Building the Case for Brief Psychointerventions in the Treatment of Specific Phobias in Children and Adolescents

Abstract

Specific phobias are one of the most prevalent childhood anxiety disorders. Research suggests that phobias in children, such as animal or situational phobias, lead to significant impairments in peer relations, social and academic competence. Hence it is imperative to treat phobias within children and adolescents early to avoid more serious, engrained symptoms later in the lifespan. This review focuses on traditional exposure-based cognitive–behavioural therapies, and the more recent one-session exposure therapy for phobia treatment (Ost, 1987), a procedure that has only begun to be administered to children. Further, controlled trials evaluating the efficacy of 1-session exposure therapy with phobic children are urgently required. We also address challenges for researchers using psycho-education to control nonspecific treatment effects.

CBT for Adolescents With Anxiety: Mature Yet Still Developing

“…In its briefest form, CBT for specific phobias in youths has been reduced to a one-session treatment that lasts several hours (104,105). One-session treatment has been assessed in mixed child-adolescent samples in seven studies, including several randomized clinical trials (106)(107)(108), and is considered an effective treatment for specific phobias (108).…”

Brief Psycho-Social Interventions in the Treatment of Specific Childhood Phobias: A Controlled Trial and a 1-Year Follow-Up

“…Since detailed treatment outcome variables are beyond the scope of this article, a subsequent study using the present sample will endeavour to acquire a clearer indication of individual differences by investigating treatment outcomes such as anxiety sensitivity, length of phobia and its origins along with maternal psychopathology. This may further improve cost and time effectiveness and allow for the delivery of treatment that is most sensitive to the practical and clinical needs of the context of implementation (Berman et al, 2000;Flatt & King, 2008;Kazdin & Kendall, 1998;March & Curry, 1998;Silverman & Berman, 2001).…”

“…Successful psycho-social intervention can be accomplished in a one-session controlled environment through habituating the physiological fear response, contesting catastrophic cognitions and preventing avoidance of the phobic stimulus (Davis & Ollendick, 2005;Öst, 1997). Unlike traditional CBT, confounding variables between sessions are eliminated as well as being time and cost-effective (Flatt & King, 2008).…”

“…It is therefore necessary for research to (a) collect more evidence that OST is efficacious in children using a an unchanged clinician; (b) add to the paucity of studies that employ a controlled outcome trial (Menzies & Clark, 1993;Ollendick et al, 2009;Öst et al, 2001b); (c) use a follow-up study to gain higher insight into treatment outcome preservation; (d) assess the effectiveness of using naturalistic generalisation behavioural experiment procedures to improve follow-up outcomes (Koch et al, 2004); (e) investigate the application of psycho-education, whether exclusively understanding the tripartite response can alleviate a child's phobic symptoms (Flatt & King, 2008;Silverman et al, 2008); and (f) employ a questionnaire that assesses the emotional outcome (i.e., the physiological, cognitive and behavioural fear reaction; Flatt & King, 2009). Such conclusions can assist therapists in allowing for more time and cost-efficient mental health treatment (Kazdin, 1993; and provide information that can augment treatment flexibility in terms of specific therapeutic methods.…”

Fear and Phobia: A Critical Review and the Rational-Choice Theory of Neurosis

“…One issue common to these theories is that panic disorder and agoraphobia are rarely found in children under the age of ten (DSM-IV-TR, 2000; Goodwin et al, 2005), as opposed to specific phobias (Flatt & King, 2008;King et al, 1998;Marks, 1987a;Stinson et al, 2007). Another concern is that while existing theories view agoraphobia as a by-product of panic disorder (Bouton et al, 2001;Mineka & Zinbarg, 2006;Klein, 1993), agoraphobia develops in the absence of panic attacks in a significant number of cases, and at times may even predict the development of panic disorder (Bienvenu et al, 2006;Wittchen et al, 2008).…”