The Aspiring Psychologist Podcast - Ghosting, Phobias & Anxiety? The Psychology of Extinction Learning

Starting point is 00:00:00 I think I'm a pretty good judge of character and I love sharing tips and tricks with people which genuinely help them to run their clinical practices more efficiently. This episode is supported by WriteUp and they're a brand I've been using in my own clinical practice for over six years. I really do genuinely rate them and use the Write Up platform for each and every clinic session I book or conduct. That's why I'm so happy to be working with them. In case you don't know already, Write Up isn't all in one practice. management platform built in the UK for UK clinicians. So that's your diary, your client records, your notes, your invoicing, your secure messaging, all in one place, all GDPR compliant,

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Starting point is 00:01:30 What's not to like. Now on with the show. Why do some fears disappear whilst others seem to live in the body and the mind forever? Why can one bad experience shape someone for years? And why do humans keep expecting the worst even when things are actually okay? Today Dr Martin Quigley and I unpack the fascinating psychology behind extinction learning, phobia's anxiety, habits and how our brains learn safety. And if you've ever been ghosted, stick around to find out what that's all about too.

Starting point is 00:02:05 Hope you find it really useful. Welcome along to psychology. Actually, I'm Dr. Marianne Trent. I'm a qualified clinical psychologist. And today I'm joined by Dr. Martin Quigley. Welcome along, Martin. Hello, good morning, everybody. Thank you so much for being here.

Starting point is 00:02:26 Could you tell us, in a nutshell, what your job is and what you do? Certainly. So I'm a senior lecturer in the School of Psychology at Swansea University. I've worked there for the last six or seven years now. And my day-to-day job involves teaching and researching all things related to psychology. I primarily teach on undergraduate programs at the moment, teaching things like research methods and statistics, introduction to clinical psychology, individual differences, which involves things like personality, intelligence, and learning, psychopathology. conditioning and gambling harm. So wide variety of different topics there and I also

Starting point is 00:03:07 research in all those areas as well. Very wide variety and it's bringing back lovely memories of some of my undergrad content. So yeah, thank you for that. So we're getting together today to think about something called extinction learning. Could you help us understand kind of what that is? Certainly. So I guess there's two parts to understanding this concept, which is a really basic and fundamental aspect of psychology. If we think about the term learning, we may often think about classroom contacts with young children, being taught in school environments, or we may be thinking about people acquiring a certain skill, something like they may be

Starting point is 00:03:48 learning to swim in later life or learning a musical instrument or language. When we're talking about learning in psychological terms, what we're talking about is a relatively permanent change in behaviour based on some experience that you've had. So that's the phenomena that we're referring to when we're talking about learning within psychology. When we're talking about extinction learning, we are referring here to this process of reducing a learned response to something or replacing an association that's being formed there. And it's a really powerful concept that we experience all the time in our day-to-day lives. and I'll give a few examples that I often refer to my students to help them try and understand this,

Starting point is 00:04:35 which usually resonate quite well with a relatively young population. I'll often refer to something like a WhatsApp conversation, where two individuals may have gone out, they may have met, they may have gone on a date, and one of them sends a message to the other, and the others perhaps hasn't been sort of feeling this date, and they produce no response. They ignore it, right? I'm sure everybody's had that response,

Starting point is 00:05:01 whether it's on a date or a friend or a colleague. And what happens is the individual who sort of prompted this communication, may send them another message, and they don't get a response again. That is effectively extinction, right? There's no outcome. There's no response there. And what you're doing is you're effectively training the individual

Starting point is 00:05:21 to stop sending you messages, right? If you don't want someone to email, tell you if you stop responding, that's a very effective example of extinction learning. That's a very sort of simple example in our day-to-day life, but it obviously can expand a lot of different scenarios. And I think we're going to talk a little bit today about some clinical examples as well where that could be relevant. Oh, Martin, that's really made me cackle. Oh, my eyes feel all watery. Like what we've done is we've got a psychological term for ghosts. That's what happens when someone ghost you.

Starting point is 00:05:59 That's precisely right. Yeah. It's extinction learning. I have to say whenever I was dating, I wasn't a ghoster, but I did used to go on date sometimes and maybe tell someone to their face. Yeah, this is great. We should definitely do this again if they asked. And then get home and be like, sorry, I just wasn't feeling it

Starting point is 00:06:15 because it is uncomfortable, but I would always reply. But yeah, when someone's ghosting you, I guess there can be a variety of reasons, but, you know, training someone to not bother me again, again is a very lovely idea. I think my husband would quite like to think about extinction learning for me when it comes to the corner of the work surface in the kitchen where I tend to open my post and maybe leave it and then the whole table where we come in where I will put my bottles and anything I happen to be carrying at the time when I come through the door. How can we how can we begin to change habits that maybe annoy us a little bit as well, but annoy other people?

