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Psychological approaches in the treatment of specific phobias: A meta-analysis
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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In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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 the citing paper
“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 the citing paper
“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
In the citing paper
“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]
In the citing paper
“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 the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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).”
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Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., Van Ameringen, M., & the Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and McGill University (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-s1-s1 · Cited by 1,090
“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).”
BackgroundInfluentialBaldwin, D. S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den Boer, J. A., Christmas, D. M., Davies, S., Fineberg, N., Lidbetter, N., et al. (2014) · Journal of Psychopharmacology · doi:10.1177/0269881114525674 · Cited by 676
Anxiety sensitivity and the anxiety disorders: A meta-analytic review and synthesis.
Olatunji, B. O., & Wolitzky-Taylor, K. B. (2009) · Psychological Bulletin · doi:10.1037/a0017428 · Cited by 609
Self-citationCognitive-behavioral therapy for anxiety disorders: An update on the empirical evidence
Kaczkurkin, A. N., & Foa, E. B. (2015) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2015.17.3/akaczkurkin · Cited by 523
Abd-Alrazaq, A. A., Rababeh, A., Alajlani, M., Bewick, B. M., & Househ, M. (2020) · Journal of Medical Internet Research · doi:10.2196/16021 · Cited by 503
“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].”
Influential
Metadata
- 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.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2008-07
- Volume
- 28
- Issue
- 6
- Pages
- 1021-1037
- ISSN
- 0272-7358 (ISSN-L)
- 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
- 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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