Psychology
Phobia Treatment
Phobia treatment involves various therapeutic approaches aimed at reducing or eliminating irrational fears and anxiety associated with specific objects or situations. Common treatment methods include cognitive-behavioral therapy (CBT), exposure therapy, and medication. These approaches help individuals gradually confront and manage their fears, leading to improved quality of life and reduced phobia-related distress.
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11 Key excerpts on "Phobia Treatment"
eBook - PDF- Heather Buchanan, Neil Coulson(Authors)
- 2012(Publication Date)
- Bloomsbury Academic(Publisher)
Within this section, we will consider some of the main psychological treatments that have been proposed, which are ■ Exposure-based therapies ■ Cognitive therapies ■ Eye movement desensitisation and reprocessing (EMDR) As the therapies that include an exposure element are the most common type of psychological therapy, we will begin by discussing these therapies in most detail. Exposure-based therapy Background The most generally accepted treatment of choice for specific phobia is exposure therapy, which has been shown to be very effective across a vari-ety of treatment outcomes (Choy et al., 2007; Wolitzy-Taylor et al., 2008). Exposure-based therapies reflect a variety of behavioural approaches that Specific phobia: Treatment 71 are all based on exposing the individual to their phobic stimulus. Thus, these relate to the conditioning theories we covered in Chapter 3. From a behavioural perspective, specific phobias are maintained because of avoid-ance of the phobic stimulus, thus phobic individuals have no opportunity to learn ■ that they can tolerate the fear ■ that the fear will reduce on its own without them avoiding the stimulus or escaping from it ■ what they fear will result from the interaction will not actually happen (e.g., that the dog will not attack them), or it won’t be as awful as they imagine. Since escaping from the phobic object reduces the individuals’ anxiety, avoidance behaviour is reinforced (see Figure 4.1). Avoidance can occur by not entering a situation or avoiding the object of the fear. A dog phobic may avoid dogs and situations that may potentially involve dogs. As they do not put themselves in the position of interacting with dogs, they do not have the opportunity to let their anxiety subside and to realise that dogs normally do not attack, bite and so on (which may be the most feared situation).
eBook - PDFProgress in Behavior Modification
Volume 16
- Michel Hersen, Richard M. Eisler, Peter M. Miller, Michel Hersen, Richard M. Eisler, Peter M. Miller(Authors)
- 2013(Publication Date)
- Academic Press(Publisher)
COGNITIVE TREATMENT OF PHOBIA CYNTHIA G. LAST Western Psychiatric Institute and Clinic University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania I. Introduction 65 II. Rationale 66 A. The Role of Cognitions in Fear: A Cognitive Model 66 B. Empirical Support 67 III. Treatment 70 A. Cognitive Treatments 70 B. Empirical Support 72 C. Interpretation of Findings 74 IV. Assessment of Cognitions 75 A. Cognitive Measures 76 B. Classification of Cognitions 78 V. Summary and Conclusions 79 References 80 I. INTRODUCTION Within the past decade, cognitive and cognitive-behavioral interventions have become popular in the treatment of a variety of clinical disorders. This trend is evident particularly in the treatment of phobias, in which cognitive treatment strategies have been used increasingly either alone or in conjunction with behav-ioral, exposure-based techniques (e.g., in vivo exposure, imaginai flooding). Despite the widespread use of cognitive treatments by clinicians, empirical findings in this area have accumulated only recently to a point at which a critical review of the efficacy of these techniques appears warranted. As such, the primary aim of this article is to consider whether the continued utilization of cognitive treatments with phobies is justified on an empirical basis. 65 Copyright © 1984 by Academic Press, Inc. PROGRESS IN BEHAVIOR MODIFICATION, VOLUME 16 All rights of reproduction in any form reserved. ISBN 0-12-535616-1 66 Cynthia G. Last II. RATIONALE A. The Role of Cognitions in Fear: A Cognitive Model The significance of maladaptive cognitions in the genesis of anxiety reac-tions and maintenance of anxiety disorders has been discussed by several cogni-tive and cognitive-behavioral theorists (Beck, 1976; Ellis, 1962; Meichenbaum, 1977). Specifically, they have proposed that catastrophic or irrational thoughts play a critical role in mediating maladaptive physiological-emotional and behav-ioral responses.
