Whatever Happened To In Vivo Therapy?
:max_bytes(150000):strip_icc()/GettyImages-503122325-568748483df78ccc150a9806.jpg "What about in vivo therapy?")
Some of my most rewarding moments as a physician over the past 50 years have been discovering and practicing behavior therapy with patients suffering from anxiety and phobias. However, it seems to me and some of my colleagues that the practice of working with patients in real-life situations to overcome their fears is much less used today than it was in the past.
Deviation from the practice of in vivo therapy may be due to a number of factors. First, the development of new and more effective drugs to reduce anxiety makes therapist-led practices seem less necessary. Additionally, the development of new treatment methods such as acceptance and commitment therapy, manual workbook therapy, virtual reality (VR), and of course Internet-based remote therapy (especially since the start of the pandemic) have allowed patients to practice the skills their therapist taught them at home rather than in real life.
However, I believe that the practice of phobias and anxiety states in vivo should continue to be an important tool in the therapist's arsenal.
My early background in in vivo therapy is best described in the following excerpt from Kate Somersscale's recently published book, Phobias and Maniacs : She was constantly chasing storms, she says, and when she heard thunder, she would fly into her basement in terror. The fear generalizes to other sudden loud sounds, such as the sound of a car exploding, the roar of a balloon, and the sound of a low-flying plane. He is afraid of summer storms in New York and, after being treated by two psychotherapists who failed to cure his phobia, he is considering leaving the area. The woman told Lubetkin that her brontophobia originated in her childhood in wartime Europe, when she was afraid of bullets and explosive bombs.
After teaching the patient relaxation techniques, Lubetkin took him to the local planetarium, where he set up the projector to show a 3-minute movie about a hurricane. The patient rested before watching the film, then watched it continuously eight times that day. He did the same on seven consecutive visits to the planetarium. He later told Lubetkin that his phobic symptoms had improved. He spent less time worrying about hurricanes, he said, and even felt like he could live on the top floor of a house he visited during the hurricane. He doesn't really mind the noise from flights or planes.
Below is a list of examples of other in vivo activities that my colleagues and I have performed with patients. Almost all are accompanied or preceded by the practice of relaxation and anxiety management techniques, including deep breathing, cognitive restructuring, and mindfulness meditation. The therapist is always present.
1. The "party" and the talk in the elevator stopped.
2. Sit on a park bench and name the owner and the dog according to the size of the dog.
3. Leaning on the balcony or terrace of a tall building.
4. Visit the entomologist at the American Museum of Natural History and see the various insect exhibits.
5. Drive the subway cars one by one and the track is cut off.
6. Eat at a variety of restaurants, from less crowded to more crowded.
8. Instruct and train patients to create an online profile and then help them make the initial phone call for a potential appointment.
9. Take the patient to the theater and sit further away from him as the movie progresses.
In fact, there are countless human experiences in which people feel cold, ashamed, and anxious, where the practical guidance of a therapist can be very helpful.
Of course, when leaving the professional office environment, additional signed agreements about real-life goals and boundaries are often needed to comply with all legal and ethical obligations.
