Disorders - Specific Phobia
Hooper, Nic
The current study compared thought suppression, focused attention (mindfulness) and unfocused attention as strategies for managing spider fear. Spider fearful participants were exposed to a strategy induction before completing a Behavioural Approach Test (BAT). The BAT is a 10 step measurement of how close participants are willing to move towards a spider. Participants were instructed to use what they learned in the pre-BAT induction to help them advance through the steps of the BAT. The results of the study indicated that participants given the thought suppression or the unfocused attention induction moved through significantly less steps of the BAT than did those given the focused attention (mindful) induction. Additionally, the thought suppression group felt significantly more anxious than the focused and unfocused attention groups following completion of the BAT. These results are discussed in terms of the impact of thought suppression on avoidance behaviour in phobias.
Copyright © 2011 Elsevier Inc. All rights reserved.
Consciousness & Cognition, 20(4) : 1824-1830
- Year: 2011
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions, Mindfulness based therapy
Pan, David, Huey-Jr, Stanley J, Hernandez, Dominica
This study is a 6-month follow-up of a randomized pilot evaluation of standard one-session treatment (OST-S) versus culturally adapted OST (OST-CA) with phobic Asian Americans. OST-CA included seven cultural adaptations drawn from prior research with East Asians and Asian Americans. Results from 1-week and 6-month follow-up show that both OST-S and OST-CA were effective at reducing phobic symptoms compared with self-help control. Moreover, OST-CA was superior to OST-S for several outcomes. For catastrophic thinking and general fear, moderator analyses indicated that low-acculturation Asian Americans benefitted more from OST-CA than OST-S, whereas both treatments were equally effective for high-acculturation participants. Although cultural process factors (e.g., facilitating emotional control, exploiting the vertical therapist–client relationship) and working alliance were predictive of positive outcomes, they did not mediate treatment effects. This study offers a potential model for evaluating cultural adaptation effects, as well as the mechanisms that account for such effects. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Cultural Diversity & Ethnic Minority Psychology, 17(1) : 11-22
- Year: 2011
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention
Raes, An K., Koster, Ernst H. W., Loeys, Tom, DeRaedt, Rudi
It is well established that exposure therapy is an effective treatment for anxiety disorders. It is less clear, however, which mechanisms are crucial in explaining its success. In previous studies, cognitive change has been identified as a mediating variable. Several theorists have argued that the addition of cognitive interventions will, therefore, result in enhanced treatment effects. We tested this hypothesis by examining cognitive mediation of treatment in a purely behavioral versus a cognitive–behavioral exposure format. Thirty-one spider phobics were randomly assigned to either behavioral exposure or to exposure as a test for maladaptive cognitions (i.e., behavioral experiments). Both treatment formats showed large treatment effects and strong cognitive mediation of these effects. This indicates that, even when cognitions are not explicitly targeted, exposure effects are cognitively mediated. This challenges the idea that cognitions have to be explicitly challenged to elicit cognitive change in exposure treatment. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)
Journal of Anxiety Disorders, 25(7) : 964-971
- Year: 2011
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention
Sy, Jennifer T., Dixon, Laura J., Lickel, James J., Nelson, Elizabeth A., Deacon, Brett J.
The current study attempted to replicate the finding obtained by Powers, Smits, and Telch (2004; Journal of Consulting and Clinical Psychology, 72, 448-545) that both the availability and utilization of safety behaviors interfere with the efficacy of exposure therapy. An additional goal of the study was to evaluate which explanatory theories about the detrimental effects of safety behaviors best account for this phenomenon. Undergraduate students (N=58) with high claustrophobic fear were assigned to one of three treatment conditions: (a) exposure only, (b) exposure with safety behavior availability, and (c) exposure with safety behavior utilization. Participants in each condition improved substantially, and there were no significant between-group differences in fear reduction. Unexpectedly, exposure with safety behavior utilization led to significantly greater improvement in self-efficacy and claustrophobic cognitions than exposure only. The extent to which participants inferred danger from the presence of safety aids during treatment was associated with significantly less improvement on all outcome measures. The findings call into question the hypothesized deleterious effects of safety behaviors on the outcome of exposure therapy and highlight a possible mechanism through which the mere presence of safety cues during exposure trials might affect treatment outcomes depending on participants' perceptions of the dangerousness of exposure stimuli.
Published by Elsevier Ltd.
Behaviour Research & Therapy, 49(5) : 305-314
- Year: 2011
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Other Psychological Interventions
Salas, Martha M., Brooks, Audrey J., Rowe, Jack E.
