Disorders - Specific Phobia
Raeder, F., Woud, M. L., Schneider, S., Totzeck, C., Adolph, D., Margraf, J., Zlomuzica, A.
The retrieval of personal mastery experiences has been linked to adaptive functions, such as increased perceived self-efficacy and coping capability. Successful exposure leads to an increased mastery experience with respect to anxiety provoking situations, possibly due to a violation of expected negative outcomes. We investigated whether the reactivation and evaluation of mastery experiences after a brief virtual reality exposure (VRE) training can enhance self-efficacy and promote exposure therapy benefit in patients with acrophobia. Acrophobic participants (N = 56) were randomly assigned to a memory reactivation and evaluation (= VRE-MRE) intervention, a control (= memory reactivation; VRE-MR), or no intervention (= VRE) after VRE. The VRE-MRE condition involved the evaluation of mastery experiences associated with exposure and related events from the past. The effects of the VRE-MRE intervention were assessed on the level of behavioral avoidance and subjective fear at post-treatment and one-month follow-up. Relative to both the VRE-MR and VRE conditions, the VRE-MRE group showed an increase in self-efficacy and exhibited more pronounced reductions in behavioral avoidance, subjective fear at the initial approach distance, as well as scores on the acrophobia questionnaire (AQ) from pre- to post-treatment. The superior effects of the VRE-MRE intervention remained evident on the level of behavioral avoidance and associated subjective fear at the initial approach distance, but not on the AQ, from pre-treatment to follow-up. These findings indicate that the reactivation and evaluation of mastery experiences could be used as a strategy to increase exposure-based therapy in anxiety disorders. Copyright © 2019, Springer Science+Business Media, LLC, part of Springer Nature.
Cognitive Therapy and Research., 43 : 948 - 958
- Year: 2019
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Papalini, S., Lange, I., Bakker, J., Michielse, S., Marcelis, M., Wichers, M., Vervliet, Bram, vanOs, Jim, VanAmelsvoort, T., Goossens, L., Schruers, K.
Background: Exposure is the gold standard treatment for phobic anxiety and is thought to represent the clinical application of extinction learning. Reward sensitivity might however also represent a predictive factor for exposure therapy outcome, as this therapy promotes positive experiences and involves positive comments by the therapist. We hypothesized that high reward sensitivity, as expressed by elevated reward expectancy and reward value, can be associated with better outcome to exposure therapy specifically. Methods: Forty-four participants with a specific phobia for spiders were included in the current study. Participants were randomly assigned to exposure therapy (n = 25) or progressive muscle relaxation (PMR) (n = 19). Treatment outcome was defined as pre- versus post-therapy phobia symptoms. Before treatment, functional brain responses and behavioral responses (i.e. reaction time and accuracy) during reward anticipation and consumption were assessed with the Monetary Incentive Delay task (MID). Behavioral and neural responses in regions of interest (i.e. nucleus accumbens, ventromedial prefrontal cortex and the ventral tegmental area) as well as across the whole-brain were subsequently regressed on treatment outcomes. Results: Exposure therapy was more effective in reducing phobia symptoms than PMR. Longer reaction times to reward cues and lower activation in the left posterior cingulate cortex during reward consumption were selectively associated with symptoms reductions following exposure therapy but not following PMR. Only within the exposure therapy group, greater symptom reduction was related to increased activation in the ventrolateral prefrontal cortex during reward anticipation, and decreased activation in the medial prefrontal cortex during reward consumption. Conclusion: Results indicate that individual differences in reward sensitivity can specifically predict exposure therapy outcome. Although activation in regions of interest were not related to therapy outcome, regions involved in attentional processing of reward cues were predictive of phobic symptom change following exposure therapy but not PMR. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Progress in Neuro-Psychopharmacology & Biological Psychiatry, 92 : 339-346
- Year: 2019
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Relaxation
Raeder, F., Merz, C.J., Tegenthoff, M., Wolf, O.T., Margraf, J., Zlomuzica, A.
