Anxiety Disorders 297
the therapist helps highlight discrepant information and
challenges the patient to see the irrationality of his or her
thoughts and expectations. Table 7.12 provides an example
of thoughts that someone with claustrophobia—a fear of en-
closed spaces—might have.
Group CBT may be appropriate for some kinds of pho-bias, such as fear of flying or of spiders (Götestam, 2002;
Rothbaum et al., 2006; Van Gerwen, Spinhoven, & Van
Dyck, 2006). However, unlike group CBT for social phobia,
group treatment for specifi c phobia does not directly target
social factors; rather, group CBT is a cost-effective way to
teach patients behavioral and cognitive methods to overcome
their fears.
Targeting Social Factors:
A Limited Role for Observational Learning
Observational learning may play a role in the development
of a specifi c phobia, but to many researchers’ surprise, seeing
others model how to interact normally with the feared stimu-
lus generally is not an effective treatment for specifi c phobias. Perhaps observational
learning is not effective because patients’ cognitive distortions are powerful enough
to negate any positive effects modeling might provide. For instance, someone with a
spider phobia who observes someone else handling a spider might think, “Well, that
person isn’t harmed by the spider, but there’s no guarantee that I’ll be so lucky!” Nev-
ertheless, such observational learning can be a helpful addition to CBT (Antony &
Swinson, 2000b).
FEEDBACK LOOPS IN TREATMENT: Specifi c Phobias
When treatment is effective in creating lasting change in one type of factor, it causes
changes in the other factors. Consider dental phobia and its treatment. Over 16% of
people between the ages of 18 and 26 have signifi cant dental anxiety, according to
one survey (Locker, Thomson, & Poulton, 2001). One study examined the effect of a
single session of CBT on dental phobia (Thom, Sartory, & Joehren, 2000). The treat-
ment, which consisted of stress management training and imaginal exposure to dental
surgery, occurred 1 week prior to the surgery, and patients were asked to practice
daily during the intervening week. Another group of people with dental phobia was
only given a benzodiazepine 30 minutes before surgery. A third group was given noth-
ing; this was the control group. Both types of treatment led to less anxiety during the
dental surgery than was reported by the control group. However, those in the CBT
group continued to maintain and show further improvement at a 2-month follow-up:
70% of them went on to have subsequent dental work, whereas only 20% of those in
the benzodiazepine group and 10% of the control group did so.
The neuropsychosocial approach leads us to consider how the factors and theirfeedback loops interact to produce such a specifi c phobia: The medication, although
temporarily decreasing anxiety (neurological factor), did not lead to sustained
change either in brain functioning or in thoughts about dental procedures. The CBT,
in contrast, targeted psychological factors and also led to changes in a neurological
factor—brain functioning associated with decreased anxiety and arousal related to
dental surgery. In turn, these changes led to social changes—additional dental work.
And the added dental visits presumably led to better health, which in turn affected
the participants’ view of themselves and their interactions with others. Indeed, if the
visits had cosmetic effects (such as a nicer smile), their social benefi ts would be even
more evident. Such feedback loops (see Figure 7.13) underlie the treatment of all
specifi c phobias.
- Many closed-in places, e.g., elevators, small rooms,
do not have enough air. - I will faint.
- If I go into a closed-in space, e.g., elevator or cave,
I will not be able to get out. - I will not be able to cope if I get stuck in a closed-in
place. - If I get too nervous, I may hurt myself.
- I will embarrass myself.
- I will lose control.
- I cannot think straight in enclosed places.
- I will go crazy.
- I will die.
Source: Antony, Craske, & Barlow, 1995, p. 105. For more information
see the Permissions section.
Table 7.12 • Fearful Thoughts Related
to ClaustrophobiaP SN