Evidence-Based Assessment and Treatment of Speciﬁc Phobias in Adults Heather K. Hood and Martin M. Antony
Speciﬁc phobias are among the most common psychological problems (Kessler et al. 2005); however, speciﬁc phobias are seldom the primary reason that individuals seek treatment (Brown et al. 2001b). Because speciﬁc phobias are rarely the focus of clinical attention, there is a common—though in many cases mistaken—perception that speciﬁc phobias are straightforward and uncomplicated. In addition, because the fear associated with speciﬁc phobias is typically limited to the phobic stimuli and rarely associated with pervasive anxiety outside of the phobic situation, some believe that speciﬁc phobias are necessarily less severe than other anxiety disorders. The clinical picture of speciﬁc phobias, however, can be very different. Individuals with speciﬁc phobias can incur serious life impairment, such as failure to obtain necessary medical care, interference with social activities, and lost time and reduced productivity at work. In some cases, the impairment is comparable to that seen in other mental disorders (Wittchen et al. 1998). In addition, phobias are sometimes associated with complex symptom proﬁles, including physiological symptoms, extensive coping and avoidance behaviors, and unhelpful or distorted cognitions. Therefore, a thorough assessment using multiple methods is important to evaluate the idiosyncrasies of each client’s presentation. The purpose of this chapter is to review the elements of a comprehensive, evidence-based assessment and treatment plan for speciﬁc phobia. It will provide an overview of diagnostic and clinical features of speciﬁc phobia, review the empirical status of commonly used assessment and treatment methods, and conclude with recommendations for assessment and intervention.
M. M. Antony ( ) · H. K. Hood Department of Psychology, Ryerson University, Toronto, Canada e-mail: firstname.lastname@example.org T. E. Davis III et al. (eds.), Intensive One-Session Treatment of Speciﬁc Phobias, Autism and Child Psychopathology Series, DOI 10.1007/978-1-4614-3253-1_2, © Springer Science+Business Media, LLC 2012 19
H. K. Hood and M. M. Antony
Assessment of Speciﬁc Phobia
The primary purposes of the clinical assessment of speciﬁc phobias are to establish a diagnosis, formulate a case conceptualization and treatment plan, and evaluate treatment progress and outcome. However, the diagnosis of speciﬁc phobias can be challenging. Speciﬁc phobias are frequently comorbid with other anxiety disorders and often share many features. In one study, 27% of patients presenting with a current principal diagnosis of speciﬁc phobia also reported symptoms consistent with another anxiety disorder (Brown et al. 2001b), and diagnostic disagreement is not uncommon for disorders that share features, such as speciﬁc phobia and panic disorder with agoraphobia (Brown et al. 2001a). Therefore, a thorough understanding of diagnostic criteria and potential sources of diagnostic error are required for an accurate assessment. Although no formalized protocols have been established for an evidence-based assessment of speciﬁc phobias, Antony and Rowa (2005) suggest that the core dimensions to be assessed should include diagnostic features, fear cues and triggers, avoidance and safety behaviors, physical symptoms, distress and impairment, development and course of the problem, treatment history, environmental or family factors, medical or health issues, and other comorbid problems or disorders.
According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association 2000), speciﬁc phobias are characterized by intense fear and avoidance of a circumscribed object or situation, such as ﬂying, driving, heights, enclosed spaces, animals, injections, or blood. The fear reaction occurs in anticipation of or immediately upon encountering the...