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Thomas H. Ollendick - One of the best experts on this subject based on the ideXlab platform.
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Training with tarantulas: A randomized feasibility and acceptability study using experiential learning to enhance exposure therapy training
Journal of anxiety disorders, 2020Co-Authors: Hannah E. Frank, Thomas H. Ollendick, Emily M. Becker-haimes, Lara S. Rifkin, Lesley A Norris, Thomas M. Olino, Hilary E. Kratz, Rinad S. Beidas, Philip C. KendallAbstract:Abstract Background Although exposure is a key evidence-based intervention for anxiety, it is infrequently used in clinical settings. This study employed a novel training strategy, experiential learning, to improve exposure implementation. This study aimed to assess the feasibility and acceptability of experiential training and preliminary training effectiveness. Methods Participants were 28 therapists who were randomized to (a) training-as-usual or (b) experiential training (training-as-usual plus a One-Session Treatment for fear of spiders). Workshops lasted one day and were followed by three months of weekly consultation. Results Experiential training was viewed as feasible and acceptable. Participants, including those who were fearful of spiders, had a positive response to the training and reported it to be useful. There was a significant increase in the number of exposures used by therapists receiving experiential training compared to training-as-usual at 1-month follow-up. Conclusions A one-day training resulted in significant improvements in knowledge, attitudes toward exposure, and self-efficacy in using exposure. Preliminary findings suggest that experiential training resulted in greater use of exposure post-training compared to training-as-usual. Results provide evidence for the feasibility and acceptability of experiential training as a strategy to increase the use of evidence-based interventions.
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virtual reality one session Treatment of child specific phobia of dogs a controlled multiple baseline case series
Behavior Therapy, 2020Co-Authors: Lara J Farrell, Kirra A. Krisch, Allison M Waters, Taka Miyamoto, Caroline L Donovan, Thomas H. OllendickAbstract:Abstract Specific phobia (SP) typically onsets in childhood and frequently predicts other mental health disorders later in life. Fortunately, childhood SP can be effectively treated with cognitive behavior therapy (CBT), including the exposure-based One-Session Treatment (OST) approach. Despite empirical support for CBT and OST, clinicians, for various reasons, frequently fail to implement exposure-based therapy in routine clinical practice, including perceived difficulties in implementing exposure. Virtual reality (VR) exposure therapy may overcome some of these challenges and provides an alternative modality of therapy. This preliminary study examined the efficacy of VR OST for 8 children with a SP of dogs (aged 8–12 years) (M = age 10.25; SD = 2.11) using a multiple-baseline controlled case series. Following a stable baseline period of either 2, 3, or 4 weeks, it was expected that specific phobia severity would significantly decline after VR OST and remain improved over the 3-week maintenance phase. Assessments were conducted postTreatment and at 1-month follow up (study end-point). It was found that phobia symptoms remained relatively stable across the baselines, with significant reductions from preTreatment to postTreatment and to follow-up on clinician severity ratings (pre- to post- g = 1.12; pre- to follow-up g = 2.40), target symptom ratings (g = 1.14; 1.29), and behavioral avoidance (g = -1.27; -1.96). The Treatment was also associated with clinically significant outcomes, whereby at one-month follow up, 75% of children were considered “recovered” and 88% completed the BAT (interacted with their feared stimuli). This study provides support for the effectiveness of VR OST.
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A Pilot Study of One-Session Treatment for Specific Phobias in Children with ASD Traits
Journal of Child and Family Studies, 2020Co-Authors: Ashley Muskett, Sarah R. Radtke, Thomas H. OllendickAbstract:Objectives One-Session Treatment (OST), a three-hour Treatment which includes psychoeducation, exposure, participant modeling, cognitive challenges, and positive reinforcement, has been shown to be effective for the Treatment of childhood phobias. Several comorbid anxiety conditions such as Generalized Anxiety Disorder and Social Anxiety Disorder have been shown to have little or no negative effects on Treatment outcomes for OST whereas others such as Attention-Deficit Hyperactivity Disorder have been shown to compromise Treatment outcomes. This study sought to examine the initial efficacy of OST for children with a behavioral profile demonstrating specific traits of Autism Spectrum Disorder (ASD). We undertook this exploratory study to determine the feasibility and potential efficacy of this brief Treatment with these youth. Methods Two variations of the Treatment were trialed. In the OST condition, the child alone received Treatment with minimal parental involvement. In the Augmented OST condition, two clinicians were assigned to each family: one clinician worked with the child and the other with the parent. Families in both Treatments returned for follow-up assessments one-week, 6-months, and 1-year later. Results A repeated-measures ANOVA revealed significant reductions in phobia severity as well as increases in overall functioning for both forms of Treatment. Conclusions These results suggest that OST may be an effective intervention for children with ASD traits who evince SPs. Future controlled studies will need to examine the efficacy of this brief intervention with carefully diagnosed youth with ASD as well as explore specific components that make it effective for these children.
