One-session treatment of specific phobias in youths: A randomized clinical trial.

Sixty children, ages 7-17 years, who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnosis for various specific phobias were randomized to (a) 1-session exposure treatment alone, (b) 1-session treatment with a parent present, or (c) wait-list control group for 4 weeks. After the waiting period, the wait-list patients were rerandomized to the active treatments. The patients' phobias were assessed with behavioral approach tests (approach behavior, experienced anxiety, and physiological reactions), whereas general anxiety, depression, phobic tendencies, and anxiety sensitivity were assessed with self-report inventories. Assessments were done pre-, post-, and 1-year following treatment. Results showed that both treatment conditions did significantly better than the control condition, whereas the treatment groups did equally well on most measures, and the effects were maintained at follow-up. The implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress-induced recovery of fears and phobias.

Asserts that the characteristics of human phobias resemble the kind of learning found during the amnesic period of infancy. As certain neural systems mature, conditioning begins to exhibit adult characteristics such as context dependency, sharp generalization, and rapid extinction. The adult learning system seems to be structured at least partially through the lasting influence of infantile experience. Under (hormonal) stress, residues of early experience are reinstated and incorporated into adult memory where they directly control behavior, and this control exhibits infantile characteristics. Evidence suggests that once acquired, such conditional fears might never be eliminated using traditional extinction or counterconditioning procedures. This view leads to a renewed emphasis on the role of experience in human development. (5 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preparedness and phobias: A review.

The preparedness theory of phobia holds that humans are biologically prepared to learn to fear objects and situations that threatened the survival of the species throughout its evolutionary history (Seligman, 1971). Biological preparedness is postulated to be responsible for the rapid acquisition, irrationality, belongingness, and high resistance to extinction considered characteristic of phobias. Psychophysiological experiments testing this theory have involved comparisons between fear-relevant stimuli (e.g., slides of snakes) and fear-irrelevant stimuli (e.g., slides of flowers) as conditioned stimuli in Pavlovian aversive conditioning paradigms. Researchers have predicted that autonomic responses conditioned to fear-relevant stimuli should mimic the aforementioned characteristics of phobias. The evidence most consistent with the theory is the enhanced resistance to extinction of electrodermal responses established to fear-relevant stimuli. Hypotheses regarding ease of acquisition, irrationality, and belongingness have received either only minimal or equivocal support. Alternative explanations are discussed for the resistance to extinction effect, the conceptual basis of preparedness theory, and its clinical implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implosive therapy with semiclinical phobias.

Describes a 2-phase investigation using 52 female volunteers with semiclinical phobias of insects. Ss' interview data support vicarious learning family-dependency interpretations rather than traumatic conditioning interpretations of the etiology of phobias. Compared with previous samples of phobic college students Ss showed significantly greater degrees of fear on an overt-behavior assessment test and self-report measures (e.g., Fazio's Inventory of Reported Fears). A brief course of implosive therapy was not found to be as effective as a form of treatment based on J. Andrews' suggestions. Treatment-research implications are briefly discussed. (33 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The existential psychotherapy of phobias.

Describes the existential psychotherapy of phobic patients. The failure of much contemporary psychotherapy is based in an insufficient psychology of the phobic process. The phobic mechanism is intentional and derives from the focused awareness patients have of their own vulnerability in a certain situation and an attempt to preempt the situation by the creation of a mythology that permits a degree of control and a concomitant loss of awareness of the experience to be avoided. The psychotherapy of phobic patients is comprised of 5 stages. Patients must be assured as to the correctness, integrity, and limited effect of their anxiety. They then come to see the intentionality and integrity in their phobic structures and subsequently recognize their power over the process should they be willing to restructure their way of being in the world. The 4th step occurs with the reclamation of the specific knowledge and feelings that patients have attempted to render unconscious. The final stage is the constant attentiveness to the interpersonal process and the suffering and survival of the primary difficulty. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Common phobias

Mrs. Brown, a 65-year-old woman, was terrified of being alone at night and suffered from nyctophobia. Her husband had been dead for several years, and her 40-year-old son lived in another state with his family. She often called him in the middle of the night in a state of panic, and he felt helpless about her situation. She lived in a senior housing community that never had any problems with crime. Nonetheless, she lived in a continual stage of anxiety.     

Some defensive and cognitive aspects of phobias.