Starting point is 00:06:58 Can we use Extinction Learning for that? Yeah, so the key premise behind Extinction Learning, if we think about it as like breaking an association that already exists, right? It's the removal of an outcome. It's the removal of some form of reinforcement. month. So as I indicated there that in the, I like your, yeah, it's effectively ghosting, right, where you're not providing a response there. It could be that you have a, you can apply this to any organism, right, to children, to animals. It could be that you have a child who's seeking attention and they know if they go to a certain area of the room where they're not supposed to go,

Starting point is 00:07:38 that you're going to respond, right? You're going to stand up. You're going to go over. You're going to guard the area. If you keep on doing that, you're going to, you're going to are effectively reinforcing that behaviour. If you remove the response, obviously you have to do this in a safe environment, you can't let them sort of wander off into danger. But if you remove that response, that is extinction. And all organisms are effectively good at realising this change in their environment, this change in behaviour and the change in contingencies there. So that simple removal of a response, a reinforcer and outcome is incredibly effective. And I would argue we see that all the time in the environment around us. And it's just understanding where extinction's happening and how it can be

Starting point is 00:08:19 used powerfully and how it can really influence our own behaviour. I'm acutely aware of how I'm using extinction in my day-to-day life, not just as a researcher, but as an individual who's thinking, right, do I want to reinforce this? Do I want to encourage this? Do I want to prompt a response? Yeah. Those sorts of questions are ever present on my mind. Yeah, I wonder if you can kind of apply this extinction learning to sibling birth order and how parenting changes as well, because that definitely made me think about when I had just one child, if he'd been crawling over to the curtains and, you know, jangling them and, you know, wobbling them. I'm not, no, darling, we don't do that.

Starting point is 00:09:01 You know, I'd been redirecting and giving him attention. Second time around, probably so tired, and just wanted a break, I'd probably have a little bit of an assessment and be like, hmm, it's fine. Not going to kill himself, he's just playing in the curtains. So have I extinguished my own response there? Is that what I've done? Possibly.

Starting point is 00:09:24 There's also another related to, we like lots of technical terms within our learning theory and conditioning, which is my sort of area of expertise and where I did my PhD. There's possibly other explanations which sound very similar. and on the surface they are, they're quite subtle in their difference, which is habituation. And habituation sounds technical, but it's simply the fact that repeated exposures to something have a sort of a diminishing effect on our behaviour. So a classic example, and again, these are things that I'm certainly aware of all the time around me. You may have had experience of living

Starting point is 00:10:00 in a flat or an environment where there's a noisy neighbour in the first couple of days, you know, you're really startled by this. You can hear every foot. step and you're almost like heightened arousal as a response to it and then a couple of weeks or months later you just start to drown that out right that just become you habituate to it is the technical term it's that reduced response um that's occurring uh in your environment and i think of that often when i've had friends for instance when i lived in a flat where i did have noisy neighbors above me who would come and stay over with me and they'd be really like what's going on up there and i'd be like oh yeah that's that's my neighbour. You know, that's just how loud they are. But to them, it's really startling.

Starting point is 00:10:40 To me, living there for months on end, I've just habituated to that. And that's possibly what's also happening there when you were talking about that response when you're like, they're okay. Yeah, that's happened before. There's no negative. You just, you're sort of adapting to that. Yeah, that makes total sense. And that really reminded me, you know, if you go into someone's house and they live quite near a train line and you hear a, Oh, and you're like, oh, wow, train. I didn't even hear it. And you're like, wow, because they've habituated to that and they've stopped hearing it.

Starting point is 00:11:14 It makes me think of an old neighbor I used to have. And we lived in a terraced row. And one of the neighbors got a husky dog who used to like to howl a lot. And the walls were quite thin because it was a new build. I just couldn't habituate to that. And one of the reasons that we kind of wanted to. move ultimately. So there's some things that we can habituate to and others that are always going to be trickier, I would guess. Yeah. Yeah, there's massive individual differences. So I would

Starting point is 00:11:48 argue extinction as a phenomena, habituation the same is generally applicable to organisms, to animals and humans, but everybody has different thresholds, right? So like people's sensitivity to extinction learning or to habituate into things. things is going to vary. Not everybody's going to have the same response. And people are going to have different, what's salient to someone, so what stands out in their environment is going to be different to people. Some people may be particularly sensitive to an auditory sound. So it may be the sound of the train or the dog, whatever it may be, whereas some people say, that doesn't bother me, but there's a little red light in the corner,

Starting point is 00:12:26 which is really irritating me. You know, well, I've certainly been this person myself, with suddenly, for some reason, the ticking of a clock becomes like the lounder. loudest sound in the world and I've literally had to take the batteries out of the clock. Now, you know, I've heard that ticking of a clock a long time, but for whatever reason at that particular moment in time, that becomes particularly salient to me. So everybody has different thresholds there. Oh, it's making me realise my thresholds where everything are quite low. I've definitely been in Airbnb's and I had to take clocks off walls and move them. And then if my husband's charging a toothbrush and it's flashing, I'm like, I can see it. He's like, you've got an eye