Cortisol administration prior to treatment can promote the efficacy of exposure-based treatments in specific phobia: cortisol has been proposed to reduce fear retrieval at the beginning of exposure and to enhance the acquisition and consolidation of corrective information learned during exposure. Whether cortisol exerts a beneficial therapeutic effect when given after exposure, e.g., by targeting the consolidation of new corrective information, has not been addressed so far to date. Here, we examined whether post-exposure cortisol administration promotes fear reduction and reduces return of fear following contextual change in specific phobia. Furthermore, the effect of cortisol on return of fear following contextual change (i.e., contextual renewal) was assessed. Patients with spider phobia (N = 43) were treated with a single session of in-vivo exposure, followed by cortisol administration (20 mg hydrocortisone) in a double-blind, placebo-controlled study design. Return of fear was assessed with behavioral approach tests (BATs) in the familiar therapy context (versus a novel unfamiliar context) at one-month and seven-month follow-up assessment. Exposure was effective in reducing fear from pre-treatment to post-treatment (i.e., 24 h after exposure) on fear-related behavioral (approach behavior during the BAT), psychophysiological (heart rate during the BAT) and subjective (fear during the BAT, spider-fear related questionnaires) measures of therapeutic outcome, with no add-on benefit of cortisol administration. Cortisol had no effect on contextual renewal at one-month follow-up. However, in a subsample (N = 21) that returned to the seven-month follow-up, an adverse effect of cortisol on fear renewal was found, with cortisol-treated patients showing an increase in subjective fear at the final approach distance of the BAT from post-treatment to seven-month follow-up. These and previous findings underline the importance of considering the exact timing of cortisol application when used as an add-on treatment for extinction-based psychotherapy: post-exposure cortisol administration does not seem to be effective, but might promote fear renewal at the subjective level. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Psychoneuroendocrinology, 99 : 174-182
- Year: 2019
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions, Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention
Davis, T. E., Ollendick, T. H., Odiest, L. G.
One-Session Treatment is a well-established evidence-based treatment for specific phobias in youths that incorporates reinforcement, cognitive challenges, participant modeling, psychoeducation, and skills training into a single, massed session of graduated exposure. This review begins by briefly examining the phenomenology, etiology, epidemiology, and assessment of specific phobias and then pivots to a description of One-Session Treatment. We examine the use of One-Session Treatment with children and adolescents, briefly discussing its components and application, and subsequently review almost two decades of research supporting its efficacy. Finally, we propose future directions for research and practice. Copyright © 2019 by Annual Reviews. All rights reserved.
Annual Review of Clinical Psychology, 15 : 233-256
- Year: 2019
- Problem: Specific Phobia
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Exposure therapy, Exposure and response prevention
Katz, B. A., Breznitz, H., Yovel, I.
Recent variants of exposure therapy ask clients to directly engage with the distress associated with avoided experiences in order to become more resilient to future anxiety-provoking situations. In this study, we consider how this engagement impacts behavioral willingness. Forty-eight participants with high fear of cockroaches completed in vivo exposures while either mindfully attending externally to the feared object (Ext), or to both the object and their internal distress (Int/Ext). While both groups showed improvement, behavioral, subjective and physiological measures revealed different patterns of change. Immediate testing showed that participants in the Ext condition improved more in subjective distress, with no other differences between groups. A second testing a week later in an ecologically valid environment showed that participants the Int/Ext intervention continued to improve behaviorally, regardless of their reported subjective discomfort. These findings highlight the importance of explicit engagement with distress during exposures, that forego immediate subjective relief for long-term behavioral improvement. Copyright © 2018 Elsevier Ltd
Behaviour Research and Therapy, 113 : 9-17
- Year: 2019
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Other Psychological Interventions
Gujjar, K. R., vanWijk, A., Kumar, R., deJongh, A.
Background: Although Virtual Reality Exposure Therapy (VRET) has proven to be effective in the treatment of various subtypes of specific phobia, there is limited evidence of its role in the treatment of dental phobia. Method(s): A single-blind RCT was conducted among 30 randomized patients with dental phobia to either VRET or informational pamphlet (IP) condition. Primary outcome anxiety measures (VAS-A, MDAS and DFS) were evaluated at baseline, pre- and post-intervention, 1-week, 3-months and 6-months follow-up. Secondary outcome measures assessed were pre-post behavioral avoidance, temporal variations of heart rate and VR-experience during and post-VRET, and dental treatment acceptance in both conditions at 6-month follow-up. Result(s): Intention to treat analysis, using a repeated measures MANOVA, revealed a multivariate interaction effect between time and condition (p = 0.015) for all primary outcome measures (all ps < 0.001). Only patients of the VRET condition showed a significant reduction in anxiety scores (mean reduction [s.d.]: VAS-A 44.4 [36.1]; MDAS 7.1 [5.4]; DFS 21.2 [13.1]) whereas the patients in the IP group did not (mean reduction [s.d.]: VAS-A -0.33 [7.7]; MDAS -0.33 [1.3]; DFS -1.9 [3.8]), F (15, 14) = 3.3, p = 0.015. Conclusion(s): VRET was found to be efficacious in the treatment of dental phobia. Copyright © 2018 Elsevier Ltd
Journal of Anxiety Disorders, 62 : 100-108
- Year: 2019
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Technology, interventions delivered using technology (e.g. online, SMS)
Watson, D. R., Garfinkel, S. N., VanPraag, C. G., Willmott, D., Wong, K., Meeten, F., Critchley, H. D.