Divided phobias into 2 nonexhaustive groupings—animal phobias and situation phobias. Three hypotheses were tested: (a) animal phobics will use more obsessional defenses, whereas situation phobics will use more hysterical defenses; (b) animal phobics will show greater psychological differentiation than situation phobics, and (c) situation phobics will show greater physiognomic sensitivity than animal phobics. Ss consisted of 36 severely phobic adults, 18 of each type. Both the Defense Mechanism Inventory and the Holtzman Inkblot Technique were used to measure defenses. The Hidden Figures Test was used to measure psychological differentiation and the Physiognomic Cue Test was used to measure physiognomic sensitivity. The results confirm 2 of the 3 hypotheses. Phobic types showed significant differences in the use of ego defense mechanisms, as predicted. Animal phobics were significantly more field independent than situation phobics, as predicted. Factor analysis yielded 4 nameable factors, 2 of which differentiated the 2 phobic groups. Results suggest that phobias cannot be viewed as a single neurotic entity. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age of onset in different phobias.

The age of onset, other background data, and measures from behavioral avoidance tests were studied in 370 phobic patients. They belonged to six different categories: agoraphobia (n?=?100), social phobia (n?=?80), claustrophobia (n?=?40), animal phobia (n?=?50), blood phobia (n?=?40), and dental phobia (n?=?60). Results showed that animal phobia had the earliest onset age (7 years), followed by blood phobia (9 years), dental phobia (12 years), social phobia (16 years), claustrophobia (20 years), and agoraphobia (28 years). The groups also differed in marital and occupational status, heart rate, anxiety experiences during the behavioral test, and general fearfulness. On the whole, agoraphobia and animal phobia stood out as the extremes on many measures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Components in a treatment of insect phobias.

Tested 3 components of a supportive but directive approach to overcoming mild aversion to insects. Ss were 28 female undergraduates in 3 treatment groups and 1 control group (n = 7 each). Treatment tapes used signal-safety conditioning messages, positive reinforcement, or negative reinforcement. Self-report and overt behavior measures of fear were recorded for 5 consecutive approach-assessment tests. Each treatment component was associated with significant (p     

Fears and phobias in women: A community study.

Conducted interviews and administered the Present State Examination to 449 women (aged 18–65 yrs) in Calgary, Canada. Results show a high prevalence of mild fears (244/1,000 population) and phobias (190/1,000 population). Only 3 Ss had a phobia that was incapacitating to any significant degree. Animal fears were the most prevalent, followed by nature, social, mutilation, and separation fears. There were small but significant associations between the occurrence of any one type of fear and the occurrence of other types of fear. The associations between affective intensity of fear, somatic awareness, and avoidance were low, particularly for social fears and separation fears. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

One-session treatment of specific phobias in youth: A randomized clinical trial in the United States and Sweden.

One hundred and ninety-six youth, ages 7–16, who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for various specific phobias were randomized to a one-session exposure treatment, education support treatment, or a wait list control group. After the waiting period, the wait list participants were offered treatment and, if interested, rerandomized to 1 of the 2 active treatments. The phobias were assessed with semistructured diagnostic interviews, clinician severity ratings, and behavioral avoidance tests, whereas fears, general anxiety, depression, and behavior problems were assessed with self- and parent report measures. Assessments were completed pretreatment, posttreatment, and at 6 months following treatment. Results showed that both treatment conditions were superior to the wait list control condition and that 1-session exposure treatment was superior to education support treatment on clinician ratings of phobic severity, percentage of participants who were diagnosis free, child ratings of anxiety during the behavioral avoidance test, and treatment satisfaction as reported by the youth and their parents. There were no differences on self-report measures. Treatment effects were maintained at follow-up. Implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of childhood phobias

Childhood phobias can be successfully treated using a variety of behavioral strategies, provided there has been a psychometrically sound assessment. Measures are also important for the evaluation of treatment efficacy and the testing of hypotheses generated by new ideas and theories of children's phobias. This paper outlines broad-based assessment procedures used in the evaluation of children's phobias, including the behavioral or problem-focused interview, the diagnostic interview, self-report inventories, caregiver completed instruments, behavioral observations, self-monitoring and physiological assessment. Reflecting recent theoretical and clinical advances in the study of childhood internalizing disorders, we also explore laboratory-based measures and family assessment measures. Particular attention is given to psychometric issues and developmental sensitivity in our discussion of these assessment procedures.     

Effect of subject control and graduated exposure on snake phobias.

