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Intensive Cognitive-Behavioural Treatment for Specific Phobia in Children and Adolescents
Abstract
The one session treatment approach (Öst, 1989) incorporates cognitive behavioural techniques into a single 3-hour intensive session. This treatment approach has led the field in the development of more efficient and intensive approaches for treating childhood anxiety problems, and for childhood specific phobia is now considered a ‘well established’ treatment (Ollendick & Davis III, 2012). This review examines the clinical phenomenology of specific phobia in youth, provides a brief description of OST along with the evidence to support its efficacy, and provides suggestions for future research.
... To actively engage them in the therapeutic process, they use humor and a playful approach, encouraging them to bring material of their choice in the sessions. Although OST may be a well-established, cost and time-effective treatment for childhood fears, combining cognitive challenges, participant modeling, reinforcement, psycho-education, and skills training into a single three-hour session of graduated in vivo exposure-not all children respond fully to this treatment, with some children not responding at all (Milliner & Farrell, 2014). Lack of motivation to engage in therapy is one of the major challenges in the treatment of childhood fears (Oar et al., 2015) and yet a prerequisite for inclusion in studies evaluating the effectiveness of fear interventions. ...
A case is presented illustrating how the cognitive behavior drama (CBD) model was used to provide a 6-year-old child diagnosed with autism the motivation to engage in a process of gradual exposure to a fear-provoking stimulus, which led to the complete elimination of fear-related symptoms and maintenance of treatment effects for 1 year postintervention. Furthermore, the results of this study support previous findings on the effectiveness of the CBD model in treating childhood fears in high-functioning individuals diagnosed with an autism spectrum disorder and further exemplifies the rationale and structure of the model to allow for replication of the study to a wider population.
... These results imply that some aspects of anxiety are more related to depression than others, which is in line with previous research. For example, specific phobias in children are highly comorbid with other mental disorders (Ollendick, Davis & Sirbu, 2009), but more so with other anxiety disorders than with mood disorders (Milliner & Farrell, 2014). Compulsivity was the symptom dimension that had least unique associations with other dimensions in the cross-sectional networks, suggesting that compulsive behaviors may be considered a cluster of symptoms that in part is distinct from symptoms of depression, anxiety and distressing thoughts. ...
Background
Anxiety, depression, and obsessive-compulsive symptoms often onset during middle childhood and are major causes of disability in young individuals. A better understanding of how these symptoms are linked and unfold over time is important to develop valid etiological models and effective prevention and treatment.
Methods
In the present study, 950 community children (8–14 years) reported on a broad range of internalised symptoms at three time points over the course of a year. First, factor analysis was used to examine the overarching dimensions of these symptoms. Second, network analysis was used to examine unique cross-sectional associations among these empirically supported symptom dimensions. Last, longitudinal structural equation models (SEMs) were used to examine temporal associations among the symptom dimensions.
Results
Six broad symptom dimensions fitted the self-report data well at all time points. These dimensions were conceptualized as depression, general anxiety, situational fears, compulsivity, intrusive thoughts, and somatic anxiety. Network analysis showed that these dimensions formed a highly interconnected network with general anxiety and somatic anxiety being most central (i.e., most strongly associated with other dimensions) at all time points. Longitudinal SEMs supported the central role played by general anxiety in the temporal associations among these dimensions.
Conclusions
Overarching expressions of internalized psychopathology are highly interconnected in middle childhood with possible central roles played by general and somatic anxiety. Interventions aimed at a general proneness for anxiety may be warranted in preventing and treating internalizing symptoms in middle childhood.
... Traditionally, CBT for specific phobia involves 8-12 weekly sessions (approximately 1 h each in duration). However, in the 1980s seminal work by Ö st led to the development of an intensive treatment approach, called one session treatment (OST), that involves a single session of massed exposure that is maximised to 3 h in duration (Milliner and Farrell 2014;Ö st 1989).OST was initially trialled with adults, delivering favourable outcomes (Ö st et al. 1991a, 1997), and following this was successfully adapted and tailored for use with children and adolescents. During the single intensive session, a range of cognitive behavioural techniques are utilised, including exposure, cognitive challenges, participant modelling, reinforcement, and psychoeducation (see Davis III et al. 2012 for a through treatment description). ...
Blood-injection-injury (BII) phobia is a chronic and debilitating disorder, which has largely been neglected in the child literature. The present paper briefly reviews the aetiology of specific phobias with particular attention to BII and provides an integrated developmental model of this disorder in youth. Evidence-based treatments for child-specific phobias are discussed, and the development of a modified one session treatment (OST) approach to enhance treatment outcomes for BII phobia in children and adolescents is described. This approach is illustrated in two children with a primary diagnosis of BII phobia. The cases illustrate the unique challenges associated with treating BII in youth and the need for a modified intervention. Modifications included addressing the role of pain (e.g., psychoeducation, more graduated exposure steps) and disgust (e.g., disgust eliciting exposure tasks) in the expression of the phobia and fainting in the maintenance of this phobia. Moreover, it is recommended that parents be more actively involved throughout treatment (e.g., education session prior to OST, contingency management training, guidance regarding planning exposure tasks following treatment) and for families to participate in a structured e-therapy maintenance programme post-treatment.
Background and Aim: Anxiety is one of the most common disorders in
childhood and can be a reason for the growth and continuation of anxiety and
other mental health problems in other stages of life. Therefore, identifying and
treating anxious children is very important. The present study was carried out with
the aim of designing a multifaceted intervention and evaluating its effectiveness
in reducing children's anxiety. Method: The current research has two qualitative
and quantitative parts. In the qualitative part, in order to design a multi-modal
intervention, the basis of the content of the multi-modal intervention was
identified and designed from the theme analysis method, and its validity was
confirmed. In the quantitative phase of the research, the effectiveness of
multimodal intervention in reducing children's anxiety was evaluated. The
research method of this part was semi-experimental and with a pre-test, post-test,
follow-up plan with a control group. The statistical population of the research
included all children aged 8-12 years old with anxiety disorders who referred to
counseling centers and psychological services in Rasht and their mothers. 40
children and their mothers were randomly selected as a statistical sample and
divided into two experimental groups (10 girls, 10 son and their mothers) and
control group (10 girls, 10 boys and their mothers) were placed. The experimental
group underwent multimodal intervention treatment for 24 sessions (16 child
sessions, 8 mother sessions) of 90 minutes, and the control group remained on the
waiting list and did not receive any psychological intervention until the post-test.
Then, a post-test was performed for both groups and a follow-up was done after
4 months. To collect data, Spence Children's Anxiety Questionnaire, short version
(2018), was used. The analysis of the data in this section was done by repeated
measurement variance analysis. Results: The results showed that there is a
difference between the mean of the test and control groups in the post-test and
follow-up stages of anxiety (P<0.05). In other words, the multimodal intervention
program reduced anxiety in anxious children, and this reduction continued in the
follow-up period. Conclusion: Based on the findings of the research, it can be
concluded that the multi-faceted intervention considering the different
dimensions of the child is an efficient intervention to reduce the child's anxiety.
Blood-Injection-Injury (BII) Phobia is a severe and impairing disorder that has been understudied in youth. The present study aimed to define patterns of response and remission following a modified One-Session Treatment (OST) including an e-therapy maintenance program for children and adolescents with BII Phobia. Moreover, characteristics of different responder groups were examined in order to determine correlates of a poorer response. Youth (n = 20; 8–18 years) were categorized into four responder groups (e.g., immediate remitter, delayed remitter, partial responder, and nonresponder) based upon defined criteria for remission. Immediate remitters to treatment were more likely to have a primary diagnosis of injection phobia, rather than a combined blood and injection phobia. Nonresponders reported significantly greater disgust sensitivity at pretreatment and were more likely to have a comorbid diagnosis of Social Phobia. In regards to within session change, youth who achieved the exposure goal of having a blood test during treatment had a significantly stronger treatment response. These preliminary findings may assist clinicians in the planning and delivering of intensive Cognitive Behavioral Treatment (CBT) approaches for BII Phobia in youth.
The present study evaluated the effectiveness of a modified One Session Treatment (OST), which included an e-therapy homework maintenance program over 4 weeks for Blood-Injection-Injury (BII) phobia in children and adolescents. Using a single case, non-concurrent multiple-baseline design, 24 children and adolescents (8-18 years; 7 males, 17 females) with a primary diagnosis of BII phobia were randomly assigned to a one, two or three week baseline prior to receiving OST. Primary outcome measures included diagnostic severity, diagnostic status, and child and parent fear ratings. Secondary outcome measures included avoidance during behavioural avoidance tasks (BAT), global functioning and self and parent reported anxiety, fear and depression. Efficacy was assessed at post-treatment, 1-month, and 3-month follow-up. BII symptoms and diagnostic severity remained relatively stable during the baseline periods and then significantly improved following implementation of the intervention. Treatment response was supported by changes across multiple measures, including child, parent and independent clinician ratings. At post-treatment 8 of the 24 (33.33%) children were BII diagnosis free. Treatment gains improved at follow-ups with 14 (58.33%) children diagnosis free at 1-month follow-up and 15 (62.5%) diagnosis free at 3-month follow-up. Preliminary findings support the effectiveness of a modified OST approach for BII phobic youth with treatment outcomes improving over follow-up intervals.
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Forty-three youth aged 7–17 years old who fulfilled DSM-IV criteria for assorted specific phobias, were randomised to a one-session exposure treatment, a psycho-education package or a waitlist control conditions. Participants were assessed using semi-structured interviews, self-report measures and an individualised behavioural avoidance test (BAT). Assessments were completed pre- and posttest. At the 1-year follow-up, self-report measures along with a generalised version of the individualised BAT were re-administered. Results exhibited that both active treatment conditions were superior to the waitlist control on the BAT, self-efficacy ratings; however, no significant differences were found on functioning levels and other self-report measures with the exception of the Fear Survey Schedule — Revised. Additionally, no significant differences were found between the two active conditions at posttest or the 1-year follow-up. Implications and future research strategies are discussed.
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.
This study investigated the characteristics of each of the specific DSM-III-R (American Psychiatric Association, 1987) anxiety disorders in a clinic sample of 188 anxiety disordered children. Characteristics examined included sociodemographic variables (age-at-intake, gender, and race of the child, and family marital and socioeconomic status) and clinical variables (disorder age-at-onset and severity, and history of additional disorders). Findings are discussed in light of the contemporary literature on childhood anxiety disorders.
Eye movement desensitisation and reprocessing (EMDR) is a relatively new therapeutic technique that has been proposed as a treatment for post-traumatic stress disorder and other anxiety complaints.
We compared the efficacy of EMDR with that of exposure in vivo in the treatment of a specific phobia. Twenty-two spider-phobic children who met the DSM-III-R criteria for specific phobia participated in the study. Children were treated with one session of exposure in vivo and one session of EMDR in a crossover design. Treatment outcome was evaluated by self-report measures, a behavioural avoidance test and a physiological index (skin conductance level).
Results showed positive effects of EMDR, but also suggest that it is especially self-report measures that are sensitive to EMDR. Improvement on a behavioural measure was less pronounced, and exposure in vivo was found to be superior in reducing avoidance behaviour. With regard to skin conductance level, EMDR and exposure in vivo did not differ.
EMDR has no additional value in treatment of this type of animal phobia, for which exposure in vivo is the treatment of choice.
This study examined the efficacy of eye movement desensitization and reprocessing (EMDR) and exposure in the treatment of a specific phobia. Twenty-six spider phobic children were treated during 2 treatment phases. During the first phase, which lasted 2.5 hr, children were randomly assigned to either (a) an EMDR group (n = 9), (b) an exposure in vivo group (n = 9), or (c) a computerized exposure (control) group (n = 8). During the 2nd phase, all groups received a 1.5-hr session of exposure in vivo. Therapy outcome measures (i.e., self-reported fear and behavioral avoidance) were obtained before treatment, after Treatment Phase 1, and after Treatment Phase 2. Results showed that the 2.5-hr exposure in vivo session produced significant improvement on all outcome measures. In contrast, EMDR yielded a significant improvement on only self-reported spider fear. Computerized exposure produced nonsignificant improvement. Furthermore, no evidence was found to suggest that EMDR potentiates the efficacy of a subsequent exposure in vivo treatment. Exposure in vivo remains the treatment of choice for childhood spider phobia.
