Table Of ContentAutism and Child Psychopathology Series
SeriesEditor
JohnnyL.Matson
DepartmentofPsychology,LouisianaStateUniversity,BatonRouge,LA,USA
Forothertitlespublishedinthisseries,goto
http://www.springer.com/series/8665
Thompson E. Davis III • Thomas H. Ollendick
Lars-Göran Öst
Editors
Intensive One-Session
Treatment of Specific
Phobias
2123
Editors
ThompsonE.DavisIII Lars-GöranÖst
DepartmentofPsychology DepartmentofPsychology
LouisianaStateUniversity StockholmUniversity
BatonRouge,LA Stockholm
USA Sweden
ThomasH.Ollendick
VirginiaTech
ChildStudyCenter
Blacksburg,VA
USA
ISBN978-1-4614-3252-4 ISBN978-1-4614-3253-1(eBook)
DOI10.1007/978-1-4614-3253-1
SpringerNewYorkDordrechtHeidelbergLondon
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Preface
Specific phobias are one of the most common mental health problems included in
theDiagnosticandStatisticalManualofMentalDisorders(DSM-IV-TR2000).Es-
timatessuggestthelifetimeprevalenceofspecificphobiamaybeashighas12.5%
(Kessleretal.2005).Whiletreatmentsforspecificphobiahaveexistedfordecades,
behaviorandcognitive-behavioraltherapies(CBT)havebecomethepreferredtreat-
mentsoverthelast20years.Oftheseinterventionsforspecificphobia,one-session
treatment (OST; Öst 1987, 1997) in particular has emerged as the intervention of
choicewhenworkingwithadults, adolescents, orchildrenwithanyofavarietyof
specific phobias. Moreover, OST has been highly recommended as the evidence-
basedtreatmentofchoicefortrainingbeginningnovicetherapistsortrainingthose
new to CBT by a past president of theAssociation for Behavioral and Cognitive
Therapies(ABCT;Albano2009). Thepurposeofthiseditedvolumeistosumma-
rizethecurrentinformationonspecificphobiasandontreatingthesedisorderswith
OST—anintensive,exposure-basedCBT.
OrganizationoftheBook
Ineditingandwritingthisbook,wehavetriedtocreateavolumethatwouldbeuseful
toclinicalandacademicprofessionalsalike.Thisbookisdesignedtobearesource
for both practitioners serving clients (as a treatment reference or manual) and for
researchersandeducators(asatrainingvolume).Asaresult,wehavechosentodivide
this volume into three broad parts. Each of the chapters can be read and reviewed
individuallytogainorrefreshinformationinaspecificarea,ortheentirevolumecan
bereviewedcollectivelytocovermanyofthetopicsimportanttoprovidingCBTfor
specificphobia.PartIfocusesonprovidingabroadbackgroundonspecificphobia
psychopathologyanditsassessmentandevidence-basedtreatmentinbothadultsand
children.Followingthisreview,PartIIprovidesanin-depthinstructiononpreparing
for,conducting,andevaluatingOST.Finally,PartIIIcoversavarietyoftopicsthat
maybeofinteresttothoseconductingexposuretherapyforspecificphobiasincluding
aguidetotrainingotherstoconductOST,ethicalissueswhenusingexposuretherapy,
v
vi Preface
providingtreatmenttothosewithintellectualand/ordevelopmentaldisabilities,the
currentevidencefortheuseofOST,andcurrentandfuturetechnologicaladvances
withexposuretherapies.