eBook - PDF- Mario Maj, Hagop S. Akiskal, Juan José Lopez-Ibor, Ahmed Okasha, Mario Maj, Hagop S. Akiskal, Juan José López-Ibor, Ahmed Okasha, Juan José Lopez-Ibor, Mario Maj, Hagop S. Akiskal, Juan José López-Ibor, Ahmed Okasha(Authors)
- 2004(Publication Date)
- Wiley(Publisher)
Once patients experience this process they become convinced of its therapeutic usefulness and they can and very often do apply the exposure principle at every occasion. A point comes in treatment 218 __________________________________________________________________________________________ PHOBIAS where they spontaneously take the initiative of abandoning the most tacit of avoidance and escape mechanisms such as mental distractions, applied relaxation or breathing techniques, the anxiolytic they carried in their pockets for many months or years, praying etc. The goal of treatment is to approximate a situation where the patient no longer takes precautionary measures to avoid experiencing anxiety/fear and where the only response elicited by fear, less and less frequent and severe, is to simply acknowledge its neurotic nature. The approach is both therapeutic and prophylactic and may underlie the lasting effects of behavioural treatment. Research questions. The empirical evidence shows lasting improvement with behavioural treatments. Whether this is due to the enduring effects of acute treatment or to ongoing maintenance treatment warrants investiga- tion. One way of addressing this question would be to monitor the use of anxiety management strategies, in addition to symptom severity, over the follow-up period. The evidence presented by Barlow et al. clearly suggests that the effect- iveness of exposure depends on self-exposure regardless of whether instructions are provided by a therapist or not. Questions have also been raised regarding the specific role of cognitive therapy independent of exposure. Given the importance of translating evidence into practical experience, it may be valuable therefore to ascertain the extent to which patients require a fully manualized cognitive behaviour approach above and beyond the simple formulation of therapeutic rationale and instructions for self-directed exposure in everyday clinical practice.
- Philip Graham, Shirley Reynolds(Authors)
- 2013(Publication Date)
- Cambridge University Press(Publisher)
One session treatment offers a cost- and resource-effective way to alleviate children’s fears and improve their quality of life. Whilst one of the most frequent forms of child anxiety disorder and typically debilitating in nature for both children and families, childhood phobias are often very responsive to our best psychosocial treatments. In cases where children do not fully respond to first-line treatments, guidelines now exist to inform clinicians in making treatment decisions. Efforts must now be made to ensure effective dissemination of evidence-based treatments, such as OST and other CBT-based procedures. References American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders. 4th Edition, text revision. Washington, DC: American Psychiatric Association Task Force. Barrett, P. M., Rapee, R. M., Dadds, M. R., & Ryan, P. (1996). Family enhancement of cognitive style in anxious and aggressive children: threat bias and the FEAR effect. Journal of Abnormal Child Psychology, 24, 187–203. Beck, A. T. (1993). Cognitive therapy: past, present, and future. Journal of Consulting and Clinical Psychology, 61, 194–198. Beck, A. T. & Clark, D. A. (1997). An information processing model of anxiety: automatic and strategic processes. Behavioral Research and Therapy, 35, 49–58. Bener, A., Ghuloum, S. & Dafeeah, E. E. (2011). Prevalence of common phobias and their socio- demographic correlates in children and adolescents in a traditional developing society. African Journal of Psychiatry, 14, 140–145. Berman, S. L., Weems, C. F., Silverman, W. K. & Kurtines, W. (2000). Predictors of outcomes in exposure-based cognitive and behavioral treatments for phobic and anxiety disorders in chil- dren. Behavior Therapy, 31, 713–731. Bloch, M. H. & McGuire, J. F. (2011). Pharmacological treatment for phobias and anxiety disorders. In McKay, D. & Storch, E. A. (Eds.), Handbook of Child and Adolescent Anxiety Disorders, pp.
