Disorders - Specific Phobia
Londono-Tobon, A., Reed, M. O., Taylor, J. H., Bloch, M. H.
Objective: School refusal is an important pediatric problem with significant negative short- A nd long-term outcomes. Specific psychosocial treatments appear effective in reducing school refusal, but many children do not respond to these treatments. Although systematic reviews have examined the efficacy of psychological interventions for school refusal, no systematic reviews on pharmacological interventions exist. Methods: We conducted a comprehensive literature search of MEDLINE, PsycINFO, Scopus, and Embase for randomized controlled trials (RCTs) or quasi-experimental pharmacologic trials in children and adolescents with school refusal reported in English or Spanish until July 1, 2017. Two authors screened study titles and abstracts for eligibility. Data regarding the population, intervention, comparison, and outcomes for each trial were extracted and reported. Effect sizes for school attendance are presented. Results: The search identified 6 articles, including 7 trials (6 RCTs and 1 open label) and 306 youths. Pharmacologic treatments investigated for school refusal included antidepressants (imipramine, clomipramine, and fluoxetine) and benzodiazepines (alprazolam). All pharmacotherapies studied had pretreatment to posttreatment improvements on school refusal, depression, and anxiety symptoms. However, included trials were severely underpowered and did not demonstrate significant improvement compared to placebo. Conclusions: Data regarding pharmacological treatments for school refusal are sparse. Most trials in this area were conducted before development of newer antidepressants, were underpowered, and have significant methodological limitations that are characteristic of the time in which they were conducted. This systematic review highlights the need for more trials with newer pharmacologic agents, larger sample sizes, and improved systematic assessments of school refusal and comorbidities. School refusal represents an important functional outcome for many children, especially those with anxiety and depression. Future pharmacologic studies of anxiety and depression in children may benefit from incorporating specific school refusal measures as secondary outcomes. Copyright © 2018, Mary Ann Liebert, Inc.
Journal of Child and Adolescent Psychopharmacology, 28(6) : 368-378
- Year: 2018
- Problem: Anxiety Disorders (any), Specific Phobia
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants, Antidepressants (any)
, Anticonvulsants/mood stabilisers (excl. lithium)
Farrell, L. J., Waters, A. M., Oar, E. L., Tiralongo, E., Garbharran, V., Alston-Knox, C., McConnell, H., Collings, N., Zimmer-Gembeck, M., Donovan, C. L., Testa, C., Storch, E. A., Ollendick, T. H.
Background: D-Cycloserine has potential to enhance exposure therapy outcomes. The current study presents a preliminary randomized, placebo-controlled double-blind pilot trial of DCS-augmented one-session treatment (OST) for youth (7-14 years) with specific phobia. A secondary aim of this pilot study was to explore the effects of youth age and within-session fear reduction as potential moderators of DCS outcomes in order to generate hypotheses for a larger trial. It was hypothesized that DCS would be associated with greater improvements than placebo, that children (7-10 years) would have greater benefits than adolescents (11-14 years), and that DCS effects would be stronger for participants with the greater within-session fear reduction during the OST. Method(s): Thirty-five children and adolescents were randomized to either OST combined with DCS (n = 17), or OST combined with placebo (PBO; n = 18) and assessed at 1 week, 1 month, and 3 month following treatment. Result(s): There were no significant pre- to post-treatment or follow-up benefits of DCS relative to placebo. Secondary analyses of age indicated that relative to PBO, DCS was associated with greater improvements for children (but not adolescents) on measures of severity at 1-month follow-up. Children in the DCS condition also showed significantly greater improvement to 1 month on global functioning relative to other groups. Conversely, adolescents had significant post-treatment benefits in the PBO condition on symptom severity measures relative to DCS, and adolescents in the DCS condition had significantly poorer functioning at 3 months relative to all other groups. Finally, there was a trend for within-session fear reduction to be associated with moderating effects of DCS, whereby greater reduction in fear was associated with greater functioning at one-month follow-up for children who received DCS, relative to PBO. Limitation(s): The study sample was small and therefore conclusions are tentative and require replication. Conclusion(s): Age and within-session fear reduction may be important moderators of DCS-augmented one-session exposure therapy, which requires testing in a fully powered randomized controlled trial. Copyright © 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.