Starting point is 00:13:05 I can still see it. So yeah, maybe I need to work on my tolerance. So if he was wanting me to not put things on the hall table, part of my argument is that's what a table is for. But we could maybe use some pattern interruption to get me to think more before I do that. Would that be kind of like an errorless learning type thing? Or is that a completely different concept that I've just one in there, Martin. Yeah. Yeah, there are two different things. This is, um, airless learning and extinction learning. So in errorless learning, we're trying to introduce some form of sort of mastery and guidance and a prompt, which could be very effective for the reason that you're saying. If, if, if this was someone, it's typically used in populations, perhaps in rehabilitation for people who

Starting point is 00:13:52 who've had some neuropsychiatric issue. So in that particular instance, it would be trying to, what whilst the skill of all the behaviours being learned, is trying to prevent any errors from creeping in. So that one, they sort of gain an efficient mastery of the skill quickly without any potential interference. Two, from like an efficiency perspective of sometimes when people do learn errors or even if it's unnecessary behaviors, it may not be that they're doing something wrong, but it's just inefficient.

Starting point is 00:14:21 It's not a necessary thing to do. That can cognitively be a competing demand, which can place sort of an additional stress. And if you're thinking about populations, perhaps, where they may not have the capacity for that. If they've had some issue like a stroke or they have some sort of behavioral issues where they're particularly sensitive to things,

Starting point is 00:14:43 it's a sort of a fast and efficient way to doing that. Extinction learning is different in the sense that is purely focusing on almost how to break or an association that's been formed or sort of reduce a response there. But there are certainly other behavioral phenomena that could be applied or behavioral techniques to reduce that behavior that you've referred to there if you were leaving something where your husband didn't want you to. So that's where perhaps

Starting point is 00:15:12 things like reinforcement would be particularly relevant or things like positive punishment, negative punishment, that those techniques could be more applicable there. So it could be the case that, you know, if he wanted you to do that, perhaps he provides you with some reinforcement, positive reinforcement by giving some sort of reward or incentive or if he wanted that to stop he could try and sort of introduce some what these sound like very technical terms here when we're thinking about this in behavioral terminology but it could be that there's some sort of aversive outcome to that that if you do that the you know the meal doesn't get cooked tonight or whatever that may be right which sounds very autocratic there but that that's sort of like the basic terminology that is used

Starting point is 00:15:59 to try and sort of explain how we can reinforce or remove people's behaviours. I see. So it's those power games, isn't it? If you keep leaving your water bottle there, I'm going to put it in the bin, and then you'll learn because you won't have a water bottle. But what I would prefer, now I'm speaking to you, is like, well, every day that I don't leave anything on the hall table, how about I have a five-minute massage? Because that will be my reward. And then over time, I won't need the reward. So is that like a little bit of a little bit of, bit of, I can't remember the order. Is it operant conditioning? Classical conditioning? What would it be? Would it be classical if I didn't need the reward anymore? Yeah. Yeah. Well, so operant conditioning is

Starting point is 00:16:41 what you're going to do, where there's some form of reinforcement. Classical conditioning is a simple pairing of events. So that's when two events appear together regardless of your behaviour. So for instance, the classic example is which also psychology seems we'll be familiar with is from Ivan Pavlov, a Russian physiologist who won a Nobel Prize for his work. And in that particular instance, he was looking at the salivation responses of canines, dogs to food. And what he noted is that whenever there was an auditory cues, who commonly is referred to as a bell or it could be a metronome, which signal that the food would be delivered, the dog started to salivate in response to it. So they had learned an association that there's an auditory cue, there's a sound in my

Starting point is 00:17:28 environment that predicts the delivery of food. And that wasn't contingent on anything they did. That was going to happen anyway, but they started to salivate as soon as they heard the sound, right? That's classical conditioning, two events which appeared together. Operant conditioning is where there's some consequence as a result of your behaviour. So that would be, if we were to try and take that example I've just provided there with Power Plov and the dogs, that would be that the food would only be rewarded if they did something, right? So perhaps they were trained to sit on command or to raise their paw and sort of high-five the experiment, whatever it may be, that would sort of be a form of operant conditioning.

Starting point is 00:18:07 So going back to your example there, which you raised, if you didn't want something left in a certain area of the house, for instance. and you said you kind of like the idea of positive reinforcement. That would be, and it doesn't need to be tangible, right? Not all of these things, like the degree of positive reinforcement that is provided is, you know, that's dependent upon the individual and the resources they have available. It could simply be praise. It could be, thank you so much for doing that. It really helped.

