Psychotherapy for specific phobia in adults
- Randi E McCabe, PhD
Randi E McCabe, PhD
- Associate Professor of Psychiatry & Behavioural Neurosciences
- McMaster University
- Richard Swinson, MD
Richard Swinson, MD
- Professor Emeritus
- 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 .
Psychotherapy for specific phobia in adults is discussed here. The epidemiology, pathogenesis, clinical manifestations, course, and diagnosis of specific phobia in adults are discussed separately. Pharmacotherapy for specific phobia in adults is also discussed separately. Specific phobias and other manifestations of acute anxiety experienced by patients undergoing clinical procedures are also 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 "Pharmacotherapy for specific phobia in adults" and "Overview of fears and phobias in children and adolescents".)
First-line treatment for specific phobia is cognitive-behavioral therapy (CBT) that includes exposure treatment . CBT consists of cognitive and behavioral strategies designed to alter maladaptive thoughts and behaviors that serve to maintain emotional distress. Different types of exposure and different combinations of CBT interventions are used to treat differing presentations of specific phobia .
Pharmacotherapy 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. Medications (most commonly benzodiazepines) may also be used when there is insufficient time to treat with CBT (eg, patient with fear of flying presents a week or two prior to anticipated flight) and/or when exposure to the feared stimulus is expected to be a rare occurrence (eg, city-dwelling patient with fear of horses needs to travel to a ranch for a family event). (See "Pharmacotherapy for specific phobia in adults".)
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- TREATMENT OVERVIEW
- EXPOSURE THERAPY
- Types of exposure
- - In vivo exposure
- - Imaginal exposure
- - Virtual reality exposure
- - Other
- ADDITIONAL INTERVENTIONS
- Cognitive therapy
- Anxiety management
- Safety behaviors
- Applied tension
- Systematic desensitization
- Eye movement desensitization and reprocessing
- COMPARING CBT AND MEDICATION
- COMBINING CBT AND MEDICATION
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS