Abstract
ObjectiveExposure based large-group one-session treatments (LG-OSTs) proved feasible in different situational fears and showed promising short- and long-term outcomes. Based on prior LG-OST protocols we explored feasibility and effectiveness of an LG-OST protocol in four cohorts of individuals highly fearful of heights (N = 104). Moreover, we aimed to identify predictors of LG-OST outcome in order to provide individualized treatment recommendations in the future.MethodsParticipants’ fear of heights was assessed at pre- and post-treatment as well as at 5 months follow-up using questionnaires and a behavioral approach test (BAT). Pre-treatment indices of negative emotional traits and positive mental health, the extent by which fear-evoking expectancies were violated during exposure, and post-treatment group perception processes were assessed in order to predict the outcome.ResultsThe LG-OST procedure proved feasible and effective in terms of both subjective and behavioral fear of heights. Post-treatment effects sizes of questionnaires assessing fear of heights ranged between d = 0.94 – 1.43. After the treatment, about half of the participants (49.5%) were able to ascend an aerial fire ladder up to a maximum of 30 m (vs. pre-treatment 17.3%). Follow up results showed the long-term stability of effects. Among psychological constructs, positive mental health and expectancy violation were the strongest predictors of LG-OST long-term outcome.ConclusionWe conclude that exposure based LG-OSTs are feasible, effective and very efficient compared to individual face-to-face settings. Thus, they represent very promising treatment alternatives for situational fears including fear of heights. Moreover, clinical research may benefit from LG-OST protocols as its high standardization may facilitate the search for mediators and moderators of exposure outcomes.
Highlights
In Europe, the demand for cognitive behavioral treatment (CBT) due to common mental health problems is steadily increasing
Three research reports exist where OSTs have been delivered in small group settings of three to eight individuals (Öst, 1996; Öst et al, 1997b; Götestam, 2002). They all targeted spider phobia and reported feasibility and substantial fear reductions resulting from the group approaches, especially when employing direct rather than indirect exposure strategies such as participant modeling
It could be shown that genetic variations of the serotonin transporter gene emerged to strongly moderate the long-term large-group settings (LG-OSTs) outcome. Such results demonstrate a possible benefit of LG-OST beyond clinical usefulness, i.e., its utility as a research instrument
Summary
Exposure based large-group one-session treatments (LG-OSTs) proved feasible in different situational fears and showed promising short- and long-term outcomes. Based on prior LG-OST protocols we explored feasibility and effectiveness of an LG-OST protocol in four cohorts of individuals highly fearful of heights (N = 104). We aimed to identify predictors of LG-OST outcome in order to provide individualized treatment recommendations in the future
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