One-session Treatment for Spider Fears
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/17/2018 |
| Start Date: | January 20, 2018 |
| End Date: | January 2020 |
Despite the efficacy of exposure and response prevention (ERP) for anxiety and phobias,
recent theoretical research on fear extinction via inhibitory learning suggests that
cognitive restructuring (CR)--the explicit challenging of maladaptive beliefs (e.g,.
overestimation of threat)--may actually attenuate exposure outcomes during an exposure trial.
That is, by verbally disputing certain beliefs (e.g., "the spider will jump on me and attack
me and I will faint from the anxiety") before an exposure task (e.g., gradually approaching a
non-venomous spider), anxious individuals may experience less "surprise" from the
non-occurrence of feared outcomes, and consequently experience less inhibitory learning
(e.g., learning that spiders are not inherently dangerous). Thus, the investigators aim to
empirically test the conventional (yet recently challenged) assumption that cognitive
restructuring is a necessary component for psychosocial interventions for phobias.
90 participants recruited from the Psychology Department Participant Pool and the community
will participate in this study. All participants will meet DSM-5 criteria for spider phobia.
Following consent, participants will complete a pre-test assessment of various aspects of
spider phobia. Participants will then receive education about the nature of anxiety/spider
phobia and be randomly assigned to one of three 45-min intervention conditions: (a) CR before
EXP, (b) EXP before CR, and (c) stress management (a control condition that involves neither
CR nor EXP). Following the intervention, participants will complete a 10-minute post-test
assessment and be scheduled to return for a follow-up assessment a month later.
recent theoretical research on fear extinction via inhibitory learning suggests that
cognitive restructuring (CR)--the explicit challenging of maladaptive beliefs (e.g,.
overestimation of threat)--may actually attenuate exposure outcomes during an exposure trial.
That is, by verbally disputing certain beliefs (e.g., "the spider will jump on me and attack
me and I will faint from the anxiety") before an exposure task (e.g., gradually approaching a
non-venomous spider), anxious individuals may experience less "surprise" from the
non-occurrence of feared outcomes, and consequently experience less inhibitory learning
(e.g., learning that spiders are not inherently dangerous). Thus, the investigators aim to
empirically test the conventional (yet recently challenged) assumption that cognitive
restructuring is a necessary component for psychosocial interventions for phobias.
90 participants recruited from the Psychology Department Participant Pool and the community
will participate in this study. All participants will meet DSM-5 criteria for spider phobia.
Following consent, participants will complete a pre-test assessment of various aspects of
spider phobia. Participants will then receive education about the nature of anxiety/spider
phobia and be randomly assigned to one of three 45-min intervention conditions: (a) CR before
EXP, (b) EXP before CR, and (c) stress management (a control condition that involves neither
CR nor EXP). Following the intervention, participants will complete a 10-minute post-test
assessment and be scheduled to return for a follow-up assessment a month later.
Recent conceptualizations of the mechanisms by which exposure therapy (EXP; i.e., confronting
one's fear in a systematic and therapeutic way) works in the treatment of phobias focus on
the importance of extinction learning). This "inhibitory learning model" proposes that EXP
helps the phobic individual learn that phobic stimuli are not dangerous; yet older
danger-related learning is not "erased", and so must be inhibited by the new "safety
learning." Research indicates that incorporating surprise into EXP (e.g., the patient is
surprised that the spider didn't bite) maximizes this type of inhibitory learning and would
correspond to better outcomes for phobias then when there is no surprise at the outcome of
EXP.
Traditionally, EXP is used with the addition of cognitive restructuring (CR), which involves
discussing and disputing exaggerated beliefs that underlie one's fears (e.g., "spiders are
very dangerous"). CR encourages phobic individuals to re-evaluate their expectations of
danger when encountering phobic stimuli, and therefore might rob the individual of the
opportunity to be surprised when actually facing their fear.
Despite the theoretical plausibility of the importance of surprise during EXP, this question
has yet to be investigated empirically. The aim of the present study is to test the
hypothesis that incorporating surprise into EXP (by postponing CR until after EXP) will
enhance immediate and long-term outcome of EXP for spider phobia.
one's fear in a systematic and therapeutic way) works in the treatment of phobias focus on
the importance of extinction learning). This "inhibitory learning model" proposes that EXP
helps the phobic individual learn that phobic stimuli are not dangerous; yet older
danger-related learning is not "erased", and so must be inhibited by the new "safety
learning." Research indicates that incorporating surprise into EXP (e.g., the patient is
surprised that the spider didn't bite) maximizes this type of inhibitory learning and would
correspond to better outcomes for phobias then when there is no surprise at the outcome of
EXP.
Traditionally, EXP is used with the addition of cognitive restructuring (CR), which involves
discussing and disputing exaggerated beliefs that underlie one's fears (e.g., "spiders are
very dangerous"). CR encourages phobic individuals to re-evaluate their expectations of
danger when encountering phobic stimuli, and therefore might rob the individual of the
opportunity to be surprised when actually facing their fear.
Despite the theoretical plausibility of the importance of surprise during EXP, this question
has yet to be investigated empirically. The aim of the present study is to test the
hypothesis that incorporating surprise into EXP (by postponing CR until after EXP) will
enhance immediate and long-term outcome of EXP for spider phobia.
Inclusion Criteria:
- Participants must
1. be 18 years or older,
2. be fluent in English, and
3. meet DSM-5 criteria for specific (spider) phobia to be considered eligible
Exclusion Criteria:
- Participants will be deemed ineligible if they do not meet the above inclusion
criteria or
1. are allergic to spiders or bee stings,
2. are experiencing current psychosis, mania, or substance abuse, or
3. successfully complete 10 of 13 possible BAT steps in the pretreatment appointment
(to ensure that participants are indeed spider phobic at pretreatment).
We found this trial at
1
site
Chapel Hill, North Carolina 27599
(919) 962-2211
Phone: 919-843-7264
University of North Carolina at Chapel Hill Carolina’s vibrant people and programs attest to the...
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