Complementary Therapies in Clinical Practice 16 (2010) 203e207

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Complementary Therapies in Clinical Practice

journal homepage: www.elsevier.com/locate/ctnm

Neuro-linguistic programming and application in treatment of phobias

Mahishika Karunaratne*
St Georges University of London, Cranmer Terrace, London SW17 0RE, United Kingdom

a b s t r a c t
Keywords:
Neuro-linguistic programming (NLP)
Phobia
Anxiety
Visual
Kinaesthetic
Dissociation
Treatment

Phobias are a prevalent and often debilitating mental health problem all over the world. This article aims
to explore what is known about the use of Neuro-linguistic Programming (NLP) as a treatment for this
condition. Whilst there is abundant experiential evidence from NLP practitioners attesting to the efcacy
of this method as a treatment for phobias, experimental research in this area is somewhat limited. This
paper reviews evidence available in literature produced in the UK and US and reveals that NLP is
a successful treatment for phobias as well as being particularly efcient due to the relatively brief time
period it takes to effect an improvement.
2010 Elsevier Ltd. All rights reserved.

1. Introduction
Neuro-Linguistic Programming (NLP) arose in America in the
1970s, from the collaboration of John Grinder and Richard Bandler.14
It originated when Bandler, a student of Psychology at the University
of California, Santa Cruz, transcribed recorded psychotherapy
sessions given by the Gestalt therapist Fritz Perls. Bandler discovered
specic word and sentence structures used by Perls which seemed to
maximise the efcacy of positive suggestions given to patients. He
described his observations to John Grinder, an assistant professor of
linguistics and the two went onto further examine the work of Fritz
Perls. They also analysed the work of Virginia Satir, a hugely
successful family therapist who consistently resolved family relationships which other therapists found impossible, and Milton
Erickson, a globally renowned hypnotherapist. Bandler and Grinder
intended to identify the patterns utilised by these three exceptionally successful therapists in order to create models and techniques
that could be taught so that other individuals could achieve similar
success. The ndings were described in their rst publication, The
Structure of Magic in 1975.
From these beginnings, NLP developed as a method of achieving
personal excellence as well as a study of the ways of thinking and
communication utilised by the most successful people. The title
Neuro-Linguistic Programming has a threefold meaning. The term
neurological denotes that all behaviour derives from the neurological processing of information provided by the ve senses. The
linguistic part of the title refers to the fact that language is fundamental to the organization of thoughts and communication. The

* Tel.: 44 (0) 7737330106.

E-mail address: m0101039@sgul.ac.uk
1744-3881/$ e see front matter 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ctcp.2010.02.003

term programming acknowledges the manner in which ideas and

behaviours can be modied and managed to create desirable results.
The study and practice of NLP grew rapidly both in the United
States and globally, and there are now NLP training providers in
many areas of the world. It is estimated that over 100,000 participants have attended NLP training courses in the UK.16 Since its
beginnings NLP has achieved substantial fame as a popular
approach to communication and personal development. It is
frequently practiced in professional elds such as sales, management and sports training. Whilst NLP has a wide range of applications today, it is particularly useful in the eld of medicine in
a variety of ways including methods for developing rapport with
patients and thus maximising benets gained within the medical
consultation as well as techniques for treating specic medical
problems such as Irritable Bowel Syndrome, substance abuse,
obesity and chronic pain.17,18 As mentioned, NLP originated from
the study of three successful psychotherapists, and as such NLP is
also highly applicable in psychotherapy. From the basis of family
therapy as outlined in the Structure of Magic 2, NLP has given rise to
many powerful psychological techniques for remedying conditions
such as anxiety and depression.14 One area of psychotherapy in
which NLP has proved particularly promising due to the claim of
a cure in one hour or less (Bandler and Grinder, 197920, as cited in
Ref. 12) is the treatment of phobias.
2. Phobias
The DSM-IV denes phobia as the experience of unreasonable
fear or anxiety in connection with exposure to specic objects or
situations often leading to a disproportionate urge to avoid the
feared object.2 Phobias can be separated into three categories.
Specic phobia (previously known as simple phobia) can be

