Role-reversed systematic desensitization in the treatment of a writing phobia

A role-reversal technique was employed to teach cognitive coping skills to a patient with a writing phobia. The patient presented desensitization scenes to the therapist and devised coping strategies for lessening anxiety. Treatment resulted in a reduction of anxiety and an increased ability to write in the presence of other people. A 10-mo. follow-up showed no relapse.     

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.     

Contamination vs. harm-relevant outcome expectancies and covariation bias in spider phobia

There is increasing evidence that spiders are not feared because of harmful outcome expectancies but because of disgust and contamination-relevant outcome expectancies. This study investigated the relative strength of contamination- and harm-relevant UCS expectancies and covariation bias in spider phobia. High (n=25) and low (n=24) spider fearful individuals saw a series of slides comprising spiders, pitbulls, maggots, and rabbits. Slides were randomly paired with either a harm-relevant outcome (electrical shock), a contamination-related outcome (drinking of a distasting fluid), or nothing. Spider fearful individuals displayed a contamination-relevant UCS expectancy bias associated with spiders, whereas controls displayed a harm-relevant expectancy bias. There was no evidence for a (differential) postexperimental covariation bias; thus the biased expectancies were not robust against refutation. The present findings add to the evidence that contamination ideation is critically involved in spider phobia.     

Virtual reality in the treatment of spider phobia: a controlled study

This study explored whether virtual reality (VR) exposure therapy was effective in the treatment of spider phobia. We compared a treatment condition vs. a waiting list condition in a between group design with 23 participants. Participants in the VR treatment group received an average of four one-hour exposure therapy sessions. VR exposure was effective in treating spider phobia compared to a control condition as measured with a Fear of Spiders questionnaire, a Behavioural Avoidance Test (BAT), and severity ratings made by the clinician and an independent assessor. Eighty-three percent of patients in the VR treatment group showed clinically significant improvement compared with 0% in the waiting list group, and no patients dropped out. This study shows that VR exposure can be effective in the treatment of phobias.     

Questionnaire dimensions of spider phobia

The construction is described of a questionnaire designed to measure separate dimensions of cognitive-behavioural responsiveness to spiders in spider phobics. Dimensions of vigilance, preoccupation and coping-avoidance are established. Data are presented on differences between phobics and normals on the questionnaire, on correlations between the questionnaire measures and avoidance test measures, and on the effects of desensitization on the questionnaire measures.     

Self-reported automaticity and irrationality in spider phobia

Spider phobic women (n = 39) and nonfearful controls (n = 41) completed a 20-item questionnaire measuring the extent to which they experience their fear reactions to spiders as automatic and irrational. For the phobic sample, therapy outcome data were also collected. Results suggest that spider phobics tend to view their attitude to spiders as irrational and in this respect, they do not differ from control subjects. Furthermore, compared to control subjects, phobics more often perceive their responses to spiders as automatic, i.e., not under intentional control. Contrary to expectation, no robust correlation was found between automaticity and irrationality. Interestingly, automaticity was not related to treatment outcome, while irrationality to some extent predicted therapy outcome (i.e., the more phobics experienced their fear as irrational, the more they profited from exposure treatment).     

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.     

Automatic processing in spider phobia: implicit fear associations over the course of treatment

This study evaluates the cognitive model of anxiety by investigating treatment-related changes in automatic associations to evaluate schematic processing. Spider-phobic participants (n = 31) and healthy controls (n = 30) completed fear-based Implicit Association Tests (IATs), which are reaction-time measures that tap implicit associations without requiring conscious introspection. The specific tasks involved classifying pictures of snakes and spiders along with semantic categorizations (good vs.bad, afraid vs. unafraid, danger vs. safety, and disgusting vs. appealing). Phobic individuals were assessed before and after group-based exposure treatment and 2 months later, controls were assessed at matched time points. Results supported clinical applications for implicit fear associations, including prediction of phobic avoidance, and treatment sensitivity of the fear- and disgust-specific automatic associations.     

Exposure in vivo vs applied relaxation in the treatment of blood phobia

Eighteen patients with phobia for bloodt, wounds and injuries were treated with exposure in vivo or applied relaxation. They were assessed on different self-report, behavioral and physiological measures before and after treatment. The patients were treated individually for 9 sessions, 1 per week. The within-group comparisons showed that both groups had improved significantly on most of the measures and that these improvements were sustained or furthered at the 6-month follow-up. Furthermore, 10 of the 16 who completed the treatment became blood donors. The between-group comparisons showed exposure to be better than applied relaxation on three of the self-report measures at post-treatment assessment, but not at follow-up. The groups did equally well on the behavioral and physiological measures. The conclusion that can be drawn is that the coping-orientated method of applied relaxation is as effective as exposure in vivo in the treatment of blood phobia.     

Imagery ability and exposure in vivo in spider phobia

The present study deals with the effect of imagery ability on treatment outcome in spider phobias. Thirty-eight spider phobics completed the Questionnaire on Mental Imagery (QMI) and the Spider Questionnaire (SPQ). Subjects also went through a behavioral approach task (BAT) during which heart rate and avoidance behavior were measured. Each subject was then given one-session treatment as described by Ost. Immediately after treatment, SPQ and BAT data were again obtained. On the basis of their QMI scores, subjects were assigned to a 'good', 'moderate', or 'poor' imagers group. Neither pre-treatment nor post-treatment measures were found to vary as a function of imagery ability. Thus it appears that, at least for specific phobias such as spider fear, imagery ability is not a relevant variable for predicting the effects of in vivo exposure.     

Use of systematic desensitization in the treatment of airplane phobic patients

There have been several studies of the phenomenon of airplane phobia mostly dealing with professional aviators and aircrews (Goorney, 1960; Aitken, 1970). There has also been a report of the use of penthranization in the in vivo desensitization of an airplane phobic patient (Mildman, 1969). Recently one case of successful in vivo desensitization using flight simulators and flight instruction has been reported (Bernstein and Beaty, 1971).This paper describes the application of Wolpe's (Wolpe, 1969) technique of systematic desensitization for persons with an airplane phobia.     

Danger expectancies, self-efficacy and insight in spider phobia

In the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, (1994) Diagnostic and statistical manual of mental disorders (4th ed.) Washington, DC: author) phobic adults and adolescents are said to "recognize that the phobia is excessive or unreasonable" given the actual danger posed by the feared situation. The present study examined perceptions of danger in 15 spider phobic subjects and a matched set of controls before, during and after a spider-avoidance test. When detached from the phobic stimulus, phobic subjects: (1) gave higher estimates of the probability of being bitten than controls did; (2) gave higher estimates of the injuries that would result from being bitten and (3) in line with these first two findings, believed their high levels of anticipated anxiety were more reasonable and appropriate to the demands of the situation than controls did. These findings are inconsistent with the prevailing notion that when detached from the phobic situation patients can accurately evaluate the danger of potential phobic encounters. Instead, the findings suggest that phobic individuals, whether detached or in the presence of the feared object, have relatively limited insight into the irrationality of their fears. In examining the mediation of phobic phenomena, both self-efficacy and danger estimates remained significantly related to the anxiety and avoidance experienced in the spider-avoidance task. Further research designed to experimentally establish the likely causal roles of these two constructs is warranted.