Background: Objective: Design: Setting: Participants: Intervention: Outcome Measures: Results: Conclusions: Specific phobia is one of the most prevalent anxiety disorders. Emotional Freedom Techniques (EFT) has been shown to improve anxiety symptoms; however, their application to specific phobias has received limited attention.This pilot study examined whether EFT, a brief exposure therapy that combines cognitive and somatic elements, had an immediate effect on the reduction of anxiety and behavior associated with specific phobias.The study utilized a crossover design with participants randomly assigned to either diaphragmatic breathing or EFT as the first treatment.The study was conducted at a regional university in the Southwestern United States.Twenty-two students meeting criteria for a phobic response to a specific stimulus (‚â•8 on an 11-point subjective units of distress scale).Participants completed a total of five two-minute rounds in each treatment intervention.Study measures included a behavioral approach test (BAT), Subjective Units of Distress Scale (SUDS), and Beck Anxiety Inventory (BAI).Emotional Freedom Techniques significantly reduced phobia-related anxiety (BAI P = .042; SUDS P = .002) and ability to approach the feared stimulus (BAT P = .046) whether presented as an initial treatment or following diaphragmatic breathing. When presented as the initial treatment, the effects of EFT remained through the presentation of the comparison intervention.The efficacy of EFT in treating specific phobias demonstrated in several earlier studies is corroborated by the current investigation. Comparison studies between EFT and the most effective established therapies for treating specific phobias are recommended.
Copyright © 2011 Elsevier Inc. All rights reserved.
Explore, 7(3) : 155-161
- Year: 2011
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Southam-Gerow, M. A., Weisz, J. R., Chu, B. C., McLeod, B. D., Gordis, E. B., Connor-Smith, J. K.
Objective: Most tests of cognitive behavioral therapy (CBT) for youth anxiety disorders have shown beneficial effects, but these have been efficacy trials with recruited youths treated by researcher-employed therapists. One previous (nonrandomized) trial in community clinics found that CBT did not outperform usual care (UC). The present study used a more stringent effectiveness design to test CBT versus UC in youths referred to community clinics, with all treatment provided by therapists employed in the clinics. Method: A randomized controlled trial methodology was used. Therapists were randomized to training and supervision in the Coping Cat CBT program or UC. Forty-eight youths (56% girls, 8 to 15 years of age, 38% Caucasian, 33% Latino, 15% African-American) diagnosed with DSM-IV anxiety disorders were randomized to CBT or UC. Results: At the end of treatment more than half the youths no longer met criteria for their primary anxiety disorder, but the groups did not differ significantly on symptom (e.g., parent report, eta-square = 0.0001; child report, eta-square = 0.09; both differences favoring UC) or diagnostic (CBT, 66.7% without primary diagnosis; UC, 73.7%; odds ratio 0.71) outcomes. No differences were found with regard to outcomes of comorbid conditions, treatment duration, or costs. However, youths receiving CBT used fewer additional services than UC youths ((chi)21 = 8.82, p = .006). Conclusions: CBT did not produce better clinical outcomes than usual community clinic care. This initial test involved a relatively modest sample size; more research is needed to clarify whether there are conditions under which CBT can produce better clinical outcomes than usual clinical care.
Journal of the American Academy of Child & Adolescent Psychiatry, 49(10) : 1043-1052
- Year: 2010
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
, Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
St-Jacques, J., Bouchard, S., Belanger, C.
Objective: The first objective of this study was to assess if a combined treatment with mostly virtual reality-based (in virtuo) exposure increases phobic children's motivation toward therapy compared to children who only receive in vivo exposure. Another objective was the assessment of motivation as a predictor of treatment outcome. Method: Thirty-one DSM-IV-diagnosed arachnophobic participants aged from 8 to 15 years were randomly assigned to 1 of 2 treatment conditions: in vivo exposure alone or in virtuo plus in vivo exposure. Measures of motivation were taken at pretest and at the end of each part of the treatment; some other measures were taken at each session. The "Why Are You in Therapy?" questionnaire for children was the target measure of motivation and the main variable in the study. Outcome measures were taken at pretest, at the end of each part of the treatment, and at the 6-month follow-up. This study was conducted between September 2006 and March 2007. Results: The results showed that children who received in virtuo exposure did not show a higher level of motivation toward their treatment than those who received in vivo exposure, but statistically significant interactions were found for both parts of the treatment. Multiple regression analysis confirmed that motivation was a significant predictor of outcome (P < .01), especially extrinsic integrated motivation. Participants in the combined treatment were significantly more phobic before beginning treatment, but both treatments appeared successful (P < .001). Conclusions: In this study, the use of virtual reality did not increase motivation toward psychotherapy. At the end of the second part of therapy, all participants were comparably efficient in facing a live tarantula. These results bear important clinical implications concerning how to use virtual reality with children and concerning motivation of children toward therapy in general. They are discussed in the light of how to present in virtuo therapy to children. Trial Registration: controlled-trials.com Identifier: ISRCTN87716831. (copyright) Copyright 2010 Physicians Postgraduate Press, Inc.
Journal of Clinical Psychiatry, 71(7) : 924-931
- Year: 2010
- 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, comparing delivery mode (e.g. online vs. face-to-face)
Deacon, B. J., Sy, J. T., Lickel, J. J., Nelson, E. A.
Exposure therapy is traditionally conducted with an emphasis on the elimination of safety behaviors. However, theorists have recently suggested that the judicious use of safety behaviors may improve the tolerability of this treatment without reducing its efficacy. The present study tested this notion by randomly assigning participants with high claustrophobic fear to receive a single-session intervention with or without access to safety aids during early exposure trials. Improvement was generally equivalent between the treatment conditions, and no reliable benefits or drawbacks were associated with the judicious use of safety behaviors. The theoretical and clinical implications of these findings are discussed. (copyright) 2009 Elsevier Ltd. All rights reserved.