Starting point is 00:18:38 I didn't have the need to speed around and clean things up from that area today. It really helped me able to get to work earlier, which meant that I could get back early and we could spend more time together. Whatever that may be, it doesn't. Or it could be, you know, thank you for doing that. I want to pick something up for you as a little treat on the way back. What would you like, right? And that could be the process.

Starting point is 00:18:58 I love that idea. I'm all about the praise, all about the positive. So yeah, it could just be when you spot something that hasn't happened that usually would, that you'll actually thank you. I noticed that the whole table was clear today. And I really loved it because it helped me do a bit of a deep. exhale and like, oh, okay, good. I'm not having to moan about that today. Yeah, I think I can definitely think about, yeah, like praising and reinforcing some stuff around my parenting as well,

Starting point is 00:19:26 because it can be so easy to trip into just moaning at people, can't it? And we forget to say thank you or forget to notice the absence of certain behaviours or the presence or of other more pro-social behaviours. I'd argue as well that it's something that I've sort of become acutely aware of is, and I think most people I spoke to agree to us, when a job's done well often, we sort of, there's little praise in in many instances because we go, well, that worked as it should. And when something doesn't go right, we're very sort of alert to that. Like you can teach 400 people a year and 399 can be like, that's great, I enjoyed that.

Starting point is 00:20:11 And you may hear from one or two of those 399 people who said, Thank you. That was really useful. I learned a lot. Now, there may be one person who hated it for whatever reason. They didn't like the style. They didn't like the delivery. They didn't get what they thought they were going to get. And you can guarantee you'll be hearing from them, right, to say, I'm not happy with this process. And so I always try and think of, I like to provide that positive reinforcement to the things that I see. So if I sort of have a pleasant meal and a lovely, you know, the service around that, I'll say thank you. I really enjoyed that. That was a lovely meal and I appreciate that.

Starting point is 00:20:47 If I go to a bank and I have to talk to someone and they help me and it's not, you have to ring this call line and come back in 14 days and fill out seven forms. I'll say, thank you. That was really efficient. I appreciate that. Is there any positive feedback I can provide? So I'm very much someone who seeks to provide that positive reinforcement in the world around me to try and sort of encourage the things that I think are doing well.

Starting point is 00:21:09 And then likewise, if things aren't, you know, of course you got to feed that back appropriately. But I think there's often a skew towards when things work well, that's what should have happened. When things didn't, that's where people become sort of alert and potentially a bit more vocal about things. Absolutely. And of course, as humans, we've got this negative attribution by us, haven't we? And that's there to save our life, really, because it makes sense to pay attention to the stuff that is maybe a risk or, you know, is kind of a bit erroneous than what we're expecting. but that doesn't always lead to us having, you know, a sedate, calm, happy experience. I love the idea of actually, yeah, praise it.

Starting point is 00:21:49 I do that as well. Makes me think of when I was in Prett-M-J in Bath. And I met the loveliest, loveliest woman there who worked there. And I have to say, I use Pratt a lot, but I don't use it for their cheery, you know, banter. I generally find it's quite officious, you know. there's not much two-way repartee. This lady was lovely. She deserves an award. And so I thanked her. I told her that she'd been my favourite pre-staff ever. And then I sent something into head office as well because it matters, doesn't it? It really does matter. You know, when we're doing

Starting point is 00:22:26 something well, that should be recognised as well. 100%. And it's those little things which can have a huge impact. And it can not that this is the intention for doing this, but it can be sort of reciprocally beneficial. I've certainly done that with people where I've been impressed and sort of raise the fact that I would like to provide some positive feedback to staff, line managers, whoever it may be. And then indirectly, that's come around to sort of benefit myself where someone will reach out to me on LinkedIn and say, thank you so much for that. I didn't realize you did that. That was so helpful. If there's anything I can ever do for you. And then you've sort of got a connection there. And it's not done in that sort of cynical way. It's just trying to encourage the things that

Starting point is 00:23:07 being done well around you, but I think it can also sort of come back in a positive light sometimes as well, where that has a nice feel for both of you, where you get sort of a friend or a connection out of that as well. So that may also be applicable to people with certain autistic traits or behaviours as well. Yeah. And that said, if people want to offer us any positive feedback for this episode, we would love to hear it. You can tag us both on socials. Dr. Martin Quigley is on LinkedIn. I'm Dr. Marianne Trent everywhere. I genuinely love it. When people tag me in their stories, they say, I'm listening to this. I really love it. Sharing it with their audience. And also on LinkedIn, you can leave someone a recommendation, can't you. If you really value them, you've worked with them, you've worked under them, you've worked above them, you've worked alongside them and you want to endorse them, you can do that. So people don't always know that about LinkedIn. Okay, so before we hit record, I was telling you that when I was in sixth form, people used to chase me around with horrible, scratchy sponge.

Starting point is 00:24:07 because I'm not a fan of sponges. But obviously when it comes to phobias, that is a fairly low level and it doesn't really impact on my life. But phobias can really ruin people's lives, can't they? And I understand that extinction learning can help with that. Yeah. So, yeah, just to provide some context to what we mean when we refer to a phobia, because often people ask me, do I have a phobia? Or is this a phobia? I don't like this thing.

