Psychological approaches in the treatment of specific phobias: A meta-analysis

Wolitzky-Taylor, Kate B.; Horowitz, Jonathan D.; Powers, Mark B.; Telch, Michael J.

doi:10.1016/j.cpr.2008.02.007

Cited by 531Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and ApplicationsPsychological Treatments and Assessments

Psychological approaches in the treatment of specific phobias: A meta-analysis

Wolitzky-Taylor, Kate B., Horowitz, Jonathan D., Powers, Mark B., Telch, Michael J.·2008·Clinical Psychology Review

DOI 10.1016/j.cpr.2008.02.007

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Abstract

Data from 33 randomized treatment studies were subjected to a meta-analysis to address questions surrounding the efficacy of psychological approaches in the treatment of specific phobia. As expected, exposure-based treatment produced large effects sizes relative to no treatment. They also outperformed placebo conditions and alternative active psychotherapeutic approaches. Treatments involving in vivo contact with the phobic target also outperformed alternative modes of exposure (e.g., imaginal exposure, virtual reality, etc.) at post-treatment but not at follow-up. Placebo treatments were significantly more effective than no treatment suggesting that specific phobia sufferers are moderately responsive to placebo interventions. Multi-session treatments marginally outperformed single-session treatments on domain-specific questionnaire measures of phobic dysfunction, and moderator analyses revealed that more sessions predicted more favorable outcomes. Contrary to expectation, effect sizes for the major comparisons of interest were not moderated by type of specific phobia. These findings provide the first quantitative summary evidence supporting the superiority of exposure-based treatments over alternative treatment approaches for those presenting with specific phobia. Recommendations for future research are also discussed.

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Studies indicate that in vivo exposure is the core therapeutic mechanism.
“Studies indicate that in vivo exposure is the core therapeutic mechanism (57, 59–61).”
From Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report (2022) · cites this paper as [61]
Exposure therapy is the single most effective treatment for all specific phobias and multiple therapy sessions are highly effective in terms of sustained improvement.
“Still, the core of these findings aligns with the fact, that exposure therapy is the single most effective treatment for all specific phobias and that multiple therapy sessions are highly effective in terms of sustained improvement (61).”
From Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report (2022) · cites this paper as [61]
Longer therapy session regimens seem to generate more favorable outcomes compared to shorter ones, with sustained exposure appearing to be the key factor of long-term treatment success.
“Also, longer therapy session regimens seem to generate more favorable outcomes compared to shorter ones, with sustained exposure appearing to be the key factor of long-term treatment success (57, 61).”
From Combined Fainting and Psychogenic Non-epileptic Seizures as Significant Therapy Hurdles in Blood-Injury-Injection Phobia: A Mini-Review and Case Report (2022) · cites this paper as [61]
In vivo exposure is the treatment of choice for specific phobia and the most effective intervention for this disorder.
“In vivo exposure is the treatment of choice for SP, and it has been established as the most effective intervention for this disorder (Choy et al., 2007; Wolitzky-Taylor et al., 2008).”
From An internet-based treatment for flying phobia using 360° images: A feasibility pilot study (2022) · cites this paper as Wolitzky-Taylor et al., 2008
In vivo exposure is the most effective intervention for specific phobias.
“Research establishes that in vivo exposure is the most effective intervention for specific phobias (Choy et al., 2007; Wolitzky-Taylor et al., 2008).”
From An Internet-based treatment for Flying Phobia using 360° images: Study protocol for a feasibility pilot study (2021) · cites this paper as Wolitzky-Taylor et al., 2008