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Brief, Intensive, and Concentrated Treatment of Specific Phobia in a Child With Minimally Verbal Autism Spectrum Disorder:
Clinical Case Studies, 2019Co-Authors: Ashley Muskett, Sarah R. Radtke, Thomas H. OllendickAbstract:This case study illustrates a brief, intensive, cognitive behavioral therapy (CBT) for a young male client with a specific phobia of dogs and comorbid autism spectrum disorder (ASD). CBT has been shown to be an effective Treatment for anxiety in children with ASD; however, this work has not often been extended to children with language impairment. This case study presents significant modifications to One-Session Treatment (OST) for specific phobia to make it applicable to a child with minimally verbal ASD. The intervention included four 3-hr Treatment sessions conducted over the course of four consecutive days. Assessment sessions were conducted before Treatment, and 1 week and 3 months following Treatment. The client’s phobia symptoms decreased following the intervention at both the postTreatment and follow-up sessions. The Reliable Change Index (RCI) was calculated to evaluate changes from preTreatment to postTreatment and follow-up and demonstrated a clinically significant decrease in phobia symptomology following intervention. The results suggest the potential efficacy for a brief, intensive, and concentrated CBT Treatment for a child with minimally verbal ASD and a severe phobia.
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One-Session Treatment of Specific Phobias in Children: Recent Developments and a Systematic Review
Annual review of clinical psychology, 2018Co-Authors: Thompson E. Davis, Thomas H. Ollendick, Lars-göran ÖstAbstract:One-Session Treatment is a well-established evidence-based Treatment for specific phobias in youths that incorporates reinforcement, cognitive challenges, participant modeling, psychoeducation, and skills training into a single, massed session of graduated exposure. This review begins by briefly examining the phenomenology, etiology, epidemiology, and assessment of specific phobias and then pivots to a description of One-Session Treatment. We examine the use of One-Session Treatment with children and adolescents, briefly discussing its components and application, and subsequently review almost two decades of research supporting its efficacy. Finally, we propose future directions for research and practice.
Thompson E. Davis - One of the best experts on this subject based on the ideXlab platform.
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One-Session Treatment of Specific Phobias in Children: Recent Developments and a Systematic Review
Annual review of clinical psychology, 2018Co-Authors: Thompson E. Davis, Thomas H. Ollendick, Lars-göran ÖstAbstract:One-Session Treatment is a well-established evidence-based Treatment for specific phobias in youths that incorporates reinforcement, cognitive challenges, participant modeling, psychoeducation, and skills training into a single, massed session of graduated exposure. This review begins by briefly examining the phenomenology, etiology, epidemiology, and assessment of specific phobias and then pivots to a description of One-Session Treatment. We examine the use of One-Session Treatment with children and adolescents, briefly discussing its components and application, and subsequently review almost two decades of research supporting its efficacy. Finally, we propose future directions for research and practice.
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Clinical and cost-effectiveness of One-Session Treatment (OST) versus multisession cognitive-behavioural therapy (CBT) for specific phobias in children: Protocol for a non-inferiority randomised controlled trial
BMJ open, 2018Co-Authors: Barry Wright, Thompson E. Davis, Cindy Cooper, Alexander J Scott, Lucy Tindall, Shehzad Ali, Penny Bee, Katie Biggs, Trilby Breckman, Lina GegaAbstract:Specific phobias (intense, enduring fears of an object or situation that lead to avoidance and severe distress) are highly prevalent among children and young people. Cognitive-behavioural therapy (CBT) is a well-established, effective intervention, but it can be time consuming and costly because it is routinely delivered over multiple sessions during several months. Alternative methods of treating severe and debilitating phobias in children are needed, like One-Session Treatment (OST), to reduce time and cost, and to prevent therapeutic drift and help children recover quickly. Our study explores whether (1) outcomes with OST are 'no worse' than outcomes with multisession CBT, (2) OST is acceptable to children, their parents and the practitioners who use it and (3) OST offers good value for money to the National Health Service (NHS) and to society. A pragmatic, non-inferiority, randomised controlled trial will compare OST with multisession CBT-based therapy on their clinical and cost-effectiveness. The primary clinical outcome is a standardised behavioural task of approaching the feared stimulus at 6 months postrandomisation. The outcomes for the within-trial cost-effectiveness analysis are quality-adjusted life years based on EQ-5D-Y, and individual-level costs based of the intervention and use of health and social service care. A nested qualitative evaluation will explore children's, parents' and practitioners' perceptions and experiences of OST. A total of 286 children, 7-16 years old, with DSM-IV diagnoses of specific phobia will be recruited via gatekeepers in the NHS, schools and voluntary youth services, and via public adverts. The trial received ethical approval from North East and York Research Ethics Committee (Reference: 17/NE/0012). Dissemination plans include publications in peer-reviewed journals, presentations in relevant research conferences, local research symposia and seminars for children and their families, and for professionals and service managers. ISRCTN19883421;Pre-results. © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.