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M. Karunaratne / Complementary Therapies in Clinical Practice 16 (2010) 203e207

subdivided into ve types; fear of animals e.g. arachnophobia, fear

of the natural environment e.g. hydrophobia (fear of water),
situational fear e.g. claustrophobia or fear of ying, and bloodinjectioneinjury phobia e.g. fear of needles. The fth category is
named other and includes phobias that do not t into the above
four categories, e.g. fear of situations which may cause illness.
Specic phobia has a lifetime prevalence of 12.5%.10
The second category of phobia is social phobia which is a fear of
social situations and can be further subdivided into generalised social
phobia, and specic social phobia in which fear is only triggered in
particular situations such as public speaking. The third category of
phobia is agoraphobia which is fear and anxiety in crowded spaces.
Phobias are an extremely prevalent problem worldwide. A study by
the National Institute of Mental Health has revealed phobias to be the
most frequently occurring mental disorder amongst women of all
age groups, and the second most prevalent disorder in men over the
age of twenty-ve years.10 Current statistics approximate that there
are over ten million adults suffering from phobias in the United
Kingdom today, and between 8.7% and 18.1% of the population in the
United States. Phobias can be extremely debilitating as avoidance of
fear triggers can limit quality of life and in the case of some specic
phobias such as dental phobia, can have serious consequences for the
individuals health.13
3. NLP and Anchoring
The acquisition of a phobia is an example of rapidly acquired
Pavlovian classical conditioning, and is a consistent response based
on learning over a single trial.9 Exposure to a stimulus linked with
a simultaneous fear response causes a powerful association to be
made between the two events. On subsequent occasions, even
imagining the stimulus is enough to provoke a fear response.17 The
acquisition and expression of a phobia, i.e. the initiation of the fear
response on encountering or imagining a phobic trigger can also be
thought of as an example of anchoring.18
In NLP, a stimulus which is associated with and triggers a physiological response is termed an anchor.14 Anchors can be kinaesthetic,
auditory or visual e.g. certain songs, images or smells can be
extremely evocative of emotional states. An anchor can be created by
vividly imaging a desired stated then simultaneously applying
a chosen anchor (e.g. making a st is an example of a kinaesthetic
anchor) in order to create an association (for a full explanation see
Ref. 14, p. 56). The method of anchoring allows access to a desired
emotional state at any time and whilst the acquisition of a phobia is
an example of anchoring, this technique can also be used to cure
simple phobias, through a method known as collapsing anchors.
In this method, two opposing emotional states are experienced
at once, resulting in the creation of an original state. For this
technique, both the negative state i.e. the phobia and the desirable
positive state are identied. For example, the negative state could
be a fear of ying and the positive one a desire to be able to travel
on business trips freely.5
First the positive state is elicited and anchored e.g. by touching
one arm. Then the negative state is recalled and anchored by
touching the other arm. The client is then asked to recall the experience of both states in turn, with each anchor applied in turn. Then
both anchors are red at the same time, with the negative anchor
removed before the positive. When asked to imagine a situation in
the future in which they would normally have expected to feel
negative, the subject should now be able to do this without
expressing any negative physiology. In order for this technique to
work, the positive anchor must be stronger than the negative one
and the negative anchor must be removed before the positive one.
The above technique is applicable to simple phobias. However it
is not as useful in dealing with more troubling phobias such as Post