Investigated the influence of 2 of the variables in H. Leitenberg's graduated exposure technique for treating phobias, graduated exposure, and S control of the exposure time. 15 snake-phobic 18-60 yr old undergraduates were randomly assigned to 1 of 3 treatment groups: Group 1, S control, graduated exposure, feedback; Group 2, E control, graduated exposure, feedback; and Group 3, E control, nongraduated exposure, feedback. The exposure time of Group 2 was yoked to Group 1, and the exposure time for Ss in Group 3 was equal to the average time in Group 1. All treatments significantly reduced phobic behavior, as measured by avoidance behavior in the presence of the phobic object. Greatest reduction in behavioral avoidance was shown by Group 1, followed by Group 2. Group 3 showed the least reduction. Subjective fear significantly decreased from pretesting to posttesting for all groups, but the groups did not differ from each other on the posttest. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thought stopping and covert assertion in the treatment of phobias.

Discusses thought stopping as a technique for treating obsessive thoughts through anxiety reduction. 6 typical cases are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Survey of current clinical and research trends in clinical psychology.

Surveyed directors of 115 clinical PhD and PsyD psychology programs with accreditation from the American Psychological Association to explore trends in the training of clinical psychologists. The most popular area of clinical research appeared to be behavioral medicine/health psychology. The most popular specialty clinics allowing training in a specific domain of clinical psychology were family therapy, behavioral medicine, neuropsychology/rehabilitation, and couples therapy. Ss in PhD programs were more likely than those in PsyD programs to subscribe to a cognitive-behavioral/social-learning orientation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypothesis validity of clinical research.

Hypothesis validity refers to the extent to which research results reflect theoretically derived predictions about the relations between or among constructs. The role of hypotheses in theory testing is discussed. Four threats to hypothesis validity are presented: (a) inconsequential research hypotheses, (b) ambiguous research hypotheses, (c) noncongruence of research hypotheses and statistical hypotheses, and (d) diffuse statistical hypotheses and tests. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Participant modeling with or without cognitive treatment for phobias.

To determine whether cognitive treatment would enhance the effectiveness of participant modeling (PM) treatment for phobias, 36 subjects phobic to dogs and cats were given either PM alone, PM with self-instructional training, PM with self-verbalizations ("thinking aloud"), or placebo treatment. The three PM treatments produced substantial and equivalent improvement in behavior at posttest, in contrast to the placebo group, which did not change. At follow-up, the combined PM/self instructional training group showed more phobic behavior and lower self-efficacy than the other PM groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative effectiveness of guided mastery and exposure treatments for intractable phobias.

Compared the exposure model and the self-efficacy model by randomly assigning 32 18–76 yr old individuals with driving or height phobias to 1 of the treatment conditions or to a control condition. Results show that treatments were equivalent in duration of exposure and in degree of inducement to confront threats rapidly, but the self-efficacy (mastery) model was significantly more effective than exposure in restoring Ss' behavioral functioning and diminishing their anticipated anxiety and performance-related anxiety. Both treatments were more effective than the control condition. It is suggested that self-efficacy predicted therapeutic behavior change significantly better than did anxiety, exposure duration, or performance level achieved during treatment. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The origins of specific phobias: Influential theories and current perspectives.

Fears are quick and adaptive responses that permit powerful reply to imminent threats. Less adaptive, phobias are extreme manifestations of fear to objects or situations in the absence of a proportional danger. Although the utility of fear is accepted, the nature of phobias is controversial. Initial theories favored a fear conditioning-based explanation, with vicarious and information learning pathways subsequently included as additional routes to the development of specific phobias. More recently, an important group of investigations strengthened the case for a nonassociative account of fear acquisition proposing that evolutionarily relevant fears can occur without any need of critical learning experiences. In parallel, there is some evidence for a dedicated fear module in the detection of threats, involving the amygdala, which is relatively independent from conscious cognitive control. Nonetheless, cognitive models stress learning and developmental factors and their role in the etiology and maintenance of phobic behavior. This article critically reviews each of these views and theories stressing their recent developments, weaknesses, and controversies with an aim to provide the groundwork for the construction of a more integrated position. Finally, the authors suggest encouraging trends in recent research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On "Stress-induced recovery of fears and phobias."

Jacobs and Nadel (1985) proposed a neurobiological theory to explain the etiology of phobias. Their theory, however, is based on questionable assumptions about clinical fears. The present article is a critique of these assumptions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)