Can Virtual Reality Cure My (Really Weird) Phobia?

From ELLE

This article originally appeared in the June 2016 issue of ELLE.

One night last fall, I kayaked with about 15 other tourists out into an empty bay on Vieques, an island off Puerto Rico, to see some famous glowing microorganisms. The bay was large, the moon small, the blackness almost total. I shared a boat with my husband and toddler, trailing a logorrheic guide who stopped periodically to expound in broken English on the dinoflagellates' life cycle before disappearing again into the mist up ahead. Our paddles pierced the water in delicious sunbursts of bright bluish-yellow; we chatted with some newlyweds from Chicago. I congratulated myself for being the kind of parent who lets her kid stay up past ten to witness miracles of nature.

And then, out of the corner of my eye, I saw something flash white on the surface of the water. It was 50 or so yards away, on a shimmering stretch of bay low-lit by the moon. In an instant my body seized up, my eyes squeezed shut, and my paddle collapsed onto my lap. "Babe," I stammered. But my husband had seen it, too, and was already paddling in the opposite direction. "You're going to have to get us back by yourself," I gasped. I knew he was rolling his eyes behind me, but I couldn't help it. Getting any closer would cause me to faint. Or die.

Hello, my name is Meredith, and I am afraid of buoys.

Yes, I mean those benign inanimate objects that float in water, the ones you've probably never given a second thought to. I imagine you have questions-most people do-so here are my answers: No, I'm not really scared of the ocean, or of drowning. I am an excellent swimmer, thank you, a lifeguard on Lake Michigan back in college (never mind that if someone had been clinging for dear life to the shallow, dinky buoy that defined the far edge of the swimming area, I wouldn't have been able to save him). I'm not afraid of sea creatures, either: I'd happily swim with a whale if that didn't require jumping off a boat, which would inevitably drop an anchor line (my stomach flipped as I typed that). It's not even the slimy algae congealing on the underside of a buoy. It's the thing itself, the whole harmless assemblage of steel and rubber. Sometimes I dream I'm swimming beneath a mooring field, navigating a watery maze of taut, ghostly chains. In my waking life, I would not do this for a million dollars.

A phobia is defined as a persistent, irrational fear that interferes with one's daily life. My phobia doesn't really impede my Brooklyn existence, but it's inconvenient on tropical vacations, not to mention on occasional ferry rides into Manhattan, during which I imagine in great detail the cardiac event that would occur if I were to fall overboard and drift into a harbor piling. Over the years I've realized that I'm afraid not just of buoys but of anything man-made that is underwater, including shipwrecks, boat motors, and pool cleaners. I've discovered that this phobia has a name, submechanophobia, and a subreddit, whose 19,000-plus subscribers post pictures and videos-cruise ship propellers, scenes from Waterworld-that I'm too terrified to click on. Most seem just as confused as I am about why, exactly, we're so scared.

And yet, though I know my fear is irrational, I can't talk myself out of it. No phobic can. Don't bother telling an aviophobe she's more likely to die in a car crash than a plane crash, or a claustrophobe that the walls are not, in fact, closing in on her. She knows. We know. Phobias live not in the thinking brain, but in the lizard brain-the part that told cavemen to run from predators. It's the mind's primal defense, before the prefrontal cortex chimes in with information and context (yes, that's a spider, but it's a daddy longlegs, not a black widow). In phobics, the fear brain and the thinking brain are not on speaking terms. That is how you get to be a 36-year-old mother of two who is terrified of the floating dock at her friends' New Jersey lake house.

I don't remember becoming afraid of buoys; I only remember being afraid of them. At 10 or 11, I signed up for sailing class in Port Jefferson Harbor, near where we lived on Long Island, only to hyperventilate when my skiff drifted into a mooring; I was too embarrassed to tell the instructors why I was sobbing as they dragged me to safety. For years, I held my fear like a secret-a deep, dark mystery that confirmed my essential weirdness and the fact that I'd never have a boyfriend. The main clue to its origins was my sister, the only person I've ever met who shares it. Recently, vacationing at the Hotel du Cap-Eden-Roc in Antibes, France, with her husband, she posted a picture of the property's famed swimming area, which is framed by yellow buoys. "Not gettin' in that water," she wrote, "and it's not because of the sharks."

I've often wondered if our parents are somehow to blame for this. My father tells a story about a fellow pilot from his days in the Navy who tipped his plane off the edge of the aircraft carrier-when the guy went over the side, he looked up and saw the boat passing above him. The thought of its giant underwater screws and propellers makes my dad shiver to this day. Is it possible that he conditioned me to fear things underwater, even though I first heard that story as a teenager?

Or maybe it was my mother's generally high level of fearfulness, which tends to focus on more common triggers, like strangers and New York City. Did her jumpiness seed something more irrational in her daughters? It could have been the scary-looking pool-cleaning machine in our backyard pool in Texas, where we lived for a couple of years during elementary school. Or, wait-there was the small lake in upstate New York where we swam as toddlers….