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One-Session Treatment for Specific Phobias: A Review of Öst's Single-Session Exposure with Children and Adolescents
Cognitive behaviour therapy, 2013Co-Authors: Thomas H. Ollendick, Thompson E. DavisAbstract:The purpose of this brief paper is to review the current status of One-Session Treatment (OST) for specific phobias in children and adolescents. Following a brief historical overview and description of OST, we systematically describe eight studies that have examined its efficacy in children and adolescents aged between 7 and17 years. We also explore phobia subtypes, age, gender, and comorbidity as possible moderators of Treatment outcome. Studies have been conducted in Australia, Austria, the Netherlands, the USA, and Sweden. Although there is limited evidence that OST works better for animal phobias than other subtypes of phobias and for girls than boys, across studies there is considerable evidence that it is generally effective across phobia subtypes and for both boys and girls. No age differences in outcomes were noted, nor were any differences noted due to comorbidity. OST was found to be equally effective with children and adolescents with co-occurring multiple phobias and other anxiety disorders. Moreover, in at least one study, it was found to reduce untreated phobic and anxiety disorders in addition to the treated phobias. It is concluded that OST is a highly effective intervention for the Treatment of specific phobias in children and adolescents.
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One-Session Treatment of a Specific Phobia of Swallowing Pills A Case Study
Clinical Case Studies, 2013Co-Authors: Thompson E. Davis, Erin T. Reuther, Brittany M. RudyAbstract:This case study presents the Treatment of a 23-year-old single White male with a specific phobia of swallowing and choking on pills. He presented for Treatment as part of a larger Treatment study f...
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Empirical Status of One-Session Treatment
Intensive One-Session Treatment of Specific Phobias, 2012Co-Authors: Thompson E. Davis, Whitney S. Jenkins, Brittany M. RudyAbstract:One-Session Treatment (OST) is a massed, intensive exposure Treatment that is maximized to a single 3-hour session. OST uniquely incorporates a variety of efficacious methods such as participant modeling, reinforcement, psychoeducation, and cognitive challenges during graduated exposure (Davis and Ollendick, Clinical Psychology: Science and Practice 12:144–160, 2005; Davis et al., Cognitive and Behavioral Practice 16:294–303, 2009; Ost, Phobias: A handbook of theory, research, and Treatment, pp. 227–247, 1997; Zlomke and Davis, Behavior Therapy 39:207–223, 2008). To address these points, various other chapters have covered the implementation of OST (see Chaps. 4–7 and 9) using the extant literature to describe the principles and administration of OST with a variety of different individuals. This chapter, however, will examine the literature to determine the evidence base behind the use of OST, and its current evidentiary standing will be evaluated and updated (see Davis et al., Clinical Psychology Review 31:592–602, 2011; Davis and Ollendick, Clinical Psychology: Science and Practice 12:144–160, 2005; and Zlomke and Davis, Behavior Therapy 39:207–223, 2008 for previous reviews). The most detailed review of OST to date, by Zlomke and Davis (Behavior Therapy 39:207–223, 2008), summarized the literature and concluded that approximately 85–90% of individuals receiving OST benefited significantly from the Treatment and that it met empirically supported Treatment criteria for a probably efficacious intervention at that time. In the years since Zlomke and Davis, however, a number of other studies have added to the evidence base for OST making a new, updated review timely.
Lars-göran Öst - One of the best experts on this subject based on the ideXlab platform.
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One-Session Treatment of Specific Phobias in Children: Recent Developments and a Systematic Review
Annual review of clinical psychology, 2018Co-Authors: Thompson E. Davis, Thomas H. Ollendick, Lars-göran ÖstAbstract:One-Session Treatment is a well-established evidence-based Treatment for specific phobias in youths that incorporates reinforcement, cognitive challenges, participant modeling, psychoeducation, and skills training into a single, massed session of graduated exposure. This review begins by briefly examining the phenomenology, etiology, epidemiology, and assessment of specific phobias and then pivots to a description of One-Session Treatment. We examine the use of One-Session Treatment with children and adolescents, briefly discussing its components and application, and subsequently review almost two decades of research supporting its efficacy. Finally, we propose future directions for research and practice.
