When Pfeffer and Joanna arrived at the café filled with young moms and their kids, Joanna returned to a distracted, almost disconnected state. She was hypervigilant and tense.
Pfeffer wasted little time and as soon as he found a willing mom, he asked Joanna when was the last time she had held a child. "Never," she replied.
Pfeffer suggested that now might be a good time to start. Joanna nodded slightly, eyeing the tiny little girl whose mother was holding her in outstretched arms, beaming at Joanna. She carefully placed the baby in her lap. Silence.
Pfeffer asked Joanna how it was. She looked closely at the child, held her a tiny bit tighter, and after a moment, smiled. Another door was opening.
Although exposure therapy is dramatic, the effect tends to diminish without follow through.
It's like taking your medication when you have a virus. You may start to feel better halfway through but if you don't finish, you may get sick again," Pfeffer says. "The brain needs sufficient time for that memory to take hold. The analogy is playing a sport or learning a musical instrument. If you don't practice, you will know the basics but you'll get rusty and lose your touch.
"When it comes to facing your fear, though there's so much on the line, it's almost a life or death matter. It's easy to default back to the old way unless you have what I call a good program."
Immediately after therapy, Joanna began practicing her own exposures, but she was inconsistent. In the months since, she has had her ups and downs. She relies heavily on her boyfriend and keeps a restricted daily routine.
But, she says, "I think I am about 50 percent better than I was."
She also believes the time is right for her to tackle the rest of her phobia.
Clinical psychologist Foa says, "Exposure therapy is the way we teach our children not to be afraid. It's the normal way we get over fears in everyday life. If you see a child afraid of going into the water, you say, 'Go with mommy, and we will go to the edge of the water, mommy will hold you.' And that's exposure."