For a long time, I thought of my phobia as a personality quirk: good at cocktail parties, not something I could cure. But lately I've felt like my fear brain is generally out of whack. Even my more pedestrian fears-getting cancer; moving to the suburbs (in a house, no one would hear me scream); the host of calamities that could befall my children-have become wildly disproportionate to any actual risk. Is my phobia-something I've been scared of for 30 years, even though I know it can't hurt me-a symptom of a larger problem? Perhaps it's time to find out.

As he wraps a cord around my stomach and sticks three Velcro sensors to my fingers, Robert Reiner, PhD, says, "I haven't seen too many people I'd describe as laid-back who have phobias. Most of you are pretty cranked up." I'm sitting in a large reclining chair beneath several computer screens in a small lab in Reiner's Upper East Side psychotherapy practice; EEG brain-mapping helmets hang on the back of the door. Reiner has never heard of submechanophobia specifically, but he has treated plenty of other arcane afflictions, including a fear of sinus clearing (one of his patients asked a cab driver to pull over and let him out on a deserted highway at 1 A.M. after the driver blew his nose) and a fear of certain words (one man was terrified of chairperson). Reiner once chased a fear-of-flying patient down East 90th Street after showing her a virtual reality video of a plane cabin. That woman's phobia took 22 sessions to conquer; most take 12 to 16.

According to the National Institute of Mental Health, nearly 9 percent of the U.S. adult population is phobic, making irrational fear one of the most common mental illnesses. When I ask Reiner if phobias are First World Problems, like gluten allergies and "work-life balance"-surely people who face real threats like war and starvation are not also afraid of Styrofoam and the color green?-he assures me that a small percentage of every population becomes phobic. Twice as many women as men report phobias, a fact that no one can really explain-it could be hormonal; it could be due to the fact that women are more likely to seek mental health treatment. "We know that high-risk times for the onset of anxiety disorders are puberty, during and after pregnancy, and during menopause," says Karen Cassiday, PhD, managing director of the Anxiety Treatment Center of Greater Chicago.

Unlike a closely related anxiety disorder, PTSD, most phobias have no single traumatic precipitating incident. They occur spontaneously, usually in childhood. "On average, people with phobias are more fearful in general," says Franklin Schneier, MD, a research psychiatrist in the Anxiety Disorders Clinic at the New York State Psychiatric Institute. "Maybe the amygdala, which orchestrates fear response, is hypersensitive. That could be inherited, or it could be based on life experience." When I describe my situation to JoAnn Difede, PhD, director of the Program for Anxiety and Traumatic Stress Studies at Weill Cornell Medical College in New York, she suggests it could be nature and nurture: "Maybe you have a genetic sensitivity and you saw the way your father interacted with objects. It's not so clear that you have to be consciously aware of your parents' fear. So much human communication is nonverbal. We soak up our environment, particularly as children."

In 2013, an Emory University study suggested that specific phobias-not just a predisposition for fearfulness-can be inherited. Apparently, when mice are shocked while they're being exposed to a certain scent, their biological offspring and even their, uh, grandmice are sensitive to that scent, even if they've never personally encountered it (nonbiological mice pups raised by the mice who had been shocked did not show increased sensitivity). The results suggest that trauma-not unlike lifestyle choices, including diet-can alter DNA. Still, few of the experts I consulted were willing to conclude that my phobia was gifted to me by shipwrecked human ancestors. "It's too soon to say for sure that phobias themselves are inherited," says Stephanie Maddox, PhD, a research fellow in psychiatry at Harvard Medical School. (A friend suggested I cross-check this theory with a past-life regressionist. Stay tuned!)

Reiner, for his part, is not interested in the psychological origins of my phobia. "Put it this way: If I break my ankle, knowing how I did it doesn't help me. I still need an orthopedist to set it properly."

If phobias' origins are mysterious, their treatment is not. The gold-standard, practiced for more than 50 years, is exposure therapy: subjecting people to their feared object or experience in slow increments. "It has the highest success rate of anything we do in mental health," says Cassiday.

Once a fear develops, it is exacerbated by avoidance. For all the mental energy I've expended on buoys, I've never touched or even swum up to one; my brain has never been given the chance to learn that it won't actually kill me. Prior to our meeting, Reiner instructed me to obsess over buoys "like a teenage girl obsesses over horses." Begrudgingly, I found the largest, rustiest, grossest channel buoy Google Images had to offer, tilting eerily in a glassine sea, and made it my desktop background. I began trolling the submechanophobia subreddit daily, occasionally covering my eyes as pictures of submerged ocean liners and NASA test pools materialized onscreen. This exposure, coupled with discussing my phobia with every shrink on the Eastern seaboard, had a rapid numbing effect: I soon found myself clicking links that have six exclamation points, lingering on pictures of spooky sunken airplanes and fire trucks.

