Miller, C. Silva, S. Bouchard, C. Belanger, T.
Intensive One-Session Treatment of Specific Phobias - graphsauglastu.ga
Review From the reviews: "The current text is indeed a welcome addition to the literature because of its breadth of coverage but also because it provides an up-to-date overview of the literature. For therapists who regularly treat clients with specific phobias, the text really is a must have. For those with a more academic or research interest in the treatment of specific phobias, not only does the text provide an up-to-date overview of OST research, but it also highlights where gaps remain. Vakgebieden Psychotherapie. Ollendick, Lars-Goran A-st Editie ed.
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Intensive One-Session Treatment of Specific Phobias (Autism and Child Psychopathology Series)
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Intensive One-Session Treatment of Specific Phobias
Susie Orbach. Judith Hoare. Oliver Sacks. On Becoming a Person. Carl Rogers. The Gift Of Therapy. Irvin D. Overcoming Low Self-Esteem, 2nd Edition. Melanie Fennell. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All relevant data are within the paper and its Supporting Information files. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist. In the case of the animal phobia subtype [ 3 ], the prevalence ranges between 3. Currently, the treatment of choice for SP including small animal phobia is in vivo exposure [ 9 , 10 ]. However, there are several difficulties in the application of this technique.
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In fact, only 7. This may be due to the lack of evidence-based treatments offered by the health care system, the long waiting lists, or the fact that many therapists are not well trained in applying exposure therapy [ 13 — 15 ]. Some studies have found that therapists may be reluctant to provide exposure-based therapy [ 17 , 18 ] because they consider it cruel and at odds with some ethical considerations [ 16 , 19 ].
Although the empirical data do not support such ideas and it has been demonstrated that exposure therapy is effective and safe and it does not produce higher dropout rates than other forms of therapy [ 21 ], still some patients and therapists may be reluctant to receive this technique [ 22 , 23 ]. Thus, new models for delivering therapy could be useful to improve the opinions about exposure therapy and to bring evidence-based techniques to those who need them and reduce the general impact of the burden of mental illness worldwide [ 13 ].
Specifically, VR has been shown to be an effective tool for applying the exposure component in the treatment of anxiety [ 26 — 30 ]. In the case of SP, the data on the treatment of spider phobia show that VRE is effective for this problem in adults [ 31 ] and children [ 32 ], more effective in comparisons with wait-list control groups [ 33 , 34 ] and as effective as in vivo exposure [ 35 ].
VR is also well accepted [ 24 , 36 , 37 ], even in children [ 38 ]. Augmented Reality AR is a variant of VR that combines the real world with virtual elements, using computer graphics mixed with the real world in real time [ 39 ]. In AR, the person sees an image composed of a visualization of the real world and a series of virtual elements, which, at the same time, are super-imposed on the real world. The most important aspect of AR is that the virtual elements supply the person with relevant information that is not found in the real world. The literature shows great advances in AR applications in other fields [ 40 — 42 ].
In the psychological treatment field, AR presents the same advantages as VR that is, total control over the way the exposure is conducted, easier access to the threatening stimuli, no risk of real danger to the patient, the possibility of going beyond reality, confidentiality , but it can be less expensive than VR because it is not necessary to model the whole environment.
It consisted of a case study of a woman who suffered from cockroach phobia. Results from this case study [ 43 ] showed a decrease in scores on fear and avoidance and on the variables related to the BAT. Specifically, after the AR exposure session, the participant was capable of interacting with real cockroaches, and the improvements were maintained at the 1-month follow-up.
This same AR system has been shown to be useful for inducing anxiety in participants [ 49 ], and it has also been tested using a multiple baseline design with 6 individuals who suffered from cockroach phobia [ 50 ].
Results showed that AR exposure was effective, as all the participants improved significantly on all the outcome measures. Furthermore, the improvements were maintained over time 6- and month follow-ups. These preliminary studies show that exposure through AR can be useful for the treatment of SP cockroaches and spiders. However, despite these promising results, we have found no randomized controlled trials on AR efficacy compared to the current treatment of choice for SP, in vivo exposure, nor any study focused on analyzing the opinion and acceptance by the participants of AR exposure.
Thus, the present study aims to examine the efficacy and acceptance expectations and satisfaction of two treatment conditions in which the exposure component was applied in different ways: in vivo IVE versus the AR system ARE , in a randomized controlled trial. Taking into account the meta-analysis data in the literature on IVE, we expect this treatment to be efficacious.
Data from previous AR pilot tests lead us to predict that this procedure will also be effective. The authors confirm that all ongoing and related trials for this intervention are registered. The participants were randomly assigned to the two experimental conditions. Repeat measurements at pre-treatment, post-treatment, three-month follow-up, and six-month follow-up were included. Regarding the sample size, power calculations were based on data from two meta-analyses [ 28 , 29 ].
Both of them were based on studying the efficacy of VR for the treatment of anxiety disorders, and both included the BAT as outcome measure. This decision was made for two main reasons: first, although data were available from meta-analyses on VR efficacy for the treatment of SP using several VR sessions, there were no data available from RCT about the efficacy of VR or AR applied in a single session that could serve as a reference.
Therefore, we decided to be more conservative and increase the sample size in order to have more power and try to avoid a Type II error. The recruitment processes as well as the data collection took place at January to January Participants were recruited through advertisements sent by mail to university community members and announcements placed around the campus and in the local media. Inclusion criteria were: a meeting DSM-IV-TR [ 5 ] for the diagnosis of SP animal subtype to cockroaches or spiders; b being at least 18 years old and having a minimum 1-year duration of the phobia; c being willing to follow the study conditions and sign the consent form; and d presenting a score of at least 4 on the fear and avoidance scales of the diagnostic interview applied.
Exclusion criteria were: a having another psychological problem that requires immediate attention; b having current alcohol or drug dependence or abuse, psychosis or severe organic illness; c currently being treated in a similar treatment program; d being capable of inserting their hands in a plastic container with a cockroach or a spider during the behavioral test ; and e taking anxiolytics during the study or in the case of taking them, changing the drug or dose during the study. The randomization of the participants took place after assessing the eligibility criteria.
The person responsible for the randomization was an independent researcher with no clinical involvement in the trial and no access to the study data. Therapists and participants involved in the trial were blind to treatment allocation during the assessment. The assessment protocol included diagnostic, main outcome, and secondary measures to assess the main features of the spider and cockroach phobias, interference and severity measures as well as expectations and satisfaction regarding the exposure treatment.
In this paper, the most relevant measures are presented. For this study, a container containing a live cockroach or spider was placed 5 meters from the entrance to a room. Then, participants were asked to enter the room and come as close to the animal as possible. This measure was used in a previous study where a more detailed description was provided [ 50 ].
This is a self-report questionnaire containing 18 items about spiders and designed to assess the severity of the phobia. Scores can range from 0 to Muris and Merckelbach [ 56 ] found that the mean score in a group of people before treatment was In the same study, the mean score of control subjects without spider phobia was 3. The FSQ has excellent psychometric properties.
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