The Efficacy of Psychological Therapies for Specific Phobias in Adults and Some Unanswered Questions

Background: Specific phobias are common across the lifespan. Although exposure-based therapies have the most evidence of efficacy, reviews have cautioned that evaluations of some interventions are limited in number and have pointed to the need for more research. Furthermore, several permitted the inclusion of non-randomized clinical trials or samples exhibiting elevated fear but not necessarily a full diagnosis. We sought to update the literature on the empirical support of psychological treatments for specific phobias in adults through the selection of studies that met stringent criteria along with application of the system developed by Chambless and Hollon [1998: J Consult Clin Psychol 66: 7-18], which had not in isolation been done so previously.Methods: Electronic searches of the PubMed and PsycINFO databases were conducted in February 2014 to identify suitable randomized clinical trials. Thirty-eight met our inclusion criteria.Results: In vivo exposure was the most researched psychological therapy and found to be efficacious and specific. The evidence for virtual reality exposure was less strong though it had a similar level of empirical support. Several other therapies, including applied tension for blood phobia, were found to be possibly efficacious pending replication by other groups.Conclusions: Exposure-based therapy is the optimal treatment for specific phobias, but several gaps remain in the literature. Most studies investigated interventions for spider phobia. More clinical trials conducted by independent research teams are needed on therapies for other subtypes. There is a dearth of literature on the treatment of phobic disorders in older adults and medically unwell patients. This needs to be a priority on research agendas since we have an aging population. Moreover, failure to address blood-injection-injury phobia in a timely manner in patients who are under the care of medical services may affect adherence to recommendations and lead to a deterioration in health.