Disorders - Specific Phobia
Oldham-Cooper, R., Loades, M.
Background: Coping Cat (CC), a generic cognitive-behavioral intervention for anxiety disorders in children and young people, is recommended in the United Kingdom for social anxiety disorder (SAD), generalized anxiety disorder, separation anxiety (SA), and specific phobias (SP), with disorder-specific approaches generally favored in treatment of anxiety disorders in adults. Objectives: To compare CC with disorder-specific cognitive-behavioral therapy (CBT) interventions based on anxiety-related treatment outcomes. Study Selection: Primary research articles describing treatment of children and young people aged 7-17 for SAD, generalized anxiety disorder, SA, and SP, using CC or disorder-specific CBT. Results: Ten studies implemented CC and four implemented disorder-specific CBT. One study compared CC with a disorder-specific approach. There was a lack of data to support use of CC in treatment of SPs. However, CC was equally effective as disorder-specific treatments for SA and SAD. Conclusions: A lack of data exists for disorder-specific CBT interventions compared to CC. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Journal of Child and Adolescent Psychiatric Nursing, 30(1) : 6-17
- Year: 2017
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
, Specific Phobia
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Telch, M. J., York, J., Lancaster, C. L., Monfils, M. H.
We tested postretrieval extinction as an augmentation strategy for enhancing in vivo exposure therapy for naturally acquired pathological fear. Participants displaying marked phobic responding to either spiders or snakes were randomized to receive a standard one session in vivo exposure therapy protocol under one of two conditions. The experimental group (RFM-EXP) completed a 10-s fear reactivation procedure 30 min prior to initiating exposure therapy. Controls (EXP-RFM) completed the reactivation procedure after completing exposure therapy. Expected and peak fear during confrontation with live spiders or snakes were collected at pretreatment, posttreatment, and 1-month follow-up. RFM-EXP participants displayed significantly lower phobic responding at the 1-month follow-up relative to EXP-RFM controls. Unexpectedly, RFM-EXP participants showed more rapid fear attenuation during exposure relative to controls. Results provide preliminary support for further investigation of this exposure augmentation strategy across a wider range of anxiety-related disorders. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Clinical Psychological Science, 5(2) : 367-378
- 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, Other Psychological Interventions
Esposito, M., Gimigliano, F., Barillari, M. R., Precenzano, F., Ruberto, M., Sepe, J., Barillari, U., Gimigliano, R., Militerni, R., Messina, G., Carotenuto, M.
BACKGROUND: Selective mutism (SM) is a rare disease in children coded by DSM-5 as an anxiety disorder. Despite the disabling nature of the disease, there is still no specific treatment. AIM: The aims of this study were to verify the efficacy of six-month standard psychomotor treatment and the positive changes in lifestyle, in a population of children affected by SM. DESIGN: Randomized controlled trial registered in the European Clinical Trials Registry (EuDract 2015-001161-36). SETTING: University third level Centre (Child and Adolescent Neuropsychiatry Clinic). POPULATION: Study population was composed by 67 children in group A (psychomotricity treatment) (35 M, mean age 7.84+/-1.15) and 71 children in group B (behavioral and educational counseling) (37 M, mean age 7.75+/-1.36). METHODS: Psychomotor treatment was administered by trained child therapists in residential settings three times per week. Each child was treated for the whole period by the same therapist and all the therapists shared the same protocol. The standard psychomotor session length is of 45 minutes. At T0 and after 6 months (T1) of treatments, patients underwent a behavioral and SM severity assessment. To verify the effects of the psychomotor management, the Child Behavior Checklist questionnaire (CBCL) and Selective Mutism Questionnaire (SMQ) were administered to the parents. RESULTS: After 6 months of psychomotor treatment SM children showed a significant reduction among CBCL scores such as in social relations, anxious/depressed, social problems and total problems (P<0.001), Withdrawn (P=0.007) and Internalizing problems (P=0.020). Regarding SM severity according to SMQ assessment, children of group A showed a reduction of SM symptoms in all situations (school, P=0.003; family, P=0.018; and social, P=0.030 situations) and in SMQ total score (P<0.001). CONCLUSIONS: Our preliminary results suggest the positive effect of the psychomotor treatment in rehabilitative program for children affected by selective mutism, even if further studies are needed. CLINICAL REHABILITATION IMPACT: The present study identifies in psychomotricity a safe and efficacy therapy for pediatric selective mutism.
European Journal of Physical & Rehabilitation Medicine, 53(5) : 643-650
- Year: 2017
- Problem: Anxiety Disorders (any), Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Rihm, J. S., Sollberger, S. B., Soravia, L. M., Rasch, B.
