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Getting Unconscious Conflict to Work For, Rather than Against, Us: The Therapeutic Effects of Unconscious Exposure

A longstanding clinical conviction is that people with anxiety disorders must directly confront their feared object or situation in order to reduce fear of it. This dogma is the basis of exposure therapy and cognitive-behavioral therapies. Challenging this belief, Dr. Siegel and his collaborators have repeatedly shown that repeated, unconscious exposure to phobic stimuli–what they term very brief exposure (VBE)–reduces avoidance and self-reported fear of a live tarantula in highly spider-phobic persons. VBE is based on both the neuroscience of fear and psychoanalytic theory, specifically Freud’s (1932) proposal that “inside of every phobic, there is a counter-phobic”: phobic people are actually unconsciously conflicted about their fears. Dr. Siegel presents a series of randomized controlled tests (RCTs) of VBE, including RCTs conducted during fMRI scanning and psychophysiological monitoring, which provide a window into the dynamic mechanisms of unconscious exposure. He also presents current and future research directions, which include using VBE to treat combat-related, post-traumatic stress disorder in recent US combat veterans, and to reduce phobia-based, COVID-19 vaccine hesitancy.