Journal of Behavior Therapy & Experimental Psychiatry, 41(1) : 71-80
- Year: 2010
- 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
Flatt, N., King, N.
Forty-three youth aged 7-17 years old who fulfilled DSM-IV criteria for assorted specific phobias, were randomised to a one-session exposure treatment, a psychoeducation package or a waitlist control conditions. Participants were assessed using semi-structured interviews, self-report measures and an individualised behavioural avoidance test (BAT). Assessments were completed pre- and posttest. At the 1-year follow-up, self-report measures along with a generalised version of the individualised BAT were re-administered. Results exhibited that both active treatment conditions were superior to the waitlist control on the BAT, self-efficacy ratings; however, no significant differences were found on functioning levels and other self-report measures with the exception of the Fear Survey Schedule - Revised. Additionally, no significant differences were found between the two active conditions at posttest or the 1-year follow-up. Implications and future research strategies are discussed.
Behaviour Change, 27(3) : 130-153
- Year: 2010
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Psychoeducation
Andersson, Gerhard, Waara, Johan, Jonsson, Ulf, Malmaeus, Fredrik, Carlbring, Per, Ost, Lars-Goran
The authors compared guided Internet-delivered self-help with one session of live-exposure treatment in a sample of spider-phobic patients. A total of 30 patients were included following screening on the Internet and a structured clinical interview. The Internet treatment consisted of five weekly text modules, which were presented on a web page, a video in which exposure was modeled, and support provided via Internet. The live-exposure treatment was delivered in a 3-hr session following a brief orientation session. The main outcome measure was the behavioral approach test (BAT), and as secondary measures the authors used questionnaires measuring anxiety symptoms and depression. Results showed that the groups did not differ at posttreatment or follow-up, with the exception of the proportion showing clinically significant change on the BAT. At posttreatment 46.2% of the Internet group and 85.7% in the live-exposure group achieved this change. At follow-up the corresponding figures were 66.7% for the Internet group and 72.7% for the live treatment. Within-group effect sizes for the spider phobia questionnaire were large (d = 1.84 and 2.58 for the Internet and live-exposure groups, respectively, at posttreatment). The authors conclude that guided Internet-delivered exposure treatment is a promising new approach in the treatment of spider phobia. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
Cognitive Behaviour Therapy, 38(2) : 114-120
- Year: 2009
- 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, Self-help
, Technology, interventions delivered using technology (e.g. online, SMS)
Wolitzky, Kate B., Telch, Michael J.
The current study investigated the efficacy of an exposure augmentation strategy in which the phobic individual is encouraged to enact actions that are in direct opposition to the fear action tendencies associated with acrophobia. Participants (N=88) meeting DSM-IV criteria for specific phobia (acrophobia) were randomized to (a) exposure with oppositional actions (E+OA), (b) exposure only (EO), (c) a credible placebo consisting of pulsed audio-photic stimulation (APS), or (d) a waitlist control (WLC). Treatment consisted of six, 6-min exposure trials. Participants were assessed with questionnaire, behavioral, and physiologic measures at pre- and posttreatment, and at a 1-month follow-up session. Participants receiving E+OA showed significantly greater improvement on behavioral and questionnaire measures than those in the other 3 conditions at both posttreatment and follow-up. Further, whereas treatment improvement generalized to an untrained context for those receiving E+OA, such was not the case for EO- and APS-treated participants. Findings suggest augmenting exposure with oppositional actions may enhance treatment outcome and thus warrant additional investigation with clinical samples.
Behavior Therapy, 40(1) : 57-71
- Year: 2009
- Problem: Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention
Wood, J. J., McLeod, B. D., Piacentini, J. C., Sigman, M.
Objective To compare the relative long-term benefit of family-focused cognitive behavioral therapy (FCBT) and child-focused cognitive behavioral therapy (CCBT) for child anxiety disorders at a 1-year follow-up. Method Thirty-five children (6-13 years old) randomly assigned to 12-16 sessions of family-focused CBT (FCBT) or child-focused CBT (CCBT) participated in a 1-year follow-up assessment. Independent evaluators, parents, and children rated anxiety and parental intrusiveness. All were blind to treatment condition and study hypotheses. Results Children assigned to FCBT had lower anxiety scores than children assigned to CCBT on follow-up diagnostician- and parent-report scores, but not child-report scores. Exploratory analyses suggested the advantage of FCBT over CCBT may have been evident more for early adolescents than for younger children and that reductions in parental intrusiveness may have mediated the treatment effect. Conclusion FCBT may yield a stronger treatment effect than CCBT that lasts for at least 1 year, although the lack of consistency across informants necessitates a circumspect view of the findings. The potential moderating and mediating effects considered in this study offer interesting avenues for further study.
Child Psychiatry & Human Development, 40(2) : 301-316
- Year: 2009
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Specific Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)