Exposure therapy induces extinction learning and is an effective treatment for specific phobias. Sleep after learning promotes extinction memory and benefits therapy success. As sleep-dependent memory-enhancing effects are based on memory reactivations during sleep, here we aimed at applying the beneficial effect of sleep on therapy success by cueing memories of subjective therapy success during nonrapid eye movement sleep after in vivo exposure-based group therapy for spider phobia. In addition, oscillatory correlates of re-presentation during sleep (i.e., sleep spindles and slow oscillations) were investigated. After exposure therapy, spider-phobic patients verbalized their subjectively experienced therapy success under presence of a contextual odor. Then, patients napped for 90 min recorded by polysomnography. Half of the sleep group received the odor during sleep while the other half was presented an odorless vehicle as control. A third group served as a wake control group without odor presentation. While exposure therapy significantly reduced spider-phobic symptoms in all subjects, these symptoms could not be further reduced by re-presenting the odor associated with therapy success, probably due to a ceiling effect of the highly effective exposure therapy. However, odor re-exposure during sleep increased leftlateralized frontal slow spindle (11.0-13.0 Hz) and right-lateralized parietal fast spindle (13.0-15.0 Hz) activity, suggesting the possibility of a successful re-presentation of therapy-related memories during sleep. Future studies need to further examine the possibility to enhance therapy success by targeted memory reactivation (TMR) during sleep. Copyright © 2016 Rihm, Sollberger, Soravia and Rasch.
Frontiers in Human Neuroscience, 10 (no pagination)(340) :
- Year: 2016
- 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, Other complementary & alternative interventions
McMurtry, C. M., Taddio, A., Noel, M., Antony, M. M., Chambers, C. T., Asmundson, G. J., Pillai-Riddell, R., Shah, V., MacDonald, N. E., Rogers, J., Bucci, L. M., Mousmanis, P., Lang, E., Halperin, S., Bowles, S., Halpert, C., Ipp, M., Rieder, M. J., Robson, K., Uleryk, E., Votta-Bleeker, E., Dubey, V., Hanrahan, A., Lockett, D., Scott, J.
Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.
Cognitive Behaviour Therapy, 45(3) : 217-35
- Year: 2016
- Problem: Specific Phobia
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention
Dour, H. J., Brown, L. A., Craske, M. G.
BACKGROUND AND OBJECTIVES: Although exposure therapy is highly efficacious for anxiety disorders, many individuals do not respond. Drawing from the science of fear extinction and reinstatement, the current study evaluated whether a training designed to increase valence of the feared stimulus improved the longevity of treatment outcomes.
METHODS: Participants were 61 undergraduate students with fear of spiders (>10 on Spider Phobia Questionnaire, M = 20.45, SD = 3.98) who were randomized to receive positive valence training or control training. Participants completed exposure over two days, with training conditions at the end of the first day. Tests of spontaneous recovery and reinstatement were conducted one week later.
RESULTS: Compared to control, the Positive Valence Training group demonstrated significantly less subjective fear at test of spontaneous recovery and less behavioral avoidance after reinstatement. Change in valence predicted subjective fear at spontaneous recovery and after reinstatement but did not predict behavioral avoidance after reinstatement.
LIMITATIONS: Due to the relatively small size and homogeneity of the sample, as well as the limited methods of training (i.e., film clips only) and outcome measurement (i.e., self-report and behavioral measures), current results should be interpreted with caution.
CONCLUSIONS: Adjunct positive valence training may enhance the longevity of exposure treatment.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Journal of Behavior Therapy & Experimental Psychiatry, 50 : 277-82
- Year: 2016
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Cougle, J. R., Summers, B. J., Harvey, A. M., Dillon, K. H., Allan, N. P.
Background: Disgust is thought to play a prominent role in multiple anxiety disorders and fears, including spider phobia, though little attention has been given to specific treatment strategies that may be effective for multiple disgust-based fears. Aims: In the present study, we evaluated contamination-focused exposure as a potential transdiagnostic treatment strategy for disgust-based fears in a spider fearful sample. Method: Women with significant spider fear were randomized to three 30-minute sessions of exposure therapy involving repeated contact with a dirt mixture (n = 17) or a waitlist control condition (n = 17). Assessments of spider fear and disgust were administered at baseline and at one-week posttreatment. Results: At high (but not low) levels of pretreatment disgust propensity, exposure led to lower in vivo spider fear and perceived danger than waitlist, though exposure had no effects on spider-related disgust. Similar effects of exposure on spider fear were found at high levels of pretreatment spider-related disgust. Exposure also reduced fear and danger perceptions, but not disgust, related to a separate contamination assessment (touching a toilet). No effects of treatment were found on self-report measures of spider fear or disgust propensity. Conclusions: These findings suggest contamination-focused exposure therapy may be an effective transdiagnostic treatment strategy for individuals with elevated disgust propensity. Limitations and directions for future research are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Behavioural and Cognitive Psychotherapy, 44(6) : 640-651
- Year: 2016
- 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
Fox, E., Zougkou, K., Ashwin, C., Cahill, S.
