Treatment Of Specific Phobias Research Articles

Treatment of Specific Phobia in Children: Are All the Components of the Phobic Response of Equal Importance?

Davis and Ollendick provide a review on the efficacy of treatments for childhood specific phobias, thereby analyzing to what extent various treatments are effective in altering the three components of the pathological fear response (i.e., subjective, behavioral, physiological). In this commentary, it is noted that there are marked differences in the reactivity of the three response systems among various types of specific phobias and among individuals suffering from this anxiety disorder, suggesting that it is important to tailor the intervention to the individual response pattern of the phobic patient. However, because outcome research indicates that effective treatments for phobias should include exposure-based exercises, a reduction of the behavioral fear response seems to be the primary target of intervention. Furthermore, it is largely unknown to what extent the three-systems model is applicable to childhood phobias. In the meantime, there is emerging evidence demonstrating that developmental processes have a clear impact on children's perception of fear-related symptoms.

How Children Experience Brief-Exposure Treatment of Specific Phobias

Examined how 56 children who had received brief-exposure treatment for specific phobias experienced the treatment. It was also investigated whether there was a relation between the children's reported experiences before, during, and after the treatment and therapy outcome. Results indicated that the treatment was experienced as something positive, and the large majority of the children appreciated the pace and degree of control they had during treatment, as well as the therapist and the treatment outcome. The response patterns did not differ between sexes, diagnostic groups, mode of treatment, or age groups. The therapy outcome of the children was not found to differ according to the children's pretreatment expectations and feelings during the treatment, neither according to the children's evaluations of the pace of the treatment nor of the therapist's. However, children's reports about their feelings upon termination of the treatment and the satisfaction with the treatment differed significantly depending on the treatment outcome. Results and tentative explanations of these are discussed and implications for future lines of research are suggested.

Treatment of Specific Phobias with Eye Movement Desensitization and Reprocessing (EMDR): Protocol, Empirical Status, and Conceptual Issues

This paper considers the current empirical status of Eye Movement Desensitization and Reprocessing (EMDR) as a treatment method for specific phobias, along with some conceptual and practical issues in relation to its use. Both uncontrolled and controlled studies on the application of EMDR with specific phobias demonstrate that EMDR can produce significant improvements within a limited number of sessions. With regard to the treatment of childhood spider phobia, EMDR has been found to be more effective than a placebo control condition, but less effective than exposure in vivo. The empirical support for EMDR with specific phobias is still meagre, therefore, one should remain cautious. However, given that there is insufficient research to validate any method for complex or trauma related phobias, that EMDR is a time-limited procedure, and that it can be used in cases for which an exposure in vivo approach is difficult to administer, the application of EMDR with specific phobias merits further clinical and research attention.

Evidence for fear of restriction and fear of suffocation as components of claustrophobia

Recent investigations of the aetiology and treatment of specific phobias have focussed on clarifying the concerns underlying phobic anxiety. It has been proposed that claustrophobic fear is comprised of separable confinement and suffocation components. This paper presents data from 78 general medical outpatients undergoing magnetic resonance imaging (MRI) scans in two major teaching hospitals. The findings support the two factor structure of claustrophobia, in that exposure to confinement reduced confinement subscale scores, but did not influence suffocation scores.

Prediction of outcome in the treatment of specific phobia. A cross validation study

The purpose of this study was to investigate possible predictors of treatment outcome in specific phobia at 1 week after treatment, and at 1 year follow-up. The subjects ( n = 138) came from four studies (two on spider phobia, one on blood phobia and one on injection phobia), and all had been diagnosed with simple phobia according to DSM-III-R. The dependent variable was clinically significant improvement in three different factors; avoidance behavior in a behavior test, self-rated anxiety during the test, assessor rating of phobic severity or fainting behavior. Fourteen variables covering self-report, demographic and physiological variables, and data from the behavior test were used as prognostic variables. Multiple regression analyses were used in a cross validation procedure. The results showed that diastolic blood pressure at pretest was a predictor at post-treatment for one sample and credibility was found as a predictor for the other sample both at post-treatment and at 1 year follow-up. Analyses were made for the diagnoses and the treatments but the results were inconclusive. Despite the large sample size and the cross validation procedure no stable predictors were found for short- and long-term outcome. The few significant predictors should be considered as chance findings.

Return of fear: The role of inhibition

In a previous study investigating the relationship between subjective, physiological and behavioural changes during treatment of specific phobias, a marked between-session increase was found in subjective fear after high, but not after low intensity phobic stimulation although the groups showed similar fear ratings and heart rates immediately after treatment (Grey et al, 1979). It was hypothesized that the high intensity stimulation led to ‘treatment fatigue’; a state of deactivation, the recovery from which led to a return of fear. In this study high intensity in vivo stimulation was used for the treatment of phobic subjects under conditions of distributed and massed practice. No differences emerged between treatment conditions. A small group of Ss with a conspicuously high heart rate (mean level 120 bpm) when rating zero fear, showed a significant increase in fear after one week's interval, although they had shown similar improvement to the Ss during treatment. Subjects in both treatment conditions showed lower heart rate at all post-treatment assessments than pre-treatment. The high initial heart rate Ss continued to have higher heart rate than other Ss throughout the experiment, although they showed a decrease after treatment. It was only these Ss with desynchronously high heart rate, i.e. high heart rate with zero fear ratings, who suffered a return of fear, whereas high heart rate during high fear did not predict either response to treatment or return of fear. A further finding was a lack of correlation between the behavioural and physiological indices of fear, namely, between distance and heart rate at high levels of fear.

An appraisal of hypnosis

'There is no doubt that Freud is right in his remark that the eager readiness of the medical profession to employ the term suggestion ' is due not so much to the propagandism of the Nancy school as to the alleviating discovery that a great economy of thought can thereby be effected' (Jones, 1910). Hypnosis tends today to be little used in psychiatric practice. Occasionally it is employed, as a useful adjunct to psychotherapy or manipulation of the environment, in the treatment of patients with hysterical conversion symptoms. A relaxation procedure with or without hypnotic suggestions may be followed in the treatment of specific phobias (which are rare), or in the treatment of tension headachewhich is common but far more often treated with psychotherapy and medication. Claims are made for its use in psychosomatic conditions, e.g. warts or asthma, and in the treatment of pain in childbirth. But typically, in such instances, warts respond to alternative means of suggestion, whilst asthma benefits most in respect of patients' reports of subjective well-being but very much less in regard to physical indices like vital capacity (Maher-Loughnan & Kinsley, 1968; Maher-Loughnan, 1970). Similarly pain in childbirth is only relieved erratically, and probably not more than moderately, by hypnosis, so that whilst relaxation training is widely practised (Chertok, 1969) hypnosis itself is rarely used. In this country there are one or two research workers in the field of hypnotism and systematic experimental work is conducted by a number of psychologists in North America. In the U.S.S.R. the subject attracts attention, in a framework of Pavlovian theory. The writer only uses the technique occasionally but has employed it from time to time in the past, and many, perhaps most, psychiatrists in the U.K. do not use it at all. Nevertheless the subject remains of considerable theoretical and human interest.

Modified implosive (flooding) therapy: treatment of phobias in London

This is a report of recent developments in behaviour therapy in the treatment of phobias, observed while studying at the Institute of Psychiatry in London, England from July 1971 to May 1972. The modified flooding technique as practised by Marks and his team is less extreme than that employed by Stampfl. Furthermore it is more rapid and practical than Wolpe's systematic desensitization, while it is as efficient as this method in the treatment of specific phobias and surpasses it in the treatment of agoraphobia. In specific phobias flooding in practice gives better results than flooding in imagination. In agoraphobia the superiority of one part of the treatment over the other has not yet been demonstrated. The importance of prolonged exposure to the phobic situation is now obvious. This technique is not time consuming, the treatment is active, generally well accepted by the patients and improvement, both subjective and objective, is remarkable.