Research suggests that the sequelae of childhood anxiety disorders, if left untreated, can include chronic anxiety, depression, and substance abuse. The current study evaluated the maintenance of outcomes of children who received a 16-week cognitive-behavioral treatment for primary anxiety disorders (generalized, separation, and social anxiety disorders) an average of 7.4 years earlier. The 86 participants (ages 15 to 22 years; 91% of the original sample) and their parents completed diagnostic interviews and self- and parent-report measures. According to the diagnostic interviews, a meaningful percentage of participants maintained significant improvements in anxiety at long-term follow-up. With regard to sequelae, positive responders to anxiety treatment, as compared with less positive responders, had a reduced amount of substance use involvement and related problems at long-term follow-up. The findings are discussed with regard to child anxiety and some of its sequelae.
This chapter explores the developmental epidemiology of anxiety disorders. It reviews current evidence about prevalence and comorbidity, examines what recent studies can tell us about the homotypic and heterotypic continuity of anxiety disorders and syndromes, and discusses the evidence from recent epidemiologic studies that relates to the idea that there may be three clusters of anxiety disorders.
When I started research and clinical work with specific phobics in the mid 1970s, very little differentiation was made in the research literature between agoraphobia, social phobia, and specific phobia regarding the number of therapy sessions. Thus, I used eight 1-hour sessions in my early studies on specific phobias. After having worked with that format for about 5 years I started getting bored seeing the same patients week after week. I also began to question why behavior therapists should follow the same format as devised by psychodynamic short-term therapy (i.e. one session per week for 12–20 weeks).
Specific phobias are highly prevalent, affecting 5–10 % of children and adolescents in community samples and 15 % in mental health settings. Phobic youth experience significant interference and distress in their day-to-day lives and are at an increased risk of academic and social difficulties as well as adult psychopathology. Phobias have a complex etiology, developing from a multiplicity of factors including genetics, learning history, parenting, and evolutionary preparedness. This chapter reviews empirically supported assessment and treatment interventions for phobic youth. Strong empirical support currently exists for cognitive and behavioral treatments. In particular, the chapter focuses on the one-session treatment (OST) approach, which incorporates cognitive behavioral techniques into an intensive (3-h) treatment package. OST is a cost-effective and rapid treatment for phobic youth, with four randomized trials in four different countries now supporting its use. A case report illustrating the implementation of this treatment is presented.
Specific phobias are among the most prevalent psychological problems, and are often associated with serious life impairment and complex symptom profiles, including physiological symptoms, impairing coping and avoidance behaviors, and unhelpful or distorted cognitions. Therefore, a thorough assessment using multiple methods is important to evaluate the idiosyncrasies of each client’s presentation. The purpose of this chapter is to review the elements of a comprehensive, evidence-based assessment and treatment plan for specific phobia. The chapter provides an overview of diagnostic and clinical features of specific phobia, reviews the empirical status of commonly used assessment and treatment methods, and concludes with recommendations for assessment and intervention.
Anxiety disorders are the most common mental health problems in youth, affecting 8–27 % of youth (Costello, Egger, & Angold, 2005). These disorders represent serious mental health problems for children and adolescents and lead to daily distress and impairment, peer and social relation problems (Chansky & Kendall, 1997; Langley, Bergman, McCracken, & Piacentini, 2004; Piacentini, Peris, Bergman, Chang, & Jaffer, 2007; Strauss, Forehand, Smith, & Frame, 1986), and significant difficulties in academic achievement (Kessler, Foster, Saunders, & Stand, 1995; King & Ollendick, 1989). Additionally, anxious youth often have poor self-esteem, more physical problems, and greater family conflict and distress than their peers (Ezpeleta, Keeler, Alaatin, Costello, & Angold, 2001; Harter, Conway, & Merikangas, 2003; Strauss, Frame, & Forehand, 1987). If untreated, childhood anxiety disorders tend to be chronic and unremitting in their course (Aschenbrand, Kendall, Webb, Safford, & Flannery-Schroeder, 2003; Keller, et al., 1992; Pine, Cohen, Gurley, Brooks, & Ma, 1998) and predict the development of other psychopathology later in life (Last, Perrin, Herson, & Kazdin, 1996; Woodward & Fergusson, 2001) including depression (Brady & Kendall, 1992; Cole et al., 1998; Pine et al., 1998; Seligman & Ollendick, 1998), externalizing disorders, and substance use disorders (Bittner et al., 2007, Costello et al., 2003, Last et al., 1996).
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.