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The association between estradiol levels, hormonal contraceptive use, and responsiveness to One-Session-Treatment for spider phobia in women
Psychoneuroendocrinology, 2018Co-Authors: Bronwyn M. Graham, Melissa J. Black, Lars-göran ÖstAbstract:Preclinical studies have demonstrated that conditioned fear extinction is impaired in females with low endogenous levels of the sex hormone estradiol, due to menstrual fluctuations or hormonal contraceptive use. As fear extinction is a laboratory model of exposure therapy for anxiety and trauma disorders, here we assessed the hypothesis that Treatment outcomes may be diminished when exposure therapy occurs during periods of low estradiol. 90 women with spider phobia (60 cycling and 30 using hormonal contraceptives) underwent a One-Session exposure Treatment for spider phobia, following which, serum estradiol levels were assessed. A median split in estradiol level was used to divide cycling participants into two groups; lower and higher estradiol. Behavioral avoidance and self-reported fear of spiders were measured pre-Treatment, post-Treatment, and at a 12 week follow-up assessment. Women using hormonal contraceptives exhibited a significantly slower rate of improvement across Treatment, greater behavioral avoidance at post-Treatment and follow-up, and fewer self-initiated post-Treatment exposure tasks, relative to both groups of cycling women, who did not differ. No group differences in self-reported fear were evident. Correlational analyses revealed that across the whole sample, lower estradiol levels were associated with slower rates of improvement across Treatment, and greater self-reported fear and behavioral avoidance at post-Treatment, but not follow-up. These results provide the first evidence of an association between endogenous estradiol, hormonal contraceptive use, and exposure therapy outcomes in spider phobic women. Hormonal profile may partly account for variability in responsiveness to psychological Treatments for anxiety and trauma disorders in women.
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The mediating role of changes in harm beliefs and coping efficacy in youth with specific phobias.
Behaviour research and therapy, 2017Co-Authors: Thomas H. Ollendick, Sarah M. Ryan, Nicole N. Capriola-hall, Lena Reuterskiöld, Lars-göran ÖstAbstract:Individuals with specific phobias (SPs) often experience catastrophic cognitions and compromised efficacy regarding their ability to cope when in the presence of the phobic object/situation. In the current study, 165 children (7-16 years; 62% male) received either One Session Treatment or Educational Support Therapy for their SP. The children identified their feared belief and rated "how bad" it was, "how likely" it was to occur, and their ability to cope if it did occur. All of these ratings were reduced from pre-Treatment to 6-month follow-up, across both Treatment conditions. However, ratings of "how bad" and "how likely" reduced to a significantly greater degree for children who received OST. Greater change in each of the three beliefs predicted lower clinician severity ratings (CSRs) at post-Treatment and 6-month follow-up. Additionally, changes in "how bad" and "how likely" the children rated their beliefs, and their reported ability to cope, partially mediated the relationship between Treatment and post-Treatment and follow-up CSRs. Overall, these findings suggest that although both Treatment conditions produced changes in harm beliefs and coping efficacy, OST elicited greater changes and these changes may be important mechanisms in reduction of SP clinical severity.
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Harm beliefs and coping expectancies in youth with specific phobias
Behaviour research and therapy, 2017Co-Authors: Thomas H. Ollendick, Sarah M. Ryan, Lars-göran Öst, Nicole N. Capriola, Lena ReuterskiöldAbstract:Catastrophic beliefs and lowered coping expectancies are often present in individuals with specific phobias (SPs). The current study examined these beliefs and expectancies in 251 youth who received One Session Treatment for one of the three most common types of SP in youth (animals, natural environment, and situational). We compared the children's subjective beliefs to objective ratings of the likelihood of occurrence and the dangerousness of the feared events. Results revealed pre-Treatment differences in the youths' beliefs across phobia types and age. Specifically, children with animal phobias rated their beliefs as more likely to occur than did children with environmental and situational phobias. In addition, older children rated their beliefs as more dangerous than younger children. However, regardless of phobia type or child age, the beliefs improved following Treatment. Changes in catastrophic beliefs and coping expectancies were related to changes in clinical severity following Treatment but not 6-months following Treatment. Moreover, at pre-Treatment, children viewed their beliefs as significantly more catastrophic and likely to occur than did independent coders of these beliefs; however, these differences were no longer evident following Treatment. Clinical implications are discussed, highlighting how changes in beliefs and expectancies might be associated with Treatment outcomes.