Traumatic Stress Disorder (PTSD) where even thinking briey about

the event can cause anxiety.17,3
Phobias are believed to be associated with the amygdala, a part of
the limbic system within the temporal lobe of the brain, found
posterior to the pituitary gland, which is responsible for secreting
hormones that regulate fear and aggression.19 Research using
animals, where brain activity is recorded while fear is conditioned
using an aversive stimulus, has revealed that the amygdala is active
during presentations of the stimulus to which fear has been
conditioned. Research with humans utilising neuroimaging techniques such as positron-emission tomography (PET) and functional
magnetic resonance imaging (fMRi) have also shown that the amygdala is active during presentation of a phobic stimulus in humans. This
area of the brain is able to store unconscious memories.18, p. 70
There are thought to be two distinct pathways by which incoming
sensory information gains access to the amygdala.19 With the rst,
longer pathway, sensory information travels via the thalamus and
cortex, where further integration and processing takes place, before
accessing the amygdala. The second shorter path bypasses the cortex
and goes directly from the thalamus to the amygdala. This pathway
effects the ght or ight response via action of hypothalamic
hormones and causes an immediate reaction to a stimulus, even
before it is registered consciously. Research indicates that conditioned responses such as phobias act via this pathway.
Exposure therapy with extinction of the fear response is a traditional method of phobia treatment, however evidence suggests that
this method effects a cure via cortical over-riding of the amygdala,
thus if the stimulus is encountered in a stressful situation where the
second shorter pathway to the amygdala is employed, the response
of the amygdala becomes prominent and the previously treated fear
response will re-emerge. Other methods of treating phobias include
counter-conditioning, using another emotional response such as
a feeling of relaxation, to compete with the fear response on exposure to the stressful stimulus. This is thought to be more effective as
pleasure has an inhibitory effect on the amygdala. The NLP phobia
cure is thought to be effective as it facilitates direct processing of the
memory of the phobia, allowing the unconscious memory in the
amygdala to be stored as a conscious memory in the hippocampus.
Thus it can be stored as long term memory of a past event, with less
attached emotional signicance.
4. The NLP phobia cure
Traumatic phobias, in which even thinking briey about an
event causes a physiological emotional response, are stored as
synaesthesias, where two representational systems become linked
so that accessing one representation always results in access to the
other.18, p. 147 In most phobias a visual/kinaesthetic synaesthesia has
been made, where accessing a memory of a picture of the traumatic
event causes a fear response, however auditory/kinaesthetic
synaesthesias, where a voice or sound can cause fear, or a kinaesthetic/kinaesthetic synaesthesia, where a touch can cause the
fear response, also exist. The NLP visual/kinaesthetic dissociation
(V/KD; Bandler and Grinder, 1979)20 phobia cure dissociates this
link. According to Bandler and Grinder (1979)20, this method can be
used to cure phobias and other unpleasant responses in less than
an hour (p. ii; as cited in Ref. 12). Richard Bandler modelled the
phobia cure on people whose phobias resolved spontaneously.
These people had dissociated from the strong negative feelings
they had previously, and were able to look at the traumatic event as
if it had happened to another individual, in the past and from
a detached point of view. Within this context, an associated
memory refers to seeing an experience from a rst person point of
view as if reliving the experience whereas the term dissociated
refers to looking at a memory from any point of view other than

M. Karunaratne / Complementary Therapies in Clinical Practice 16 (2010) 203e207

the rst person.3 When a memory is recalled in an associated

manner, the emotions and response from the original experience
are re-experienced, however when a memory is recalled in
a dissociated manner, it is possible to observe the emotions from
the situation as a bystander, without having to experience them
rst hand. This is the rationale behind the V/KD phobia cure, i.e.
that changing a memory from an associated to a dissociated one
can eliminate the strong negative feelings of the phobia response.
The steps of the phobia cure are outlined below.3 The rst
important step prior to starting is to establish rapport and a safety
anchor,14 e.g. asking the client to associate with a time when they
felt particularly safe and anchoring this kinaesthetically by holding
hands. This safety anchor is maintained throughout the process.
The client is then asked to imagine sitting in a cinema or watching
television, with a still image of themselves in a situation just before
they rst had a phobic response on the screen. They are then asked
to imagine oating out of this so that they are watching an image of
themselves watching the screen. This double dissociated state
maintains emotional distance. From this position, the client runs
the movie of themselves starting from just before they had the
phobic response, when they felt safe, to just after the response has
nished and they are safe again.
Utilising the times when the client felt safe as the start and end
points of the movie creates a bracket of safety around the memory so
that it is recalled as occurring within this frame of safety and not
played as an unpleasant loop.18 If the client expresses any negative
physiology, they are asked to stop the movie and change the submodalities of the picture e.g. by making it darker or smaller to
decrease negative feelings towards the image. When they have
managed to watch the whole movie without expressing any negative feelings, they are asked to oat back into the image of themselves watching the screen in order to reintegrate. Then the client is
asked to step into the movie and reassure the younger self that they
are safe, they have survived the experience and that they have the
resources to cope with the danger. When the client is satised that
the younger self feels safe, they are asked to bring that younger self
back into their own body in order to reintegrate again. Finally, future
pacing is introduced, and the patient is asked to think of the next
time they will encounter the stimulus, by which point, if the cure has
been successful they should be able to imagine the stimulus without
the previous excessive fearful response. During this stage safety
anchors can be red in order to emphasise the feelings of relaxation
and comfort in future encounters with the phobic stimulus.18