In this chapter, we review evidence-based assessment and treatment for specific phobias in children and adolescents (hereafter referred as children unless otherwise specified). For far too many years, the assessment and treatment of these disorders, and other childhood disorders, have been guided not by evidence but by particular theories, independent of the evidentiary support for them. In this chapter, we illustrate assessment and treatment practices that “work” and that have an ever-evolving evidence base for their use in clinical practice. In doing so, we hope to not only advance our understanding of specific phobias in children and their families but also to identify and promulgate effective interventions.
One-Session Treatment (OST) is a massed, cognitive-behavioral exposure therapy that progresses over the course of a single, 3-hour session and was developed by Öst (1987, Scandinavian Journal of Behavior Therapy, 16, 175–184; 1989, One-session treatment for specific phobias. Behavior research and therapy, 27, 1–7; 1997, Phobias: A handbook of theory, research, and treatment, 227–247). Though originally developed as an intervention with adults, the adaptation and use of OST with children and adolescents have progressed substantially in the last decade or so.
IntroductionClinical Picture and Differential DiagnosisEpidemiologyEtiologyPrinciples of TreatmentDeveloping a Treatment StrategySummaryReferences Childhood Phobias: More Questions than Answers. Authored by Michael RutterFear, Anxieties and Treatment Efficacy in Children and Adolescents. Authored by Rachel G. KleinWhere Are All the Fearful Children? Authored by Gabrielle A. Carlson and Deborah M. WeisbrotEtiology and Treatment of Childhood Phobias. Authored by Deborah C. Beidel and Autumn PaulsonFrom Development Fears to Phobias. Authored by Sam Tyano and Miri KerenAssessment and Treatment of Phobic Disorders in Youth. Authored by John S. MarchPhobias: From Little Hans to a Bigger Picture. Authored by Gordon ParkerPhobias in Childhood and Adolescence: Implications for Public Policy. Authored by E. Jane CostelloPhobias in Children and Adolescents: Data from Brazil. Authored by Heloisa H.A. Brasil and Isabel A.S. BordinPhobias: A View from the South Seas. Authored by John Scott Werry
We examine the phenomenology, epidemiology, and aetiology of specific phobias in this brief review. In general terms, a specific phobia exists when fear of a specific object or situation is exaggerated, cannot be reasoned away, results in avoidance of the feared object or situation, persists over time, and is not age-specific. Specific phobias occur in about 5% of children and in approximately 15% of children referred for anxiety-related problems. Most of these children are comorbid with other disorders. We suggest that specific phobias are multiply determined and over-determined. Genetic influences, temperamental predispositions, parental psychopathology, parenting practices, and individual conditioning histories converge to occasion the development and maintenance of childhood phobias. Inasmuch as any one specific phobia is acquired and maintained through such complex processes, we further conclude that treatment approaches will need to address these multiple dimensions before evidence-based treatments can be fully realised.
In an earlier study of an epidemiologically defined sample of first grade children, primarily between the ages of 5 and 6, self-reported anxious symptoms proved relatively stable and were significantly related to adaptive functioning. In the present study we follow that cohort of first graders longitudinally and assess the prognostic value of self-reports of anxious symptoms in first grade with respect to anxious symptoms and adaptive functioning in the late elementary school years or at about age 10. First grade anxious symptoms were found to have significant prognostic value in terms of levels of anxious symptoms and adaptive functioning in fifth grade.
This study examined predictors of exposure-based cognitive and behavioral treatments for phobic and anxiety disorders in children and adolescents. Children's so-ciodemographics, diagnostic characteristics (e.g., number of diagnoses), treatment format (i.e., individual, group), child symptoms assessed from the perspective of the child and parent (e.g., anxiety, fear), parent symptoms, and marital adjustment were examined. The best predictors of treatment outcome were depression and trait anxiety in the child, and several psychological symptoms in the parent (e.g., depression, hostility, paranoia). Parent symptoms were less effective predictors with older children and with group treatment. The results are discussed with respect to previous research findings as well as potential treatment implications.
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.
One-session treatment (OST), a variant of cognitive-behavioral therapy, combines graduated in vivo exposure, participant modeling, reinforcement, psychoeducation, cognitive challenges, and skills training in an intensive treatment model. Treatment is maximized to one 3-hour session. In this paper, we review the application of OST for specific phobia in youth and highlight practical matters related to OST and its use in a clinical setting. We also briefly review results of treatment outcome studies and suggest future directions for clinical research and practice. We conclude that OST is an efficient and efficacious treatment.