Background and Objectives: Attention Bias Modification (ABM) targets attention bias (AB) towards threat and is a potential therapeutic intervention for anxiety. The current study investigated whether initial AB (towards or away from spider images) influenced the effectiveness of ABM in spider fear.; Methods: AB was assessed with an attentional probe task consisting of spider and neutral images presented simultaneously followed by a probe in spider congruent or spider incongruent locations. Response time (RT) differences between spider and neutral trials > 25 ms was considered 'Bias Toward' threat. RT difference < - 25 ms was considered 'Bias Away' from threat, and a difference between -25 ms and +25 ms was considered 'No Bias'. Participants were categorized into Initial Bias groups using pre-ABM AB scores calculated at the end of the study. 66 participants' (Bias Toward n = 27, Bias Away n = 18, No Bias n = 21) were randomly assigned to ABM-active training designed to reduce or eliminate a bias toward threat and 61 (Bias Toward n = 17, Bias Away n = 18, No Bias n = 26) to ABM-control.; Results: ABM-active had the largest impact on those demonstrating an initial Bias Towards spider images in terms of changing AB and reducing Spider Fear Vulnerability, with the Bias Away group experiencing least benefit from ABM. However, all Initial Bias groups benefited equally from active ABM in a Stress Task.; Limitations: Participants were high spider fearful but not formally diagnosed with a specific phobia. Therefore, results should be confirmed within a clinical population.; Conclusions: Individual differences in Initial Bias may be an important determinant of ABM efficacy.; Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
Journal of Behavior Therapy & Experimental Psychiatry, 49(Pt A) : 84-93
- Year: 2015
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification
Niles, A. N., Craske, M. G., Lieberman, M. D., Hur, C.
Exposure is an effective treatment for anxiety but many patients do not respond fully. Affect labeling (labeling emotional experience) attenuates emotional responding. The current project examined whether affect labeling enhances exposure effectiveness in participants with public speaking anxiety. Participants were randomized to exposure with or without affect labeling. Physiological arousal and self-reported fear were assessed before and after exposure and compared between groups. Consistent with hypotheses, participants assigned to Affect Labeling, especially those who used more labels during exposure, showed greater reduction in physiological activation than Control participants. No effect was found for self-report measures. Also, greater emotion regulation deficits at baseline predicted more benefit in physiological arousal from exposure combined with affect labeling than exposure alone. The current research provides evidence that behavioral strategies that target prefrontal-amygdala circuitry can improve treatment effectiveness for anxiety and these effects are particularly pronounced for patients with the greatest deficits in emotion regulation.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Behaviour Research & Therapy, 68 : 27-36
- Year: 2015
- Problem: Anxiety Disorders (any), 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
Ollendick, T. H., Halldorsdottir, T., Fraire, M. G., Austin, K. E., Noguchi, R. J. P., Lewis, K. M., Jarrett, M. A., Cunningham, N. R., Canavera, K., Allen, K. B., Whitmore, M. J.
Objective: Examine the efficacy of a parent-augmented One-Session Treatment (A-OST) in treating specific phobias (SP) in youth by comparing this novel treatment to child-focused OST, a well-established treatment.; Method: A total of 97 youth (ages 6-15, 51.5% female, 84.5% White) who fulfilled diagnostic criteria for SP were randomized to either A-OST or OST. SPs were assessed with semistructured diagnostic interviews, clinician improvement ratings, and parent and child improvement ratings. In addition, measures of treatment satisfaction and parental self-efficacy were obtained. Blind assessments were completed pretreatment, posttreatment, and 1month and 6months following treatment. Analyses were undertaken using mixed models. In addition, gender, age, internalizing/externalizing problems, parent overprotection, and parent anxiety were examined as potential predictors and moderators of treatment outcome.; Results: Both treatment conditions produced similar outcomes with approximately 50% of youth in both treatments diagnosis free and judged to be much or very much improved at posttreatment and 1-month follow-up. At 6-month follow-up, however, the treatments diverged with OST resulting in marginally superior outcomes to A-OST, contrary to predictions. Only age of child predicted treatment outcome across the two treatments (older children did better); unexpectedly, none of the variables moderated treatment outcomes.; Conclusions: Parent augmentation of OST produced no appreciable gains in treatment outcomes. Directions for future research are highlighted.; Copyright © 2014. Published by Elsevier Ltd.