Starting point is 00:24:37 What is the sort of definitional criteria? So the most common clinical definition of the phobia is an irrational fear of an objectively harmless stimulus or situation. So by irrational here, we mean something which isn't quite logical given the information that we know. So if somebody has a fear of heights, but they're in an incredibly dangerous situation where they could fall, we would say, well, that is a logical, rational fear, right? They're in a dangerous situation. But if they're an entirely safe situation, there have been any instances or accidents and they

Starting point is 00:25:14 have no fear, but they have a fear of heights, we may say that this is irrational, an irrational fear. And simple or specific phobias are very common. So these are phobias of things. So it could be spiders, snakes, or situations, things like heights, being on a plane. And they are very, very, very common type of anxiety disorders. So a phobia is classed as an anxiety disorder and they're very popular in most populations. Estimates typically range them between about 7 to 15% of the population may experience a simple or specific phobia in their lifetime. And the sort of predominant view of how, or certainly one of them, as to how phobia's form is through this process of learning and conditioning. So the classic example, which is referred to within pretty much all psychology

Starting point is 00:26:04 textbooks is referred to as Little Albert or Baby Albert. And this was a study conducted by two researchers over 100 years ago now in 1920 by researchers Watson and Rainer. And in this particular example, what they claim to have demonstrated is how they could, in essence, condition someone to have a phobia. So to teach someone a phobia, which is obviously something which is highly ethical to do, but this was a quite a long time ago when a lot of these studies took place. And in their famous example, what they did was they showed a young baby named Albert, who was approximately one years old, a white rat. And whilst the white rat was being presented, they created a loud noise behind the baby's head. So they struck two metal bars together. And that

Starting point is 00:26:53 was evidence of a conditioned fear being respond, being conditioned there. So this would happen. repeatedly, so over a number of different trials, and this would essentially result in an association be informed that when this rat is present, there's a really unpleasant or aversive thing that happens, a loud noise which couldn't be explained. That research has been a sort of foundation for lots of the models and theories that have developed since in order to try and treat phobias and provide effective therapeutic interventions, and extinction learning is absolutely critical to that. trying to be achieved in extinction learning is to remove or replace that association that's been formed, that the rat suddenly symbolizes something which is aversive in the environment.

Starting point is 00:27:41 And for the large part of the history of the field, there was almost an assumption that extinction learning could erase or effectively delete that association. And what extinction learning would involve in this particular context would be presenting the, um, the, the feared object or in this case, animal, which would be a rat, and ensuring that there was no negative or aversive outcome. So there'd be no loud noise or nothing upsetting, which happens. And the idea in extinction learning is, if you present the person with this feared thing over and over again,

Starting point is 00:28:17 with no aversive outcome being delivered, this would effectively, the idea was historically that this would effectively sort of remove that association or rub it out. But we know that's not the case now. And this is something that is well established within the empirical literature. We know that extinction is not an erasure of that association. It's not the removal of that association. And we know that thanks to a few different types of studies that have been conducted

Starting point is 00:28:48 and a few different types of phenomena that's been reported. One of those is simply referred to a spontaneous recovery. So another technical term, but it's a very simple process. And what that simply means is if you condition someone through extinction learning to expect that now when they're presented with the thing that they feared the rat, that no negative outcome will appear, you can see effective extinction. So the organism may start to be very calm and they may not to show that fear. However, you may try and test that again in hours, days, weeks, months later and suddenly that fear response reemergence. And that's a particular concern for us because we want people to not relapse. We want people to not fall back into these patterns and to learn to show these associations that they've previously.

Starting point is 00:29:40 So the question of interest for us there is what's actually happening? Why is that happening? What is Extinction learning doing what we originally thought, which was sort of erasing that association? And the answer is that it is not erasing the association. what instead is happening, and we know this thanks to brilliant academics like Professor Mark Boughton, who's done lots of work on this and developed lots of theories, has demonstrated that what is effectively happening is a new type of learning, referred to as inhibitory learning, where they're learning that the outcome does not happen,

Starting point is 00:30:18 the thing that they're expecting, in certain circumstances. And what we think is happening there is that it's dependent upon the context that they find themselves in. And the factors that influence whether or not what is a context can be a source of debate there. But I think I can give a really nice example, which highlights this. Let's place this in a clinician's office.

Starting point is 00:30:42 Let's imagine we have an individual who has had some traumatic experience with the dog. And maybe that they themselves were bit or attacked by a dog where they witnessed a loved one or friend or family member be attacked by a dog. Now, they have this association that the dog is dangerous and that the dog can be a source of anxiety for them. A clinician may be successfully able to reduce their fear to the dog by gradually exposing them to dogs in safe environments such as the clinician's office. And they may therefore learn, okay, I do not need to be afraid of dogs when I'm in the clinician's office.

Starting point is 00:31:21 The problem is what happens when they leave the clinician's office. that's where the fear may reemerge. And here we can see a perfect example. This is referred to as context renewal of what Mark Bouten's research has demonstrated, that the original association has not been erased or removed. It's still there. It's just been replaced or we've tried to replace it

Starting point is 00:31:46 and written over it with a new set of associations, which is a form of inhibitory learning. The problem is when they leave that environment, that old association is still there. It's still sort of dormant in the mind. So when they go to a new environment, they now may walk back from the clinician's office through the park and be very apprehensive of the dogs. What they've effectively learnt is not dogs do not equal danger. What they've learned is dogs do not equal danger in the clinician's office. So the task of the clinician and the researcher is to try and find ways to generalize to make that new form of learning

Starting point is 00:32:22 as applicable as possible to lots of different environments. And there's been lots of work which has been done now to try and examine ways in which we can do that most effectively. Really fascinating stuff. But of course, you can only really work with someone on a phobia if they want to have a change, if they want that to be different. So my husband is not a fan of spiders. And many a time I have said, come on, you know, we'll get rid of it.

Starting point is 00:32:49 Like, we'll do some work, we'll do this. Nope, not interested. And I guess I would want to think with you about, you know, I don't love the idea of flooding to help people to overcome phobias. And I would love your thoughts on kind of treatment for phobias, Martin. That's a great point. Yeah, you're 100% right. You can't treat someone if they don't want to receive the treatment.

Starting point is 00:33:14 And it's particularly awkward. Exposure therapy is generally considered to be the most effective intervention for phobias. It's probably one of the best treatments we have for certain conditions. The issue, like you say, is with exposure therapy, you have to go and realize that effectively you are going to end up having to be exposed to the thing that you're afraid of. There's no two ways around it, right? So you have to be willing to accept that. Flooding is a sort of extreme form of exposure where the individual is confronted with the thing that they're afraid of immediately and rapidly.

Starting point is 00:33:52 So that could be, for instance, that someone who's afraid of snakes, so phobia, phytophobia, would literally be presented with a snake, which would obviously be very stressful for them. And there are ethical issues around that as well in terms of how do they respond? What type of response does that produce in them? They may have a panic attack. They may have some sort of physical unpleasant response to that, which you need to be concerned about. So flooding is not widely used.

Starting point is 00:34:21 What is typically employed in sort of the most robust empirical evidence points towards a form of therapy referred to a systematic desensitization. And this is a form of therapy where the individual has very gradual exposure to the thing that they're afraid of over weeks or months. And they will effectively establish what is referred to as a hierarchy of fear. So it may be that they simply start off with saying they don't like the name of the thing that they're afraid of. So often people say, I don't even like the word spider or tranchler. That just sounds so unpleasant to me, right? So the first stage would literally be getting them to talk about what that is, why that is, and getting them used to the term. So maybe just getting used to seeing the term written down, getting used to saying the term.

Starting point is 00:35:12 That would literally be stage one of the process, right, with a training. clinician who's going to talk about that with them. The next step may be looking at a picture. It may be looking at a cartoon picture, right? It may be something which is a bit more comical and then starting to sort of gradually get used to seeing pictures of real spiders or watching videos. Then it could be watching someone interact with a spider, but doing so from a safe environment. Then it could be being in the same room or watching one through a glass tank. And then that process can gradually build up all the way to where, of course, they will have to want to do this, but where they may be able to hold one within their hand. And that would be an incredibly successful outcome if they can do that and remain calm and feel comfortable with that.

Starting point is 00:36:00 The question of interest that clinicians and researchers are interested in is how long can we maintain that behavior? Is there a relapse issue? I mean, lots of studies will look at things like post-test follow-up. So if they come back and check whether they're still comfortable six months time, a year's time, two years time, ten years time, like how permanent is that behavior? And that's what we're most interested in. Like I say, the empirical evidence is pretty strong. There is obviously relapse issues there, which are going to occur. But we do have a pretty good base to build on with the scientific evidence about things like systematic desensitization.