TheDevelopmentandHistoryofOST
Inthe1970s,behaviortherapistsweretreatingspecificphobiaslikeanyothertypeof
phobia(i.e.,with1-hourweeklysessionsforthenumberofweeksnecessary,usually
8–10ormore).Afterhavingundertakenacoupleofrandomizedclinicaltrials(RCTs)
onspiderandsnakephobiausingthislengthoftreatment,oneofus(Öst)decidedto
tryamoreintensiveapproach.Accordingly,heaskedapatientifshewouldliketobe
treatedduringoneprolongedsession,upto3continuoushoursduringamorningor
anafternoon.Thefirstpatient(havingspiderphobia)wasverypositiveandwanted
tohavetheOST,andthetreatmentwassuccessful,taking2.5hours.Thatexperience
encouragedÖsttocollectaclinicalseriesof20specificphobiapatients,whichtook
about4years,sincespecificphobicsrarelyappliedfortreatmentthosedays.When
thesepatientswerefollowed-up90%weremuchimprovedorcompletelyrecovered
(Öst1989). ÖstthendecidedthetimewasripeforatrueclinicaltrialontheOST
andthefirststudywascompletedincollaborationwithPaulSalkovskisinOxfordon
spiderphobia(Östetal.1991).SincethenÖstetal.havecarriedoutalargenumber
of RCTs on the treatment. However, an even larger number of RCTs have been
done by researchers in Norway, England, Holland, Belgium, Germany, Austria,
USA, Canada, andAustralia. They have achieved treatment effects on a par with
thoseintheearlierstudies.ThismeansthatOSTisatreatmentmethodthatcanbe
disseminatedtotherapistsinothercountriesandisnotdependentontheoriginatorin
ordertoachievegoodeffects—atruecharacteristicofanevidence-basedtreatment.
Evidence-BaseandSummary
Indeed,theevidence-baseforOSTisverystrong.Withmorethan20yearsofstudy
documentingtheefficacyofOSTwithadultsandchildren, itcomesasnosurprise
that the research has elevated OST to the ranks of “empirically-supported treat-
ment.”Impressivelytoo,thesetreatmenteffectsarelong-lasting—withmostpatients
maintainingimprovementsorcontinuingtoshowfurtherimprovementat1-yearand
greater follow-ups. Moreover, the treatment’s 3-hour format offers a unique and
timelybenefit:acost-effective,briefapproachtotreatingoneofthemostcommon
mentalhealthissues,specificphobia.
ThompsonE.DavisIII
ThomasH.Ollendick
Lars-GöranÖst
Preface vii
References
Albano,A.(2009).Commentary:Specialseries:Intensivecognitive-behavioraltreatmentsforchild
andadolescentanxietydisorders.CognitiveandBehavioralPractice,16,358–362.
AmericanPsychiatricAssociation(2000). Diagnosticandstatisticalmanualofmentaldisorders
(4thed.textrevision).Washington:AmericanPsychiatricAssociation
Kessler,R.C.,Berglund,P.,Demler,O.,Jin,R.,&Walters,E.E.(2005).Lifetimeprevalenceand
age-of-onsetdistributionsofDSM-IVdisordersintheNationalComorbiditySurveyReplication.
ArchivesofGeneralPsychiatry,62,593–602.
Öst, L.-G. (1987). One-session treatments for a case of multiple simple phobias. Scandinavian
JournalofBehaviorTherapy,16,175–184.
Öst,L-G.(1989).One-sessiontreatmentforspecificphobias.BehaviourResearchandTherapy,27
1–7.
Öst, L.-G. (1997). Rapid treatment of specific phobias. In G. C. L. Davey (Ed.), Phobias: A
handbookoftheory,research,andtreatment(pp.227–247).NewYork:Wiley.
Öst, L-G., Salkovskis, P., & Hellström, K. (1991). One-session therapist-directed exposure vs.
self-exposureinthetreatmentofspiderphobia.BehaviorTherapy,21,407–422.
Acknowledgements
Theextensivecontributionsofmanyotherstoaprojectsuchasthiscannotbeem-
phasized enough. Foremost, this volume was made possible through considerable
clinical research and clinical practice from many of our professional colleagues.