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Real World Applications of One-Session Treatment
Intensive One-Session Treatment of Specific Phobias, 2012Co-Authors: Lena Reuterskiöld, Lars-göran ÖstAbstract:Randomized Clinical Trials (RCTs) using cognitive-behavioral therapy (CBT) and specifically One-Session Treatment (OST) for the Treatment of a broad spectrum of specific phobias have been conducted in both adult and child samples, and across countries. Furthermore, in clinical practice, OST has been extended to include even more unusual phobias such as fish, mushrooms, knees, and ET (the Extra-Terrestrial movie character) with equally good Treatment effects overall. Despite these positive outcomes the dissemination of OST in the real world has not been as evident. There are several explanations for why clinicians might not choose OST for patients presenting with various specific phobias. They may experience problems regarding: 1. Finding appropriate materials and a variety of stimuli for exposure and behavioral tests (e.g., dogs, snakes, bees, spiders, snails, elevators, enclosed places, costumed characters). 2. How to store animals and insects appropriately to keep them healthy and fresh for exposure work. 3. Assisted exposure (e.g., finding and engaging dog handlers, snake owners, etc.), cost, and time. 4. Exposure outside of the clinic: ethical issues and insurance coverage. 5. Reimbursement for the OST format (up to 3 hour instead of the 1 hours/week format).
Lara J Farrell - One of the best experts on this subject based on the ideXlab platform.
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virtual reality one session Treatment of child specific phobia of dogs a controlled multiple baseline case series
Behavior Therapy, 2020Co-Authors: Lara J Farrell, Kirra A. Krisch, Allison M Waters, Taka Miyamoto, Caroline L Donovan, Thomas H. OllendickAbstract:Abstract Specific phobia (SP) typically onsets in childhood and frequently predicts other mental health disorders later in life. Fortunately, childhood SP can be effectively treated with cognitive behavior therapy (CBT), including the exposure-based One-Session Treatment (OST) approach. Despite empirical support for CBT and OST, clinicians, for various reasons, frequently fail to implement exposure-based therapy in routine clinical practice, including perceived difficulties in implementing exposure. Virtual reality (VR) exposure therapy may overcome some of these challenges and provides an alternative modality of therapy. This preliminary study examined the efficacy of VR OST for 8 children with a SP of dogs (aged 8–12 years) (M = age 10.25; SD = 2.11) using a multiple-baseline controlled case series. Following a stable baseline period of either 2, 3, or 4 weeks, it was expected that specific phobia severity would significantly decline after VR OST and remain improved over the 3-week maintenance phase. Assessments were conducted postTreatment and at 1-month follow up (study end-point). It was found that phobia symptoms remained relatively stable across the baselines, with significant reductions from preTreatment to postTreatment and to follow-up on clinician severity ratings (pre- to post- g = 1.12; pre- to follow-up g = 2.40), target symptom ratings (g = 1.14; 1.29), and behavioral avoidance (g = -1.27; -1.96). The Treatment was also associated with clinically significant outcomes, whereby at one-month follow up, 75% of children were considered “recovered” and 88% completed the BAT (interacted with their feared stimuli). This study provides support for the effectiveness of VR OST.
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D-cycloserine-augmented One-Session Treatment of specific phobias in children and adolescents.
Brain and behavior, 2018Co-Authors: Lara J Farrell, Allison M Waters, Ella L Oar, Evelin Tiralongo, Vinay Garbharran, Clair Alston-knox, Harry Mcconnell, Nigel Collings, Melanie J. Zimmer-gembeck, Caroline L DonovanAbstract:Background: D‐Cycloserine has potential to enhance exposure therapy outcomes. The current study presents a preliminary randomized, placebo‐controlled double‐blind pilot trial of DCS‐augmented one‐session Treatment (OST) for youth (7–14 years) with specific phobia. A secondary aim of this pilot study was to explore the effects of youth age and within‐session fear reduction as potential moderators of DCS outcomes in order to generate hypotheses for a larger trial. It was hypothesized that DCS would be associated with greater improvements than placebo, that children (7–10 years) would have greater benefits than adolescents (11–14 years), and that DCS effects would be stronger for participants with the greater within‐session fear reduction during the OST. Methods: Thirty‐five children and adolescents were randomized to either OST combined with DCS (n = 17), or OST combined with placebo (PBO; n = 18) and assessed at 1 week, 1 month, and 3 month following Treatment. Results: There were no significant pre‐ to post‐Treatment or follow‐up benefits of DCS relative to placebo. Secondary analyses of age indicated that relative to PBO, DCS was associated with greater improvements for children (but not adolescents) on measures of severity at 1‐month follow‐up. Children in the DCS condition also showed significantly greater improvement to 1 month on global functioning relative to other groups. Conversely, adolescents had significant post‐Treatment benefits in the PBO condition on symptom severity measures relative to DCS, and adolescents in the DCS condition had significantly poorer functioning at 3 months relative to all other groups. Finally, there was a trend for within‐session fear reduction to be associated with moderating effects of DCS, whereby greater reduction in fear was associated with greater functioning at one‐month follow‐up for children who received DCS, relative to PBO. Limitations: The study sample was small and therefore conclusions are tentative and require replication. Conclusions: Age and within‐session fear reduction may be important moderators of DCS‐augmented one‐session exposure therapy, which requires testing in a fully powered randomized controlled trial.
