Tuesday, May 3, 2016

The Cure For Fear | New Republic

Karin Klaver woke in the darkness and searched the nightstand for her iPhone. It was 2 a.m. Her husband slept quietly beside her. They had arrived in Johannesburg early that morning on the red-eye from Amsterdam and spent the day window shopping and people watching in the city. "This is nice," Klaver had thought to herself as she and her husband relaxed on the outdoor terrace of a shopping mall.

That evening, they retired to a bed-and-breakfast with garden rooms and enthusiastic online reviews. The couple were on their way to Port Elizabeth, where they own a house and spend several weeks each year. But this was the first time they had stayed overnight in South Africa's biggest city.

In the blackness of the room, Klaver sensed a presence at her bedside. A man was standing there with a gun in his hand, and he raised it to her head. Terrified, Klaver rolled onto her stomach. If she was to be shot, she thought to herself, better to be shot in the back. Her movement woke her husband, and the intruder demanded their cash and valuables. Then he slipped away into the night, leaving them unharmed but shaken.

Back in Holland, Klaver, 56, struggled to resume her normal life. What had once been comfortable and familiar now felt like an iron maiden. "Everything would remind me of what happened in Johannesburg," she said. She was nervous around unfamiliar men, and her house became a racket of threatening noises. The wind rustling in the curtains could keep her awake for hours. Nothing could dispel the dread that had overwhelmed her in that hotel room, when she was sure that she would die. "It was always there," she recalled recently. "It felt like a balloon inside."

Klaver found it difficult to talk about her anxiety, even with her husband. Thinking back to the robbery left her feeling even more isolated and vulnerable. "The first seconds, you feel so very, very lonely," she said. She resisted the idea of psychotherapy, with its long sessions devoted to reliving and processing the trauma.

A year and a half later, in 2013, Klaver read an item in the newspaper about Merel Kindt, a professor of clinical psychology at the University of Amsterdam. Kindt had developed a revolutionary treatment that could "neutralize" fear memories with a single pill. This treatment was a scientific breakthrough, building on decades of psychological research. It was also deceptively simple. "It was quick and dirty, and that's what I like," Klaver said. She wrote an email to Kindt introducing herself, and Kindt invited her to the university for a screening.

In the lab, one of Kindt's assistants asked Klaver a series of questions. What did she remember about the robbery? How did she feel when she remembered it? Kindt reviewed Klaver's answers and recognized the intrusive memories, avoidance behaviors, and other hallmarks of post-traumatic stress disorder. Klaver would indeed be a good candidate for the treatment, Kindt decided.

Three weeks later, Kindt, a striking woman with sharp features, crisp blue eyes, and stylishly tousled blonde hair, ushered Klaver into a small, plain room with a table and two chairs. Klaver, who has shoulder-length silver hair, wore black to the session. Normally, a patient who had suffered a traumatic experience might expect a therapist to proceed slowly and gently, offering comfort and support. Instead, Kindt dived straight in, pushing Klaver to relive the night of the robbery and focus on the source of her fear. "There is no escape," Kindt told her, as Klaver wept into her hands. "Nobody can help you." After 15 minutes, Klaver seemed shattered by her memories, and Kindt abruptly stopped the interrogation. She gave Klaver a round, white pill, which she swallowed with a sip of water. "I was totally broken," Klaver said.

Klaver went to bed early that night and slept for twelve hours. When she woke the next morning, she found that her memory was transformed. She recalled the details of what had happened in that bedroom in Johannesburg: She could still see the man's dirty cap, oversized jeans, and cheap plastic shoes. Yet she was able for the first time to think about the experience without anxiety or panic. "It felt like there was not that much weight on my shoulders," she said.

A pill of propranolol, which doctors have prescribed for decades to treat heart disease. Now it may be put to a very different use.

When she returned to see Kindt a week later, she wore white, as though to telegraph her mood reversal. "It's really gone," Klaver said. "It is quite special, isn't it?" Kindt smiled and leaned forward in her chair. "Yes," she agreed. "Very special."

Kindt, 48, has devoted her career to understanding human fear and memory. She has built her own laboratory, published in the most prestigious scientific journals, and developed a simple treatment she hopes might one day help millions of people who suffer from PTSD, phobias, and other anxiety disorders. In her clinic, she has seen it work in hundreds of cases, and yet she still marvels every time she sees a patient disencumbered of fear and trauma after such a short procedure. In those moments, she told me recently, her work doesn't feel like science or medicine at all. "It still feels," she said, "a bit like magic."

The sober-minded scientific community shares Kindt's awe. "'Cure' is a word not often encountered in psychiatry," Roger Pitman, a psychiatrist at Harvard Medical School, wrote in December in the journal Biological Psychiatry, in response to a study in which Kindt had successfully treated a group of people who were afraid of spiders. But a cure is exactly what Kindt appears to have found.

Not all fear needs to be cured, of course. A healthy amount of fear is essential to survival. When we encounter danger, the brain activates the sympathetic nervous system. Adrenaline floods our veins, our hearts race, and our fight-or-flight responsekicks into gear. The more quickly we can recognize a threat, the better our ability to avoid it in the future. In this way, our fears are lessons we have drawn from our experiences in the world. "Fear is a very adaptive emotion," Kindt said. "Because of fear, we anticipate and plan."

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