Meta-analyses have demonstrated the efficacy of psychological treatments in group and individual formats in patients with panic disorder, specific phobia, SAD, OCD, GAD, or PTSD.
“Meta-analyses have demonstrated the efficacy of psychological treatments in group and individual formats in patients with panic disorder [54-56], specific phobia [57], SAD [58,59], OCD [60-63], GAD [55,64,65], or PTSD [66-69]”
From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [57]
A greater number of sessions predicted more favorable outcomes in a meta-analysis of specific phobia treatment.
“While one-session treatments have demonstrated efficacy [313], a meta-analysis found that a greater number of sessions predicted more favorable outcomes [57].”
From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [57]
In vivo exposure is superior to alternative types at posttreatment but not at follow-up for specific phobias.
“Both in vivo exposure and virtual reality exposure (VRE) can be effective [57,311,312], with in vivo exposure being shown to be superior to alternative types (e.g., imaginal, virtual reality, etc.) at posttreatment but not at follow-up [57].”
From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [57]
Both in vivo exposure and virtual reality exposure can be effective for specific phobias.
“Both in vivo exposure and virtual reality exposure (VRE) can be effective [57,311,312], with in vivo exposure being shown to be superior to alternative types (e.g., imaginal, virtual reality, etc.) at posttreatment but not at follow-up [57].”
From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [57]
A meta-analysis of 33 RCTs found that treatment outcomes were not moderated by type of specific phobia.
“While a meta-analysis of 33 RCTs of psychological approaches found that treatment outcomes were not moderated by type of specific phobia [57], studies have suggested that certain subtypes may respond more favorably to specific types of treatment (Table 18).”
From Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) · cites this paper as [57]
The effect size of chatbots on acrophobia in RCT [38] was 2.0, substantially higher than the total effect size of therapist-assisted exposure treatment on phobias (1.1) reported by a meta-analysis [46].
“The effect size of chatbots on acrophobia in this RCT [38] was substantially higher than the total effect size of therapist-assisted exposure treatment on phobias reported by a meta-analysis (2.0 versus 1.1) [46].”
From Effectiveness and safety of using chatbots to improve mental health: systematic review and meta-analysis (2020) · cites this paper as [46]
The automated VR treatment produced effect sizes (d=2·0) that greatly exceeded the mean effect size reduction in phobias with therapist-assisted exposure treatment using real heights (d=1·1).
“Findings of a meta-analysis indicated a mean effect size reduction in phobias with therapist-assisted exposure treatment (using real heights) of d=1·1;19 our automated VR treatment produced effect sizes that greatly exceeded this value (d=2·0).”
From Automated psychological therapy using immersive virtual reality for treatment of fear of heights: A single-blind, parallel-group, randomised controlled trial (2018) · cites this paper as [19]

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Augmenting In Vivo Exposure With Fear Antagonistic Actions: A Preliminary Test⁎⁎We would like to thank David Seivers and Mind Alive, Inc., for supplying the D.A.V.I.D. devices used to conduct the APS treatment and to Melody Otto, Heather Zapalac, Andrea Cubriel, Brian Coquyt, and Mealika Brown for their assistance with data collection.Portions of these data were previously presented at the 2004 annual meeting of the Association for the Advancement of Behavior Therapy.This research was conducted in partial fulfillment of the Masters of Arts in Psychology for the first author (KBW) under the supervision of the senior author (MJT).
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Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders
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BackgroundInfluential
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Background
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“7 %) [2].”
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“In addition, the data obtained support the meta-analysis carried out by [77], where in vivo exposure compared to other forms of SP treatment (including the use of VR) was superior at post-treatment, but not at the follow-ups.”
Result
Exposure therapy in eating disorders revisited
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Clinical Psychological Science
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Psychosoziales und Diabetes (Teil 1)
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Effects of Post-Session Administration of Methylene Blue on Fear Extinction and Contextual Memory in Adults With Claustrophobia
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Augmenting In Vivo Exposure With Fear Antagonistic Actions: A Preliminary Test⁎⁎We would like to thank David Seivers and Mind Alive, Inc., for supplying the D.A.V.I.D. devices used to conduct the APS treatment and to Melody Otto, Heather Zapalac, Andrea Cubriel, Brian Coquyt, and Mealika Brown for their assistance with data collection.Portions of these data were previously presented at the 2004 annual meeting of the Association for the Advancement of Behavior Therapy.This research was conducted in partial fulfillment of the Masters of Arts in Psychology for the first author (KBW) under the supervision of the senior author (MJT).
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Psychosoziales und Diabetes (Teil 2)
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Authors: Wolitzky-Taylor, K. B., Horowitz, J. D., Powers, M. B., & Telch, M. J.
Affiliations: The University of Texas at Austin (US)
Corresponding author: Telch, Michael J.
ORCID: Wolitzky-Taylor, Kate B.
Powers, Mark B.
Telch, Michael J.
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2008-07
Volume: 28
Issue: 6
Pages: 1021-1037
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2008.02.007
OpenAlex: W2003047492
Cited by: 530
References: 99
Citations by year: 2026: 30 · 2025: 48 · 2024: 22 · 2023: 33 · 2022: 35 · 2021: 50 · 2020: 38 · 2019: 26 · 2018: 38 · 2017: 42 · 2016: 21 · 2015: 26 · 2014: 27 · 2013: 26 · 2012: 25
FWCI: 1.63
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
UvA-DARE (University of Amsterdam) (submittedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
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, psychotherapy efficacy, placebo effect, in vivo exposure, imaginal exposure, virtual reality exposure, number of treatment sessions, single-session intervention
MeSH terms: Behavior Therapy, Humans, Phobic Disorders, Psychotherapy, Placebo Effect, Randomized Controlled Trials as Topic, Treatment Outcome

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Psychological approaches in the treatment of specific phobias: A meta-analysis

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