In order to make the above mentioned process of dissociation more complete, some practitioners also include
a further component.18 After proceeding through the stages
of the phobia cure upto the point just before future pacing,
the client is asked to imagine the end point of the movie
again, in full colour, and then to imagine going through the
movie backwards at a fast pace with all actions and speech
in reverse, and draining the colour out until they have
reached the beginning of the movie, just before the phobic
reaction started, to a point when they felt safe. The purpose
of this is to obscure the submodalities and remove any final
vestiges of the phobic reaction. This stage can be repeated
a number of times, until the memory is entirely neutralised.
Walker describes the successful use of this method to treat
a patient with a long standing phobia of spiders. This
patient, despite her fear of spiders, had in the past fearlessly
handled snakes and crocodiles, and memories of this
occasion were used as a safety anchor. Following application of the V/KD phobia cure, the patient was able to
approach and handle spiders without any adverse reaction.

205

There are a large number of case studies and experiential

evidence for success of the above phobia cure described in literature concerning the use of NLP in treatment of phobias. Andreas3
describes the use of the V/KD phobia cure to successfully treat
individuals with a variety of phobias including two individuals with
a fear of elevators and one individual with a fear of public speaking
who had previously spent thousands of dollars unsuccessfully
attempting to cure his phobia. Andreas describes how the phobia
cure initially took one hour, but over time has been limited to
fteen minutes, and more recently two minutes.
Andreas also describes use of the swish pattern as a cure for
phobias. This method involves recalling a pleasant memory,
varying the submodalities of the picture such as brightness and size
to maximise the agreeableness of the picture, then introducing the
phobic stimulus into the picture and varying the characteristics of
this picture such as decreasing size or draining colour, until the fear
of the stimulus is minimised (for a full description see Ref. 18).
However like the collapsing anchors method, this technique is not
as effective for traumatic phobias such as post traumatic stress
disorder.18,3
5. Evidence in research
Despite the experiential evidence and case studies attesting to
the efcacy of NLP in the treatment of phobias, the research literature base supporting the use of NLP techniques in this area is
limited.16 However, there is some research regarding the efcacy of
NLP in curing phobias.
Furman8 describes a study comparing the efcacy of four
different brief therapies for the treatment of Post Traumatic Stress
Disorder. The methods studied were the NLP V/KD phobia cure, Eye
Movement Desensitization and Reprocessing (EMDR), Thought
Field Therapy (TFT), and Traumatic Incident Reduction (TIR).
Measures used were treatment time and a follow up measure of
subjective units of disturbance (SUD) score, a rating of the intensity
of distress client on a scale from zero to ten. All four methods were
shown to be effective at eliminating distress associated with PTSD.
TFT was revealed to be the most effective, V/KD and EMDR were
equally effective and TIR was shown to be the least effective. This
study is useful in demonstrating the efcacy of NLP as compared to
other treatments, however treatment time was not consistent for
all methods used, and as the NLP V/KD phobia cure is known to be
effective within a very brief time period, it would have been useful
if this was taken into account in the experiment as well.
Einspruch and Forman7 evaluated a program for curing phobias
based on NLP. Thirty-one individuals with various phobias were
assessed on measures of Mark's Phobia Questionnaire and Fear
Inventory and the Beck Depression Inventory Scale before and after
eight weeks of treatment. Findings showed a marked improvement
in the individuals who received treatment as compared to controls.
However the details of treatment used in this experiment were not
outlined so it is not clear which method or methods were being
used. However ndings suggested that NLP was a promising therapeutic technique for treating phobias.
In a pretesteposttest control group design study by Liberman
(1984),21 twelve subjects meeting the DSM-III criteria for Simple
Phobia were treated using the NLP phobia cure. Subjects in the
control group engaged in imagery of pleasant scenes. Both conditions were treated for two hour long sessions in one week. Results
were measured via approach to phobic stimuli, fear thermometer
and self-report questionnaires. NLP was shown to be signicantly
useful and found to be superior to the control condition in
improving approach behaviour and in decreasing the fear response.
The effect of NLP training on social anxiety in twenty-eight
adults was measured following a twenty-one day trial.11 Post test