The present review was conducted in order to evaluate the current diagnostic criteria for specific phobia (SP) in light of the empirical evidence gathered since DSM-IV and to propose changes to DSM-V where change is clearly and reliably indicated by the evidence. In response to questions put forth by the DSM-V Anxiety, OC Spectrum, Posttraumatic, and Dissociative Disorder Work Group, four primary areas were determined for this review: the accuracy and utility of the current SP type classification system, the validity of test anxiety as a type of SP, the boundary between agoraphobia and SP, and the reliability and utility of the diagnostic criteria for SP. Developmental issues are addressed within each area. Literature reviews examining academic findings published between 1994 and 2009 were carried out and the results are included herein. The review presents a number of options and preliminary recommendations to be considered for DSM-V. All of these recommendations should be considered tentative as they await the field trials and expert consensus necessary prior to their inclusion in the DSM-V. The present review also reveals a great need for future research in the area of SP and directions for such research is provided.
A rapid and effective treatment for specific phobias, in which the treatment is done in one single session, is described in detail. The treatment method consists of a combination of exposure in vivo and modeling. The short- and long-term outcome for a consecutive series of 20 patients are reported. Mean treatment time was 2.1 h and at follow-up after an average of 4 yr 90% were much improved or completely recovered.
Twenty-eight patients with flying phobia, fulfilling the DSM-IV criteria for specific phobia, were assessed with behavioral, and self-report measures. They were randomly assigned to two treatment conditions: (1) 1-session, or (2) 5-sessions of exposure and cognitive restructuring. The first condition consisted of a single 3 hr session of massed treatment, and the second condition of 6 hr of gradual treatment. Treatment was done individually by very experienced therapists. The results showed that the two treatment conditions did equally well and there were no differences between them. At post-treatment 93% of the 1-session group and 79% of the 5-session group managed to take an unaccompanied return fight. At the 1-yr follow-up assessment the effects were maintained on all measures except the behavioral test; in both groups 64% of the patients took the flight. The most plausible reason for this deterioration is that during the follow-up year the subjects who relapsed didn't have the opportunity to fly as a job requirement with the employer paying the expenses. The implications of these results are discussed.
Investigated the frequency, comorbidity, and psychosocial impairment of specific phobia and specific fears among 1,035 adolescents 12 to 17 years old. The adolescents were recruited from 36 schools in the province of Bremen, Germany. Specific phobia and other psychiatric disorders were coded based on Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) criteria using the computerized Munich version of the Composite International Diagnostic Interview (Wittchen & Pfister, 1996). Thirty-six (3.5%) of the adolescents met DSM-IV criteria for specific phobia sometime in their life. Of all the subtypes of specific phobia, animal and natural environment phobia were the most common. More girls than boys received the diagnosis of specific phobia. One third of the adolescents with specific phobia also had depressive and somatoform disorders. Despite the high level of psychosocial impairment experienced by individuals with specific phobia both during the worst episode of their disorder and in the last 4 weeks, only a small portion of them sought professional help.
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.
Examined how 56 children who had received brief-exposure treatment for specific phobias experienced the treatment. It was also investigated whether there was a relation between the children's reported experiences before, during, and after the treatment and therapy outcome. Results indicated that the treatment was experienced as something positive, and the large majority of the children appreciated the pace and degree of control they had during treatment, as well as the therapist and the treatment outcome. The response patterns did not differ between sexes, diagnostic groups, mode of treatment, or age groups. The therapy outcome of the children was not found to differ according to the children's pretreatment expectations and feelings during the treatment, neither according to the children's evaluations of the pace of the treatment nor of the therapist's. However, children's reports about their feelings upon termination of the treatment and the satisfaction with the treatment differed significantly depending on the treatment outcome. Results and tentative explanations of these are discussed and implications for future lines of research are suggested.
Little is known about lifetime prevalence or age of onset of DSM-IV disorders.
To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication.
Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview.
Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older.
Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders.
Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups.
About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.
Handbook of child and adolescent anxiety disorders
- . E Davist
- Iii
- H Ollendickt
Contingency management, self-control, and education support in the treatment of childhood phobic disorders: A randomized clinical trial
- K Silvermanw
- M Kurtinesw
- S Ginsburgg
- F Weemsc