Pharmacotherapy for specific phobia in adults
- Richard Swinson, MD
Richard Swinson, MD
- Professor Emeritus
- McMaster University
- Randi E McCabe, PhD
Randi E McCabe, PhD
- Associate Professor of Psychiatry & Behavioural Neurosciences
- McMaster University
Specific phobia is an anxiety disorder characterized by clinically-significant fear of a particular object or situation that typically leads to avoidance behavior. Phobic fears include animals, insects, heights, water, enclosed places, driving, flying, seeing blood, getting an injection, and choking or vomiting.
Specific phobias are among the most common mental disorders and can be highly disabling [1,2]. However, they are also among the most treatable mental disorders [3-6]. Despite availability of efficacious treatments, the majority of individuals with specific phobias are hesitant to seek treatment . This may be due to lack of knowledge that the phobia is treatable, embarrassment to disclose the phobia to a health professional, accommodation of the phobia through avoidance, or fear of increased anxiety or discomfort in the course of treatment .
Pharmacotherapy for specific phobia in adults is discussed here. The epidemiology, pathogenesis, clinical manifestations, course, and diagnosis of specific phobia in adults are discussed separately. Psychotherapy for specific phobia in adults is discussed separately. Specific phobias relating to clinical procedures (eg, blood-injection-injury phobia) and other manifestations of acute procedural anxiety are discussed separately. Specific phobia and other fears in children are also discussed separately. (See "Specific phobia in adults: Epidemiology, clinical manifestations, course and diagnosis" and "Psychotherapy for specific phobia in adults" and "Acute procedure anxiety in adults: Epidemiology and clinical presentation" and "Treatment of acute procedural anxiety in adults" and "Overview of fears and phobias in children and adolescents".).
Pharmacotherapy, including benzodiazepines and serotonergic reuptake inhibitors, has a limited role in treatment of specific phobia. Medications are used when CBT is not available or when patients prefer medication to CBT despite the lack of comparably robust supporting evidence from clinical trials.
- Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:593.
- Stinson FS, Dawson DA, Patricia Chou S, et al. The epidemiology of DSM-IV specific phobia in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychol Med 2007; 37:1047.
- Davis TE 3rd, Ollendick TH, Ost LG. Intensive Treatment of Specific Phobias in Children and Adolescents. Cogn Behav Pract 2009; 16:294.
- Koerner N, Rogojanski J, Antony MM. Specific phobia. In: Cognitive-Behavioral Therapy with Adults: A Guide to Empirically-Informed Assessment and Intervention, Hofmann SG, Reinecke MA (Eds), Cambridge University Press, Cambridge 2010. p.60.
- Wolitzky-Taylor KB, Horowitz JD, Powers MB, Telch MJ. Psychological approaches in the treatment of specific phobias: a meta-analysis. Clin Psychol Rev 2008; 28:1021.
- Zlomke K, Davis TE 3rd. One-session treatment of specific phobias: a detailed description and review of treatment efficacy. Behav Ther 2008; 39:207.
- Regier DA, Narrow WE, Rae DS, et al. The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Arch Gen Psychiatry 1993; 50:85.
- Barlow DH, Allen LB, Basden SL. Psychological treatments for panic disorders, phobias, and generalized anxiety disorder. In: A Guide to Treatments That Work, 3rd ed., Nathan PE, Gorman JM. (Eds), Oxford University Press, New York 2007. p.351.
- Choy Y, Fyer AJ, Lipsitz JD. Treatment of specific phobia in adults. Clin Psychol Rev 2007; 27:266.
- Wilhelm FH, Roth WT. Acute and delayed effects of alprazolam on flight phobics during exposure. Behav Res Ther 1997; 35:831.
- Jöhren P, Jackowski J, Gängler P, et al. Fear reduction in patients with dental treatment phobia. Br J Oral Maxillofac Surg 2000; 38:612.
- Roy-Byrne PP, Cowley DS. Pharmacological treatments for panic disorder, generalized anxiety disorder, specific phobia, and social anxiety disorder. In: A guide to treatments that work, 3rd ed., Nathan PE, Gorman JM. (Eds), Oxford University Press, New York 2007. p.395.
- Berggren U, Linde A. Dental fear and avoidance: a comparison of two modes of treatment. J Dent Res 1984; 63:1223.
- Hammarstrand G, Berggren U, Hakeberg M. Psychophysiological therapy vs. hypnotherapy in the treatment of patients with dental phobia. Eur J Oral Sci 1995; 103:399.
- Willumsen JF, Newell ML, Filteau SM, et al. Variation in breastmilk HIV-1 viral load in left and right breasts during the first 3 months of lactation. AIDS 2001; 15:1896.
- Ciraulo DA, Sands BF, Shader RI. Critical review of liability for benzodiazepine abuse among alcoholics. Am J Psychiatry 1988; 145:1501.
- Alamy S, Wei Zhang, Varia I, et al. Escitalopram in specific phobia: results of a placebo-controlled pilot trial. J Psychopharmacol 2008; 22:157.
- Benjamin J, Ben-Zion IZ, Karbofsky E, Dannon P. Double-blind placebo-controlled pilot study of paroxetine for specific phobia. Psychopharmacology (Berl) 2000; 149:194.
- Abene MV, Hamilton JD. Resolution of fear of flying with fluoxetine treatment. J Anxiety Disord 1998; 12:599.
- Balon R. Fluvoxamine for phobia of storms. Acta Psychiatr Scand 1999; 100:244.
- Ressler KJ, Rothbaum BO, Tannenbaum L, et al. Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear. Arch Gen Psychiatry 2004; 61:1136.
- Norberg MM, Krystal JH, Tolin DF. A meta-analysis of D-cycloserine and the facilitation of fear extinction and exposure therapy. Biol Psychiatry 2008; 63:1118.
- Hofmann SG, Pollack MH, Otto MW. Augmentation treatment of psychotherapy for anxiety disorders with D-cycloserine. CNS Drug Rev 2006; 12:208.
- Smits JA, Rosenfield D, Otto MW, et al. D-cycloserine enhancement of fear extinction is specific to successful exposure sessions: evidence from the treatment of height phobia. Biol Psychiatry 2013; 73:1054.
- de Quervain DJ, Bentz D, Michael T, et al. Glucocorticoids enhance extinction-based psychotherapy. Proc Natl Acad Sci U S A 2011; 108:6621.
- Soravia LM, Heinrichs M, Aerni A, et al. Glucocorticoids reduce phobic fear in humans. Proc Natl Acad Sci U S A 2006; 103:5585.
- Diemer J, Domschke K, Mühlberger A, et al. Acute anxiolytic effects of quetiapine during virtual reality exposure--a double-blind placebo-controlled trial in patients with specific phobia. Eur Neuropsychopharmacol 2013; 23:1551.