Brain and Behavior, 8 (6) (no pagination)(e00984) :
- Year: 2018
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, D-cycloserine (DCS)
Kodal, A., Fjermestad, K., Bjelland, I., Gjestad, R., Ost, L. G., Bjaastad, J. F., Haugland, B. S. M., Havik, O. E., Heiervang, E., Wergeland, G. J.
Cognitive behavioral therapy (CBT) has demonstrated favorable long-term outcomes in youth with anxiety disorders in efficacy trials. However, long-term outcomes of CBT delivered in a community setting are uncertain. This study examined the long-term outcomes of individual (ICBT) and group CBT (GCBT) in youth with anxiety disorders treated in community mental health clinics. A total of 139 youth (mean age at assessment 15.5 years, range 11-21 years) with a principal diagnosis of separation anxiety disorder (SAD), social anxiety disorder (SOP), and/or generalized anxiety disorder (GAD) were evaluated, on average, 3.9 years post-treatment (range 2.2-5.9 years). Outcomes included loss of all inclusion anxiety diagnoses, loss of the principal anxiety diagnosis and changes in youth- and parent-rated youth anxiety symptoms. At long-term follow-up, there was loss of all inclusion anxiety diagnoses in 53%, loss of the principal anxiety diagnosis in 63% of participants as well as significant reductions in all anxiety symptom measures. No statistical significant differences in outcome were obtained between ICBT and GCBT. Participants with a principal diagnosis of SOP had lower odds for recovery, compared to those with a principal diagnosis of SAD or GAD. In conclusion, outcomes of CBT for youth anxiety disorders delivered in community mental health clinics were improved at nearly 4 years post-treatment, and recovery rates at long-term follow-up were similar to efficacy trials. Copyright © 2017 The Authors
Journal of Anxiety Disorders, 53 : 58-67
- Year: 2018
- Problem: Generalized Anxiety Disorder, Specific Phobia
- Type: Randomised controlled trials
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other service delivery and improvement interventions
Lima, J., McCabe-Bennett, H., Antony, M. M.
Background: The present study examined the efficacy of virtual reality (VR) exposure therapy for treating individuals with storm fears by comparing a one-session VR exposure treatment with a one-session progressive muscle relaxation (PMR) and psychoeducation session. Aims: It was predicted that there would be a reduction in storm-related fear post-treatment for individuals in both conditions, but that this reduction would be greater for those in the VR exposure condition. It was predicted that improvements would be maintained at 30-day follow-up only for those in the VR exposure condition. Method: Thirty-six participants each received one of the two treatment conditions. Those in the PMR treatment group received approximately 30 minutes of PMR and approximately 15 minutes of psychoeducation regarding storms. Those in the VR treatment group received approximately 1 hour of VR exposure. Additionally, participants were asked to complete a pre-treatment and post-treatment 5-minute behavioural approach test to assess changes in storm fears. They were also asked to complete a measure assessing storm phobia. Results: There was a significant interaction between treatment group and self-reported fear at post-treatment, such that fear decreased for both groups, although the reduction was stronger in the VR group. Results also showed that reductions in storm fear were maintained at 30-day follow-up for both groups. Conclusions: Although this study used a small non-clinical sample, these results offer preliminary support for the use of VR exposure therapy in the treatment of storm-related fear. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Behavioural and Cognitive Psychotherapy, 46(2) : 251-256
- Year: 2018
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Psychoeducation, Relaxation
Minns, S., Levihn-Coon, A., Carl, E., Smits, J. A. J., Miller, W., Howard, D., Papini, S., Quiroz, S., Lee-Furman, E., Telch, M., Carlbring, P., Xanthopoulos, D., Powers, M. B.
