One-session Exposure Treatment Research Articles

The association between estradiol levels, hormonal contraceptive use, and responsiveness to one-session-treatment for spider phobia in women

Preclinical studies have demonstrated that conditioned fear extinction is impaired in females with low endogenous levels of the sex hormone estradiol, due to menstrual fluctuations or hormonal contraceptive use. As fear extinction is a laboratory model of exposure therapy for anxiety and trauma disorders, here we assessed the hypothesis that treatment outcomes may be diminished when exposure therapy occurs during periods of low estradiol. 90 women with spider phobia (60 cycling and 30 using hormonal contraceptives) underwent a one-session exposure treatment for spider phobia, following which, serum estradiol levels were assessed. A median split in estradiol level was used to divide cycling participants into two groups; lower and higher estradiol. Behavioral avoidance and self-reported fear of spiders were measured pre-treatment, post-treatment, and at a 12 week follow-up assessment. Women using hormonal contraceptives exhibited a significantly slower rate of improvement across treatment, greater behavioral avoidance at post-treatment and follow-up, and fewer self-initiated post-treatment exposure tasks, relative to both groups of cycling women, who did not differ. No group differences in self-reported fear were evident. Correlational analyses revealed that across the whole sample, lower estradiol levels were associated with slower rates of improvement across treatment, and greater self-reported fear and behavioral avoidance at post-treatment, but not follow-up. These results provide the first evidence of an association between endogenous estradiol, hormonal contraceptive use, and exposure therapy outcomes in spider phobic women. Hormonal profile may partly account for variability in responsiveness to psychological treatments for anxiety and trauma disorders in women.

Large Group Exposure Treatment: a Feasibility Study in Highly Spider Fearful Individuals.

A large group one-session exposure treatment (LG-OST) based on indirect modeled exposure strategies was carried out to investigate its feasibility and effectiveness in a sample of highly spider fearful individuals (N = 78). The stability of LG-OST-effects was assessed at 8-month follow-up (FU). Furthermore, a second sample (N = 30) of highly spider fearful individuals was treated in a standard, single-person one-session treatment (SP-OST) design to compare LG-OST-effects to a standard spider fear treatment. Participants’ fear of spider was assessed by multiple questionnaires and by a behavioral approach test. The fear assessment took place before and after the respective intervention, and at 8-month FU in LG-OST. Regarding subjective spider fear measures, LG-OST mainly showed medium to large effect sizes, ranging from Cohen’s d = 0.69 to d = 1.21, except for one small effect of d = 0.25. After LG-OST, participants approached the spider closer at post-treatment measures (d = 1.18). LG-OST-effects remained stable during the 8-month FU-interval. However, SP-OST-effects proved superior in most measures. An LG-OST-protocol provided evidence for feasibility and efficiency. The effects of LG-OST were equal to those of indirect modeled exposure strategies, carried out in single-settings. LG-OST may represent a useful tool in future phobia-treatment, especially if it can match the effects of single-setting OST, e.g., by including more direct exposure elements in future large group attempts.

Endogenous cortisol levels influence exposure therapy in spider phobia

Previous research in patients with phobia showed that the administration of glucocorticoids reduces fear in phobic situations and enhances exposure therapy. Glucocorticoids underlie a daily cycle with a peak in the morning and low levels during the evening and night. The aim of the present study was to investigate whether exposure is more effective when conducted in the morning when endogenous cortisol levels are high. Sixty patients meeting DSM IV criteria for specific phobia (animal type) were randomly assigned to one-session exposure treatment either at 08.00 a.m. (high cortisol group) or at 06.00 p.m. (low cortisol group). Participants returned for a posttreatment assessment one week after therapy and a follow-up assessment three months after therapy. Both groups showed good outcome, but patients treated in the morning exhibited significantly less fear of spiders in the behavioral approach test (BAT) and a trend for lower scores on the Fear of Spiders Questionnaire (FSQ) than patients treated in the evening. This effect was present at posttreatment and follow-up. Our findings indicate that exposure therapy is more effective in the morning than in the evening. We suggest that this may be due to higher endogenous cortisol levels in the morning group that enhance extinction memory.

Internet-Based Exposure Treatment Versus One-Session Exposure Treatment of Snake Phobia: A Randomized Controlled Trial

In this study, the authors compared guided Internet-delivered self-help with one-session exposure treatment (OST) in a sample of snake phobic patients. A total of 30 patients were included following a screening on the Internet and a structured clinical interview. The Internet treatment consisted of four weekly text modules which were presented on a web page, a video in which exposure was modelled, and support provided via Internet. The OST was delivered in a three-hour session following a brief orientation session. The main outcome was the behavioural approach test (BAT), and as secondary measures questionnaires measuring anxiety symptoms and depression were used. Results showed that the groups did not differ at post-treatment or follow-up, with the exception of a significant interaction for the BAT in favour of the OST. At post-treatment, 61.5% of the Internet group and 84.6% of the OST group achieved a clinically significant improvement on the BAT. At follow-up, the corresponding figures were 90% for the Internet group and 100% for the OST group (completer sample). Within-group effect sizes for the Snake Phobia Questionnaire were large (d = 1.63 and d = 2.31 for the Internet and OST groups, respectively, at post-treatment). It is concluded that guided Internet-delivered exposure treatment is a potential treatment option in the treatment of snake phobia, but that OST probably is better.