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Play-Modified One-Session Treatment for Young Children with a Specific Phobia of Dogs: A Multiple Baseline Case Series
Child Psychiatry & Human Development, 2018Co-Authors: Lara J Farrell, Helen Kershaw, Thomas OllendickAbstract:The One-Session Treatment (OST) approach for SPs is deemed well-established, and has been found to be highly effective for older children and adults; however, has not yet been trialled with very young children. The present study examines the preliminary effectiveness of play-modified OST for young children with a SP of dogs, using a multiple baseline controlled case series design. Treatment involved play modified One-Session of intensive cognitive-behavioural therapy (OST plus Play) which was followed by brief telephone delivered maintenance calls over the 3 weeks immediately following Treatment. Four young children (4 years of age) participated and symptoms were assessed at pre-Treatment, across a 1–3 week baseline phase, immediately following the OST plus Play, and at 1 and 3 months follow-up. Visual inspection provided evidence for stability of symptoms across the baseline phase, followed by reductions in symptoms over the course of Treatment and follow-up. Non-parametric analyses offered further support, with significant improvements in following the intensive OST plus Play intervention.
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Patterns of Response and Remission Following a One-Session Treatment for Blood-Injection-Injury Phobia in Youth
Child & Family Behavior Therapy, 2017Co-Authors: Ella L Oar, Allison M Waters, Lara J Farrell, Elizabeth Gwendolyne Conlon, Thomas H. OllendickAbstract:Blood-Injection-Injury (BII) Phobia is a severe and impairing disorder that has been understudied in youth. The present study aimed to define patterns of response and remission following a modified One-Session Treatment (OST) including an e-therapy maintenance program for children and adolescents with BII Phobia. Moreover, characteristics of different responder groups were examined in order to determine correlates of a poorer response. Youth (n = 20; 8–18 years) were categorized into four responder groups (e.g., immediate remitter, delayed remitter, partial responder, and nonresponder) based upon defined criteria for remission. Immediate remitters to Treatment were more likely to have a primary diagnosis of injection phobia, rather than a combined blood and injection phobia. Nonresponders reported significantly greater disgust sensitivity at preTreatment and were more likely to have a comorbid diagnosis of Social Phobia. In regards to within session change, youth who achieved the exposure goal of having a blood test during Treatment had a significantly stronger Treatment response. These preliminary findings may assist clinicians in the planning and delivering of intensive Cognitive Behavioral Treatment (CBT) approaches for BII Phobia in youth.Griffith Health, School of Applied PsychologyNo Full Tex
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Cognitive Behavioral Therapy in a One-Session Treatment for a Preschooler With Specific Phobias.
Journal of cognitive psychotherapy, 2017Co-Authors: Helen Kershaw, Caroline L Donovan, Lara J Farrell, Thomas H. OllendickAbstract:Anxiety disorders among preschool-aged children are as prevalent as in older children, yet younger children are even less likely to receive Treatment for these frequently impairing childhood disorders (Egger & Angold, 2006). Specific phobias (SPs) are often the earliest form of anxiety to onset, affect 2.3% of preschoolers (Egger & Angold, 2006), and tend to be stable from 3 years of age to at least 6 years of age (Bufferd, Dougherty, Carlson, Rose, & Klein, 2012). Recently, our group developed and piloted a modified intensive One-Session Treatment (OST) incorporating play therapy for preschoolers with SP (Farrell, Kershaw, & Ollendick, in press). Given that highly fearful young children may find concentrated, rapid exposure therapy highly confronting, we integrated play therapy into the commencement of this Treatment to (a) assist with rapid rapport building with the therapist and (b) enhance the child's motivation through engaging them with play. An initial, controlled, baseline case series (N = 4) provided preliminary evidence of the feasibility, acceptability, and effectiveness of this innovative One-Session (3 hours) therapy-POP! Pre-schoolers Overcoming Phobias (POP; Farrell et al., in press). The approach combines child-centered, nondirective play therapy (during Hour 1) and empirically supported OST (during Hours 2 and 3), with 4-year-old preschool children with clinical SPs of dogs. This article presents a case description of POP, describing the assessment approach, cognitive-behavioral case formulation, and intensive Treatment of a 4-year-old girl who presented with a severe SP of dogs, along with various other comorbid SPs.
