One-session treatment of specific phobias: a detailed description and review of treatment efficacy

One-Session Treatment (OST) is a form of massed exposure therapy for the treatment of specific phobias. OST combines exposure, participant modeling, cognitive challenges, and reinforcement in a single session, maximized to three hours. Clients are gradually exposed to steps of their fear hierarchy using therapist-directed behavioral experiments. Although there are several studies in the literature examining the efficacy of OST, little has been done to summarize this research. In the following review, research on and empirical support for OST are reviewed with an emphasis on the types of stimuli, samples, and methodologies utilized. Research generally supports OST's efficacy, although replication by independent examiners using adult and child samples is needed using more rigorous comparisons (e.g., psychological placebo or other treatments). Overall, OST continues to be a promising treatment for specific phobias; however, a great deal more investigation is needed to identify mechanisms of change, mediators, and moderators.     

One-session cognitive treatment of dental phobia: preparing dental phobics for treatment by restructuring negative cognitions

The purpose of this study was to investigate the effectiveness of a single session of cognitive restructuring in a sample of phobic dental patients. Fifty-two patients were randomly assigned to one of three conditions: cognitive restructuring (modification of negative cognitions), provision of information (about oral health and dental treatment), and a waiting list control condition. Both interventions maximally lasted one hour. In comparison with the waiting list control condition and the information intervention condition, the cognitive intervention condition not only showed a large decrease in frequency and believability of negative cognitions, but also exhibited a clear decline in dental trait anxiety. Analysis at a follow-up of one year demonstrated a further, drastic reduction in dental anxiety in both intervention conditions, wherein the difference among these conditions was not maintained. It is concluded that it is possible to obtain substantial reductions of dental trait anxiety through a single session of cognitive restructuring. Nevertheless, repeated exposure to the dental situation seems necessary for a further reduction of anxiety.     

Comorbidity in youth with specific phobias: Impact of comorbidity on treatment outcome and the impact of treatment on comorbid disorders

The purpose of the present study was twofold. In an analysis of data from an existing randomized control trial of brief cognitive behavioral treatment on specific phobias (One-Session Treatment, OST; Ollendick et al., 2009), we examined 1) the effect of comorbid specific phobias and other anxiety disorders on treatment outcomes, and 2) the effect of treatment of the specific phobia on these co-occurring disorders. These relations were explored in 100 youth presenting with animal, natural environment, situational, and “other” types of phobia. Youth were reliably diagnosed with the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent versions (Silverman & Albano, 1996). Clinician severity ratings at post-treatment and 6-month follow-up were examined as were parent and child treatment outcome satisfaction measures. Results indicated that the presence of comorbid phobias or anxiety disorders did not affect treatment outcomes; moreover, treatment of the targeted specific phobias led to significant reductions in the clinical severity of other co-occurring specific phobias and related anxiety disorders. These findings speak to the generalization of the effects of this time-limited treatment approach. Implications for treatment of principal and comorbid disorders are discussed, and possible mechanisms for these effects are commented upon.     

Behavioral treatment of thunder and lightning phobias.

The use of four different behavioral techniques in the treatment of six female clients with thunder and lightning phobia is described. The techniques (Systematic desensitization. Covert reinforcement. Stress inoculation training, and Self administered desensitization with tape recorder) were evaluated in single-case experimental designs, using both self-report, behavioral, and physiological data.The immediate and follow-up results showed that five of the clients were completely recovered and the sixth markedly improved after their respective treatment (10–14 session). These results and the questions concerning continuous assessment in single-case design and external validity of laboratory assessment in phobic conditions are discussed.     

Cotherapy treatment of phobias: A case study

A case study is presented of the treatment of a woman who had suffered from claustrophobia for over 13 years, by cotherapists using a combination of desensitization and flooding techniques. By assuming specific roles, the therapists expedited the therapeutic process to a successful conclusion in a brief period of time.     

Thunderstorm phobias

This study, consists of a retrospective analysis made from the case notes of 10 thunderstorm phobics who were treated between 1963 and 1977.A wide range of data was abstracted from the histories in order to formulate some generalizations concerning the aetiology of this type of phobia. All the patients studied were female, generally they had experienced the problem in childhood usually in a severe form and its further exacerbation was often attributed to aversive life events. While many reported related sensitivities such as overreaction to sudden and loud noises, other psychiatric problems were rarely presented for treatment.     

Reciprocal inhibition by aversion relief in the treatment of phobias

The treatment reported is a combination of Wolpeian reciprocal inhibition and aversion-relief therapies. The relief following termination of electric shock was substituted for Jacobsonian relaxation in the reciprocal inhibition of anxiety. Photographs of phobic objects and tape recordings of narrated phobic experiences were utilized in treating seven phobic patients and one ticqueur. Six of the seven phobic patients were free of phobic fears, without symptom substitution, at time of follow-up. Theoretical implications and research possibilities of the treatment procedure are discussed.     

Conditioning experiences and phobias

A retrospective study was conducted to examine the extent to which phobias are associated with a conditioning pathway to fear. The Phobic Origin Questionnaire (Öst and Hugdahl, Behav. Res. Ther. 19, 439–477, 1981) was administered to a sample of 91 phobic outpatients (patients with panic disorder with agoraphobia, social phobics, simple phobies). Results show clearly that conditioning experiences occur more frequently than either vicarious or informational, learning experiences, which confirms the findings previously reported by Rimm, Janda, Lancaster, Nahl and Dittmar (Behav. Res. Ther. 15, 231–238, 1977) and by Öst and Hugdahl (1981; Behav. Res. Ther. 21, 623–631, 1983). Yet, conditioning experiences consist mainly of panic attacks in confined environments. The findings also suggest that a considerable number of phobias are based on a combination of different pathways to fear.     

The etiology of specific fears and phobias in children: a critique of the non-associative account

The non-associative account of phobic etiology assumes that a number of specific fears (e.g., fear of heights, water, spiders, strangers, and separation) have an evolutionary background and may occur in the absence of learning experiences (e.g., conditioning). By this view, these specific fears pertain to stimuli that once posed a challenge to the survival of our prehistoric ancestors. Accordingly, they would emerge spontaneously during the course of normal development and only in a minority of individuals, these specific fears would persist into adulthood. While the non-associative approach has generated interesting findings, several critical points can be raised. First, it capitalizes on negative findings, i.e., the failure to document learning experiences (e.g., conditioning, modeling) in the history of phobic children. Second, it largely ignores factors that have been found to be crucial for the acquisition of early childhood fears (e.g., the developmental level of the child, stimulus characteristics such as novelty, aversiveness, and unpredictability, and early experience with uncontrollable events). As an alternative to the non-associative account, we briefly describe a multifactorial model of childhood fears and phobias.     

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 psychoanalytic view of phobias. Part IV: General theory of phobias and anxiety.

This is the final part of the work on the psychoanalytic view of phobias. Here we consider general views of phobias, developments and issues in the psychoanalytic theory of anxiety, as it relates to phobias, and take up aspects of some broader theoretical issues, including nosology.