On the Other Side of Fear
A Cure for Fear, Topic’s new four-part documentary by filmmaker Lana Wilson, follows Dr. Merel Kindt, a professor of clinical psychology at the University of Amsterdam, who has developed a simple but effective new treatment for people with debilitating fears. Patients travel from all over the world to make a two-session appointment with Dr. Kindt: in the first session, she will trigger their fear and administer a beta-blocker called propranolol; then, in the second encounter, she tests their new reaction. It sounds unlikely, but it works shockingly well for many of Dr. Kindt’s patients.
But what are the long-term effects? Topic caught up with three subjects of the documentary a few months after their treatment in Amsterdam. Among the three participants, none have had relapses into panic; one patient even found herself seeking out her former fears so she could marvel at her own calmness. “My identity still has to change,” she said, “because this fear has been with me for such a long time.”
Arinde Fear of snakes
“The Netherlands is one of the few countries that doesn’t really have a lot of snakes,” says Arinde, an undergraduate student at Leiden University. Nevertheless, the 28-year-old says she’s been afraid of them for as long as she can remember. There isn’t a specific trigger that comes to mind, she says; it could be the fact that they don’t have feet, or that they use their tongues to smell. Once Arinde tried to watch an episode of the wildlife documentary series Planet Earth that featured a snake, but her breathing sped up and she began to panic. Even though it was only on-screen, the presence of the snake felt unbearable.
Over a year ago, when Arinde was studying at her university’s library, she came across a magazine article documenting Dr. Kindt’s work with a person terrified of cockroaches. At the time, Arinde was planning a ten-month trip to Asia and South America—places, she thought, where she would likely encounter snakes. She emailed Dr. Kindt’s assistant to book a session.
“There wasn’t a real way to prepare,” says Arinde. Dr. Kindt told her that sleep was essential in the night before and after the treatment. She shouldn’t have alcohol, nor should she try to face her fear in advance—the first session would provide the necessary trigger, which she’d then counter with the propranolol.
Dr. Kindt arranged for a visit to a reptile house and an encounter with a small python. (The professor actually had to make a trip there herself first—she’s not too fond of snakes either.) With Dr. Kindt’s encouragement, Arinde managed to come within a few feet of the reptile. She took the propranolol. Then she went home, thinking, “This is not gonna work—this is insane!”
The next day, Arinde and Dr. Kindt returned to the reptile house, where everything was set up exactly as before: the same snake, the same handler. But this time, when Arinde entered the room, she says she felt nothing. She wasn’t completely comfortable in the presence of the python, but she felt calm; she even wanted to try holding it, and let the handler wrap it around her wrists.
Today, if Arinde sees a snake, “nothing happens,” she says. The feeling is still unpleasant, she explains, but the memory of the fear is gone. “My brain sometimes still doesn’t understand why I’m not afraid.”
Zane Post-traumatic stress disorder
“I tried everything, from drinking to going to Bali to learn Buddhism to spending time in the woods,” says Zane, a Canadian veteran who served with the German military and was deployed in Afghanistan. But nothing could suppress the nightmarish memories of his time in Kabul, including one particular firefight that he couldn’t seem to shake. A month after he left the military in 2004 and returned home to Toronto, Zane started experiencing flashbacks. He would get sweaty and confused and begin to dissociate from the world around him. He also started to get chest pains, and he was eventually diagnosed with post-traumatic stress disorder.
The success rate for treating PTSD is low across a variety of different therapies, and many of those who enter treatment programs will eventually drop out. “Military traumas are different from other traumas,” says Dr. Kindt in A Cure for Fear. “Soldiers are told to suppress and control their emotions, but for the treatment to work, the patients have to immerse themselves into the fear.” For Zane’s first session, Dr. Kindt used virtual reality to trigger his PTSD, plunging him back into the experience of being caught in a nighttime firefight in Kabul.
A day after administering the propranolol, Dr. Kindt asked Zane to revisit the same confrontation, in the same way he had the previous day. He described it calmly: “Yesterday I had the sensation of my equipment, the smells, the sounds. Whereas today … it was more of a boom, and then it was gone. It wasn’t crushing me.”
Three months after the treatment, Zane’s nightmares haven’t returned. Zane doesn’t feel like his PTSD is cured, though. He says his experiences of war still come back to him regularly, but his physical response to those memories is lessened; he no longer sweats, gets anxious, or feels hypervigilant. “Everyone else is trying to cure PTSD—it’s like, no, cure the emotional response,” Zane says. “That’s what Dr. Kindt seems to have been able to do.”
Samuel Fear of spiders
“You would be surprised the places spiders can hide, even in Manhattan,” says Samuel, who works in finance in New York City. Samuel says that before meeting Dr. Kindt, he had tried to cure his fear of spiders via six months of exposure therapy; it wasn’t successful, he says, because he didn’t feel like his doctor understood his phobia, and he found it hard to be a compliant patient.
After Samuel read a 2016 opinion piece in the New York Times about Dr. Kindt’s research, he decided that he wanted in. “I think when you have a fear that bad, you’ll do just about anything to get over it,” the 35-year-old says. In November 2017, he booked a flight to Amsterdam. On the first day of his session with Dr. Kindt, he tried not to think about what was ahead. In preparation, Dr. Kindt had positioned a tarantula in a small glass cage in the center of a table in a closed room.
Samuel began to hyperventilate when he saw the spider, and his sense of panic quickly spiked. Dr. Kindt then gave Samuel the propranolol, and for the rest of the afternoon he distracted himself by walking around Amsterdam, visiting museums and taking photos. The next morning, he woke up feeling less apprehensive. “I was hopeful that it worked, and it worked well,” he said.
When he entered the room again the next day, he says, he found it hard to describe what he was feeling. The entire experience felt alien; he didn’t like it, but he also didn’t dislike it. He even agreed to touch the tarantula.
“It’s just a completely different way of living, not having this fear,” Samuel says. “I saw a spider the other day in my car, and I was fine with it. I brushed it away with my hand.”
Dr. Merel Kindt Professor of clinical psychology
When phobic or traumatized patients book a session with Dr. Kindt, they are led into a room that contains whatever they fear most—which could be anything from a tarantula to a mouse—and, as gently as possible, the professor pushes them to their limits.
The patients need to become fully immersed in the experience of their own fear because if they don’t, Dr. Kindt’s technique may not work. In a 2008 study, the doctor and her researchers were surprised to find that when 60 undergraduate students who had been conditioned to fear spiders first encountered one and then took the beta-blocker propranolol—generally used to treat high blood pressure—they would later exhibit almost no symptoms of fear when facing a spider again. Dr. Kindt found she was able to replicate the results of that study again and again; nearly 80 percent of the time, the fear wouldn’t return. Direct exposure to the feared object was essential, as a memory needs to be triggered in order for the pill to work, so that bad associations can be replaced with neutral ones.
As she recounts in A Cure for Fear, Dr. Kindt once tried this treatment on herself, when her daughter had to go through a difficult surgery to correct a minor deformity in her leg. But looking back, she says she’s not sure she would do it again; perhaps there was some feeling that day she missed—some color of memory that was blunted—that she will never be able to retrieve. “I don’t think that we should try to neutralize all our negative or difficult emotions from life,” she says. “They are part of our lives.”