Now I was ready to meet my phobia face to face-or pretty darn close to it-via a Samsung Gear VR headset attached to Reiner's cell phone. He has found virtual reality-also used on soldiers with PTSD returning from Iraq and Afghanistan-coupled with breathing exercises to be more than 90 percent effective in treating phobias. The first step is syncing my breathing with my heart rate, which he says disables the body's fight-or-flight response, making it impossible to have a panic attack. Reiner instructs me to breathe slowly, six times per minute, until I descend into a state of deep, sleepy relaxation. The oversize plastic VR goggles are held in place over my eyes with a black sash; the biofeedback sensors on my fingers track my galvanic skin response (GSR) or "visceral anxiety," similar to what a lie detector test measures. We start with a video of a Polaris pool cleaner, an object that scares me in real life but that I feel vaguely ridiculous staring at in a shrink's office. ISIS and climate change threaten humanity, and here I sit watching a blond model prattle on about the suction features of the gadget that cleans leaves out of her pool. The overachiever in me feels stressed that I am not sufficiently stressed. Is my phobia even "real"? Still, Reiner tells me that my anxiety levels have in fact quadrupled.

The goal is to play the video again and again until it has no effect on me. "If you stay in the presence of something you're scared of, all the neuroreceptors for the fear chemicals will get saturated," Cassiday explains. "That takes two or three minutes. If you see a horror movie for the second or third time, it's not as scary. That's habituation." It takes me only one session to conquer the Polaris video. The following week, I begin by staring at the gray, placid expanse of the Gulf of Alaska. The camera starts at sea level. I know deep down that I'm actually in Manhattan, but the illusion is powerful. The sound effects are, too: I hear water lapping in surround sound. My chair is even moving, bobbing as though I'm in the water. Suddenly the camera swings around and I see that the diver holding it is clutching a massive sensor buoy, the kind that collects and transmits oceanographic information. I scream. My eyes squeeze shut; my deep breathing is forgotten. Reiner is suddenly firm, speaking loudly. "Keep breathing," he says. "You're hyperventilating." My hands are shaking; I can't open my eyes. Later, Reiner will tell me my GSR spiked 250 percent. Translation: My lizard brain is losing its shit. "I can't do this," I say. Reiner stops the video. He tells me he's going to run it from the top.

This time I'm ready. When the camera swings around to the buoy, and then-Ahhhhh!!! Ahhhhh!!!-dips underwater, I wince but manage to keep my eyes open. I force myself to breathe deeply. The underside of this buoy is a mass of pipes and clanging steel, all dingy and brown and slimy with seaweed. My chair rocks. I stare in abject horror. Reiner starts the video again. And again. And again. By the eighth time, I'm having short moments where logic can be heard above the din of panic; it's informing me that I'm just sitting in a therapist's office watching video of an "underwater submersible," as Reiner calls it. Still, my limbic system behaves as if death is imminent, flooding my body with cortisol again and again. It's a slow learner.

After about an hour of this, my GSR spikes for a second time late in the video. When Reiner asks me what happened, I realize my mind had drifted; I was thinking about an important email I'd neglected to send. I was thinking about an email while swimming (sort of) with a buoy? Habituation! Reiner is thrilled, and I am, too. He plays the video again. My anxiety rises and falls. Nothing happens.

Ultimately, exposure therapy is not a matter of getting rid of fear. It's about feeling it crest and then uneventfully subside. It's about learning that fear itself can't kill you.

This feels like a significant victory, if an isolated one. Confronting my phobia has not, as I'd hoped, magically made me less anxious in general. I wonder if exposure therapy could work for my other hang-ups. For instance, Cassiday, the Chicago therapist, uses the techniques on patients preoccupied with the idea of their children's deaths. She talks them through worst-case scenarios, funeral arrangements; she makes them marinate in the outlandish constructs of their dark imaginations. This doesn't make her patients' nightmares more or less likely to come true, but it does allow them to stop pre-experiencing them. Eventually, she says, even the most horrible thoughts lose power. Fear is about the unknown, after all (death being the ultimate unknown). This seems particularly relevant to my phobia, which is literally about that which extends below the surface, into some fathomless deep. What's really down there can never be as scary as what I imagine.

In the end, I haven't cured my phobia. To do so would have required facing it in reality and not just the virtual kind, and I'm really not longing to swim with a buoy the way a plane-phobic person might be interested in, say, crossing the Atlantic. What I am interested in: staring my fear in the face. And I did that. I looked at its dreaded underside and emerged unscathed. These days, when I ride the ferry, I still stare reflexively at the massive red channel buoys in the East River, wondering if I could actually swim up to one to save myself from drowning. I really try to picture it. It's cold, and I've fallen from the boat. I'm tired, weighed down by my clothes. I swim closer, waiting for the charge to hit. I embrace it.