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.     

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.     

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).     

Pathways to spider phobia.

Using a revised version of the Phobic Origin Questionnaire (POQ; Ost, L. G. & Hugdahl, K. Behaviour Research and Therapy, 19, 439-477; 1981), the present study examined whether conditioning experiences, modeling experiences, and/or informational learning experiences were more often reported by spider phobics (n = 41) than by non-fearful controls (n = 30). The two groups did not differ with regard to the overall frequency of conditioning or modeling events. Remarkably, the frequency of informational learning was higher among non-fearful Ss than among phobics. Although the limitations inherent to the retrospective nature of the present study should be borne in mind, the data suggest that, at least in spider phobics, conditioning events, modeling experiences, and/or informational learning do not necessarily give rise to phobic fears.     

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.     

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.     

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.     

Placebo effects in spider phobia: an eye-tracking experiment

ABSTRACT

Several eye-tracking studies have revealed that spider phobic patients show a typical hypervigilance-avoidance pattern when confronted with images of spiders. The present experiment investigated if this pattern can be changed via placebo treatment. We conducted an eye-tracking experiment with 37 women with spider phobia. They looked at picture pairs (a spider paired with a neutral picture) for 7?s each in a retest design: once with and once without a placebo pill presented along with the verbal suggestion that it can reduce phobic symptoms. The placebo was labelled as Propranolol, a beta-blocker that has been successfully used to treat spider phobia. In the placebo condition, both the fixation count and the dwell time on the spider pictures increased, especially in the second half of the presentation time. This was associated with a slight decrease in self-reported symptom severity. In summary, we were able to show that a placebo was able to positively influence visual avoidance in spider phobia. This effect might help to overcome apprehension about engaging in exposure therapy, which is present in many phobic patients.     

Effect of distraction and coping style on in vivo exposure for specific phobia of spiders

Recent studies have generated mixed findings regarding the effects of distraction on exposure-based treatments. Results have also been inconsistent regarding the effects of monitoring and blunting coping styles on outcome. The present study attempted to integrate these two areas of research. We hypothesized that the effect of distraction on treatment outcome might depend on coping style. Specifically, we predicted that for blunters (i.e.. individuals who tend to avoid threat-related information), distraction would interfere with the effects of exposure. However, we predicted that distraction might benefit monitors (i.e., individuals who tend to seek out threat-related information). Sixty individuals with a specific phobia of spiders underwent a single, two-hour session of exposure treatment. During the first hour, half of the participants were distracted by listening to an audiotape and the other half underwent exposure without distraction. In the second hour, all participants underwent focused exposure. Based on measures of heart rate, subjective fear, and behavioral testing, participants improved after one hour of treatment, and improved further during the second hour. However, neither distraction, coping style, nor their interaction had a significant effect on outcome. The present study provides support for the benefits of behavioral treatment for specific phobias. However, our hypotheses regarding distraction and coping style were not confirmed.     

Applied tension, exposure in vivo, and tension-only in the treatment of blood phobia.

Thirty patients with phobia for blood, wounds and injuries were treated individually with applied tension (AT), exposure in vivo (E), or tension-only (T) for 5 sessions. They were assessed on self-report, behavioral and physiological measures before and after treatment, and at a 1 yr follow-up. All groups improved significantly, and the improvements were maintained at follow-up. Applying stringent criteria, 90% of the AT-, 80% of the T-, and 40% of the E-patients were clinically improved at the end of treatment. The corresponding figures at follow-up were 100, 90 and 50%, respectively. AT differed significantly, and T marginally from E at both assessments. Applied tension, or tension-only should, from a clinical point of view, be considered the treatment of choice for blood phobia.     

Questionnaire dimensions of spider phobia: a replication and extension

Two studies are presented in this paper. The first presents an analysis of an extended version of the Spider Phobia Questionnaire (SPQ), which can be used to assess cognitive, behavioural and physiological aspects of responsiveness to spiders in spider phobics. The second examines the relationship between these measures and measures of behavioural avoidance, subjective anxiety and physiological response in high and low fear subjects during an avoidance test. The lack of an expected relationship between the two sets of measures is discussed.     

Fading vs systematic desensitization in the treatment of snake and spider phobia

Fading, a new technique for the treatment of phobias, was compared to systematic desensitization and a waiting-list control group for clients with snake and spider phobia. The fading technique used slides of the phobic stimulus instead of imagery, and slides of positive scenes capable of arousing a calm positive feeling as anxiety-antagonists. The clients were assessed on different self-report, behavioural and physiological measures before and after treatment. The clients were treated individually and received eight sessions, one per week. The within-group comparisons showed that both the fading and the desensitization group changed significantly on most, of the dependent measures, but the control group did not. The between-group comparisons yielded fewer significancies but on four of the 12 dependent measures both treatment groups were significantly better than the control group, while there were no differences between the fading and desensitization groups.     

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.