Phobia In Adults Research Articles

Recognizing and differentiating dental anxiety from dental phobia in adults: a systematic review based on the German guideline "Dental anxiety in adults".

Objectives: The prevalence of "dental anxiety" (DA) is often underestimated and numerous diagnostic methods are available for dental practitioners. It is difficult to differentiate between a dental phobia requiring an interdisciplinary approach and DA, which can be managed by dental practitioners alone. The appropriate use of diagnostic tools is key for the successful management of highly anxious and/or phobic patients. The aim was to provide a guideline to recognize dental fear and to differentiate DA from patients who are highly anxious or even have a phobia. Data sources: In total, 8,929 articles that were selected for the development of the German guidelines for "Dental anxiety in adults" in PubMed, Web of Science, Embase, and MedPilot were filtered for diagnosis of DA disorder. The focus for this review was on the use of scales to measure DA levels. The methods and tools used in the 51 reviewed articles to assess DA levels were evaluated in terms of their practicability and suitability in daily practice to differentiate between phobia (ie, DA disorder) and nonpathologic anxiety. In addition, the internal consistency (Cronbach alpha) of the questionnaires/tools was determined. Conclusion: All identified DA questionnaires validated in the German language had an acceptable to excellent internal consistency (0.7 to 0.986). The only validated questionnaire-free method was galvanic skin reaction measurement. For the assessment of DA and diagnosis of a DA disorder in adults, the survey by means of any suitable questionnaire or even several questionnaires in combination with a behavioral observation of the patient is currently the method of choice.

Alexithymic and autistic traits: Relevance for comorbid depression and social phobia in adults with and without autism spectrum disorder

High alexithymic traits and psychiatric comorbidities such as depression and social phobia are frequently observed among adults with autism spectrum disorder. In this study, we tested whether alexithymic and/or autistic traits are risk factors for depressive and social phobic symptoms in adults with autism spectrum disorder (n = 122), patients with social interaction difficulties other than autism (n = 62), and neurotypical participants (n = 261). Multiple regression analyses of these three groups demonstrated that both traits explained considerable variance of depressive and social phobic symptoms. In adults with autism spectrum disorder, alexithymic traits were predictive of depressive symptoms, while autistic traits predicted social phobic symptoms. In patients with social interaction difficulties other than autism, alexithymic and autistic traits were identified as predictors of social phobic symptoms, while no variable predicted depressive symptoms. In neurotypicals, both alexithymic and autistic traits were predictive of depressive and social phobic symptoms. Our results, therefore, highlight the importance of assessing both alexithymic and autistic traits in patients with and without autism spectrum disorder for identifying comorbid psychopathology. Depending on the underlying core symptomatology, alexithymic and/or autistic traits increase the risk of depressive and social phobic symptoms calling for therapeutic strategies to prevent or at least reduce comorbid psychopathology.Lay abstractAdults with autism often develop mental health problems such as depression and social phobia. The reasons for this are still unclear. Many studies found that alexithymia plays an important role in mental health problems like depression. People with alexithymia have difficulties identifying and describing their emotions. Almost every second person with autism has alexithymia. Therefore, we explored in this study whether alexithymia is linked to worse mental health in autistic people. We looked at two common diagnoses, depression and social phobia. We found that alexithymia increased symptoms of depression, while autistic traits increased symptoms of social phobia. Our results suggest that alexithymia and autistic traits can increase the risk of mental health problems. An early assessment could help prevent mental health problems and improve quality of life.

Recent developments in the intervention of specific phobia among adults:arapid review.

Specific phobia is highly prevalent worldwide. Although the body of intervention studies is expanding, there is a lack of reviews that summarise recent progress and discuss the challenges and direction of research in this area. Hence, this rapid review seeks to systematically evaluate the available evidence in the last five years in the treatment of specific phobias in adults. Studies published between January 2014 to December 2019 were identified through searches on the electronic databases of Medline and PsychINFO. In total, 33 studies were included. Evidence indicates that psychotherapy, and in particular cognitive behaviour therapy, when implemented independently or as an adjunctive, is a superior intervention with large effect sizes. Technology-assisted therapies seem to have a beneficial effect on alleviating fears and are described to be more tolerable than in vivo exposure therapy. Pharmacological agents are investigated solely as adjuncts to exposure therapy, but the effects are inconsistent; propranolol and glucocorticoid may be promising. A handful of cognitive-based therapies designed to alter fear arousal and activation pathways of phobias have presented preliminary, positive outcomes. Challenges remain with the inherent heterogeneity of specific phobia as a disorder and the accompanying variability in outcome measures and intervention approaches to warrant a clear conclusion on efficacy.

成人の歯科恐怖症に対する認知行動療法:最近の治療研究の動向(展望)

成人の歯科恐怖症に対する認知行動療法:最近の治療研究の動向(展望)

Efficacy of virtual reality exposure therapy for the treatment of dental phobia in adults: A randomized controlled trial

BackgroundAlthough Virtual Reality Exposure Therapy (VRET) has proven to be effective in the treatment of various subtypes of specific phobia, there is limited evidence of its role in the treatment of dental phobia. MethodA single-blind RCT was conducted among 30 randomized patients with dental phobia to either VRET or informational pamphlet (IP) condition. Primary outcome anxiety measures (VAS-A, MDAS and DFS) were evaluated at baseline, pre- and post-intervention, 1-week, 3-months and 6-months follow-up. Secondary outcome measures assessed were pre-post behavioral avoidance, temporal variations of heart rate and VR-experience during and post-VRET, and dental treatment acceptance in both conditions at 6-month follow-up. ResultsIntention to treat analysis, using a repeated measures MANOVA, revealed a multivariate interaction effect between time and condition (p = 0.015) for all primary outcome measures (all ps < 0.001). Only patients of the VRET condition showed a significant reduction in anxiety scores (mean reduction [s.d.]: VAS-A 44.4 [36.1]; MDAS 7.1 [5.4]; DFS 21.2 [13.1]) whereas the patients in the IP group did not (mean reduction [s.d.]: VAS-A −0.33 [7.7]; MDAS −0.33 [1.3]; DFS −1.9 [3.8]), F (15, 14) = 3.3, p = 0.015. ConclusionsVRET was found to be efficacious in the treatment of dental phobia.

The Efficacy of Psychological Therapies for Specific Phobias in Adults and Some Unanswered Questions

Background: Specific phobias are common across the lifespan. Although exposure-based therapies have the most evidence of efficacy, reviews have cautioned that evaluations of some interventions are limited in number and have pointed to the need for more research. Furthermore, several permitted the inclusion of non-randomized clinical trials or samples exhibiting elevated fear but not necessarily a full diagnosis. We sought to update the literature on the empirical support of psychological treatments for specific phobias in adults through the selection of studies that met stringent criteria along with application of the system developed by Chambless and Hollon [1998: J Consult Clin Psychol 66: 7-18], which had not in isolation been done so previously. Methods: Electronic searches of the PubMed and PsycINFO databases were conducted in February 2014 to identify suitable randomized clinical trials. Thirty-eight met our inclusion criteria. Results: In vivo exposure was the most researched psychological therapy and found to be efficacious and specific. The evidence for virtual reality exposure was less strong though it had a similar level of empirical support. Several other therapies, including applied tension for blood phobia, were found to be possibly efficacious pending replication by other groups. Conclusions: Exposure-based therapy is the optimal treatment for specific phobias, but several gaps remain in the literature. Most studies investigated interventions for spider phobia. More clinical trials conducted by independent research teams are needed on therapies for other subtypes. There is a dearth of literature on the treatment of phobic disorders in older adults and medically unwell patients. This needs to be a priority on research agendas since we have an aging population. Moreover, failure to address blood-injection-injury phobia in a timely manner in patients who are under the care of medical services may affect adherence to recommendations and lead to a deterioration in health. Keywords: Empirically supported treatments, qualitative review, randomized clinical trials.

An Adaptation of the Questionnaire for Social Anxiety and Social Competence Deficits (SASKO) for Adolescents and its Evaluation in a German Student Sample

In the diagnostics of social phobia in adults the SASKO self-report questionnaire serves as an instrument that measures social anxiety and social deficits as two separate dimensions. This paper describes the development of an adaptation of the SASKO for adolescents (SASKO-J) and verifies its applicability, factor structure, and psychometric properties. The factor structure and reliability of the SASKO-J were evaluated in an unselected sample of 228 German students from grades 7 to 11 (M = 14.77 years, SD = 1.33; 50% girls). In a second sample of 115 students the validity was examined (M = 15.84, SD = 1.65; 61% girls). Confirmatory factor analysis confirmed the five-factor structure of the SASKO (two anxiety and two deficit related factors and an additional factor “loneliness”). With the exception of the subscale “information-processing deficits”, the internal consistencies were satisfactory to good (0.77≤α≤0.88). The results regarding convergent and divergent validity were also good. Students from different types of school differed in their levels of social anxiety, girls reported significantly more fear of rejection than boys, and the youngest students had the highest level of symptoms. Future research should address the optimizing of the subscale “information-processing deficits” and should examine the psychometric properties of the SASKO-J in a clinical sample.

Assessing Fear of Storms and Severe Weather: Validation of the Storm Fear Questionnaire (SFQ)

To date, research on storm phobia has been limited by a lack of validated self-report measures for evaluating the severity of anxiety, phobic avoidance, and distress associated with storms and severe weather. The current research presents the development and validation of the Storm Fear Questionnaire (SFQ), a 15-item self-report questionnaire that assesses the cognitive, affective, and behavioral aspects thought to be associated with Storm Phobia in adults. Three studies were conducted to assess 1) the factor structure, internal consistency, and convergent and discriminant validity of the SFQ, 2) the test-retest reliability of the SFQ, 3) the extent that scores on the SFQ were associated with subjective anxiety ratings during a Behavioral Approach Test (BAT) involving exposure to a virtual thunderstorm, and the extent to which SFQ scores distinguished community participants with versus without a fear of storms. Exploratory factor analyses supported a one-factor model with good internal consistency (Cronbach’s α = .95), good convergent and discriminant validity with self-report measures of anxiety, worry, depression, and other specific phobias, and acceptable test-retest reliability. Moreover, there was a significant positive association between SFQ scores and anxiety ratings following the BAT involving exposure to a virtual thunderstorm and participants with a high fear of storms reported significantly higher SFQ scores than those with a low fear of storms. In sum, the SFQ has good psychometric properties and appears to be a valuable tool for assessing the severity of fear associated with storms and severe weather. Research evaluating the diagnostic and clinical utility of the SFQ is still needed.

The Pathology of Social Phobia Is Independent of Developmental Changes in Face Processing

While social phobia in adolescence predicts the illness in adulthood, no study has directly compared the neural responses in social phobia in adults and adolescents. The authors examined neural responses to facial expressions in adults and adolescents with social phobia to determine whether the neural correlates of adult social phobia during face processing also manifest in adolescent social phobia. Blood-oxygen-level-dependent (BOLD) responses were compared in 39 medication-free participants with social phobia (25 adults and 14 adolescents) and 39 healthy comparison subjects (23 adults and 16 adolescents) matched on age, IQ, and gender. During fMRI scans, participants saw angry, fearful, and neutral expression stimuli while making a gender judgment. Significant diagnosis-by-emotion interactions were observed within the amygdala and the rostral anterior cingulate cortex, as has previously been hypothesized. In these regions, both the adolescent and adult social phobia patients showed significantly increased BOLD responses relative to their respective age-matched comparison subjects, and there was no evidence of age-related modulation of between-group differences. These enhanced responses occurred specifically when viewing angry (rostral anterior cingulate cortex) and fearful (amygdala and rostral anterior cingulate cortex) expressions but not when viewing neutral expressions. In addition, the severity of social phobia was significantly correlated with the enhanced rostral anterior cingulate cortex response in the adults. The neural correlates of adult social phobia during face processing also manifest in adolescents. Neural correlates that are observed in adult social phobia may represent the persistence of profiles established earlier in life rather than adaptive responses to such earlier perturbations or maturational changes. These cross-sectional observations might encourage longitudinal fMRI studies of adolescent social phobia.

Recognition of irrationality of fear and the diagnosis of social anxiety disorder and specific phobia in adults: Implications for criteria revision in DSM-5

In DSM-IV, the diagnosis of social anxiety disorder (SAD) and specific phobia in adults requires that the person recognize that his or her fear of the phobic situation is excessive or unreasonable (criterion C). The DSM-5 Anxiety Disorders Work Group has proposed replacing this criterion because some patients with clinically significant phobic fears do not recognize the irrationality of their fears. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project we determined the number of individuals who were not diagnosed with SAD and specific phobia because they did not recognize the excessiveness or irrationality of their fear. We interviewed 3,000 psychiatric outpatients and 1,800 candidates for bariatric surgery with a modified version of the Structured Clinical Interview for DSM-IV. In the SAD and specific phobia modules we suspended the skip-out that curtails the modules if criterion C is not met. Patients who met all DSM-IV criteria for SAD or specific phobia except criterion C were considered to have "modified" SAD or specific phobia. The lifetime rates of DSM-IV SAD and specific phobia were 30.5 and 11.8% in psychiatric patients and 11.7 and 10.2% in bariatric surgery candidates, respectively. Less than 1% of the patients in both samples were diagnosed with modified SAD or specific phobia. Few patients were excluded from a phobia diagnosis because of criterion C. We suggest that in DSM-5 this criterion be eliminated from the SAD and specific phobia criteria sets.

Treating Spider Phobia Using Neuro Emotional Technique™: Findings from a Pilot Study

Specific phobia, the most common anxiety disorder, can disrupt lives, limit work efficiency, reduce self-esteem, and strain relationships. Current interventions show some degree of success, yet relapse is common. Consequently, the need for a more effective and durable intervention is evident. The purpose of this pilot study is to investigate the efficacy of a new intervention, Neuro Emotional Technique (NET), on individuals with spider phobia, and to determine whether further investigation is warranted. Participants who met the inclusion criterion that spider phobia impacted their daily lives were randomized to either a control group that received no intervention (N = 7), or to an experimental group that received two 30-minute sessions of NET approximately 2 weeks apart (N = 8). The primary measure was the Subjective Units of Distress Scale, and secondary measures were the Spider Questionnaire, Behavioral Assessment Test, Beck Anxiety Inventory, and change in heart rate (HR). Compared with the no-intervention control group, statistical analysis indicates a significant advantage for the NET group in regard to state anxiety/subjective distress, reported fear, and avoidant behavior. The difference between the two groups for general anxious symptomatology (trait anxiety) and change in HR was not statistically significant. No adverse reactions were reported. The findings of this pilot study suggest that NET is a promising intervention for spider phobia in adults. A larger, full-scale study is required to confirm these results.

Empirically supported psychological interventions for social phobia in adults: a qualitative review of randomized controlled trials

Social phobia is a chronic disorder that results in substantial impairment. We conducted a qualitative review of randomized controlled trials (RCTs) of psychological interventions for social phobia. Articles were identified through searches of electronic databases and manual searches of reference lists. They were classified by psychological interventions evaluated. Data regarding treatment, participants and results were then extracted and tabulated. We identified which psychological interventions are empirically supported, using the scheme proposed by Chambless & Hollon (Journal of Consulting and Clinical Psychology 1998, 66, 7-18). Thirty studies evaluating the efficacy of social skills training (SST), exposure therapy and/or cognitive treatments were identified. Cognitive behavior therapy (CBT), involving cognitive restructuring and exposure to feared and avoided social situations or behavioral experiments, was found to be an efficacious and specific treatment for social phobia. Exposure therapy was found to be an efficacious treatment since most of the evidence of its efficacy was from comparisons with no treatment. There were mixed findings regarding the relative efficacy of CBT and in vivo exposure. Some studies reported that the interventions were equivalent, while others found that patients treated with CBT had a better outcome. There was little evidence to support the use of SST. CBT is the psychological intervention of choice for social phobia. The findings of this review are compared to those of other major reviews and limitations are discussed.

Paroxetine: current status in psychiatry

Paroxetine is a selective serotonin reuptake inhibitor (SSRI) with antidepressant and anxiolytic properties. It is commercially available in both an immediate-release (paroxetine) and a controlled-release formulation (paroxetine CR). The latter product was developed to improve gastrointestinal tolerability. Paroxetine is the most potent inhibitor of the reuptake of serotonin among the available SSRIs. It has approved indications for the treatment of major depression, obsessive–compulsive disorder, panic disorder, generalized anxiety disorder, post-traumatic stress disorder and social phobia in adults. Paroxetine CR is approved for the treatment of major depression, social anxiety disorder, panic disorder and premenstrual dysphoric disorder in adults. While the overall efficacy of paroxetine appears to be comparable with other SSRIs in the treatment of major depression, it is approved for use in a wider variety of anxiety disorders than any other antidepressant. Long-term data suggest that paroxetine is effective in preventing relapse or recurrence of depression for up to 1 year. Limited data show that paroxetine maintains a therapeutic response over 1 year in obsessive–compulsive disorder and up to 6 months in panic disorder. The side-effect profile of paroxetine is largely similar to that of the other SSRIs, although paroxetine tends to be more sedating and constipating in some patients, perhaps due to its anticholinergic activity. The potential for discontinuation syndrome and weight gain appears to be slightly higher with paroxetine than with other SSRIs. This review focuses on the immediate release and controlled-release formulations of paroxetine. It summarizes the efficacy and tolerability data for both formulations, with a particular emphasis on paroxetine CR which was introduced in 2002. It also discusses emerging evidence in other clinical areas and recent data that have led to modifications in the safety profile of paroxetine.

Incidence of DIS/DSM-IV social phobia in adults.

The aim of the study was to estimate the incidence of social phobia in the general population. The Baltimore cohort of 3481 subjects, sampled during the 1981 Epidemiologic Catchment Area study, was traced. A total of 1920 subjects were re-interviewed from 1993 to 1996 using the Diagnostic Interview Schedule (DIS). A subsample of 349 subjects was interviewed by psychiatrists using the Schedules for Clinical Assessment in Neuropsychiatry. The estimated incidence of DIS/DSM-IV social phobia is 4-5/1000/year. New cases were found in all age groups, with the highest rates in subjects with baseline depressive and panic disorders. Psychiatric evaluations showed broad diagnostic concordance with DIS diagnoses in incident cases. However, validity indices were highly dependent on diagnostic thresholds. None of the psychiatrist-ascertained social phobics had received treatment for the disorder, although the majority were considered likely to benefit from treatment. New cases of social phobia occur in adults of all age groups, and are often secondary to other psychiatric conditions.

Social phobia in adults with stuttering

The authors evaluated features of social anxiety in a group of adult stutterers to explore the soundness of the DSM-IV requirement that social phobia not be diagnosed in patients who stutter if their phobia relates to their stuttering. They conducted diagnostic interviews and verbal fluency assessments with 16 consecutive adults seeking speech therapy for stuttering. Patients also completed scales measuring social phobia symptoms and associated disability. When DSM-IV criteria were modified to permit a diagnosis of social phobia if phobic symptoms were clearly excessive in relation to the severity of stuttering, seven of the 16 patients were given a diagnosis of social phobia. All seven identified social anxiety as an important source of role impairment. Three of the seven patients entered cognitive-behavioral group therapy and benefited from this intervention. Many adults seeking treatment for stuttering have salient difficulties with social anxiety that may prove amenable to cognitive-behavioral interventions. By precluding a diagnosis of social phobia in these patients, DSM-IV may hinder the identification of social anxiety as a source of disability and may limit access to treatment.