An Unexpected Psychiatric Benefit of Social Media: Exposure Therapy

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Arachnophobia, the irrational fear of spiders, is one of the most common specific phobias with a prevalence of 2.7 to 6.1% of the general population affected.¹ In the DSM-5, under the umbrella of anxiety disorders, specific phobias are characterized by intense fear related to a specific object or situation, and a strong desire to avoid either the situation or object.² They often begin in early childhood, with incidence peaking during midlife and old age. It is estimated that the prevalence of specific phobias around the world range from 3%-15%.³ Significant anticipatory anxiety and avoidance behavior often limits or prevents confrontations with the phobic stimulus.¹

Cognitive behavioral therapy and exposure therapy are considered first-line treatments for phobias. Exposure therapy involves gradually exposing the individual to their fear of spiders in a controlled environment, called in vivo exposure, in which the patient directly encounters their fear and uses a hierarchy of progressively more challenging exposures in hopes of decreasing fear response and treating the phobia.⁴ All of this is managed by a therapist, of course. Access to the phobic stimulus is not always feasible in clinic, however. For instance, not many therapists would be willing to keep live spiders in their offices. As a result, exposure without live stimuli is also an option, using pictures, imagination, or even virtual reality headset devices that create an immersive effect.⁴ These high tech devices can induce fear without the requirement of having a real animal in the room, with randomized controlled trials already showing statistically significant clinical improvement outcomes.⁴

When Phobias Get Personal

Growing up in a tropical country like Brazil, encounters with small but terrifying critters, in particular spiders, were not an uncommon daily occurrence to me. Sadly, the constant unscheduled and unwanted meetings with spiders may have led me to the diagnosis of arachnophobia as a teenager. Much to my dismay, I struggled with this debilitating anxiety disorder for many of my adult years. Fortunately, I stumbled upon a free, self-guided, and effective exposure therapy for arachnophobia through the social media website Reddit.

Reddit is a platform where users submit content like links, text, posts, images, and videos that are then voted up or down by other members. Accessible via its website or app, it is a forum-style platform that addresses a wide range of interests and is organized into topic-specific communities called subreddits, in which individuals can discuss and share information on that topic. Oftentimes, the algorithm will spontaneously suggest new subreddits you may want to join, much like other social media websites suggest product advertisements.

I do not recall how or why Reddit suggested the r/Spiders subreddit (Figure 1), yet I joined it out of morbid curiosity. Not long after, in the middle of happy and mindless scrolling through my preferred gossip and TV show posts, a spider picture or video would pop up on my feed. The first few (or few hundred) times, I think I jumped 5 feet into the air and yelled some profanities out of fear and surprise. Later, I rationalized these were simply consequences of my own actions. After all, I was the one who joined the subreddit, and the algorithm was just doing its job. With time (and lots of yelling), I eventually got desensitized to pictures, then to videos, and now I can even identify different spider species without breaking a sweat (or swearing). I call it a successful, randomized, free, and nontime-consuming type of exposure therapy.

Figure 1: r/spiders homepage

Without knowing, I had implemented a new modality of exposure therapy on myself by utilizing a social media website that is free and easy to access on any mobile device or computer.

I hope that sharing my story can create awareness and incite conversations between clinicians and patients on novel approaches to exposure therapy that utilize accessible, free, and widely used social media platforms. To my knowledge, the use of social media as a form of exposure therapy for arachnophobia has not yet been studied. As such, more studies are needed to compare its effectiveness and feasibility with its’ traditional in vitro or augmented reality counterparts.

Dr. Alvim de Paula is a third-year psychiatry resident at the Mount Sinai Beth Israel Hospital, in New York City, New York.

Dr Packer is an assistant clinical professor of psychiatry and behavioral sciences at Icahn School of Medicine at Mount Sinai in New York, New York.

References

1. Polák J, Sedláčková K, Janovcová M, et al. Measuring fear evoked by the scariest animal: Czech versions of the Spider Questionnaire and Spider Phobia Beliefs Questionnaire. BMC Psychiatry. 2022;22(1):18.

2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association; 2013.

3. Eaton WW, Bienvenu OJ, Miloyan B. Specific phobias. Lancet Psychiatry. 2018;5(8):678-686.

4. Jurcik T, Zaremba-Pike S, Kosonogov V, et al. The efficacy of augmented reality exposure therapy in the treatment of spider phobia-a randomized controlled trial. Front Psychol. 2024;15:1214125.