Anxiety Disorders ____________________________________________________________________________
PSYCHOLOGIC TREATMENTS EFFECTIVE IN SPECIFIC PHOBIA
Treatment Approach
Phobia(s)
Exposure-based treatments Virtual reality exposure
All specific phobias
Heights, flying, spiders, claustrophobia
Computer-based self-help programs
Spiders, flying, small animals Blood-injection-injury type
Applied muscle tension (i.e., exposure with muscle tension exercises)
Cognitive therapy and exposure
Dental, flying
Source: [120]
Table 4
The National Collaborating Centre for Mental Health recommends against routinely offering computerized CBT to treat specific phobias in adults. (https://www.nice.org.uk/guidance/ cg159/resources/social-anxiety-
TREATMENT OF SPECIFIC PHOBIA Patients with specific phobias generally do not consult medical professionals when able to avoid the specific feared situations or objects. Exposure therapy is effective in treating specific phobia and is the favored approach. PSYCHOTHERAPY Exposure-based therapies are the treatments of choice and show a high degree of successful remission for all phobias. In vivo exposure and virtual reality exposure to phobic stimuli or situations are both effective, with in vivo exposure superior to imaginal and virtual reality exposure at post-treatment but not at follow-up [307]. The effectiveness of exposure-based therapy is enhanced when exposure sessions are grouped closely together; when exposure is prolonged, real (not imagined), and provided in different settings; and when there is some degree of therapist involvement instead of being entirely self-directed. A greater number of sessions have been shown to predict more favorable outcomes. There is no evidence that flooding is more effective, and patients usually find graded, progressive exposures more tolerable [307]. A variety of psychotherapeutic options have been found effective for the treatment of specific phobias, with some approaches recommended for particular phobias ( Table 4 ) [120]. For blood-injection-injury phobias, an effective approach is combining exposure therapy with muscle tension exercises (applied tension) designed to prevent fainting. Using stress- reducing medical devices, such as decorated butterfly needles and syringes, has significantly reduced needle phobia and stress in pediatric and adult patients. With dental phobias, use of CBT can reduce avoidance of oral injections and decrease patient anxiety [120; 307]. Long-term treatment of specific phobia is rare. CBT and expo- sure therapies show sustained benefits at long-term follow-up assessments following a time-limited course of treatment [120].
disorder-recognition-assessment-and-treatment- pdf-35109639699397. Last accessed April 27, 2025.) Level of Evidence : Expert Opinion/Consensus Statement
PHARMACOTHERAPY Pharmacotherapy has a minimal role in specific phobia treat- ment, largely from the lack of drug therapy research and the success of exposure therapies. Alprazolam benefit was studied in 28 women with flying phobia during two air travel expo- sures, one week apart. Compared with subjects given pre-flight placebo for both flights, those receiving alprazolam before the first flight had less anxiety and symptoms but greater heart and respiratory rates. Those given alprazolam had a substantial increase in panic attacks during the second flight compared with the first flight (71% vs. 7%), greater overall anxiety, and further elevation in heart rate. Alprazolam increased physi- ologic activation under acute stress conditions and hindered the therapeutic effects of exposure therapy for flying phobia [120; 308]. These findings require replication to determine clinical utility. Some benefit is suggested by small trials of paroxetine or esci- talopram. However, there is too little evidence to recommend any drug treatment of specific phobias [224]. A NOVEL APPROACH COMBINING MEDICATION AND EXPOSURE THERAPY In 2015, a potential landmark study of 45 subjects with spider phobia was published. A pre-treatment two-minute tarantula exposure was followed four days later by randomization to propranolol without exposure or to exposure and then propranolol 40 mg or placebo (within 10 minutes). All three groups went through tarantula exposure 9 days, 16 days, 90 days, and one year later [309].
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