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M. Karunaratne / Complementary Therapies in Clinical Practice 16 (2010) 203e207

measures of efcacy included the Liebowitz Social Phobia Scale

which was also administered at a six month follow up, and selfreport scores of fear and avoidance in social places were obtained.
There were substantial reductions in scores on these questionnaires
for all participants following training. However there was no formal
control condition in this experiment, and pre test scores employed
for comparison were obtained from a different experiment, therefore reliability of these results is limited. More research is needed to
investigate the efcacy of NLP in treating social phobia, as this
a widespread and prevalent problem.
Both the NLP phobia cure and collapsing of anchors have been
proven to be therapeutically effective individually, and Stanton15
investigated results when the two are used in conjunction. This
study also incorporated the use of hypnotic induction to maximise
results and was shown to be effective in the treatment of an individual with a telephone phobia. Although this was reported to be
highly effective, as it was only performed with one individual,
therefore this method needs to be applied to a larger population of
more than one individual in order to gauge a measure of efcacy.
An early piece of research by Allen1 explored the efcacy of NLP
in changing the behaviour of thirty-six students with snake
phobias. As well as the NLP condition, there was a control group
and a group that received systematic desensitization therapy.
Measures of severity of the phobia used were fear thermometer
and behaviour avoidance. Effectiveness was gauged by asking the
students to attempt to pick up a snake following treatment. This
study found that both treatment conditions had no effect on fear of
snakes. However as it is normal even for individuals without
a phobia to have a degree of fear when handling a snake, subjects
may have experienced a reduction in their fear of snakes despite
being reluctant to handle one, and due to outcome measure used
here, this reduction in fear may not have been apparent. Further
research with larger populations and different phobias is needed to
assess the efcacy of NLP in curing phobias.
6. Further applications
In addition to the direct treatment of phobias, the NLP V/KD
phobia cure may also be applicable to the treatment of chronic pain.
Research into the association between fear and pain indicates that
using the NLP phobia cure to eliminate fear in individuals with
chronic pain can also lead to elimination of the pain itself.6 The
authors discuss a case in which this method was applied successfully, that of a woman who was attending the GP concerning pain in
her lower legs which originated from a severe sprain three years
previously and which had resulted in the need for surgical reconstruction of one ankle. She had been suffering with subsequent pain
in both legs for over a year and had tried a variety of treatments
including physiotherapy and binding her legs whilst playing sports,
all without success. The patient was a kinaesthetic individual and
revealed a phobia that she had had for a number of years, of
climbing stairs. In order to explore the possibility that the chronic
leg pain was an attempt by the unconscious to protect the patient
from using stairs, the phobia cure was attempted. This was so
successful that not only was the phobia of stairs cured, but the
patient was able to engage in sporting activities without pain
almost immediately after the session.
Walker18 also relates the use of this method to help a patient
with a phobia of motorbikes, which arose after a traumatic
accident. Since the accident, the patient had also had chronic
shoulder pain. However, on successful application of the phobia
cure, as well as elimination of the phobia, she also reported the pain
to have disappeared. Such incidents are thought to be due to the
fact that when memories are stored as visual/kinaesthetic synaesthesias, remembering the event also causes the muscular