Starting point is 00:36:39 And just very quickly, we talked about this very briefly. at the start of it. There's now new approaches to rolling out some of these therapies as well, which involve technology like virtual reality headsets. So it can be difficult to get access to certain things that people are afraid of, and it can be difficult to create controlled environments where they're safe. But there are some packages where people will have access to an app. I've worked with a brilliant team, Emmercify, who are based at Swansea University, to develop one for arachnophobia, where the participant or the patient

Starting point is 00:37:16 would have a virtual reality headset on. And within this environment, they'd first be exposed to the thing that we're afraid of. Say it was a spider on the table. Then they could walk up to the table. Then they could remove the thing in the particular app that we created the final stage was that they could actually pick it up with a cup

Starting point is 00:37:34 and using the handset or to hit it with a paper, which was resting unstable. So there's all sorts of cool new technologies which can allow interesting ways to interact with some of those things in a scalable way, which doesn't require that sort of one-to-one of a patient going through everything in a room together. Yeah, really good. It does sound like fascinating stuff and it's kind of making me remember kind of shark phobia. And obviously, for the most part, if you don't live near the sea or you don't regularly go in the sea, that's probably not so much of an issue. But actually sometimes people are so scared of sharks. I mean, my kids were watching Jaws this morning. I came downstairs and they were watching Jaws like, oh, nothing like

Starting point is 00:38:19 watching Jaws at 6.30 in the morning. So I don't think they have shark phobia. But some people will really struggle to sit on a sofa and have their feet on the floor because it makes them feel vulnerable and it's that shark feeling. And similarly, sharks do crop up everywhere, don't they? They might be on greetings cards or you know you might suddenly see one on a poster or a train station or you know you might be on a on a tube and there might be now someone's reading the National Geographic and there's a picture of a shark so even things that you think are not actually super common in people's lives if it is impacting on them clinically impacting on their sleep reducing their well-being that is to something they might want to engage with so that they

Starting point is 00:39:03 can just feel calmer and happier and less, you know, more in control, less disturbed. And I guess the VR would work really well for that because we don't generally get up and close and personal with sharks. There's actually a study on that precise, with shark phobias. And there's only one that I'm aware of. I'm sure there may be more. But there's one where, and it was a very small sample. I'm not even sure if it was a case study. So it was one participant who took part in it. But where they developed a program which precisely addressed that where they could literally see the shark then you know be in that environment there's there's always that difficulty and we were talking about that in terms of that balance of like irrational and rational fears because obviously things like sharks

Starting point is 00:39:46 are can be dangerous things like spites can be dangerous it's just proportionally how much of an impact and how much danger are they having on your day to day life and the answer is probably very slim. But if you're living a life where you are sort of constantly aware and alert and conscious and its impact in your day-to-day activities, that is a problem. If you're somebody who enters a room and you're wondering where the spiders may be and there's no sign of any spider and you've not seen a spider and it's not spider, you know, that's probably having an impact on your life. if you're somebody who's worried about going to an outing in case they've got some sort of, you know, zoo where it's going to be a spider or something like that,

Starting point is 00:40:32 and you don't want to walk around it and you're thinking, I may not want to go out to that. That's impacting on your life. If you're not sleeping well because you're worried that there may be a spy behind the headboard, that's exactly what you said. That's causing psychological distress. That's disrupting your sleep, your well-being, your ability to socialize with people. So it has like wide range in impact, even with things that like you say may not appear obvious to people.

Starting point is 00:40:57 Spider-snakes heights are typically the three most common, but it's not unique to those things. People have focus or all sorts of things like you've addressed. Amazing. That's fascinating stuff. And thinking then about the kind of positive feedback and positive appraisal, is there any way we might be doing ourselves a disservice when we maybe haven't been worried about things and then we just, you know, brush it off at a later days. Yeah, so there's a key theory which is developed by Michelle Crask, who's in states in UCLA, I believe, and she's done some work looking at how extinction learning can be sort of generalized more broadly. So if we think that things aren't being erased or things aren't being deleted

Starting point is 00:41:46 and says, how can we make sure that that generalise, as much as possible. And one way to do this is to reflect on instances where we may, the technical term is experience expectancy violation. So we expect something bad to happen. We may be worried about some outcome. We may have some fear, but it doesn't happen. Now, the key there is to actually reflect on the fact that, okay, the adverse thing that I thought was going to happen didn't happen. What we may often do is simply sort of write that off and go, okay, well, today went well, but God knows what's going to happen tomorrow, right? And it's about reflecting on that expectancy.

Starting point is 00:42:23 Like, well, you thought that was going to be a bad thing yesterday. And nothing happened. It all went well. That concern that you had about that awkward meeting with that colleague, it didn't happen. That concern that you had that, whether it's in a clinical context, that the dog was going to bark, the spider was going to bite, that didn't happen. So it's trying to reflect on those instances and really recognize them to try and update. the information that we have there and to get a more realistic assessment of things to some extent that, okay, things are okay, they're not always going to work out negatively for me.

Starting point is 00:42:57 I can have some, you know, positivity of this and realize the reality of what's going on. So I think that's really important and that's been identified as one of the strategies, which was really effective in treating phobias, that realization that the bad thing that I thought was going to happen didn't happen and really sort of, you know, recognizing that point. Sounds that we can use this as a strategy for retraining people who have, shall we say, as a glass is half empty approach, you know, every time they put a letter in a postbox, they're like, it's going to get lost because it always gets lost.