Jürgen Margraf - One of the best experts on this subject based on the ideXlab platform.
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Large-group One-Session Treatment: Feasibility and efficacy in 138 individuals with phobic fear of flying.
Behaviour research and therapy, 2020Co-Authors: André Wannemueller, Svenja Schaumburg, Sally Tavenrath, Alina Bellmann, Katharina Ebel, Tobias Teismann, Sören Friedrich, Jürgen MargrafAbstract:Recent research suggests that exposure-based large-group One-Session Treatments (LG-OSTs) may represent useful and efficient Treatment options for different types of phobic fear. Although there are effective single session- and small group-interventions for the Treatment of clinically relevant Fear of Flying (FoF), no LG-OST for this type of phobic fear has been realized so far. The present study aimed to investigate feasibility and efficacy of an LG-OST for the Treatment of clinically relevant FoF. Two months after an initial diagnostics to assess FoF severity and confirm the underlying diagnoses (89% specific flight phobia; 10% agoraphobia), 138 patients attended the LG-OST consisting of psychoeducation, imparting of a breathing technique and a joint 2 ½ hour exposure flight in a chartered airplane (Airbus A320). FoF again was assessed at pre- and post-Treatment as well as at 6-months follow-up with the latter again containing clinical diagnostics. Only a small decrease in FoF emerged in the pre-Treatment interval. From pre-to post-Treatment however, substantial reductions in FoF were observed with a large mean 'intention-to-treat' effect size of Cohen's d = 1.42 that remained stable over time (mean d = 1.44). At follow-up, 71% of the patients were rated as fully (55%) or partially remitted (16%). Also concerning the Treatment of clinically relevant FoF, a LG-OST proved feasible and effective. Therefore, LG-OST can be regarded as a highly efficient and promising Treatment tool which in terms of efficiency combines the advantages of One-Session individual and group Treatments.
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Large-Group One-Session Treatment: Feasibility in Highly Height Fearful Individuals and Predictors of Outcome
Frontiers in psychology, 2019Co-Authors: André Wannemueller, Piotr Gruszka, Sarah Chwalek, Sonja Fröhlich, Miriam Mulders, Svenja Schaumburg, Johanna Schöttes, Sonja Wiederhold, Jürgen MargrafAbstract:Objective Exposure based large-group One-Session Treatments (LG-OSTs) proved feasible in different situational fears and showed promising short- and long-term outcomes. Based on prior LG-OST protocols we explored feasibility and effectiveness of an LG-OST protocol in four cohorts of individuals highly fearful of heights (N = 104). Moreover, we aimed to identify predictors of LG-OST outcome in order to provide individualized Treatment recommendations in the future. Methods Participants' fear of heights was assessed at pre- and post-Treatment as well as at 5 months follow-up using questionnaires and a behavioral approach test (BAT). Pre-Treatment indices of negative emotional traits and positive mental health, the extent by which fear-evoking expectancies were violated during exposure, and post-Treatment group perception processes were assessed in order to predict the outcome. Results The LG-OST procedure proved feasible and effective in terms of both subjective and behavioral fear of heights. Post-Treatment effects sizes of questionnaires assessing fear of heights ranged between d = 0.94 - 1.43. After the Treatment, about half of the participants (49.5%) were able to ascend an aerial fire ladder up to a maximum of 30 m (vs. pre-Treatment 17.3%). Follow up results showed the long-term stability of effects. Among psychological constructs, positive mental health and expectancy violation were the strongest predictors of LG-OST long-term outcome. Conclusion We conclude that exposure based LG-OSTs are feasible, effective and very efficient compared to individual face-to-face settings. Thus, they represent very promising Treatment alternatives for situational fears including fear of heights. Moreover, clinical research may benefit from LG-OST protocols as its high standardization may facilitate the search for mediators and moderators of exposure outcomes.
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Large-Group One-Session Treatment: A Feasibility Study of Exposure Combined With Applied Tension or Diaphragmatic Breathing in Highly Blood-Injury-Injection Fearful Individuals.