Objective: Spider phobia is a common form of anxiety disorder for which exposure therapy is an effective first-line treatment. Motivated by the observed modulation of threat processing by afferent cardiac signals, we tested the hypothesis that interoceptive information concerning cardiovascular arousal can influence the outcomes of computerized exposure therapy for spider phobia. Method Fifty-three normal healthy participants with high spider phobia scores underwent one of the following three modified computerized exposure protocols, defined by the timing of exposure to brief spider stimuli within the cardiac cycle: systole (during afferent baroreceptor firing); diastole (during baroreceptor-quiescent interbeat interval); random (noncontingent on cardiac cycle). Outcomes were judged on phobic and anxiety measures and physiological data (skin conductance). Individuals were also rated on interoceptive accuracy. Result(s): MANCOVA analysis showed that timing group affected the outcome measures (F(10,80) = 2.405, p =.015) and there was a group interaction with interoception ability (F(15,110) = 1.808, p =.045). Subjective symptom reduction was greatest in the systolic group relative to the other two groups (diastolic (t = 3.115, ptukey =.009); random (t = 2.438, ptukey =.048)), with greatest reductions in those participants with lower interoceptive accuracy. Behavioral aversion reduced more in cardiac-contingent groups than the noncontingent (random) group (diastolic (t = 3.295, ptukey =.005); systolic (t = 2.602, ptukey =.032)). Physiological (skin conductance response) responses remained strongest for spider stimuli presented at cardiac systole. Conclusion(s): Interoceptive information influences exposure benefit. The reduction in the subjective expression of fear/phobia is facilitated by "bottom-up" afferent signals, whereas improvement in the behavioral expression is further dependent on "top-down" representation of self-related physiology (heart rhythm). Individual interoceptive differences moderate these effects, suggesting means to personalize therapy. Copyright © 2018 by the American Psychosomatic Society.
Psychosomatic Medicine, 81(1) : 90-99
- Year: 2019
- Problem: Specific Phobia
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Technology, interventions delivered using technology (e.g. online, SMS), Other service delivery and improvement interventions
Melvin, G. A., Gordon, M. S.
Cognitive-behavioral therapy (CBT) is an evidence-based treatment for school refusal. However, some youth do not respond to CBT. The serious risks associated with school nonattendance call for novel approaches to help those who do not respond to CBT. Because school refusal is commonly associated with anxiety disorders, and the combination of CBT and antidepressant medication enhances outcomes in the treatment of anxiety disorders, combined treatment may be effective for school refusal. This narrative review evaluates the current evidence base for adding antidepressant treatment to CBT for school refusal. Six randomized controlled trials (RCTs), two open trials, six case studies/series, and one observational study were identified and reviewed. There is support for combined CBT and imipramine, but this medication is not typically used due to the risk of concerning side effects. Two recent RCTs failed to provide evidence for the superiority of combined CBT and fluoxetine. Further research in this area is required because the extant studies have a number of methodological limitations. Recommendations are provided for clinicians who consider prescribing antidepressant medication or referring for adjunctive antidepressant treatment for school refusal. Copyright © 2018
Cognitive and Behavioral Practice, 26(1) : 107-118
- Year: 2019
- Problem: Anxiety Disorders (any), Specific Phobia
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Antidepressants (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Kowalsky, J. M., Conatser, R., Ritz, T., France, C. R.
Fear of blood and needles increases risk for presyncopal symptoms. Applied muscle tension can prevent or attenuate presyncopal symptoms; however, it is not universally effective. This study examined the effects of applied muscle tension, a respiratory intervention, and a no treatment control condition, on presyncopal symptoms and cerebral oxygenation, during a simulated blood draw with individuals highly fearful of needles. Participants (n=95) completed questionnaires, physiological monitoring, and two trials of a simulated blood draw with recovery. Presyncopal symptoms decreased across trials; however, no group differences emerged. Applied muscle tension was associated with greater cerebral oxygenation during trial two, and greater end-tidal carbon dioxide during both trials. The respiratory intervention did not differ from the no treatment control. Applied muscle tension is an intervention that can increase cerebral oxygenation and end-tidal carbon dioxide. While the respiratory intervention is promising within therapeutic settings, it was not efficacious after a brief audio training.
Journal of Behavioral Medicine, 41(6) : 771-783
- Year: 2018
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Meditation
, Relaxation
Siegel, P., Warren, R., Jacobson, G., Merritt, E.
