The Dichotomy of Fear

I am absolutely terrified of injections and blood draws. Last year at ClickerExpo in Providence, I took advantage of the opportunity to ask behavior maven...

Casey Lomonaco  |  Jun 10th 2010


I am absolutely terrified of injections and blood draws.

Last year at ClickerExpo in Providence, I took advantage of the opportunity to ask behavior maven Karen Pryor if she had any suggestions for how I might tackle this fear. I know that heart disease and diabetes run in my family on both sides, and yet my overpowering fear keeps me from getting routine maintenance and diagnostic medical care.

Definitely a problem that cannot go unaddressed forever. Karen was gracious enough to provide me with some great advice and put me in touch with Theresa McKeon, one of TAG Teaching‘s founders for tips on how I might work through my own fear using the same techniques I use with reactive dog clients.

Fear is often irrational. My rational brain tells me my fear of needles is silly, my neurochemical and physiologic responses to my trigger tell me otherwise. When there is a needle in room, there is no rationing with me.

As a child, I would kick and bite at the physician and his attendants; multiple attendants were often needed to restrain me for inoculations. I’ve avoided situations requiring injections since then, but wonder how different my reaction would be now that I’m an adult. Since ration doesn’t come into play in these situations, I wouldn’t rule potential aggressive behaviors of my own out of the equation. Might I bite the nurse today? Without any work addressing the fear issue, there’s a good chance a muzzle would be indicated for my visit to the hospital lab!

If you took me to a doctor’s office for an injection and kicked me in the shin when I showed signs of fear, do you think it would help the situation? Lessen or increase my fear? How might your reaction influence my own, or my feelings about you?

More importantly, what might make me feel better? What makes you feel better when you’re afraid or stressed?

None of my friends have been brave enough to try such an experiment. Behavior professional or not, the answers are in some sense intuitive. Your punishment would likely not help me feel less afraid of needles. An already stressful situation would suddenly become even more stressful – I’m still stressed about the needle and my friend is now unpredictable, violent, and can no longer be viewed as a comfort but as a threat. The only thing that has changed is my opinion about having you with me next time I find myself in the situation. Instead of biting the nurse, I might bite you. Hey, at least she didn’t kick me!

Truly, the only solution to my fear of needles and your dog’s fear issues as well is in finding creative and effective ways of reinforcing bravery and survival, of teaching new life skills and coping mechanisms. In dog training, this is called counter conditioning, desensitization and DRI (differential reinforcement of incompatible behaviors). In modifying my own behavior, we use the same tools only we call them TAG Teaching and Cognitive Behavioral Therapy. Semantics, really.

Emotional signals resulting from fear are not behaviors to be reinforced or punished, but are symptoms of an underlying emotional state. Attempting to change emotions in an operant conditioning framework of consequence manipulation is like trying to cure a lung cancer patient’s coughing with OTC cough syrup. It just doesn’t tend to work very well, and when it does, the results are often temporary and then the problem comes back intensified. At best, it’s a band-aid. At worst, it prevents effective treatment and exacerbates the problem.

While the symptoms may temporarily be suppressed, the cancer rages on, intensifying. Plugging a round hole with a square peg is rarely effective.

Growling, lunging, barking, and even snapping and biting are symptoms of a fearful emotional state. In order to change the dog’s behavior, we must effectively address the causative emotions. Classical conditioning is extremely effective in dealing with these types of issues – we teach the dog that controlled exposure to the trigger predicts wonderful experiences. (Casey looks at the needle, gets a nibble of Godiva Raspberry Dark Chocolate.)

When working with a fearful dog, the dichotomy is this – you either lessen fear by making the dog feel better or intensify the fear by making the dog feel worse. Effective treatment of physical and behavioral illness results in the dissipation of symptoms. Without dealing specifically with barking, growling, biting, or lunging, these symptoms are replaced with behavioral wellness as manifested by confidence and enthusiasm, a new “conditioned emotional response” or CER.

Clients are often concerned about “reinforcing fear,” when we discuss using food rewards to classically condition a different emotional response to a trigger. Is feeding treats in a classical conditioning protocol reinforcing fear? No, because we are working toward lessening the fear by making the dog feel better. If anything, we are reinforcing bravery, just being able to eat and focus and survive in the presence of a scary thing.

I would argue, however, that punishment reinforces fear – it makes fearful behaviors more likely in the future which is the definition of reinforcement. Punishment reinforces the dog’s belief that “yes, this is an awful situation where you have no control, are at risk or threatened or injured, and where you must never let your guard down because bad things and unpleasant consequences may be around any corner.” Recent studies find that, if you’re aggressive, your dog is too.

For more on punishing fear symptoms and why it’s not a good idea, check out Pat Miller’s article, The “Gift” of Growling.