The relative efficacy and efficiency of single- and multi-session exposure therapies for specific phobia: A meta-analysis
Abstract
Exposure therapy is the preferred treatment for specific phobia (SP), with evidence supporting its efficacy whether delivered over multiple sessions or as a single session, such as One-Session Treatment. In this meta-analysis, we compared the efficiency and effectiveness of single- and multi-session exposure for SP. PsycINFO, Embase, MEDLINE, and Cochrane were systematically searched for peer-reviewed articles reporting the effects of multi-session (k = 30) and/or single-session (k = 55) in vivo exposure on SP symptoms in clinical populations (n = 1758 participants). A random-effects model was used to synthesise and compare the pre-post treatment effects (Hedges' g) on approach behaviour and self-reported SP symptoms. Mean total treatment time was significantly longer for multi-session exposure than for single-session. There were no significant differences in the pooled effect sizes of single-session and multi-session exposure at post-treatment and follow-up assessments; effect sizes were large for all outcomes. Phobia subtype significantly moderated the effect size for both treatment approaches, although the direction of association differed according to the outcome measures. Results suggest no evidence for differences in the effectiveness of single- and multi-session exposure, but single-session is more time efficient. These outcomes suggest that policies to facilitate access to single-session exposure would be beneficial.
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An a priori power analysis indicated that approximately N = 8 was needed for an effect size of 1.5 with alpha = .05 and power = 0.95 for the pre-to post-treatment analyses.
“Thus, with an alpha = .05and power = 0.95, the projected sample size needed for an effect size of 1.5 (GPower 3.1) is approximately N = 8 for the pre-to post-treatment analyses in the present pilot.”
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- Authors
- Odgers, K., Kershaw, K. A., Li, S. H., & Graham, B. M.
- Affiliations
- UNSW Sydney (AU)
- Black Dog Institute (AU)
- Corresponding author
- Graham, Bronwyn M.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2022-12
- Volume
- 159
- Pages
- 104203
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W4306958874
- Cited by
- 35
- References
- 108
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 9 · 2023: 4
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of New South Wales
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- specific phobia, exposure therapy, single-session intervention, in vivo exposure, treatment efficacy, access to mental health care
- MeSH terms
- Humans, Implosive Therapy, Phobic Disorders, Outcome Assessment, Health Care
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