One-Session Exposure Treatment for Social Anxiety With Specific Fear of Public Speaking

Objectives: This pilot study evaluated the effectiveness of one-session, exposure-based therapy, to treat social anxiety disorder (SAD) with specific fear of public speaking. Methods: A quasi-experimental pre-posttest design with repeated measures-within-subject Analysis of Variance and paired sample t-tests was used to compare pretest, posttest and one month follow-up scores. Individuals (n = 32), from 18 to 51 years old, 75% women, participated in three hours of graduated exposure to group public speaking exercises followed by homework between post and follow-up. Results: Significant changes were found from pre- to posttest and pretest to follow-up for all measures. No differences were found from posttest to follow-up. Conclusions: Advantages of brief treatment for SAD, limitations of the study, and implications for practice and future research are discussed.

Brief Psycho-Social Interventions in the Treatment of Specific Childhood Phobias: A Controlled Trial and a 1-Year Follow-Up

AbstractForty-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 psycho-education 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.

One-session treatment of specific phobias in youth: A randomized clinical trial in the United States and Sweden.

One hundred and ninety-six youth, ages 7-16, who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for various specific phobias were randomized to a one-session exposure treatment, education support treatment, or a wait list control group. After the waiting period, the wait list participants were offered treatment and, if interested, rerandomized to 1 of the 2 active treatments. The phobias were assessed with semistructured diagnostic interviews, clinician severity ratings, and behavioral avoidance tests, whereas fears, general anxiety, depression, and behavior problems were assessed with self- and parent report measures. Assessments were completed pretreatment, posttreatment, and at 6 months following treatment. Results showed that both treatment conditions were superior to the wait list control condition and that 1-session exposure treatment was superior to education support treatment on clinician ratings of phobic severity, percentage of participants who were diagnosis free, child ratings of anxiety during the behavioral avoidance test, and treatment satisfaction as reported by the youth and their parents. There were no differences on self-report measures. Treatment effects were maintained at follow-up. Implications of these findings are discussed.

Naltrexone renders one-session exposure therapy less effective: A controlled pilot study

In vivo exposure has become the gold standard treatment for specific phobia. The endogenous opioid system is one mechanism proposed to explain why exposure provides such quick and effective treatment for specific phobia. The effect of naltrexone on fear and avoidance behavior was investigated among 15 specific phobia participants who received exposure treatment. Participants were randomly assigned to receive naltrexone, placebo, or no drug prior to attending one-session exposure treatment. Mixed effects regression results revealed that across time, the naltrexone group tolerated significantly less time in the room with the feared animal (Behavioral Avoidance Index) as compared to the placebo and no drug groups. Phobic individuals assigned to the naltrexone group had significantly higher fear ratings across time in comparison to the placebo group. Results provide support for the endogenous opioid system as a potential underlying biological mechanism associated with behavioral changes during in vivo exposure.

Comparison of behavioral and cognitive-behavioral one-session exposure treatments for small animal phobias

This study evaluated the efficacy of behavioral and cognitive-behavioral one-session exposure treatment procedures with and without programmed generalization for participants with small animal phobias. Forty participants were randomly assigned to the treatment and generalization conditions. Both treatments produced significant improvements from pre-test to post-test and these results were maintained for 1 year. The treatment effect sizes ranged from large to very large across behavioral, self-report, and subjectively rated measures. Participants in the behavioral treatment condition reported that the treatment was significantly more intrusive than participants in the cognitive-behavioral treatment group. The programmed generalization condition did not produce additional measured benefit. The results are discussed in terms of the overall effectiveness of one-session exposure treatment components for small animal phobias.

Therapist behaviour during one-session exposure treatment of spider phobia: Individual vs group setting

Therapist behaviours during treatment of 54 patients with spider phobia by massed exposure during one single session, individually, in a small group (3–4), or in a large group (7–8) were studied using videotaped recordings and rated on a 5-grade scale by two independent observers. The behaviours observed more frequently in the individual treatment than in the group treatment were reality testing, feedback, and empathy. Physical contact and determination were used significantly more often in the group treatment. Furthermore, differences in behaviours used in different phases of the treatment were found. Humour increased from the beginning of the treatment through the middle and final phases of the session. Demonstration and role play decreased from the beginning of the treatment through the middle and final phases of the session. Outcome on the behaviour approach test was predicted by three variables (positively by physical contact, and negatively by instruction and assurance), and on the Spider Phobia Questionnaire (SPQ) by four variables (positively by education and physical contact, and negatively by determination and instruction). The implications of these results are discussed, along with the issues of reliability and validity of the instrument used.