sensations present at that time to be re-experienced simultaneously (Halborn and Smith, as cited in Ref. 18). The NLP phobia
cure allows dissociation of the two modalities and as such previously associated physical sensations also disappear. These cases
indicate that there are more applications for the NLP phobia cure
which should be further examined.
7. Reframing phobias
As well as the popular V/KD phobia cure, there are other alternative ways of altering the fear response using NLP. Reframing has
also been cited as a useful method of dealing with fear. Bodenhamer and Hall in their training manual Mastering Your Fears:
A NLP/Neuro-Semantics Approach to Mastering Fear and Anxiety,
focus on adapting the meaning of the fear response rather than
attempting to eliminate it.5 The rationale behind this method is
that fear is a message which is often useful and appropriate.
According to the authors, feeling fearful of a specic object, experience or environmental trigger has a certain informational value
and is thus useful as feedback about the external environment.
However certain individuals place too much emphasis on their
response to this emotion which can result in the development of
a phobia.
Many such individuals are resistant to the traditional NLP V/KD
phobia cure as it is often not a fear of a direct external trigger but
a fear of the meaning of a situation or idea. One such example is the
use of this method to cure a woman with a fear of ying, one of the
case studies in the article Multiple Patterns for Mastering Fears
(2000) Bodenhamer describes case studies where reframing was
used to master the fear response in a number of individuals with
various phobias. Bodenhamer rst elicits details about the response
itself and triggers for it. He then explores the exceptions and
representational coding of the frame.
In this case the client was associating back to an incident when
she encountered turbulence on a ight each time she thought about
ying, which would lead to phobic thoughts of death and the plane
falling etc. This type of fear lends itself to reframing with a resource
that creates a higher level construction that allows the individual
with such a fear to come to terms with it by accepting, appreciating
or owning the fear as appropriate. Bodenhamer and Hall propose
that if the discomfort associated with the fear response is eliminated then a more realistic assessment of the signicance of the
fear can be made and thus the emotion can be utilised more
appropriately. This method may be a promising new avenue in the
use of NLP for treatment of phobias in individuals resistant to the
V/KD phobia cure.
8. Resistance
It appears that reframing is a useful tool for curing phobias with
NLP, particularly as the V/KD phobia cure is not always successful
due to resistance encountered in some clients.5 Another strategy
for managing resistance is The Milton Model.4 This NLP technique
based on the work of Milton Erikson, the eminent hypnotherapist,
is rooted in the idea of resistance. It states that the conscious mind
can be resistant to change or sceptical about the value of therapies
such as NLP and hypnosis. In order to manage this, the Milton
model attempts to reach the unconscious mind, using metaphors
and contradictions in order to utilise client resistance in a positive
manner. Indeed, this method actively encourages patients to
express resistance in order to allow the opportunity to modify it
with the idea that if even one subsequent suggestion made by the
therapist is accepted, that further suggestions will be more willingly accepted thereafter.

M. Karunaratne / Complementary Therapies in Clinical Practice 16 (2010) 203e207

However despite accounts of such methods designed to help

patients who are resistant to a cure, there is little mention in
literature of cases where NLP has been completely ineffective. It is
likely that such cases do exist as few therapies or treatments are
universally successful. However deciency of information in this
area may be related to the lack of experimental evidence involving
the use of NLP. Much of the evidence in literature reviewed for this
article is based on case studies and practitioner experience rather
than controlled trials. It may be that practitioners reporting individual or limited numbers of case studies are more apt to discuss
successful cases than unsuccessful ones. Further research utilising
large patient samples is needed in order to ascertain the nature of
client resistance and methods of either overcoming it or elucidating
the types of treatment that would be effective for such individuals.
It appears then that NLP provides an efcient and effective
method for eliminating phobias. The method of double dissociation
used in the V/KD phobia cure allows the individual to gain
emotional distance from the phobic response and integrates the
memory at the level of the amygdala so that the fear response
remains eliminated, even in potentially stressful encounters with
the phobic stimulus.18 Due to this level of integration, NLP may be
superior to traditional methods of treating phobias such as exposure and extinction and systematic desensitization, as whilst these
methods have been shown to be effective, there is often relapse of
the fear response on future encounters with the phobic stimulus.
However, despite its efcacy, NLP is not utilised as frequently as the
other more traditional methods. The reason for this may be the lack
of a sufcient formal research into the efcacy of the NLP V/KD
phobia cure. This is unfortunate, as the speed with which the NLP
phobia cure is effective as compared to more traditional psychological methods, and also the potential superior efcacy make it
a promising treatment which could be hugely benecial to the large
number of individuals suffering with phobias worldwide. There is
also limited evidence regarding the use of the NLP phobia cure in
treatment of generalised social phobia, an extremely prevalent type
of phobia. More research is needed in these elds to provide a large
evidence base such that this method will become more widely
available for the treatment of all phobias. This method could
potentially be incorporated into mainstream healthcare as an
option to be offered to phobia sufferers alongside or as an alternative to current psychological treatments such as systematic
desensitization. Additionally, the NLP V/KD phobia cure may have
promising applications beyond the direct treatment of phobias.
This cure has been shown to be effective in treating chronic pain

207

where an underlying fear is the cause of the pain and as such this
area of therapy also merits further investigation.
Acknowledgements
I would like to thank my supervisor Ursula James.
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