Treatment Of Specific Phobias Research Articles

Efficacy of Virtual Reality Exposure Therapy in the Treatment of Specific Phobias: A Systematic Review

Specific phobia is defined as a notable and continuous fear of a certain object or a situation that particularly impairs daily life and functioning. It is also one of the most common psychological disorders. Exposure-based interventions are commonly used in the treatment of specific phobias. However, some limitations of the standard methods require the need for alternative approaches. In light of this, the use of virtual reality technology in psychotherapy has become increasingly widespread in recent years and is now integrated with exposure therapy. Virtual reality provides real-time interaction using the computer-generated three-dimensional environment via variety oftechnological tools. Applications of virtual reality in exposure therapy have proven to be an important intervention method, especially in the psychopathologies such as specific phobias. In this study, virtual reality exposure therapy for the treatment of specific phobias is systematically reviewed. Inclusion criteria were taken into account in the scanning performed in APA (PsycINFO), EBSCO, PubMed, Scopus, Web of Science, Science Direct, Ulakbim ve TRDizin databses following the PRISMA method. Following that, ten randomized controlled trials, which included adult participants meeting the diagnostic criteria for specific phobia, examined the efficacy of virtual reality and exposure therapy compared to the control group, and the ones with full text could be accessed, were included in this systematic review. The included studies were evaluated in terms of sample attributes, primary measurement tools, research design, characteristics of the intervention and its efficacy. In general, the findings indicate the efficacy of virtual reality exposure therapy in reducing specific phobia symptoms. Follow-up studies support the long-term maintenance of the results.

Inhibitory control and its modification in spider phobia - Study protocol for an antisaccade training trial.

Inhibitory control deficits are considered a key pathogenic factor in anxiety disorders. To assess inhibitory control, the antisaccade task is a well-established measure that assesses antisaccade performance via latencies and error rates. The present study follows three aims: (1) to investigate inhibitory control via antisaccade latencies and errors in an antisaccade task, and their associations with multiple measures of fear in patients with spider phobia (SP) versus healthy controls (HC), (2) to investigate the modifiability of antisaccade performance via a fear-specific antisaccade training in patients with SP and HC, and (3) to explore associations between putative training-induced changes in antisaccade performance in SPs and changes in diverse measures of fear. Towards aim 1, we assess antisaccade latencies (primary outcome) and error rates (secondary outcome) in an emotional antisaccade task. Further, the baseline assessment includes assessments of psychophysiological, behavioral, and psychometric indices of fear in patients with SP and HCs. To address aim 2, we compare effects of a fear-specific antisaccade training with effects of a prosaccade training as a control condition. The primary and secondary outcomes are reassessed at a post-1-assessment in both SPs and HCs. Aim 3 employs a cross-over design and is piloted in patients with SP, only. Towards this aim, primary and secondary outcomes, as well as psychophysiological, behavioral, and psychometric measures of fear are reassessed at a post-2-assessment after the second training block. This study aims to better understand inhibitory control processes and their modifiability in spider phobia. If successful, antisaccade training may assist in the treatment of specific phobia by directly targeting the putative underlying inhibitory control deficits. This study has been preregistered with ISRCTN (ID: ISRCTN12918583) on 28th February 2022.

Özgül Fobilerin Bilişsel Davranışçı Terapilerinde Sanal Gerçeklik Uygulamaları

Virtual reality (VR) applications have been increasingly used in the clinical field. Its applications in psychotherapies is becoming widespread with researches. The use of VR in psychotherapy, specifically as an exposure therapy approach, is prominently used in the treatment of specific phobias, which is one of the most common clinical presentations. There is a substantial body of literature investigating the effectiveness of VR applications in the treatment of specific phobias. The purpose of this review is to introduce the virtual environment scenarios used in virtual reality exposure therapy (VRET) applications for various specific phobias. Keywords: specific phobias, cognitive behavioral therapy, virtual reality applications

Provider experiences of virtual reality in clinical treatment.

BackgroundVirtual reality (VR) has proven effective in the treatment of specific phobias and trauma particularly when in-vivo exposure therapy might be costly (e.g. fear of flying, combat scenes). Similarly, VR has been associated with improvement of chronic pain and of acute pain during medical procedures. Despite its effectiveness as a healthcare tool, VR technology is not well-integrated into common practice. This qualitative study aims to explore the provider perception of the value of VR and identify barriers to VR implementation among healthcare providers.MethodsA 66-item self-report survey was created to examine application of VR to clinical practice, perceived value of this treatment, ease of learning the technology, billing considerations, and other obstacles. 128 providers (MDs and PhDs) who were located in the United States and had used VR as a therapeutic tool in the past year were identified through research papers, as well as user lists and news articles from VR application websites. Of the 128 providers contacted, 17% (22) completed our online self-report measure. Of these, 13% of respondents (N = 17) completed greater than 75% of the questionnaire and were considered completers. Provider responses were collected over a one-month period and qualitatively analyzed.ResultsThe majority of providers were from an academic institution (n = 12, 70.6%), and all providers practiced in the outpatient setting. Providers most commonly reported using VR for the treatment of acute pain and/or anxiety related to medical procedures (n = 11, 64.7%), followed by specific phobia (n = 6, 35.3%) and social phobia (n = 6, 35.3%). All providers agreed VR is a valuable tool they would recommend to colleagues. The majority (n = 15, 93.8%) believed VR helped their patients progress in treatment, compared with other methods. Providers cited the ability to individualize treatment (n = 14, 87.5%) and increase patient engagement (n = 15, 93.8%) as main benefits of VR. A minority reported negative feedback from patients about content (n = 4, 25%) or about the technology in general (n = 6, 37.5%), whereas all reported some form of positive feedback. The slight majority (n = 10, 58.8%) of providers did not find transitioning to VR difficult. Of those who did, cost was the most commonly cited barrier (n = 6). Regarding reimbursement, only 17.6% (n = 3) of providers reported the ability to bill for VR sessions. Most providers (n = 15, 88.2%) received training on their VR platform which they found beneficial. Comparing the trained and untrained groups found no significant difference in VR comfort level (p = 0.5058), the value of VR in practice (p = 0.551) or whether providers would recommend VR to others (p = 0.551), though sample sizes were small.ConclusionsIn corroboration with previous research, this study demonstrates that VR is well-received by patients and providers, allowing increased patient engagement and treatment individualization. However, associated costs, including an inability to bill for this service, can present a barrier to further implementation. These findings will guide further development of virtual reality as a standardized tool in psychiatry and pain management.

Effectiveness of a smartphone-based, augmented reality exposure app to reduce fear of spiders in real-life: A randomized controlled trial

Although in vivo exposure therapy is highly effective in the treatment of specific phobias, only a minority of patients seeks therapy. Exposure to virtual objects has been shown to be better tolerated, equally efficacious, but the technology has not been made widely accessible yet.We developed an augmented reality (AR) application (app) to reduce fear of spiders and performed a randomized controlled trial comparing the effects of our app (six 30-min sessions at home over a two-week period) with no intervention. Primary outcome was subjective fear, measured by a Subjective Units of Distress Scale (SUDS) in a Behavioural Approach Test (BAT) in a real-life spider situation at six weeks follow-up.Between Oct 7, 2019, and Dec 6, 2019, 66 individuals were enrolled and randomized. The intervention led to significantly lower subjective fear in the BAT compared to the control group (intervention group, baseline: 7.12 [SD 2.03] follow-up: 5.03 [SD 2.19] vs. control group, baseline: 7.06 [SD 2.34], follow-up 6.24 [SD 2.21]; adjusted group difference -1.24, 95 % CI -2.17 to -0.31; Cohen’s d = 0.57, p = 0.010).The repeated use of the AR app reduces subjective fear in a real-life spider situation, providing a low-threshold and low-cost treatment for fear of spiders.

Virtual reality in clinical practice.

Virtual reality in clinical practice.

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.

Autism Spectrum Disorder and Specific Phobia: the Role of Sensory Sensitivity: Brief Review

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder affecting approximately 1 in 59 children (Baio et al. MMWR Surveillance Summaries, 67(6), 1, 2018). A commonly experienced psychiatric comorbidity in ASD is anxiety. Although this is known, little research has been done on the specific issues concerning specific phobia in ASD, even though specific phobias (SPs) are present in up to 40% of children with ASD. As one of the leading treatments for anxiety, cognitive behavioral therapy (CBT) has been adapted for many different populations, including children with ASD. However, the work that has been done on treatment of SP in ASD has been mostly case studies from an operant perspective. These case studies have not, to our knowledge, utilized CBT; however, they suggest that behaviorally based treatments may be effective. Still, they do not explore potential mechanisms associated with the co-occurrence of these disorders, such as sensory sensitivity, that may be responsible for these differences. Within the context of ASD, Green and Ben-Sasson (Journal of autism and developmental disorders, 40(12), 1495-1504, 2010) suggest a model of SP based on classical fear conditioning theory, which suggests sensory sensitivities cause anxieties by conditioning children to associate aversive sensations with certain objects that consequently come to elicit fear and anxiety. Here, we suggest three potential modifications of CBT to address sensory sensitivity in youth with ASD. In offering these modifications, we attempt to address explicitly the potential mechanisms underlying the development of SP in youth with ASD.

Subscales of the Fear Survey Schedule-III in Community Dwelling Older Adults – Relations to Clinical and Cognitive Measures

ABSTRACTObjectives: One major obstacle to the diagnosis and treatment of specific phobias in later life is the lack of assessment tools that are relevant to the fears of older adults. This study investigated the utility of five reliable subscales (Blood/Injury, Agoraphobia, Aggression, Animal/Insect, Social Fears) derived from the Fear Survey Schedule-III, a popular measure of phobic fear, in discriminating older from younger participants.Method: The sample was comprised of 81 younger and 61 older adults who completed self-report measures of anxiety and depression and neuropsychological tests.Results: Older adults scored significantly higher than their younger counterparts only on the Aggression subscale of the FSS-III; whereas younger adults scored significantly higher than the older group only on the Social Fears subscale. These subscales showed slightly different associations with other measures of anxiety, depression, and intelligence across age groups. Within the older sample, scores on the Aggression subscale were significantly higher than all other subscales except for Social Fears.Conclusions: It is recommended that clinicians and researchers use subscale scores derived from the FSS-III, rather than total scores, when treating and studying fears of later life.Clinical Implications: Use of FSS-III subscales in assessment could result in improved detection and treatment of phobias in later life, and thus raise quality of life among the elderly. Older adults’ fears of victimization should be prioritized as a possible treatment target in clinical settings.

D-cycloserine-augmented one-session treatment of specific phobias in children and adolescents.

BackgroundD‐Cycloserine has potential to enhance exposure therapy outcomes. The current study presents a preliminary randomized, placebo‐controlled double‐blind pilot trial of DCS‐augmented one‐session treatment (OST) for youth (7–14 years) with specific phobia. A secondary aim of this pilot study was to explore the effects of youth age and within‐session fear reduction as potential moderators of DCS outcomes in order to generate hypotheses for a larger trial. It was hypothesized that DCS would be associated with greater improvements than placebo, that children (7–10 years) would have greater benefits than adolescents (11–14 years), and that DCS effects would be stronger for participants with the greater within‐session fear reduction during the OST.MethodsThirty‐five children and adolescents were randomized to either OST combined with DCS (n = 17), or OST combined with placebo (PBO; n = 18) and assessed at 1 week, 1 month, and 3 month following treatment.ResultsThere were no significant pre‐ to post‐treatment or follow‐up benefits of DCS relative to placebo. Secondary analyses of age indicated that relative to PBO, DCS was associated with greater improvements for children (but not adolescents) on measures of severity at 1‐month follow‐up. Children in the DCS condition also showed significantly greater improvement to 1 month on global functioning relative to other groups. Conversely, adolescents had significant post‐treatment benefits in the PBO condition on symptom severity measures relative to DCS, and adolescents in the DCS condition had significantly poorer functioning at 3 months relative to all other groups. Finally, there was a trend for within‐session fear reduction to be associated with moderating effects of DCS, whereby greater reduction in fear was associated with greater functioning at one‐month follow‐up for children who received DCS, relative to PBO.LimitationsThe study sample was small and therefore conclusions are tentative and require replication.ConclusionsAge and within‐session fear reduction may be important moderators of DCS‐augmented one‐session exposure therapy, which requires testing in a fully powered randomized controlled trial.

Integrating Hypnosis with Other Therapies for Treating Specific Phobias: A Case Series

There is a high prevalence of anxiety disorders including specific phobias and panic disorder in the United States and Europe. A variety of therapeutic modalities including pharmacotherapy, cognitive behavioral therapy, systematic desensitization, hypnosis, in vivo exposure, and virtual reality exposure therapy have been applied. No one modality has been entirely successful. There has been only a limited attempt to combine psychological therapies in the treatment of specific phobias and panic disorder and what has been done has been primarily with systematic desensitization or cognitive behavioral therapy along with hypnotherapy. I present two cases of multiple specific phobias that were successfully treated with hypnotherapy combined with virtual reality exposure therapy or in vivo exposure therapy. The rationale for this integrative therapy and the neurobiological constructs are considered.

Disorder-specific versus generic cognitive-behavioral treatment of anxiety disorders in children and young people: a systematic narrative review of evidence for the effectiveness of disorder-specific CBT compared with the disorder-generic treatment, Coping Cat.

Coping Cat (CC), a generic cognitive-behavioral intervention for anxiety disorders in children and young people, is recommended in the United Kingdom for social anxiety disorder (SAD), generalized anxiety disorder, separation anxiety (SA), and specific phobias (SP), with disorder-specific approaches generally favored in treatment of anxiety disorders in adults. To compare CC with disorder-specific cognitive-behavioral therapy (CBT) interventions based on anxiety-related treatment outcomes. Primary research articles describing treatment of children and young people aged 7-17 for SAD, generalized anxiety disorder, SA, and SP, using CC or disorder-specific CBT. Ten studies implemented CC and four implemented disorder-specific CBT. One study compared CC with a disorder-specific approach. There was a lack of data to support use of CC in treatment of SPs. However, CC was equally effective as disorder-specific treatments for SA and SAD. A lack of data exists for disorder-specific CBT interventions compared to CC.

Treating specific phobias in young people with autism and severe learning difficulties

AbstractAnimal phobias in young people with autism spectrum disorders (ASD) and intellectual disability (ID) can provoke behaviours that put them at risk and impede access to the community. Previous studies suggest that cognitive behavioural therapy including systematic desensitization and modelling are effective for people with ID, including those with comorbid ASD. Methods of adapting such treatment to people with little spoken language are not well described, and ethical issues concerning both young people and animals during treatment have not been addressed. The aim of this study was to describe, using a case series of consecutive referrals: (1) adaptations to systematic desensitization when communication of the young person is impaired, and (2) the ethics of involving animals in therapeutic interventions. Treatment was planned based on the use of systematic desensitization with a hierarchy of feared situations using visual symbols and schedules to communicate with the participants. Five young people with ASD, severe ID and minimal language were successfully treated for dog phobia. Modifications to treatment included both the use of non-verbal means of communication including printed symbols and graded activities such as jigsaw puzzles and picture matching to present information to clients in a more finely graded format. The treatment of specific phobias is possible with the use of minimal language provided that a variety of individualized stimuli approximating to the feared objects are developed and the safety of all participants is respected. Further work is required to develop sufficiently flexible treatment protocols, which in turn would enable a randomized controlled trial.

Efficacy of virtual reality exposure therapy for treatment of dental phobia: a randomized control trial.

BackgroundVirtual Reality Exposure Therapy (VRET) is found to be a promising and a viable alternative for in vivo exposure in the treatment of specific phobias. However, its usefulness for treating dental phobia is unexplored. The aims of the present study are to determine: (a) the efficacy of VRET versus informational pamphlet (IP) control group in terms of dental trait and state anxiety reductions at 1 week, 3 months and 6 months follow-up (b) the real-time physiological arousal [heart rate (HR)] of VRET group participants during and following therapy (c) the relation between subjective (presence) and objective (HR) measures during VRET.MethodsThis study is a single blind, randomized controlled trial with two parallel arms in which participants will be allocated to VRET or IP with a ratio of 1:1. Thirty participants (18-50 years) meeting the Phobia Checklist criteria of dental phobia will undergo block randomization with allocation concealment. The primary outcome measures include participants’ dental trait anxiety (Modified Dental Anxiety Scale and Dental Fear Survey) and state anxiety (Visual Analogue Scale) measured at baseline (T0), at intervention (T1), 1-week (T2), 3 months (T3) and 6 months (T4) follow-up. A behavior test will be conducted before and after the intervention. The secondary outcome measures are real-time evaluation of HR and VR (Virtual Reality) experience (presence, realism, nausea) during and following the VRET intervention respectively. The data will be analyzed using intention-to-treat and per-protocol analysis.DiscussionThis study uses novel non-invasive VRET, which may provide a possible alternative treatment for dental anxiety and phobia.Trial registration numberISRCTN25824611, Date of registration: 26 October 2015.

Therapists' and patients' stress responses during graduated versus flooding in vivo exposure in the treatment of specific phobia: A preliminary observational study

Exposure therapy is considered an effective treatment strategy for phobic anxiety, however, it is rarely applied in clinical practice. The under-usage might be due to various factors of which heightened stress levels not only in patients but also in therapists are presumed to be of particular relevance. The present study aimed to investigate whether different forms of exposure might lead to varying physiological and psychological stress responses in therapists and phobic patients. 25 patients with specific phobia underwent individual cognitive behavioural therapy, performed by 25 psychotherapist trainees, applying exposure sessions in graduated form or the flooding technique. Patients and therapists provided subjective evaluations of stress and five saliva samples for analysis of salivary cortisol and alpha-amylase either during two graduated exposure sessions or during one flooding session, while a regular therapy session served as control condition. Therapists displayed heightened salivary alpha-amylase release during exposure of the flooding, but not the graduated, type. Patients showed elevated salivary cortisol during flooding exposure numerically, however, not on a statistically significant level. Therapists reported more pronounced subjective stress during flooding compared to graduated exposure. Elevated stress levels should be addressed in clinical training in order to improve application of exposure in routine practice.

Non-Antidepressant Psychopharmacologic Treatment of Specific Phobias

Specific phobias are among the most frequently diagnosed disorders in community with a twelve-month prevalence of 8.7% and a lifetime prevalence of 12.5%. Exposure-based therapies constitute the most effective treatment for this type of anxiety disorders. However, pharmacotherapies can still be considered for patients suffering from specific phobias in case they were non-adherent or resistant to exposure-based therapies or in case this kind of therapies was not accessible for them. Few data support the use of antidepressant in the treatment of specific phobias. A literature search via MedLine has been done in order to review all available studies in the domain of nonantidepressant pharmacotherapy of specific phobias. The importance of benzodiazepines such as diazepam, alprazolam and midazolam resides in the short-term reduction of subjective selfreported fear during the exposure to the feared object or situation. General anesthesia for the treatment of dental phobia does not seem to be efficient unless conducted with the inhalation anesthetic nitrous oxide which seems to be efficient on the short and on the long-term. Beta-adrenergic antagonists have been essayed with conflicting results. Cognitive enhancers such as D-cycloserine, glucocorticoids and yohimbine hydrochloride, seem to be more effective than placebo after a short term period of follow-up in treating specific phobia sympotms. In conclusion, promising efficient pharmacotherapies for specific phobias consists of drugs that enhance the efficacy of exposure-based therapies sessions by reducing anticipating phobia-related fear and/or by enhancing cognition during these sessions.

The Scientific Legacy of Little Hans and Little Albert: Future Directions for Research on Specific Phobias in Youth

We review issues associated with the phenomenology, etiology, assessment, and treatment of specific phobias in children and adolescents and provide suggestions for future research and clinical practice. In doing so, we highlight the early case studies of Little Hans and Little Albert and the advances that have been made following the publication of these seminal cases. In recent years, we have witnessed a deeper understanding of the etiology of specific phobias and developed a rich array of evidence-based assessments and treatments with which to address specific phobias in youth. Although much has been accomplished in this area of inquiry, we also note that much remains to be done before we can advance more fully our understanding, assessment, and treatment of specific phobias in youth. It will be important for future work to build more firmly on these developments and to better determine the moderators and mediators of change with our evidence-based treatments and to more vigorously pursue their dissemination in real-word settings.

Current Issues in the Treatment of Specific Phobia: Recommendations for Innovative Applications of Hypnosis

Specific phobia is the most common and treatable of the anxiety disorders. Exposure-based therapies are the treatment of choice and empirically validated protocols are available that promise rapid and effective results. In many cases, however, patients are reluctant to comply with demanding schedules of exposure, increasing the risk of treatment failure. Furthermore, in clinical practice, patients often present with multiple phobias and other Axis I and Axis II disorders that can further complicate therapy. This article covers four important issues that have been addressed in the literature: (a) managing resistance to treatment, (b) reducing length of treatment, (c) clarifying the optimal application of relaxation training, and (d) applying advances in cognitive neuroscience. These issues are reviewed and recommendations proposed for ways in which to modify current treatments. Specific suggestions are provided for implementing these recommendations including examples of innovative applications of standard hypnotic techniques.

I-95 Phobia Treated With Hypnotic Systematic Desensitization: A Case Report

Systematic desensitization and hypnosis mediated therapy share empirical evidence of efficacy in the treatment of specific phobias. However, a review of the literature indicated there is limited documentation in the employment of these modalities for treating driving related phobias (DRP). This article reports on the use of hypnosis aided systematic desensitization (HASD) in the successful treatment of a case of non-accident related driving phobia, specifically manifested on Interstate 95 (I-95). The treatment consisted of 6 office sessions of HASD along with 14 in-vivo sessions where the patient performed multiple exposures/rehearsals of the behaviors that had been successfully mastered at the office visits. The results indicated that this patient with case of (DRP) was able to resume travel on I-95 at conclusion of treatment. The patient was symptom free at follow up 6 months later.

Exposure Therapy for Phobias

Reid Wilson’s approach to treating anxiety disorders draws upon cognitive behavior therapy techniques to create a brief, aggressive, paradoxical treatment for people who suffer from anxiety disorders. Research has shown that exposure therapy is by far the most effective way to get lifelong results in the treatment of specific phobias. Not many therapists had a chance to see live therapy sessions with real clients and neither to access a good training specific for phobia. In the help of those trainee therapists eager to have rapid and long-lasting results with their clients comes the video in which Reid Wilson is giving step-by-step specific instruction to both trainee-therapists and client. Reid conducts two sessions with a real client, Mary, who experiences different phases and facets of claustrophobia: the fear of using elevators (especially crowded ones), the fear of traveling in tunnels without being able to see the light at the end as humorously dr. Wilson noticed, the fear of parking in tight and dark parking structures and most of all, the fear of flying, which is the most invalidating for dr. Wilson’s client.