowered view of self will not make the client forget what happened, but will allow them to see things differently, changing the actual memory of the even subtly changing the client's view of self.

As more gains are made in fear extinction the brain will stay more in the regulated state, where learning can take place, and away from the dysregulated states of either hypoarousal, where "I check out", or hyperarousal,  where "I control everythings," that indicate a client has drifted into "survival brain."

As a virtuous cycle, the more I learn the less I am afraid, seems likely to change the automatic thoughts from fear and negativity  toward empowerment and confidence.

Nick –

You really broke down fear conditioning versus fear extinction in a way that helped me to apply this to real life, so I thank you for that! As I read your post, my immediate thought was that narrative therapy would seem to really help with fear extinction. As I’m sure you know, the basic premise of the theory is rewriting our stories. I wonder what it would be like for a client to externalize the thing they fear and then subsequently own and empower that fear in a way that really helps to establish confidence. As you mentioned, there is an element of bringing awareness to the automatic thought which can be done via psychoeducation on the cognitive model. Having a thought journal seems like a great homework assignment to use to heighten awareness here.

Thanks so much!

Quote from lpernoud on April 23, 2021, 7:52 pm

Quote from nkeeter on April 19, 2021, 8:32 pm

Fear conditioning creates ever more efficient neural pathways that reinforce the notion that "fear is a real thing that controls me." Disrupting that vicious cycle of fear/response/confirmation bias can allow a client to begin a transition from "my fear manages me" to  "I have the ability (even if only part of the time at first) to manage my fear."

Part of my job as therapist is to make as safe as possible a time and space to reprocess those "fears" and to facilitate, as Irv Yalom puts it, "corrective recapitulation of" experiences. Easing the movement through gradual steps toward an empowered view of self will not make the client forget what happened, but will allow them to see things differently, changing the actual memory of the even subtly changing the client's view of self.

As more gains are made in fear extinction the brain will stay more in the regulated state, where learning can take place, and away from the dysregulated states of either hypoarousal, where "I check out", or hyperarousal,  where "I control everythings," that indicate a client has drifted into "survival brain."

As a virtuous cycle, the more I learn the less I am afraid, seems likely to change the automatic thoughts from fear and negativity  toward empowerment and confidence.

 

Nick,

I appreciated your discussion of the brain activity that occurs during fear conditioning and how there is a biological component to experiencing fear. Your commentary on this reminded me of Dr. Childerston’s analogy of the brain creating “superhighways” for automatic thoughts, and that creating new and healthier thoughts is initially a major challenge because it is akin to using a machete to forge a new path in a jungle. In understanding our clients’ biological/chemical elements and abilities, we can gain patience in our clients’ processes and appreciation for the efforts that go into our clients creating drastic shifts on biological, behavioral, and emotional levels.

DBT is another modality that offers opportunities for effective biological change. Implementing techniques such as “checking the facts” and determining balanced, wise-minded counter-thoughts to the irrational, fear-based cognitive distortions can help clients generate new neural pathways and allow for new learning.

Quote from coriander39 on April 30, 2021, 9:13 pm

Nick, like the others here I appreciate the explanation you provided as it helped validate some of the interventions I already use, but helped me have a better understanding as to how and why they are helpful. As anxiety is often fear-based, and I often treat anxiety, I was specifically thinking of those clients. I use CBT and encourage clients to identify their automatic thoughts and identify the evidence for and against and develop potential counter thoughts. I also encourage them to acknowledge and accept their anxiety rather than distract and avoid it (unless they are ruminating, then I recommend distraction to break through the thought process so that they can later process it in a healthy way). I find this is best illustrated with my (mild) OCD clients who struggle with thoughts of harming others. Once they have done a lot of psychoeducation and development of coping skills and are eventually able to acknowledge the intrusive and automatic thoughts and then return to what they are doing, rather than panic over having the thoughts and avoid any potential triggers, they start decrease in frequency and in distress. I think it will be helpful going forward to borrow from your and Dr. Childerston’s explanations of neural biology to add to the psychoeducation for my clients.