Statement
of the Problem: Exposure is known to be highly effective
in treating specific phobias. However, exposure does not work
for all patients, and some show a return of fear at follow-up
assessments. Thus, examining the mechanisms that drive fear
reduction during exposure can help researchers develop more
potent treatments, while also shedding light on the nature of
anxiety disorders. Research in our laboratory (Sloan & Telch,
2000; Powers et al., 2004) and in the UK (Salkovskis et al,
1991; Wells et al., 1995) suggest that patients who rely on
safety aids and defensive behaviors while confronting their
phobic threats display poorer treatment outcome than patients
who do not use safety aids or who use them initially but fade
them during treatment. Moreover, it appears that the mere perceived
availability of safety aids – even when they are not actually
utilized also undermines the efficacy of exposure treatments
(Powers et al., 2004). These findings are informative in developing
new, and possibly more efficacious exposure-based treatments.
Further, these treatments tested on specific phobias can often
be applied to other anxiety disorders such as panic disorder
or social anxiety disorder.
Specific
Aims: We reasoned that if the presence of safety aids
and the engagement in safety behaviors during treatment undermines
exposure treatment outcome, perhaps the introduction of actions
incompatible with these defensive behaviors would actually facilitate
the effects of exposure. We refer to these actions as “anti-Phobic”
strategies. Examples include holding one’s hands behind
one’s back as opposed to holding on to the rail of a balcony
for a height phobic, or running towards the balcony railing
as opposed to backing away from it. Thus, the main aim of the
study is to test the efficacy of exposure with anti-phobic actions,
and to test the relative efficacy of this treatment to traditional
in vivo exposure and a placebo control group.
Design:
Participants are randomly assigned to either a) exposure with
antiphobic actions, b) exposure only, c) pulsed audio-photic
stimulation, or d) waitlist control. Treatment consists of one
session consisting of six, six-minute trials of treatment. Participants
are assessed at pre-treatment, post-treatment, and a one month
follow-up session.
Eligibility
Criteria: Participants must
• meet diagnostic criteria for specific phobia, acrophobia
(fear of heights), as determined by a structured diagnostic
interview
• report at least moderate levels of subjective fear on
two behavioral approach tests (participants are told to ascend
two different staircases);
Project Coordinator:
Kate B. Wolitzky, doctoral student
Contact Information:
(512) 471-3722; lsad@telchlab.com
