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Improving Treatment for Common Phobias


Specific phobias are a type of anxiety disorder affecting between 3 and 15 percent of the population. While effective treatments are available, most people don’t seek treatment; an estimated 10 to 25 percent of people with a specific phobia seek treatment.

While many people are afraid or uncomfortable with such things as heights or spiders, that is not necessarily a phobia. Phobias involve unreasonable fear and distress, actively avoiding the object of fear to the extent that it interferes with daily functioning.

Most common phobias involve fear of animals and heights. Other common objects or situations involved include flying, closed spaces, water, storms and blood. While it is more common to develop phobias in childhood they can also develop later in life.spider.jpg

The most common type of treatment is exposure therapy – when the person works to reduce their fear by slowly increasing exposure to the object of their fear. That exposure can be in person, through images or through virtual reality technology. New research is identifying ways to increase the effectiveness of treatment, for example through increasing the intensity of treatment, increasing individual control over exposure and precisely timing the exposure.

One recent study found that more intense therapy can lead to greater reduction in symptoms. Study participants that completed more intense exposure treatment that directly challenged their beliefs of harm benefitted more than those who completed less intense treatment. The study looked at people with a fear of spiders and the final treatment step involved allowing a spider to crawl on them.

Warren Mansell, Ph.D., with the University of Manchester in England, and colleagues looked at whether giving patients control over how much they approach or avoid the object of their fear would improve their outcomes. They found that people who had completed an exercise where they could control the distance of their exposure to a spider virtually via computer screen had a greater ability to tolerate exposure compared to people who had less control in the exercise.

Researchers at Brighton and Sussex Medical School in Brighton, England, found that treatment using exposure to images on a screen can be more effective if the visual exposure is timed with the individual’s heartbeat, compared to images timed between the heartbeats or randomly timed.

Study participants were divided into three groups: one shown pictures of spiders in time with their heartbeat; another shown images in between heartbeats; and a third shown images randomly. While all three groups showed some improvements, the greatest reduction in self-reported fear, anxiety levels and physiological response to spiders was among those with the images timed with the heartbeat.

New research recently published in the journal Lancet suggests even more reason to seek treatment for phobias. The study, led by William Eaton, Ph.D., with Johns Hopkins University, found compared to people without phobias, people with phobias were more likely to later develop another anxiety, mood and substance-use disorder. The authors conclude that “early treatment of phobias could also alter the risk of other disorders.”

References and Resources

  • Online screening for specific phobia and therapist listing from the Anxiety and Depression Association of America
  • Norberf, MM, et al. The Scarier the Better: Maximizing Exposure Therapy Outcomes for Spider Fear. Behav Copgn Psychother. 2018, nov;46(6):754-60.
  • Healey, A. Mansell, W, Tai, S. An experimental test of the role of control in spider fear. J Anxiety Disord 2017, June; 49:12-20.
  • Eaton, WW, Bienvenu OJ, Miloyan, B. Specific phobias. Lancet Psychiatry, 2018, 5:678-86.


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