eBook - PDFResearch in Counselling and Psychotherapy
Practical Applications
- Windy Dryden(Author)
- 1996(Publication Date)
- SAGE Publications Ltd(Publisher)
A voidance keeps anxiety going, and using graded exposure to reverse the avoidance reduces anxiety. The practical applications of these findings still provide the basis for the treatment of simple phobias. A marked shift in attitude toward psychological treatment had also occurred during the 1970s, reflecting a move away from the assumption that the therapist's main job is to 'make people better', toward the view that patients benefit most from learning how to solve their own problems. Treatments such as exposure were therefore presented as methods of self-help which involved learning and practising new skills, and the skills were supposedly specif ic to the particular presenting problem. When we tested this assumption by comparing two methods for treating agoraphobia: exposure versus problem-solving (Cullington, Butler, Hibbert & Gelder, 1 984), we found that the self-help problem-solving treatment, which taught people generic skills, was less ef fective than the self-help specif ic method of graded exposure, which involved repeatedly and frequently entering the situations that each person found alarming. Shifting the interaction between therapist and patient toward enabling people to use their own resources to solve problems was not as helpful as teaching them specif ic skills, how to practise them and how to apply them. The find ings from this work with agoraphobics suggested that it was important to combine a self-help approach with specific instruct ions -in this case about how to reduce avoidance. In order to help pe ople to overcome more complex anxiety states, we need to learn more about how to mobilise people's own coping resources and how to provide them with specif ic skills that could be targeted at clearly defined features of their anxiety.
- Peter Muris, S. J. Rachman(Authors)
- 2010(Publication Date)
- Elsevier Science(Publisher)
12 You did it! Closure and award of the anxiety certificate. Based on: Heard, Dadds, & Rapee (1991). Treatment and Prevention of Childhood Anxiety 229 and Barlow’s (2002) words: “Almost all experts agree that exposure to feared objects and situations is both necessary and sufficient for treating the vast majority of the patients with this condition” (p.408). Although this statement was made with regard to the treatment of phobias in adults, there is no reason to assume that this is not true for childhood phobias (King, Heyne, & Ollendick, 2005; King, Muris, & Ollendick, 2005; King, Muris, Ollendick, & Gullone, 2005; Ollendick, Davis, & Muris, 2004). In fact, the literature contains many case studies that describe exposure as an important element in the treatment of phobic children (e.g., Nelissen, Muris, & Merckelbach, 1995; Nock, 2002; Saavedra & Silverman, 2002; Sturges & Sturges, 1998). Moreover, controlled treatment outcome research has indicated that exposure-based treatments are indeed effective in reducing fear and anxiety in phobic youths. Exposure treatment of childhood phobias has been conducted in many ways. Based on the idea that two emotional states cannot occur simultaneously, Wolpe (1958) developed the treatment approach named “systematic desensitization,” during which fear and anxiety elicited by a phobic stimulus are terminated by a previously learned relaxation response. Briefly, Wolpe assumed that a response antagonistic to anxiety (e.g., physiological relaxa-tion) inhibits the emotional fear response (a phenomenon known as “reciprocal inhibition”). Various studies have demonstrated that systematic desensitization yields positive effects when treating phobic youths, and this is especially true when real-life exposure to the phobic stimulus is used to provoke fear and anxiety during the therapeutic procedure.
eBook - PDF- David J. Nutt, James C. Ballenger(Authors)
- 2008(Publication Date)
- Wiley-Blackwell(Publisher)
In the first phase of their case study, they demonstrated that Albert was not afraid of a range of stimuli, including a white rat, a white rabbit, masks with and without hair, a dog, a monkey, and a piece of burning newspaper. They also 445 Introduction The term exposure therapy refers to a group of psycho- logical interventions that have in common the inten- tional confrontation with feared, but otherwise safe objects, situations, and thoughts or memories for the purpose of reducing fear reactions to the same or sim- ilar stimuli in the future. Examples of distinct exposure therapy techniques that have been developed include systematic desensitization and other variations based on Wolpe’s (e.g. 1958) concept of reciprocal inhibi- tion; imaginal and in vivo flooding (Boulougouris & Marks 1969); and implosive therapy (Stampfl & Levis 1967). Other terms for therapeutic techniques based on exposure to feared stimuli include exposure and ritual prevention (e.g. Meyer 1966; used primarily in the literature on obsessive-compulsive disorder), pro- longed exposure (e.g. Foa et al. 1991; used primarily in the literature on post-traumatic stress disorder), and direct therapeutic exposure (Boudewyns & Shipley 1983). In this chapter, we provide a historical overview of the development of exposure therapy and illustrate its efficacy in the treatment of various anxiety conditions. It may be noted in advance that effective treatments incorporating exposure techniques have been devel- oped for all of the primary anxiety disorders currently recognized in the Diagnostic Statistical Manual, fourth edition (DSM-IV: American Psychiatric Association [APA] 1994) nomenclature. However, the unique con- tribution of exposure therapy to outcome has been best established in the treatment of specific phobias, agoraphobia, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and acute stress 24
eBook - PDF- David C.S. Richard, Dean Lauterbach(Authors)
- 2011(Publication Date)
- Academic Press(Publisher)
Exposure Therapy for Phobias 263 Holme, Humble, Madsbu, et al., 2001; Clark, Ehlers, McManus, Hackmann, Fennell, Campbell, et al.; 2003; Haug, Blomhoff, Hellström, Holme, Humble, Madsbu, et al., 2003; Hofmann, 2004). Again, more recent studies have sup-ported the effectiveness of exposure-based interventions. The question regard-ing the relative effectiveness of conventional exposure to combined or other psychological interventions or pharmacological treatments remains less clear. Hofmann (2004) examined 12-week group exposure and a group cognitive-behavioral intervention targeting speech anxiety, comparing these groups to a wait-list control. Among 90 individuals, 76% received a social phobia diagnosis at pretreatment. Both treatment groups followed standardized treatment proto-cols with common exposure steps in sessions and completed individual expo-sure homework. Both groups demonstrated significantly improved social anxiety symptoms and behavioral performance (i.e., increased public speaking time dur-ing behavioral tests) relative to the wait-list condition. The two treatments did not yield differences in outcome at post-treatment, but at 6-month follow-up evaluation, the cognitive behavioral group showed greater improvement than the exposure group. Clark, et al. (2003) examined three 16-week individual treatments for 60 diag-nosed social phobics, including fluoxetine (an antidepressant) plus self-exposure between sessions, placebo plus self-exposure between sessions, and cognitive- behavioral therapy, with a strong emphasis on cognitive elements. Exposure hierar-chies were developed individually for self-exposure. At post-treatment, all groups demonstrated significantly reduced symptoms, with a better outcome found in the cognitive behavioral group on social anxiety measures. At 12-month follow-up evaluation, cognitive behavioral therapy remained superior to the other two groups.
eBook - PDFTaking America Off Drugs
Why Behavioral Therapy is More Effective for Treating ADHD, OCD, Depression, and Other Psychological Problems
- Stephen Ray Flora(Author)
- 2012(Publication Date)
- SUNY Press(Publisher)
A Guide to Treatments that Work is published by Oxford University Press, not by a guild fighting to increase the profits of its members with prescription privileges—the APA. Therefore, conclusions reached in the “guide” are more likely to be data driven rather than profit driven. Behavior therapy empowers people to overcome their fears. Drugging people only gives them a chemical blanket to avoid and hide from their fears. SOCIAL PHOBIA Social phobia is a specific, relatively common problem in which one suf- fers from “extreme, enduring, irrational fear and avoidance of social or performance situations” (Barlow & Durand, 1999, p. G-19). The December 17, 2000, Parade magazine proclaimed on its cover that “Ten million Americans, including these stars, have suffered from some form of social phobia, a dread of human contact that can be paralyzing. DO YOU SHARE THEIR FEAR?” The smiling stars who claimed to have social phobia included Cher, Donald Sutherland, Carly Simon, Joan Baez, Barbra Streisand, Renee Fleming, and Donny Osmond. If it is true that these stars, these “social lites,” who have performed in front of mil- lions of fans, really have social phobia, then it clearly shows that the problem can be effectively dealt with, and that social anxiety is a normal and sometimes helpful thing to have (If you want to be a star, maybe “social phobia” is a good thing!). Clearly this “dread” has not stopped Specific Phobias 49 these celebrities from human contact, socializing, stardom, or becoming millionaires as a result of their social skills, their social behaviors. A common finding in psychological research is the “Yerkes-Dodson law” that shows that performance improves as arousal increases—up to a point. After maximal performance is reached, further increases in arousal decrease performance (an “inverted U”-shaped curve). Thus to perform well in social situations—in the classroom, in a meeting, at a party, or on stage—some arousal, some anxiety, is necessary.