Frontiers in psychology, 2018Co-Authors: André Wannemueller, Svenja Schaumburg, Alessa Fasbender, Zarah Kampmann, Kristin Weiser, Julia Velten, Jürgen MargrafAbstract:Objective: Large-group One-Session Treatments (LG-OSTs) might represent a promising Treatment tool as increasing evidence suggests their effectiveness in individuals with different situational fears. In the present study, we explored feasibility and effectiveness of an exposure-based LG-OST protocol applying applied tension and diaphragmatic breathing as coping strategies in a sample of 40 individuals, highly fearful of blood-injury-injection (BII). Method: We assessed participants' BII-fear using questionnaires and a behavioral approach test (BAT) before and after Treatment, consisting of a blood-drawing procedure. Stability of Treatment effects was assessed via online-survey at 7-month follow-up. Results: The LG-OST procedure evidenced feasible and effective. Pre-post Treatment comparisons showed medium to large Treatment effects (d = 0.40-0.93) regarding the questionnaire measures. After being treated, 70% of the individuals successfully underwent a blood drawing. Moreover, participants continued to improve in the post follow-up interval leading to large Treatment effects (d = 1.19-1.62). Conclusion: In treating BII-fear, LG-OSTs might not only serve within a framework of a stepped care approach but also could represent a useful single-Treatment option. Additionally, due to their high efficiency and standardization of Treatment delivery, LG-OST protocols might foster research at the interface of basic and clinical research.
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Mechanisms, genes and Treatment: Experimental fear conditioning, the serotonin transporter gene, and the outcome of a highly standardized exposure-based fear Treatment.
Behaviour research and therapy, 2018Co-Authors: André Wannemueller, Dirk Adolph, Hans-peter Jöhren, Dirk Moser, Robert Kumsta, Jürgen MargrafAbstract:Abstract There is considerable interindividual variation in response to psychotherapeutical intervention. In order to realize the long-term goal of personalised Treatment approaches, it is important to identify behavioural and biological moderators and mediators of Treatment responses. Here, we tested the predictive value of experimental fear extinction efficacy as well as the role of genetic variation of the serotonin transporter gene for the outcome of a fear-exposure Treatment. A discriminative fear conditioning paradigm was conducted in 159 adults highly fearful of spiders, dental surgeries or blood, injuries and injections. Participants were genotyped for the long (L) and short (S) allelic variant of the serotonin transporter gene linked polymorphic region (5HTTLPR) and treated with a highly standardized exposure-based One-Session Treatment. Participants' subjective fear was assessed during experimental fear conditioning and extinction. Furthermore, subjective phobic fear was assessed at pre-, post and at 7 months follow-up Treatment assessment. A threat-biased contingency learning pattern characterized by exaggerated fear responses to the CS− was associated with larger initial subjective fear reduction immediately following the large-group Treatment, p = .03. There were no learning pattern-associated differences in subjective fear at 7-month follow-up. The odds of homozygous s-allele carriers to display a threat-biased contingency learning pattern were 3.85 times larger compared to l-allele carriers, p = .01. Fear-recovery in homozygous S-allele carriers at follow-up assessment, p = .01, emerged regardless of the experimental fear acquisition pattern. Our results suggest the homozygous S-allele carriers are biologically biased towards ignoring safety signals in threat-related situations. Short-term, this response pattern might be positively related to the outcome of exposure Treatments, potentially due to increased responding to safe context conditions or a stronger violation of threat expectancies. However, alterations in inhibiting the response to cues formerly signalling threat evidenced for S-allele carriers can have negative impact on exposure success.
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Large Group Exposure Treatment: A Feasibility Study of Exposure Combined with Diaphragmatic Breathing in Highly Dental Fearful Individuals.
Frontiers in psychology, 2017Co-Authors: André Wannemueller, Hans-peter Jöhren, Alina Borgstädt, Jessica Bosch, Milena Meyers, Miriam Völse, Saskia Scholten, Jürgen MargrafAbstract:A large-group one session Treatment (LG-OST) combining exposure and diaphragmatic breathing as a bodily coping element was carried out to investigate its feasibility and effectiveness in a sample of 43 highly dental fearful individuals treated simultaneously. We assessed subjective dental fear, dysfunctional dental-related beliefs, and perceived control pre- and post-intervention and at four-month follow-up. Participants additionally performed a behavioural approach test (BAT) pre- and post-intervention. During the applied exposure exercises, four participants (9.3%) discontinued the program all reporting too high levels of distress. Regarding subjective dental fear and dysfunctional dental related beliefs post Treatment effects, LG-OST showed medium to large effect sizes, ranging from Cohen's d = 0.51 to d = 0.84 in the Intention-to-Treat analysis. Subjective dental fear improved clinically significantly in about one fourth (25.6%) of therapy completers. All post-Treatment effects remained stable over time. Concerning the behavioral fear dimension, we observed a strong ceiling effect. Already at pre-assessment, participants accomplished more than six out of seven BAT-steps. Thus, behavioral approach did not increase significantly following Treatment. Overall, the LG-OST protocol proved feasible and efficient. Compared to other One-Session individual and multi-session group Treatments the observed LG-OST effects were smaller. However, if LG-OST could match the efficacy of highly intensive short Treatments delivered in an individual setting in the future, for example, by applying a wider array of exposure exercises, it could be a very useful Treatment option as an intermediate step within a stepped care approach.
