Background

While effective, exposure therapy can be distressing, which creates problems with treatment acceptance. Can exposure be effectively delivered unconsciously—and thus without causing phobic people to experience distress? No study has tested this hypothesis in a sufficiently rigorous experiment that selected between mechanisms for reducing fear unconsciously.

Methods

We conducted a psychophysiological experiment of an unconscious exposure intervention to discern its mechanism of therapeutic action. We identified 98 highly spider-phobic participants with a validated fear questionnaire and a Behavioral Avoidance Test in which they gradually approached and exhibited impairment of a live tarantula, which was indicative of a DSM-5 diagnosis of specific phobia. These participants were randomized to viewing unconscious exposure to spiders, visible exposure to spiders, or unconscious exposure to flowers (control). In a novel psychophysiological design, concurrent changes in sympathetic arousal and subjective fear were monitored throughout exposure. Shortly thereafter, phobic participants approached the tarantula again in order to measure exposure-induced changes in real-life avoidance behavior and experienced fear.

Results

Unconscious exposure did not induce concurrent changes in sympathetic arousal or subjective fear, and subsequently reduced fear of the tarantula. Visible exposure to the same phobic stimuli, by contrast, induced significant arousal and fear, but did not affect fear of the tarantula. Levels of arousal during exposure moderated effects on fear of the tarantula: lower arousal during unconscious exposure, but not during conscious exposure, predicted greater fear reduction.

Conclusions

Unconscious exposure reduces fear by generating new implicit learning of nonaversive, stimulus-response associations that facilitate fear extinction in phobic persons.

中文翻译：

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无所畏惧，唯恐自身：无意识暴露的机械测试

背景

虽然有效，但暴露疗法可能会令人痛苦，这会导致治疗接受度出现问题。暴露是否可以在无意识的情况下有效地传递——从而不会导致恐惧症患者感到痛苦？没有研究在足够严格的实验中检验了这一假设，该实验在无意识地减少恐惧的机制之间进行了选择。

方法

我们进行了无意识暴露干预的心理生理学实验，以辨别其治疗作用机制。我们通过经过验证的恐惧问卷和行为回避测试确定了 98 名高度蜘蛛恐惧症参与者，他们逐渐接近并表现出对活狼蛛的损害，这表明 DSM-5 诊断为特定恐惧症。这些参与者被随机分为观察无意识接触蜘蛛、可见接触蜘蛛或无意识接触花朵（对照）。在一种新颖的心理生理学设计中，在整个暴露过程中监测交感神经兴奋和主观恐惧的同时变化。此后不久，恐惧症参与者再次接近狼蛛，以测量暴露引起的现实回避行为和经历恐惧的变化。

结果

无意识的暴露并没有引起交感神经兴奋或主观恐惧的同时变化，并随后减少了对狼蛛的恐惧。相比之下，明显暴露于相同的恐惧刺激会引起明显的觉醒和恐惧，但不会影响对狼蛛的恐惧。暴露期间的唤醒水平对狼蛛恐惧的影响有所缓和：在无意识暴露期间的唤醒水平较低，但在有意识的暴露期间则不然，预示着恐惧会减少。

结论

无意识的暴露通过对非厌恶性刺激反应关联产生新的内隐学习来减少恐惧，这些关联有助于恐惧症患者的恐惧消退。