Ourutmostrespectandappreciationalsogoesouttothemanyadults,adolescents,
children,andparentswhohavegenerouslygivenoftheirtimeandpatiencebypar-
ticipating in clinical case studies, randomized clinical trials, and basic research to
allowustofurtherunderstand, assess, andtreatspecificphobiasandotheranxiety
disorders.Wewouldalsoliketoextendaspecialthankstoallourauthorsfortheir
time,expertise,andcontributionstothisvolume.Withoutthem,thevolumewould
bethinindeed. Moreover, thisvolumewouldnotbepossiblewithoutthegoodas-
sistanceofJudyJonesandallofthestaffatSpringer—weareverygratefulfortheir
supportandguidance.
Finally,wewouldliketoextendspecialthankstoourfamilies,friends,andloved
ones. I (Tom Davis) would like to offer my sincerest gratitude and appreciation
to my family and friends. In particular, I owe a great deal to Tom Ollendick and
Lars-Göran Öst as early supervisors, mentors, colleagues and collaborators, and,
now, co-editors. SpecialthanksalsogotoJohnnyL.Matsonforhismentorshipat
LSU.Finally,Iwouldliketothankmywifeandbestfriend,Allison.Herpatience,
kindness, encouragement, andlovewhileIhaveworkedonthisprojectandothers
throughtheyearshavebeeninstrumentalinthedevelopmentofmycareerandmy
person.
I(TomOllendick)wishtogivethankstomyformerstudentandnowhighlyvalued
colleague,TomDavis,whoplantedtheseedforthisprojectandtomylong-timegood
friendandesteemedcolleague,Lars-GöranÖst,forintroducingmetoOSTandallof
itsintricacies.Thishasbeenafunprojectandonethatwouldnothavebeenrealized
withoutbothofthematthehelm.Ialsowishtothankmywife,Mary,ourdaughters,
Laurie Kristine and Kathleen Marie, and now our grandchildren, BradenThomas,
Ethan Ray, Calvin David, andAddison Haley. Without them, life would be filled
withspectersfartoomanytomentionandlifewouldbelessenriched.Lifeisgood
withthem,andIthankthemforallofthesupportovertheyears.
I (Lars-Göran Öst) wish to thank Tom Ollendick for his early and continuing
interest in OST as a treatment for specific phobics of all ages, andTom Davis for
ix
x Acknowledgements
taking the initiative with this book. The collaboration on this project has been fun
and stimulating. I also wish to thank my wife Margareta, our daughters Ulrika,
Cecilia,andMagdalena,andourgrandchildrenRebecca,Anton,Engla,Alvin,and
Alice.Withouttheircontinuoussupportovertheyearsmuchlesswouldhavebeen
achievedintermsofclinicalandresearchdevelopment.
Contents
PartI SpecificPhobiaAssessmentandTreatment
1 SpecificPhobia:Phenomenology,Epidemiology,andEtiology ....... 3
PeterMurisandHaraldMerckelbach
2 Evidence-BasedAssessmentandTreatmentofSpecificPhobias
inAdults ...................................................... 19
HeatherK.HoodandMartinM.Antony
3 Evidence-Based Assessment and Treatment
ofSpecificPhobiasinChildrenandAdolescents ................... 43
ThomasH.OllendickandThompsonE.DavisIII
PartII One-SessionTreatmentforSpecificPhobiainAdults
andChildren
4 One-SessionTreatment:PrinciplesandProcedureswithAdults ..... 59
Lars-GöranÖst
5 One-SessionTreatment:PrinciplesandProcedureswithChildren
andAdolescents................................................ 97
ThompsonE.DavisIII,ThomasH.Ollendick,ErinT.Reuther,
andMelissaS.Munson
6 RealWorldApplicationsofOne-SessionTreatment ................ 127
LenaReuterskiöldandLars-GöranÖst
7 HandlingDifficult-to-TreatCasesofSpecificPhobiasin
ChildhoodandAdolescence ..................................... 143
ThomasH.OllendickandV.CristianSirbu
xi