A series of experiments has shown that limiting awareness of exposure to feared stimuli through visual masking-or very brief exposure (VBE)-reduces avoidance of a live tarantula by spider-phobic participants. We investigated this process of fear reduction by directly relating the effects of VBE on electrodermal activity to its ensuing effects on phobic behavior. Sixty spider-phobic participants, identified by approaching a live tarantula and a questionnaire, were administered either VBE to masked spiders or control exposure to masked flowers. Skin conductance levels (SCLs) were continuously recorded during exposure. The participants approached the tarantula again immediately thereafter. VBE reduced avoidance of the tarantula and did not increase SCLs or cause subjective distress relative to control exposure. SCL increases during VBE were strongly negatively correlated with the reduction of self-reported fear of the tarantula: the less that SCLs increased during VBE, the more it reduced fear. VBE only increased SCLs in participants whose fear was not reduced; it did not increase SCLs in participants whose fear of the tarantula was reduced. Awareness of the stimuli did not mediate these effects. Control exposure did not yield any of these effects. In a second experiment, clearly visible exposure to spider images increased SCLs and subjective distress more than both VBE and control exposure, whereas VBE did not increase SCLs or subjective distress relative to control exposure within the same spider-phobic participants. These findings suggest that exposure to phobic images can reduce fear even when it bypasses the induction of electrodermal activity. Copyright © 2017 Society for Psychophysiological Research.
Psychophysiology, 55(5) : e13045
- Year: 2018
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Technology, interventions delivered using technology (e.g. online, SMS)
McKinnon, A., Keers, R., Coleman, J. R. I., Lester, K. J., Roberts, S., Arendt, K., etal.
BACKGROUND: Several delivery formats of cognitive behaviour therapy (CBT) for child anxiety have been proposed, however, there is little consensus on the optimal delivery format. The primary goal of this study was to investigate the impact of the child's primary anxiety diagnosis on changes in clinical severity (of the primary problem) during individual CBT, group CBT and guided parent-led CBT. The secondary goal was to investigate the impact of the child's primary anxiety diagnosis on rates of remission for the three treatment formats. METHOD(S): A sample of 1,253 children (5-12 years; Mage = 9.3, SD = 1.7) was pooled from CBT trials carried out at 10 sites. Children had a primary diagnosis of generalised anxiety disorder (GAD), social anxiety disorder (SoAD), specific phobia (SP) or separation anxiety disorder (SAD). Children and parents completed a semistructured clinical interview to assess the presence and severity of DSM-IV psychiatric disorders at preintervention, postintervention and follow-up. Linear mixture modelling was used to evaluate the primary research question and logistic modelling was used to investigate the secondary research question. RESULT(S): In children with primary GAD, SAD or SoAD, there were no significant differences between delivery formats. However, children with primary SP showed significantly larger reductions in clinical severity following individual CBT compared to group CBT and guided parent-led CBT. The results were mirrored in the analysis of remission responses with the exception that individual CBT was no longer superior to group CBT for children with a primary SP. The difference between individual and group was not significant when follow-up data were examined separately. CONCLUSION(S): Data show there may be greater clinical benefit by allocating children with a primary SP to individual CBT, although future research on cost-effectiveness is needed to determine whether the additional clinical benefits justify the additional resources required. Copyright © 2018 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.
Journal of Child Psychology & Psychiatry, & Allied Disciplines, 59(7) : 763-772
- Year: 2018
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
, Specific Phobia
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other service delivery and improvement interventions
Gremsl, A., Schwab, D., Hofler, C., Schienle, A.
Several eye-tracking studies have revealed that spider phobic patients show a typical hypervigilance-avoidance pattern when confronted with images of spiders. The present experiment investigated if this pattern can be changed via placebo treatment. We conducted an eye-tracking experiment with 37 women with spider phobia. They looked at picture pairs (a spider paired with a neutral picture) for 7 s each in a retest design: once with and once without a placebo pill presented along with the verbal suggestion that it can reduce phobic symptoms. The placebo was labelled as Propranolol, a beta-blocker that has been successfully used to treat spider phobia. In the placebo condition, both the fixation count and the dwell time on the spider pictures increased, especially in the second half of the presentation time. This was associated with a slight decrease in self-reported symptom severity. In summary, we were able to show that a placebo was able to positively influence visual avoidance in spider phobia. This effect might help to overcome apprehension about engaging in exposure therapy, which is present in many phobic patients. Copyright © 2018, © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
Cognition and Emotion, 32(8) : 1571-1577
- Year: 2018
- Problem: Specific Phobia
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions