Treatment Of Spider Phobia Research Articles

Treatment of Spider Phobia Using Repeated Exposures and Adjunctive Repetitive Transcranial Magnetic Stimulation: A Proof-of-Concept Study.

BackgroundSpecific phobias represent the largest category of anxiety disorders. Previous work demonstrated that stimulating the ventromedial prefrontal cortex (vmPFC) with repetitive Transcranial Magnetic Stimulation (rTMS) may improve response to exposure therapy for acrophobia.ObjectiveTo examine feasibility of accelerating extinction learning in subjects with spider phobia using intermittent Theta Burst Stimulation (iTBS) rTMS of vmPFC.MethodsIn total, 17 subjects with spider phobia determined by spider phobia questionnaires [Spider Phobia Questionnaire (SPQ) and Fear of Spiders questionnaire (FSQ)] underwent ratings of fear of spiders as well as behavioral and skin conductance data during a behavioral avoidance test (BAT). Subjects then received a sequential protocol of in vivo spider exposure followed by iTBS for three sessions administered to either active or control treatment sites (vmPFC [n = 8] or vertex [n = 9], respectively), followed 1 week later by repetition of questionnaires and BAT.ResultsAll subjects improved significantly regardless of group across both questionnaires (FSQ η2 = 0.43, p = 0.004; SPQ η2 = 0.39, p = 0.008) and skin conductance levels during BAT (Wald χ2 = 30.9, p < 0.001). Subjects in the vmPFC group tolerated lower treatment intensity than in the control group, and there was a significant correlation between treatment intensity, BAT subjective distress improvement, and physiologic measures (all ρ > 0.5).ConclusionThis proof-of-concept study provides preliminary evidence that a sequential exposure and iTBS over vmPFC is feasible and may have rTMS intensity-dependent effects on treatment outcomes, providing evidence for future areas of study in the use of rTMS for phobias.

Decrease in amygdala activity during repeated exposure to spider images predicts avoidance behavior in spider fearful individuals

Spider phobia is characterized by exaggerated fear of situations where spiders could be present, resulting in avoidance of such situations and compromised quality of life. An important component in psychological treatment of spider phobia is exposure to phobic situations that reduces avoidance behaviors. At the neural level, amygdala responses to phobic material are elevated, but normalizes following exposure treatment. To what extent amygdala activity decreases during a session of repeated phobic stimulation, and whether activity decrease is related to subsequent avoidance is not well studied. We hypothesized reduced amygdala activity during the course of repeated exposure to spider pictures, and that the degree of reduction would predict subsequent avoidance of spider pictures. To test our hypothesis, functional magnetic resonance imaging was performed in 45 individuals with spider fear during repeated exposure to spider pictures. Results showed that repeated exposure to spider stimuli attenuated amygdala reactivity and individual differences in activity reductions predicted subsequent avoidance behavior to spider pictures in an incentive-conflict task, with larger attenuations predicting less avoidance. At 6-month follow up, initial reductions in amygdala activation still predicted avoidance. This result demonstrates that reduction in amygdala responses is related to clinically meaningful outcomes in human anxiety, and suggests that within-session reductions in amygdala responses could be an important mechanism explaining the clinical effects of exposure therapy.

Exposure therapy for fear of spiders in an adult with learning disabilities: a case report

Accessible summary Not many researchers have written about therapy for spider fear in people with learning disabilities. In this study, a woman with learning disabilities completed a questionnaire about the therapy she was having for her fear of spiders. The results from the questionnaire suggested that the therapy did help the woman's spider fear. The results should make professionals working with people with learning disabilities think creatively about how therapy for specific fears is done and also the best way to check whether the therapy is helping. SummaryThe evidence‐base for exposure therapy in people with learning disabilities experiencing specific phobias is sparse. This case study describes the assessment, formulation and treatment of spider phobia in a woman with learning disabilities using an exposure‐based intervention augmented with mindfulness practice and bereavement work. To evaluate the intervention, a self‐report measure of spider phobia was employed and completed during a baseline (A) and intervention (B) phase. Results demonstrate a reduction in self‐reported fear after 11 sessions. This case study illustrates how in some cases modified self‐report measures can be used to evaluate psychological treatments in people with learning disabilities and also highlights the importance of being formulation‐led and creative when designing exposure‐based interventions for specific phobias.

A comparison of repeated exposure to fearful and disgusting stimuli among spider phobics

AbstractThis study examined the role of fear and disgust in repeated exposure among spider phobics. Thirty spider phobics were randomly assigned to one of two experimental groups. Both groups completed measures of fear and disgust and performed two initial standardized Behavioral Avoidance Tests (BATs; one with a fear stimulus – live tarantula, and one with a disgust stimulus – dead rat). One group was then repeatedly exposed to the tarantula and the other to the dead rat. Results of the study indicated that exposure to either the disgust stimulus or the live tarantula was associated with significant decreases in fear, avoidance, and disgust. However, it was found that repeated exposure to the fear stimulus produced a greater decrease in avoidance behavior. Results suggest that both types of exposure can be effective in alleviating associated symptoms and provide additional evidence that disgust sensitivity plays a role in the treatment of spider phobia. Copyright © 2010 John Wiley &amp; Sons, Ltd.

The relative contributions of fear and disgust reductions to improvements in spider phobia following exposure-based treatment

The present study examines the relative contributions of changes in state fear and disgust emotions to improvements in spider phobia observed with exposure-based treatment. Sixty-one treatment-seeking spider fearful individuals underwent a one-session exposure in vivo treatment. Growth curve analyses indicated that treatment was associated with significant improvements in state fear and disgust reactions to a live spider and self-reported trait spider phobia symptoms. Mediation analyses demonstrated that changes over time in state fear and disgust each explained unique variance in improvements in phobic symptoms over time. Examination of the effect size of the mediated pathways suggests that changes in fear and changes in disgust are important to reductions in the severity of spider phobia symptoms during exposure-based treatment. The implications of these findings for conceptualizing the role of fear and disgust emotions in the maintenance and treatment of spider phobia are discussed.

A Randomized, Controlled Clinical Trial of In Virtuo and In Vivo Exposure for Spider Phobia

The present study compared the efficacy of virtual reality (VR) in virtuo exposure and in vivo exposure in the treatment of spider phobia. Two treatment conditions were compared to a waiting-list condition. A 3-month follow-up evaluation was conducted in order to assess the durability of the treatment effects. Participants were randomly assigned to the treatment groups. A total of 16 participants received the in virtuo treatment, and 16 received the in vivo treatment. The waiting-list condition included 11 participants. Participants received eight 1.5-hour treatment sessions. Efficacy was measured with the Fear of Spiders Questionnaire, the Spider Beliefs Questionnaire (SBQ-F), and a Behavioral Avoidance Test (BAT). In addition, a clinician administered the Structured Interview for DSM-IV to assess DSM-IV's criteria for specific phobia and severity. Clinical and statistically significant improvements were found for both groups. Differences in treatment groups were found on one of five measures of fear: greater improvement on the SBQ-F beliefs subscale was associated with in vivo exposure.

Internet‐Based Self‐Help Versus One‐Session Exposure in the Treatment of Spider Phobia: A Randomized Controlled Trial

The authors compared guided Internet‐delivered self‐help with one session of live‐exposure treatment in a sample of spider‐phobic patients. A total of 30 patients were included following screening on the Internet and a structured clinical interview. The Internet treatment consisted of five weekly text modules, which were presented on a web page, a video in which exposure was modelled, and support provided via Internet. The live‐exposure treatment was delivered in a 3‐hr session following a brief orientation session. The main outcome measure was the behavioural approach test (BAT), and as secondary measures the authors used questionnaires measuring anxiety symptoms and depression. Results showed that the groups did not differ at posttreatment or follow‐up, with the exception of the proportion showing clinically significant change on the BAT. At posttreatment 46.2% of the Internet group and 85.7% in the live‐exposure group achieved this change. At follow‐up the corresponding figures were 66.7% for the Internet group and 72.7% for the live treatment. Within‐group effect sizes for the spider phobia questionnaire were large (d = 1.84 and 2.58 for the Internet and live‐exposure groups, respectively, at posttreatment). The authors conclude that guided Internet‐delivered exposure treatment is a promising new approach in the treatment of spider phobia.

Fear and disgust processing during repeated exposure to threat-relevant stimuli in spider phobia

Although disgust plays a significant role in the etiology of spider phobia, there remains a paucity of research examining the role of disgust in the treatment of spider phobia. Spider fearful participants ( N = 46) were randomly assigned to a disgust (view vomit images) or neutral activation (view inanimate objects) condition. They were then repeatedly exposed to a videotaped tarantula, during which time their fear, disgust, and physiological levels were assessed repeatedly. Growth curve analyses indicated that repeated exposure led to significant declines in fear and disgust with no statistically significant differences between the two conditions. However, there was marginal evidence for decreased physiological arousal during repeated exposure among spider fearful participants in the disgust activation condition compared to those in the neutral condition. Reduction in disgust during exposure in the disgust activation condition remained significant after controlling for change in fear, whereas change in fear was no longer significant after controlling for change in disgust. However, the opposite pattern of relations between change in fear and disgust was observed in the neutral activation condition. Higher fear and disgust activation during exposure was also associated with higher fear and disgust responding on a subsequent behavioral task and higher spider fear and disgust at 3-month follow-up. Baseline trait disgust propensity also predicted fear and disgust parameters during repeated exposure. The implications of these findings for the role of disgust in the treatment of spider phobia are discussed.

Long-term follow-up of computer-aided vicarious exposure versus live graded exposure in the treatment of spider phobia

This study investigated the long-term efficacy of three 45-minute sessions of live graded exposure, computer-aided vicarious exposure, or progressive muscle relaxation placebo for the treatment of spider phobia, and is a follow-up of the results previously reported by Gilroy, Kirkby, Daniels, Menzies, and Montgomery (2000). Forty-two out of 45 participants were assessed, using both subjective and behavioral assessments, at a mean of 33 months after completing treatment. The assessor was unaware of treatment group. Results showed significant improvement from pretreatment to 33-month follow-up across a range of measures in all treatment groups, although the group by time interaction was not statistically significant. Between 3-month and 33-month follow-up, no significant change was observed in any group, indicating sustained long-term improvement. The results support previous reports of the long-term efficacy of live graded exposure and indicate similar durable treatment outcome effects for computer-aided vicarious exposure.

Counterconditioning in the treatment of spider phobia: effects on disgust, fear and valence

From the perspective that disgust is a core feature of spider phobia, we investigated whether the treatment efficacy could be improved by adding a counterconditioning procedure. Women with a clinically diagnosed spider phobia ( N=34) were randomly assigned to the regular one-session exposure condition (EXP) or to the exposure with counterconditioning condition (CC). In the CC-condition tasty food-items were used during the regular exposure exercises and the participants' favourite music was played. Both treatment conditions appeared very effective in reducing avoidance behaviour and self-reported fear of spiders, strongly attenuated the disgusting properties of spiders and altered the affective evaluations in a positive direction. CC was not more effective in altering the affective valence of spiders than EXP and was not superior with respect to the long term treatment efficacy at 1 year follow up. Apparently, regular exposure treatment is already quite effective in altering the affective-evaluative component of spider phobia and it remains to be seen whether it is possible to further improve treatment outcome by means of procedures which are specifically designed to reduce the spiders' negative affective valence.

Controlled comparison of computer-aided vicarious exposure versus live exposure in the treatment of spider phobia

Forty-five participants diagnosed as having specific phobia of spiders were randomly assigned to one of three treatment groups: (a) computer-aided vicarious exposure; (b) therapist-delivered live exposure; (c) relaxation placebo. Each group received three 45-minute sessions. Phobic symptom severity was measured at pretreatment, post-treatment, and at a 3-month follow-up assessment with the Spider Questionnaire, Fear Questionnaire, Phobic Targets and Work Adjustment Ratings Scale, and a Behavioral Assessment Test with Subjective Units of Distress Rating Scale. The results showed that the computer-aided vicarious exposure was an effective treatment for spider phobia and comparable to live exposure therapy in significantly reducing phobic symptoms. Both the computer and live exposure treatments were more effective than the relaxation placebo treatment.

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.

One-session therapist directed exposure vs two forms of manual directed self-exposure in the treatment of spider phobia

Fifty-two patients with spider phobia, fulfilling the DSM-III-R criteria for simple phobia, were assessed with behavioral, physiological and self-report measures. They were randomly assigned to five different treatment conditions: (1) one session therapist-directed exposure (maximum 3 hours), (2) specific manual-based treatment in the home, (3) specific manual-based treatment at the clinic, (4) general manual-based treatment in the home and (5) general manual-based treatment at the clinic. The results show that therapist-directed one-session treatment was significantly more effective than three of the manual-based treatments, both at the post-treatment and follow-up stages. Specific manual-based treatment at the clinic was significantly more successful than the other manual-based treatments, but only at follow-up. The proportion of clinically significant improved patients at follow-up was 80% in the therapist-directed group compared to 63% for the specific manual-based treatment at the clinic, 10% for specific manual-based treatment in the home, 9% for general manual-based treatment in the home, and 10% for general manual-based treatment at the clinic. The conclusion that can be drawn is that one-session therapist-directed treatment is the treatment of choice for spider phobia but manual-based treatment is a good alternative in some cases.

The role of evaluative learning and disgust sensitivity in the etiology and treatment of spider phobia

The role of disgust and contamination sensitivity in the development and treatment of spider phobia was examined. It was predicted that spider phobia high in disgust and contamination sensitivity have been more susceptible to evaluative conditioning processes and, as a result, less often report traumatic conditioning events and benefit less from exposure treatment than phobics low in disgust sensitivity ( Baeyens, Eelen, Crombez, & van den Bergh, 1992). As a group, spider phobics ( N = 46) were characterized by higher disgust sensitivity than nonphobic control subjects ( N = 28). However, phobics high in disgust sensitivity reported, if anything, more conditioning events than low digust sensitivity phobics. Treatment effects of exposure were evident in both self-report measures and the behavioral modality. These effects were comparable for high and low disgust sensitivity phobics. Remarkably, high and low disgust sensitivity phobics did not differ with regard to the perceived dirtiness of spiders. Even when the perceived dirtiness of spiders was used as a classifying variable, no differences in acquisition history or treatment outcome emerged between high and low groups. Thus, the findings lend no support to the views that traumatic conditioning events are rare and that exposure treatment is less successful in phobics who presumably have an evaluative learning background. The methodological limitations of the present study are discussed.

One-session therapist-directed exposure vs. self-exposure in the treatment of spider phobia

Thirty-four patients with spider phobia, fulfilling the DSM-IIIR criteria for simple phobia, were assessed with behavioral, physiological, and self-report measures. They were randomly assigned to therapist-directed exposure during one session (maximum 3 hours) or self-directed exposure via a specifically written manual (during a 2-week period). Results showed that therapist-directed exposure was significantly better than self-directed exposure, both at post-treatment and at a 1 year follow-up, on the specific spider phobia self-report measures, the behavioral measures, and clinician rating of phobic severity, while there were no differences on the physiological measures. Stringent criteria for clinically significant improvement were met by 71% of the therapistand 6% in the self-directed exposure group both at post-treatment and at follow-up. Some of the reasons for the poorer results of self-exposure in this study are discussed.