One Session Treatment of Cognitive and Behavioral Therapy and Virtual Reality for Social and Specific Phobias. Preliminary Results from a Randomized Clinical Trial

By Moldovan, Ramona; David, Daniel | Journal of Evidence-Based Psychotherapies, March 2014 | Go to article overview

One Session Treatment of Cognitive and Behavioral Therapy and Virtual Reality for Social and Specific Phobias. Preliminary Results from a Randomized Clinical Trial


Moldovan, Ramona, David, Daniel, Journal of Evidence-Based Psychotherapies


Phobias are described as an exaggerated, irrational fear of specific objects or situations, characterized by significant avoidance of any in vivo or in vitro exposure to fear stimuli or enduring it with great distress when avoidance is not possible. About 4.4% percent of the adult population in the USA has one or more phobias which will mostly persist for years and become chronic; complete remissions without treatment are very rare (Narrow et al., 2002).

Social phobia is the most common anxiety disorder and the 3rd most common psychiatric disorder (Craske, 1999), having a one year prevalence of 3.2% in the US. It is characterized by excessive and persistent anxiety in social situations ranging from public speaking to performing a task in the presence of others. Most often, the severity of symptoms and degree of impairment vary, given one's work demands and the stability of social relations. Recent studies show that social phobia interferes with work performance (in 93% of the cases), social life (in 82% of the individuals) and close relationships (in 71% of the individuals) (Ruscio et al., 2007; Wallach, 2009). A specific phobia is an intense, irrational fear of something that poses little or no actual danger. Adults with phobias most often realize that these fears are irrational, but they often find that facing, or even thinking about facing the feared object or situation brings on severe anxiety. Specific phobias are rather common as they affect 19.2 million adults in the US. Among the simple phobia subtypes established by DSM - IV, fear of flying has become very common in modern societies. Statistics in US and Europe show that 10%-15% percent from the general population suffer from fear of flying and about 20%-25% experience high levels of anxiety during flying (Ost, 1997; Muhlberger, 2001). Acrophobia or fear of heights it also rather common and it is known to affect 1 in 20 adults (Coelho et al., 2009).

To a great extent, phobia is the result of classical conditioning or vicarious learning. Fear is maintained by the avoidance behavior: avoidance impedes confronting the phobia symptoms (e.g. subjective anxiety and physiological arousal) and therefore fear is not solved but negatively reinforced (therefore, exposure has the role of fear extinction) (Rothbaum et al, 2000; Emmelkamp et al., 2002). Studies investigating the impact of exposure on phobia symptoms have provided empirical evidence showing that it plays a major role in treatment outcome (Rothbaum et al, 2000; Emmelkamp et al., 2002; Powers & Emmelkamp, 2008; Wolitzky-Taylor et al., 2008).

In addition to conditioning studies, there is a large amount of research showing that both dysfunctional cognitions (Beck, 1976) and irrational beliefs (Ellis, 1979) explain to a great extent anxiety symptoms (Chambless et al., 1998; Wolitzky-Taylor et al., 2008; Wallach et al. 2009). Rational Emotive Behavioral Therapy (REBT) advances two main irrational beliefs as leading to anxiety: demandingness (DEM) and awfulizing (AWF). DEM refers to absolutist requirements, from self, others, and the world, formulated as "musts" or "shoulds". AWF refers to believing that a particular situation is catastrophic. Thus, anxiety is experienced when events are incongruent with the formulated demands of one's goals and the person evaluates the situation as being a catastrophe and/or unbearable, experiencing a low emotion-focused coping potential (David et al., 2002). Cognitive and Behavioral Therapies (CBT), namely REBT, use a number of techniques to identify and restructure dysfunctional beliefs/irrational beliefs that lead to anxiety, as well as assimilate rational cognitions and functional responses. As a matter of fact, there is extensive empirical data supporting the efficacy of CBT in treating phobias (Ost et al., 1997; Chambless et al., 1998; Choy et al., 2007; Zlomke et al. 2008; Wolitzky-Taylor et al., 2008; Wallach et al. 2009) with a large number of studies supporting the use of treatment that combines both cognitive and behavioral (mainly exposure) components (Ost et al. …

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