Stereoscopic 3D gives the viewer the same shape, size, perspective and depth they would experience viewing the real world and could mimic the perceptual threat cues present in real life. This is the first study to investigate whether an immersive stereoscopic 3D video exposure-based treatment would be effective in reducing fear of spiders. Participants with a fear of spiders (N = 77) watched two psychoeducational videos with facts about spiders and phobias. They were then randomized to a treatment condition that watched a single session of a stereoscopic 3D immersive video exposure-based treatment (six 5-min exposures) delivered through a virtual reality headset or a psychoeducation only control condition that watched a 30-min neutral video (2D documentary) presented on a computer monitor. Assessments of spider fear (Fear of Spiders Questionnaire [FSQ], Behavioral Approach Task [BAT], & subjective ratings of fear) were completed pre- and post-treatment. Consistent with prediction, the stereoscopic 3D video condition outperformed the control condition in reducing fear of spiders showing a large between-group effect size on the FSQ (Cohen's d = 0.85) and a medium between-group effect size on the BAT (Cohen's d = 0.47). This provides initial support for stereoscopic 3D video in treating phobias. Copyright © 2018 Elsevier Ltd
Journal of Anxiety Disorders, 58 : 1-7
- Year: 2018
- 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, Psychoeducation
Olatunji, B. O., Tomarken, A., Wentworth, B., Fritzsche, L.
BACKGROUND AND OBJECTIVES: The current study examines effects of exposure in multiple contexts on fear reduction and renewal and the moderating effect of baseline threat-specific and nonspecific emotionality.
METHODS: Snake-fearful participants received a negative or neutral emotion induction and were randomized to video exposure to a snake in a single context, multiple context, or a no exposure control group.
RESULTS: Anxiety in response to video presentations of a snake was significantly reduced in the two exposure groups compared to the control group, especially among those with heightened baseline threat-specific emotionality as indicated by snake anxiety ratings at baseline. Although the two exposure groups did not differ in responding when confronted with a novel snake, both exposure groups reported significantly lower snake anxiety and arousal than the control group. Subsequent analysis did show that compared to controls, the single context group demonstrated greater increase in anxiety and arousal from post-exposure to exposure to the novel snake among those with heightened snake anxiety at baseline. Furthermore, the multiple context group was less avoidant and less fearful than the single context group on a post-exposure behavioral test.
LIMITATIONS: The study used an analogue exposure paradigm with an analogue sample and findings may not be generalizable to a clinical population.
CONCLUSIONS: These findings suggest that baseline threat-specific emotionality influences fear reduction and renewal. The benefits of exposure in multiple contexts are discussed in relation to a distinct pattern of symptom change that is in line with an inhibitory learning approach.
Journal of Behavior Therapy & Experimental Psychiatry, 54 : 270-277
- Year: 2017
- 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
Preusser, F., Margraf, J., Zlomuzica, A.
Exposure therapy is highly effective in treating excessive fear related to specific objects and/or situations. However, patients with anxiety disorders often display a generalization of fear responses toward conceptually and perceptually related stimuli and situations. It is unclear whether the beneficial effects of exposure on fear reduction toward treated fear stimuli can extend to untreated fear stimuli. Here, we investigated whether basic principles of extinction generalization apply to exposure. Spider-phobic participants were randomly assigned to either two sessions of exposure treatment (n=23) with spiders or no-treatment (n=24). Prior to and after treatment, behavioral approach tests (BATs) were conducted to examine avoidance, fear and disgust responses toward the treated phobic stimulus (spider as the extinction stimulus). Likewise, BATs with the untreated fear stimulus (cockroach) were conducted to dissect the generalization of treatment effects. Treatment was highly effective in increasing approach behavior toward both treated and untreated fear stimuli. Generalization of treatment effects were evident on the behavioral (approach distance during the BAT), subjective (fear levels during the BAT) and psychophysiological level (heart rate during the BAT). However, a stronger decline in disgust was only evident for the treated fear stimulus. Notably, the herein attained generalization effects were not context-dependent. Hence, exposure therapy for spider phobia was effective in reducing fear of untreated stimuli which share common fear-evoking characteristics with spiders but were never presented during the respective exposure treatment. These findings provide clinical evidence for extinction generalization across different fear-evoking stimuli mediated via exposure. Copyright © 2017 American College of Neuropsychopharmacology. All rights reserved.
Neuropsychopharmacology, 42(13) : 2545-2552
- Year: 2017
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention
Berge, K. G., Agdal, M. L., Vika, M., Skeie, M. S.
OBJECTIVE: To evaluate the effect of five sessions of cognitive behavioural therapy (CBT) for 10- to 16-year-olds with intra-oral injection phobia. MATERIAL AND METHODS: This was a randomized delayed intervention controlled trial in 67 patients, fulfilling the DSM-5 criteria for specific phobia. All patients received the same CBT performed by dentists specially trained in CBT. The patients were randomly assigned to either an immediate treatment group (ITG) (34 patients) or a waitlist-control group (WCG) (33 patients). The WCG was put on a waitlist for 5 weeks. After treatment, all patients were combined for post-treatment analyses. Assessments including the psychometric self-report scales Intra-oral injection fear scale (IOIF-s), Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), Injection Phobia Scale for children (IS-c) and Mutilation Questionnaire for children (MQ-c) and a behavioural avoidance test (BAT) followed by a questionnaire on cognitions during the BAT, occurred pre-, post-treatment/waitlist and at a 1-year follow-up. RESULTS: CBT had a significant effect compared to no treatment (WCG). After treatment, the scores on the psychometric self-report scales were significantly reduced and higher levels in the BAT were achieved. The results were maintained at 1-year follow-up. Of the 67 patients, 70.1% received intra-oral injections during CBT treatment, whereas 69.4% of those completing the CBT, in need for further dental treatment, managed to receive the necessary intra-oral injections at their regular dentist. CONCLUSIONS: The 10- to 16-year-olds diagnosed with intra-oral injection phobia benefitted positively on CBT performed by specially trained dentists.
Acta odontologica Scandinavica, 75(4) : 294-301
- Year: 2017
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Dethier, V., Philippot, P.
This study examines the impact of partial distractor valence and schematicity (i.e., their relation to fear representation) on exposure efficacy. One hundred forty-one spider phobics were exposed to spider pictures and asked, in a between-subjects experimental design, to form mental images of words that were fear related (to spiders) and negative (schematic negative), fear unrelated and negative (non-schematic negative) or fear unrelated and positive (non-schematic positive). Multilevel measures of anxiety were performed at pre-exposure, post-exposure and 6 days' follow-up. Results show that both of the negative condition groups displayed similar results on all outcome variables and systematically differed from the positive condition group. While the latter group displayed a stronger decline in distress during exposure itself, the other groups showed greater exposure benefits: a stronger decline in emotional and avoidance responses and skin conductance responses from pre- to post-exposure and more approach behaviours when confronted with a real spider. The critical feature of distraction thus seems not to be the fact of being distracted from the phobic stimulus, but rather the fact of performing emotional avoidance by distracting oneself from negative affect. The results highlight that the acceptance of aversive emotional states is a critical active process in successful exposure. Copyright © 2017 Elsevier Ltd
Behaviour Research and Therapy, 93 : 104-115
- Year: 2017
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Diemer, J., Zwanzger, P., Fohrbeck, I., Zavorotnyy, M., Notzon, S., Silling, K., Arolt, V., Domschke, K., Pfleiderer, B.