Behavior Therapy, 46(2) : 141-155
- Year: 2015
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Exposure therapy, Exposure and response prevention, Other service delivery and improvement interventions
Peris, T. S., Compton, S. N., Kendall, P. C., Birmaher, B., Sherrill, J., March, J., Gosch, E., Ginsburg, G., Rynn, M., McCracken, J.T., Keeton, C. P., Sakolsky, D., Suveg, C., Aschenbrand, S., Almirall, D., Iyengar, S., Walkup, J. T., Albano, A. M., Piacentini, J.,
Objective: To evaluate changes in the trajectory of youth anxiety following the introduction of specific cognitive-behavior therapy (CBT) components: relaxation training, cognitive restructuring, and exposure tasks. Method: Four hundred eighty-eight youths ages 7-17 years (50% female; 74% < 12 years) were randomly assigned to receive either CBT, sertraline (SRT), their combination (COMB), or pill placebo (PBO) as part of their participation in the Child/Adolescent Anxiety Multimodal Study (CAMS). Youths in the CBT conditions were evaluated weekly by therapists using the Clinical Global Impression Scale-Severity (CGI-S; Guy, 1976) and the Children's Global Assessment Scale (CGAS; Shaffer et al., 1983) and every 4 weeks by blind independent evaluators (IEs) using the Pediatric Anxiety Ratings Scale (PARS; RUPP Anxiety Study Group, 2002). Youths in SRT and PBO were included as controls. Results: Longitudinal discontinuity analyses indicated that the introduction of both cognitive restructuring (e.g., changing self-talk) and exposure tasks significantly accelerated the rate of progress on measures of symptom severity and global functioning moving forward in treatment; the introduction of relaxation training had limited impact. Counter to expectations, no strategy altered the rate of progress in the specific domain of anxiety that it was intended to target (i.e., somatic symptoms, anxious self-talk, avoidance behavior). Conclusions: Findings support CBT theory and suggest that cognitive restructuring and exposure tasks each make substantial contributions to improvement in youth anxiety. Implications for future research are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
Journal of Consulting & Clinical Psychology, 83(2) : 239-252
- Year: 2015
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Antidepressants (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
McMurtry, C. M., Noel, M., Taddio, A., Antony, M. M., Asmundson, G. J. G., Riddell, R. P., Chambers, C. T., Shah, V.
Background: This systematic review evaluated the effectiveness of exposure-based psychological and physical interventions for the management of high levels of needle fear and/or phobia and fainting in children and adults.; Design/methods: A systematic review identified relevant randomized and quasi-randomized controlled trials of children, adults, or both with high levels of needle fear, including phobia (if not available, then populations with other specific phobias were included). Critically important outcomes were self-reported fear specific to the feared situation and stimulus (psychological interventions) or fainting (applied muscle tension). Data were pooled using standardized mean difference (SMD) or relative risk with 95% confidence intervals.; Results: The systematic review included 11 trials. In vivo exposure-based therapy for children 7 years and above showed benefit on specific fear (n=234; SMD: -1.71 [95% CI: -2.72, -0.7]). In vivo exposure-based therapy with adults reduced fear of needles posttreatment (n=20; SMD: -1.09 [-2.04, -0.14]) but not at 1-year follow-up (n=20; SMD: -0.28 [-1.16, 0.6]). Compared with single session, a benefit was observed for multiple sessions of exposure-based therapy posttreatment (n=93; SMD: -0.66 [-1.08, -0.24]) but not after 1 year (n=83; SMD: -0.37 [-0.87, 0.13]). Non in vivo e.g., imaginal exposure-based therapy in children reduced specific fear posttreatment (n=41; SMD: -0.88 [-1.7, -0.05]) and at 3 months (n=24; SMD: -0.89 [-1.73, -0.04]). Non in vivo exposure-based therapy for adults showed benefit on specific fear (n=68; SMD: -0.62 [-1.11, -0.14]) but not procedural fear (n=17; SMD: 0.18 [-0.87, 1.23]). Applied tension showed benefit on fainting posttreatment (n=20; SMD: -1.16 [-2.12, -0.19]) and after 1 year (n=20; SMD: -0.97 [-1.91, -0.03]) compared with exposure alone.; Conclusions: Exposure-based psychological interventions and applied muscle tension show evidence of benefit in the reduction of fear in pediatric and adult populations.;
Clinical Journal of Pain, 31(10 Suppl) : S109-S123
- Year: 2015
- Problem: Specific Phobia
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention