Podcast: The Experts Weigh In

MALLORY MALKIN: Hello, I'm Dr. Mallory Malkin. I'm a licensed clinical psychologist in Ellisville, Mississippi. In addition to my work as a clinician, I teach introductory psychology using Scientific American Psychology.

SCOTT COHN: Hi, I'm Dr. Scott Cohn. My background is in animal learning behavior, and I'm currently a professor of psychology at Western Colorado University.

MALLORY MALKIN: Do you also teach Introductory Psychology?

SCOTT COHN: I do. And, in fact, I also use Scientific American Psychology.

MALLORY MALKIN: Then you teach your students about Cesar Millan's work with Gavin.

SCOTT COHN: This chapter, and Gavin's story, are actually one of the reasons why I chose this textbook.

MALLORY MALKIN: Given your background in learning and behavior, what's your take on Gavin?

SCOTT COHN: My take is that Gavin's a hero. Put through a series of unfortunate events after returning from Iraq, Gavin may have been OK. Unfortunately, as a behaviorist, it's easy to see that Gavin generalized many different everyday noises with danger. For Gavin, a cell phone beep is a conditioned stimulus. And the conditioned response is to shake uncontrollably. Thankfully, Cesar Millan took a two pronged approach to treating Gavin's classically conditioned fear.

MALLORY MALKIN: How so?

SCOTT COHN: First, Cesar exposed Gavin to sounds like a cell phone and microwave.

MALLORY MALKIN: The conditioned stimuli?

SCOTT COHN: Yes, Cesar paired these noises with Gavin being in a pleasant state. Like, while Gavin's swimming or right before giving him a treat.

MALLORY MALKIN: So the original conditioned stimulus then becomes a condition stimulus for good stuff.

SCOTT COHN: Exactly.

MALLORY MALKIN: So, what's the other prong?

SCOTT COHN: Creating a different association for the conditioned stimulus doesn't make the sounds of thunder, gunfire, and explosions any less scary.

MALLORY MALKIN: In all fairness, those are scary noises.

SCOTT COHN: They are. That's why they're unconditioned stimuli. Most animals and people are afraid of really loud noises. But Gavin's response was this uncontrollable shaking.

MALLORY MALKIN: That sounds scary.

SCOTT COHN: In order to help Gavin reduce his fear response to unconditioned stimuli like thunder and fireworks, Cesar exposed Gavin to these noises while Gavin was relaxed walking on a treadmill. Sort of a virtual reality form of therapy for Gavin. Under these controlled conditions, the fireworks noises were presented quietly at first but became systematically louder and more intense over time until Gavin could remain relaxed walking around at a firing range.

MALLORY MALKIN: That's incredible. Cesar's work with Gavin reminds me of how clinicians assist patients suffering from phobias.

SCOTT COHN: I'm familiar with how these techniques can be used, but I have no firsthand experience.

MALLORY MALKIN: As a clinician, we assist patients in treatments of phobias that are interfering and impairing in their daily lives.

SCOTT COHN: Much like Gavin.

MALLORY MALKIN: Exactly like Gavin. Except, instead of firework explosions, imagine if that fear was caused by, say, rats.

SCOTT COHN: I've worked with lab rats for years, so that's hard for me to imagine.

MALLORY MALKIN: I bet. But I've treated patients that are so afraid of being bitten by rat that they're afraid to go into their own basements. No different than Gavin associating a cell phone ring with bombs going off. These patients become fearful of basements because they have a bad memory of a rat in a basement. That becomes a serious problem if you have to go into a basement for things like laundry or a basement garage at a shopping mall.

SCOTT COHN: So what do you do?

MALLORY MALKIN: The first thing I do is educate patients on phobias and normalize their symptoms. Then I teach patients how to relax. Same as Gavin. We can't do anything until the patient is calm and has learned good tools to remain calm under stress. One easy technique is called progressive muscle relaxation, or PMR That's something we might work on during a first session.

SCOTT COHN: I do PMR with my students to help them relax.

MALLORY MALKIN: Yes, and once the patient is relaxed, just like Gavin, we start exposing them to conditioned stimuli in a gradual manner under carefully controlled conditions. In the case of rats, we might start with having the patient look at images or videos of rats. But ultimately, like Gavin at the gun range, these patients learn to be so calm around rats that they'll even be able to handle rats and other rodents at, maybe, a pet shop.

But sometimes a phobia is related to something like riding the subway or flying on an airplane. These are much more difficult to treat in an office setting, and the cost of having a therapist fly places with a patient starts to add up. Plus, things like turbulence are quite unpredictable.

Almost nobody likes flying. It's cramped. It's loud. You're getting jostled around. These are conditions that trigger a stress response. That's why it's an unconditioned stimulus. Because it unconditionally causes a stress response.

SCOTT COHN: So is it a phobia?

MALLORY MALKIN: For you or me, it may be an inconvenience. We're tired when we get where we're going. It becomes a phobia when you're no longer able to get on the plane.

SCOTT COHN: What do you do then?

MALLORY MALKIN: Just like Cesar's work with Gavin, we use virtual reality therapy. Except, instead of a treadmill, we can have patients put on a pair of virtual reality goggles and experience taking a commercial flight. First with few passengers, wide seats, and a smooth takeoff. Eventually, they're able to remain calm in a virtual world of a packed flight with cramped seats and enough turbulence to make most people worried. At that point they're ready to take to the air.

SCOTT COHN: That's so interesting. Thanks for explaining how this applies to therapy with your own patients.

MALLORY MALKIN: No problem. Thanks for explaining how Cesar was able to address both the conditioned response and the unconditioned response with Gavin.