Objective Anxiety disorders are among the most frequent psychiatric disorders. Current treatment guidelines recommend antidepressants, the calcium modulator gabapentin, and benzodiazepines as pharmacological treatments. However, delayed onset of action precludes the use of antidepressants as an acute treatment, while benzodiazepines can be recommended only as an emergency treatment due to their inherent risk of dependence. Therefore, an alternative pharmacological agent with acute efficacy is needed. Preliminary evidence points towards possible anxiolytic properties of the atypical antipsychotic quetiapine. The goals of this study were to test the acute anxiolytic properties of quetiapine in patients suffering from arachnophobia in a challenge paradigm, and to assess the effects of quetiapine on the central nervous fear network. Methods In a randomized, double-blind, placebo-controlled proof-of-concept study, n = 58 arachnophobic patients underwent an fMRI scan while looking at phobia-related and neutral stimuli. Subjective anxiety was evaluated retrospectively in questionnaires. Results The functional imaging data revealed that patients showed stronger amygdala activation to phobia-related than to neutral stimuli. However, no effect of quetiapine on fear network activity was detected. Further, on questionnaire measures, quetiapine significantly reduced somatic anxiety symptoms, but had no effect on general psychological anxiety. Conclusion Viewing phobic pictures resulted in a robust amygdala activation in arachnophobic patients. Quetiapine seems to have no influence on activation in anxiety-related brain areas but appears to reduce acute somatic anxiety symptoms in patients with specific phobia. The central nervous correlates of the anxiolytic effects of quetiapine remain to be clarified in future studies. Copyright © 2017 Elsevier Inc.
Progress in Neuro-Psychopharmacology and Biological Psychiatry, 76 : 80-87
- Year: 2017
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Atypical Antipsychotics (second generation)
Healey, A., Mansell, W., Tai, S.
It is well established that uncontrollable adverse experiences lead to increased distress, but the role of client control during psychological interventions such as exposure is less clear. Earlier studies reported inconsistent findings, most likely owing to variations in the way client control was manipulated, degree of exposure, the outcome variables chosen and the follow-up periods used. Importantly, studies to date had suggested to participants that approaching their fears was beneficial thereby biasing their choices and these studies had not measured change beyond the laboratory. We recruited 96 spider-fearful student participants (mean age = 22; SD = 5.9; Range = 18-45; 86 female). The experimental design allowed full choice over their degree of exposure, and manipulated the degree of control as the extent to which their movement of a joystick influenced their virtual distance from a moving spider image. Those with high control were yoked with a low control counterpart to ensure equal amounts of exposure. Measures were elicited at baseline, post-exposure, and at follow-up. As predicted, compared to low control participants, those with high control over exposure approached closer toward a spider post-exposure and reported less spider avoidance after an average of 17 days. No group differences were found in physiological or subjective distress during the task, nor in distress and dysfunction. Copyright © 2017 Elsevier Ltd
Journal of Anxiety Disorders, 49 : 12-20
- Year: 2017
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Reiss, N., Warnecke, I., Tolgou, T., Krampen, D., Luka-Krausgrill, U., Rohrmann, S.
Background: Test anxiety is a common condition in students, which may lead to impaired academic performance as well as to distress. The primary objective of this study was to evaluate the effectiveness of two cognitive-behavioral interventions designed to reduce test anxiety. Test anxiety in the participants was diagnosed as social or specific phobia according to DSM-IV. Subsequently subjects were randomized to three groups: a moderated self-help group, which served as a control group, and two treatment groups, where either relaxation techniques or imagery rescripting were applied. Methods: Students suffering from test anxiety were recruited at two German universities (n = 180). The randomized controlled design comprised three groups which received test anxiety treatment in weekly three-hour sessions over a period of five weeks. Treatment outcome was assessed with a test anxiety questionnaire, which was administered before and after treatment, as well as in a six-month follow-up. Results: A repeated-measures ANOVA for participants with complete data (n = 59) revealed a significant reduction of test anxiety from baseline to six-month follow-up in all three treatment groups (p < .001). Limitations: Participants were included if they had a clinical diagnosis of test anxiety. The sample may therefore represent only more severe forms of text anxiety . Moreover, the sample size in this study was small, the numbers of participants per group differed, and treatment results were based on self-report. Due to the length of the treatment, an implementation of the group treatments used in this study might not be feasible in all settings. Conclusions: Group treatments constitute an effective method of treating test anxiety, e.g. in university settings. Imagery rescripting may particularly contribute to treatment efficacy. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Journal of Affective Disorders, 208 : 483-489
- Year: 2017
- Problem: Social phobia (social anxiety disorder)
, Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Self-help
, Relaxation