Starting point is 00:43:32 It's like actually, well, when that letter arrives, we need to notice that and we need to kind of retrain and re-experience that because we can't just pay attention to the awful stuff. If that doesn't happen, we should we should celebrate. celebrate that and notice it. Yeah. It's like you say about that positive praise point, which we mentioned earlier, it's recognising when things go right

Starting point is 00:43:56 and accepting that and realizing that, well, often it's when we focus on the things that go wrong or the bad things or the adverse of things that happen, but recognising when things go right, like you may have a fear of a lift and you may have got in a lift and it's not worked. You may have got in a lift 99 other times and it's worked all of those times, right?

Starting point is 00:44:15 So it's like recognizing that. My good friend Kara wouldn't let me finish this episode without me sharing with our audience about the time that I did the most psychologist type complaint ever. So it was when we were all aspiring psychologists and we'd all gone out probably as a group of about 20 assistant psychologists when we were working at St Andrews in Northampton. And I'd ordered the mushroom risotto and I am a risotto fan. I can cook it, I like it, and I will regularly choose it on menus. And afterwards, it hadn't been nice. I think I'd asked for some extra salt or some other stuff. And then at the end of the meal, I asked if I could see someone from the kitchen team.

Starting point is 00:45:03 And I said, I'll just want to give you a little bit of feedback on the risotto. I really think that you could benefit from reformulating the rest of it. be. My friend Kara still howls with laughter that I suggested the word reformulation, which of course is at the essence of psychology, isn't it? A lovely constructive wording as well there. I hope they appreciated that. That was probably one of the more sort of generous comments that they received in it as a form of a complaint. I think so. Very measured. Very measured. Very measured indeed. Dr. Martin Cruegley, it's been an absolute pleasure to speak with you.

Starting point is 00:45:49 I could have spoken to you all day, every day. If there's future episodes, people might find helpful, kind of speaking with you about, you know, one idea I've got is whether kind of having a little look at kind of undergrad psychology curriculum and what someone might learn and how that might show up in our everyday lives, because I think it's said that basically everything we do in psychology is kind of an expansion of a theory we learn in those early stages. of A level and undergrad. But yeah, if anyone's got any ideas or things they'd like us to expand on,

Starting point is 00:46:20 please do let us know in the comments or ask us a question, reach out to us on social media. Where can people learn more about you and your work, Martin? So, yeah, thank you. If you simply Google Martin Quigley, I'm usually the first result. My university page is there. My LinkedIn will come up my Google Scholar profile, which will have all my research on my personal website as well, I update that with all of my research, my teaching activities, any news that I'm, any talks I'm

Starting point is 00:46:50 giving anywhere. So yeah, I should be. I'm lucky. I think the spelling of my name with a Welsh spelling of Martin with the Y and the Quigley is relatively unique. So I'm first up on the Google search trends there. Perfect. An early adopter for the Martin Quigley with a Y, love it. Thank you again for your time. I think this is a really lovely episode. Excellent. Thank you so much. Thank you so much for your time in watching. If you're not already a subscriber, then why not? Do it now, follow the show.

Starting point is 00:47:22 And if you're watching on YouTube and you click the little bell button, you'll be notified as soon as I release new content. If you're striving for a career in psychology yourself, I think you'll really find the aspiring psychologist membership helpful, which you can join from just £30 a month with no minimum term. If you find this content helpful, I would love to know. Do drop me a comment wherever you. you're watching or listening. And if all this talk of research has wet your appetite

Starting point is 00:47:49 and made you think that you should potentially apply for research roles, then I think you'll really like the video that's on screen now that you can watch if you're on YouTube. And I will link in the show notes as well. And that episode was with the lovely Jess. I think I'm a pretty good judge of character

Starting point is 00:48:06 and I love sharing tips and tricks with people, which genuinely help them to run their clinical practices more efficiently. This episode is supported by by write-up and they're a brand I've been using in my own clinical practice for over six years. I really do genuinely rate them and use the write-up platform for each and every clinic session I book or conduct. That's why I'm so happy to be working with them. In case you don't know already, write-up is an all-in-one practice management platform built in the UK for UK clinicians.

Starting point is 00:48:38 So that's your diary, your client records, your notes, your invoicing, your secure messaging, all in one place, all GDPR compliant, all designed around the way we actually practice. Also, news just in they've recently launched an AI scribe that drafts your session notes for you and a tap-to-pay app that turns your smartphone into a card reader. Both are the kind of small changes that quietly give you hours back every week. But don't worry if you don't want to use all of those features, you don't have to either. If you've been meaning to sort your admin out or you're stuck wrestling with, the system that wasn't built for you, take a look at writeup.com. That's W-R-I-T-E-U-P-P.com.

Starting point is 00:49:23 And when you use my code, Marianne 30, you can access a free 30-day trial with 30% off for six months for up to six users. What's not to like? Now on with the show.

The Aspiring Psychologist Podcast - Ghosting, Phobias & Anxiety? The Psychology of Extinction Learning

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