Which type of treatment is a strong research supported psychological treatment for specific phobia?

Cognitive behavioral therapy (CBT)

Cognitive-behavioral therapy (CBT) is a collection of treatments that are well-established and highly effective. Given the state of the research which shows that many mental health problems are exacerbated or maintained by problematic patterns of thinking and problematic behavior patterns, CBT is best understood as an umbrella term that refers to various treatments that target a person's maladaptive thinking patterns (the "cognitive" part of cognitive-behavioral therapy) and behavioral responses (the "behavioral" part of cognitive-behavioral therapy). For anxiety-related disorders, exposure-based CBT has strong empirical support compared to other forms of psychological treatment. Exposure-based treatments have been designated as having "strong research support" (the highest designation available) by the American Psychological Association's reviews of treatment, and a number of institutions - including the American Psychiatric Association - recommend that CBT, and specifically exposure-based CBT, be considered the first-line psychological treatment for anxiety-related disorders. 

Exposure and response prevention (ERP)

Exposure therapy is a specific form of CBT that targets an individual's behavior. It has the most extensive support for the treatment of anxiety-related issues compared to other forms of psychological treatment. Exposure-based treatments have attained the designation of "strong research support" (the highest designation from the American Psychological Association) for panic disorder, generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), social anxiety disorder, and specific phobia. In exposure-based treatments, clients are gradually exposed to feared situations or anxiety-provoking stimuli, learning over time that they are able to manage their anxiety and fear. While exposure treatments reduce symptoms of anxiety, ultimately the goal is to improve clients' quality of life and their ability to function. There are various exposure-based treatments that have demonstrated effectiveness for a variety of mental health problems. For instance, exposure and response prevention (ERP) is a type of exposure treatment that is specifically used to treat people suffering from OCD. Prolonged exposure (PE) is an exposure treatment that is used for people who suffer from PTSD. Interoceptive exposure is an exposure technique used in the treatment of panic disorder.

Acceptance and commitment therapy (ACT) & mindfulness 

Mindfulness involves living in the present moment and learning to experience unwanted thoughts and emotions without judgement. Acceptance and commitment therapy (ACT) uses mindfulness strategies along with acceptance techniques. Rather than attempting to completely remove anxiety, fear, sadness or negative emotions from your life, this approach encourages people to willingly experience unpleasant thoughts and emotions while committing to act in a manner that is consistent with their values. 

Comprehensive behavioral treatment (comB)

Habit reversal training (HRT) and comprehensive behavioral treatment (ComB) are specific forms of CBT that, like exposure therapies, target behaviors. They are the treatment of choice for body-focused repetitive behaviors (BFRBs) such as trichotillomania and excoriation disorder. ComB utilizes HRT and provides a comprehensive treatment plan that may include increasing awareness, learning how to regulate emotions, adjusting physical habits, and changing environmental factors that influence problem behaviors.

Exposure therapy is a psychological treatment that was developed to help people confront their fears. When people are fearful of something, they tend to avoid the feared objects, activities or situations. Although this avoidance might help reduce feelings of fear in the short term, over the long term it can make the fear become even worse. In such situations, a psychologist might recommend a program of exposure therapy in order to help break the pattern of avoidance and fear. In this form of therapy, psychologists create a safe environment in which to “expose” individuals to the things they fear and avoid. The exposure to the feared objects, activities or situations in a safe environment helps reduce fear and decrease avoidance.

Exposure therapy has been scientifically demonstrated to be a helpful treatment or treatment component for a range of problems, including:

• Phobias
• Panic Disorder
• Social Anxiety Disorder
• Obsessive-Compulsive Disorder
• Posttraumatic Stress Disorder
• Generalized Anxiety Disorder

There are several variations of exposure therapy. Your psychologist can help you determine which strategy is best for you. These include:

• In vivo exposure: Directly facing a feared object, situation or activity in real life. For example, someone with a fear of snakes might be instructed to handle a snake, or someone with social anxiety might be instructed to give a speech in front of an audience.
• Imaginal exposure: Vividly imagining the feared object, situation or activity. For example, someone with Posttraumatic Stress Disorder might be asked to recall and describe his or her traumatic experience in order to reduce feelings of fear.
• Virtual reality exposure: In some cases, virtual reality technology can be used when in vivo exposure is not practical. For example, someone with a fear of flying might take a virtual flight in the psychologist's office, using equipment that provides the sights, sounds and smells of an airplane.
• Interoceptive exposure: Deliberately bringing on physical sensations that are harmless, yet feared. For example, someone with Panic Disorder might be instructed to run in place in order to make his or her heart speed up, and therefore learn that this sensation is not dangerous.

Exposure therapy can also be paced in different ways. These include:

• Graded exposure: The psychologist helps the client construct an exposure fear hierarchy, in which feared objects, activities or situations are ranked according to difficulty. They begin with mildly or moderately difficult exposures, then progress to harder ones.
• Flooding: Using the exposure fear hierarchy to begin exposure with the most difficult tasks.
• Systematic desensitization: In some cases, exposure can be combined with relaxation exercises to make them feel more manageable and to associate the feared objects, activities or situations with relaxation.

Exposure therapy is thought to help in several ways, including:

• Habituation: Over time, people find that their reactions to feared objects or situations decrease.
• Extinction: Exposure can help weaken previously learned associations between feared objects, activities or situations and bad outcomes.
• Self-efficacy: Exposure can help show the client that he/she is capable of confronting his/her fears and can manage the feelings of anxiety.
• Emotional processing: During exposure, the client can learn to attach new, more realistic beliefs about feared objects, activities or situations, and can become more comfortable with the experience of fear.

Source: APA Div. 12 (Society of Clinical Psychology)

Date created: July 2017

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