eBook - ePubTutorial Essays in Psychology
Volume 1
- N. S. Sutherland(Author)
- 2014(Publication Date)
- Psychology Press(Publisher)
This is a major advance on the situation which existed 15-20 years ago. It will be apparent from the material that has been presented that the evolution of the present procedures has been by a somewhat circuitous path, traveling down a number of blind alleys and making many false assumptions en route. This, however, is the stuff of scientific progress. Indeed, the rate of progress in this field is eloquent testimony to the gains that can be achieved by the application of scientific method to the investigation of psychological treatment. The rate of development of effective procedures in other fields of psychotherapy has been much less impressive. This can probably be attributed to the fact that workers in these fields have been less able to frame their hypotheses in clearly refutable form. From what we have seen in the treatment of phobias, refutable hypotheses, tested by empirical experiments, appear to be the route to therapeutic advance. Why did we have to wait until the 1950s and 1960s to see the application to the treatment of phobias of ideas that were current in the 1920s? At least some of the blame must fall on Freud and his followers. He must be given credit for his enormous contribution in suggesting that disorders such as phobias were of psychological rather than neurological origin. However, he also emphasized that the symptoms of which the patient complained, such as phobias, were merely manifestations of an "underlying problem," toward which treatment should be directed by psychoanalysis. In this way he deflected therapeutic efforts and interest away from the problems for which the patients were actually seeking help—their symptoms. It has taken some time to get back on target. References Denny, M. R. Relaxation theory and experiments. In F. R. Brush (Ed.), Aversive conditioning and learning. New York and London: Academic Press, 1971. Epstein, S. Toward a unified theory of anxiety. In B. A. Maher (Ed.), Progress in experimental personality research (Vol
eBook - PDF- Michel Hersen, Richard M. Eisler, Peter M. Miller, Michel Hersen, Richard M. Eisler, Peter M. Miller(Authors)
- 2013(Publication Date)
- Academic Press(Publisher)
Phobic and obsessive problems have to be dealt with as part of gen-eral clinical management, with aims clearly defined within the social con-text of treatment. Potential social repercussions of improvement have to be borne in mind. Patients have to be cooperative, or treatment cannot begin. Unmotivated patients or frustrating family milieus can greatly im-pair outcome. FUTURE TRENDS are likely to depart from those of the past decade. Repeated experiments have found that anxiety reduction does not depend upon Wolpe's idea of reciprocal inhibition, nor on Stampfl's notion of anxiety arousal. Neither modeling nor positive reinforcement particularly enhances exposure. Not even prevention of avoidance seems vital for out-come. Patients improve whether they are relaxed, neutral, or anxious dur-ing exposure. Although further work may yet show that the affective state during exposure can make some difference, it does not appear crucial for improvement to occur. What is crucial is still largely a mystery. The ex-posure hypothesis should be modified to accommodate at least two awk-ward facts. First, exposure can sometimes sensitize rather than habituate. Second, phobias can improve with irrelevant fear or stress immunization without any direct exposure to the phobic situation or scenes. If the con-cept of exposure is broadened into a wider coping theory (people get better when they learn to manage or deal with unpleasant experiences), we will require operational definitions of manage, cope, deal with, free of the circular reasoning which currently bedevils the area. It is not enough to say coping is that which reduces anxiety, because practically anything can alleviate anxiety, given certain conditions, and it is the latter which have to be unraveled. Progress depends upon our becoming able to de-scribe the parameters that predict whether a particular noxious stimulus will be perceived as noxious at all.
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