296 CHAPTER 7
Treating Specifi c Phobias
Treatment for specifi c phobias generally targets one type of factor, although the
benefi cial changes affect all the factors. Neurological or psychological factors are
usually the primary target of treatments.Targeting Neurological Factors: Medication
Medication, such as a benzodiazepine, may be prescribed for a specifi c phobia (alone
or in combination with CBT), but this is generally not recommended. Medication
is usually unnecessary because CBT treatment—even a single session—is highly
effective in treating a specifi c phobia (Ellison & McCarter, 2002; Öst, Ferebee, &
Furmark, 1997). However, preliminary research suggests that one medication
(D-cycloserine, an antibiotic used to treat tuberculosis) may facilitate the neural
basis of fear extinction; the combination of D-cycloserine and exposure is more ef-
fective than exposure alone (Norberg, Krystal, & Tolin, 2008; Ressler et al., 2004).Targeting Psychological Factors
If you had to choose an anxiety disorder to have, specifi c phobia probably should
be your choice. This is the anxiety disorder most treatable by CBT, with up to 90%
lasting improvement rates even after only one session (Gitin, Herbert, & Schmidt,
1996; Öst, Salkovskis & Hellström, 1991).Behavioral Method: Exposure
The behavioral method of graded exposure has proven effective in treating specifi c
phobias (Vansteenwegen et al., 2007), and is considered a fi rst-line treatment. With
this method, the patient and therapist progress through an individualized hierarchy
of anxiety-producing stimuli or events as fast as the patient can tolerate, as in expo-
sure treatment for social anxiety (discussed earlier in the chapter and in Chapter 4;
see Table 4.3), but in this case substituting the specifi c feared stimulus for the feared
social situation or interaction. Moreover, recent research on treating phobias with
exposure suggests that virtual reality exposure works as well, at least for certain
phobias (Pull, 2005), such as of fl ying and heights (Coelho et al., in press; Em-
melkamp et al., 2001, 2002; Rothbaum et al., 2001, 2002), and this technique is
part of many treatment programs for fear of fl ying. Howard Hughes provided him-
self with in vivo exposure treatment by fl ying very often as soon as he was well
enough after the plane crash.
Exposure clearly alters not only behavior but also neural activity. Consider the
results from a neuroimaging study of the effects of treating people with a spider
phobia (Paquette et al., 2003): Before treatment, part of the parahippocampal gyrus
and frontal cortex showed signifi cant activity when the participants saw pictures of
spiders. These brain areas were relatively quiet in those who did not have a spider
phobia. When viewing pictures of spiders after successful exposure treatment, the
brain activation patterns of the people with a spider phobia were similar to those
of people without the phobia. Thus, the behavioral treatment led to neurological
changes. Similar results were obtained in another study (Johanson et al., 2006).
For the blood-injection-injury type of specifi c phobia, the treatment of choice is
applied tension (Antony & Swinson, 2000b): To prevent changes in blood pressure
and fainting before exposure to the feared (and faint-inducing) stimulus, the patient
tenses all bodily muscles, which increases blood pressure, thereby preventing faint-
ing. The applied tension is followed by exposure to the feared stimulus (Öst, Fel-
lenius, & Sterner, 1991).Cognitive Methods
Cognitive methods for treating a specifi c phobia are similar to those used to treat
other anxiety disorders, such as panic disorder and social phobia. The thera-
pist and patient identify illogical thoughts pertaining to the feared stimulus, andP SN