From time to time I use systematic desensitization/exposure therapy to treat a phobia (example). Most often, I've used it with fear of public speaking. A bit of explanation for those unfamiliar with this treatment: First, I test an individual to see if they can experience anxiety or even panic by imagining the phobic situation. There are techniques that can be used to trigger the anxiety if the person has trouble recreating the phobic anxiety through imagination alone.
After we know that we can elicit the anxiety in the office, we create an anxiety hierarchy or scale. For example, for a person with a snake phobia, imagining that they are leaving their home to drive to a reptile house might rank at the low end of their scale. Arriving at the reptile facility might be at the middle range. Standing near someone holding a snake would be at the high end, while actually holding the snake would be at Defcon 1.
We create a hierarchy with small but increasing anxiety increments, perhaps ten or fifteen steps of increasingly provocative imagined situations related to the phobic situation. Next, I teach the person deep muscle relaxation, which is a technique that accomplishes exactly what the name implies. The person achieves a state of extreme relaxation.
Over time, the patient will work their way through the hierarchy, learning to maintain deep relaxation while vividly imagining the anxiety-provoking situation. This approach rests upon the principle of reciprocal inhibition, which means that one cannot experience two mutually incompatible inner states simultaneously. So if the patient can learn (incrementally) to maintain deep relaxation while imaging the feared situation, their fear level declines upon exposure to the phobic situation. Trust me, it works, although sometimes, rather than doing it in the office, it's more effective to do it in vivo, (in real-life situations). What I do when possible, is a combination of in-office, and in vivo treatment.
One additional modification is use of the drug propanolol (a beta blocker) in the treatment. Sometimes people who must periodically face the phobic situation (e.g. public speaking) while undergoing treatment, can benefit from taking propanolol shorty before a premature phobic exposure. The drug generally prevents panic, which is desirable while the person is undergoing systematic desensitization. Panic attacks in the phobic situation while we're working on systematic desensitization, can slow treatment progress.
All of this requires a great deal of work on the part of the patient. Typically, treatment requires 10 -20 weeks of sessions combined with daily practice. It's hard work for the patient, so anything that could accelerate the process would be welcome. Also, there is a small subset of patients who can't utilize this treatment because attempting deep muscle relaxation triggers panic attacks.
The new treatment, isn't actually a treatment yet, but it points to a way that treatment of phobias (as well as PTSD-related anxiety) may be possible with much less time and effort on the part of the patient. From The Guardian:
The new technique, called fMRI decoded neurofeedback (DecNef), was developed by scientists at the ATR Computational Neuroscience Lab in Japan.[...] The procedure uses a computer algorithm to analyse a patient’s brain activity in real time and pinpoint moments when their fears can be overwritten by giving them a reward. Continued