It sounds counter-intuitive: a threat can beat the fear of a threat.

A new study published in the journal Neuron shows how fear is learned and unlearned and may help in coping with anxiety and fear. The findings have strong implications for the treatment of anxiety and fear-related disorders such as extreme fear of the dentist and the dental drill.

The study suggests that people quickly learn to fear a threatening or unpleasant experience. The fear returns when cues like sights or sounds that are linked to bad experiences are sensed.

This can negatively impact on the quality of life and underlie emotional disorders like post-traumatic stress disorder, phobias and anxiety, according to researchers at the Icahn School of Medicine at Mount Sinai, a part of the Mount Sinai Health System; it is New York City’s largest integrated delivery system with seven hospital campuses and a leading medical school.

The researchers say the way to cope is to experience the threatening cues without the bad experience. This method is the most prescribed treatment for fear-related disorders.

However, this may be impractical when cues associated with a traumatic event may be difficult or unethical to reconstruct. This is true, for example, in reenacting a war zone. Or when the intensity of remembering is too overwhelming for the patient.

In cases like these, the alternative is to use the imagination to simulate real-life events. This alternative coping mechanism, long recognized in the clinic, has received little attention. As a result, it is not clear how the brain processes the way imagination affects behavior.

This time, the Mount Sinai researchers exposed 68 participants to threat conditioning, exposing them to two different sounds. One of the sounds resulted in an uncomfortable electric shock.

According to Mt. Sinai, the participants were randomized into three groups. The first group was   directed to “play” tones “in their head” to the best of their ability. The second group were actually exposed to sound stimuli.

The third was directed to imagine two neutral sounds from nature (“birds singing” and “rain falling”) as a control for the general effects of the imagination. The threat memory was then reinstated through four unscheduled shocks, after which all participants were then re-exposed to the sound stimuli.

The researchers found that imagined and real “threats” were equally effective in reducing threat-related responses elicited upon re-exposure to real-world threatening cues, said Dr. Daniela Schiller, the study’s senior author and Professor of Neuroscience and Psychiatry at the Icahn School of Medicine.

The study showed that imagining threat-eliciting cues subdues the same mechanisms as actual threats, achieving the same ability to inhibit and reduce responses to the threat in safe situations.

“Our data indicate that an internal simulation of a real-world experience can alter the way one responds to that situation in the future,” says Dr. Schiller.

In other words, it shows that therapies based on imagination is effective in treating anxiety disorders.

We are not saying that those who fear the dental chair have anxiety disorders. Still, the study provides helpful insights in how to deal with extreme fear of the dental drill./WDJ