Pediatric Specific Phobia Treatment & Management
- Author: William R Yates, MD, MS; Chief Editor: Caroly Pataki, MD more...
Approach Considerations
Behavioral therapy, which includes exposure therapy and cognitive behavioral therapy, is the first-line treatment. However, pharmacologic treatment, administered in combination with behavioral therapy, may provide some therapeutic benefit.
Specific phobia alone does not require inpatient treatment.
Go to Anxiety Disorders for more complete information on this topic.
Exposure Therapy
In this treatment technique, the patient is repeatedly exposed to the feared stimulus until the anxiety response it elicits is habituated. One-session treatment lasting as long as 3 hours and combining exposure therapy in a fear hierarchy with participant modeling, cognitive components, and reinforcement, is a promising form of treatment in patients with specific phobias.[6]
A gradual exposure program, especially for the treatment of children, is developed, in which the least-feared stimulus in a fear hierarchy is presented first, followed sequentially over time (in a graduated manner) by the more feared stimuli in the hierarchy. Fear hierarchies are created by the behavior therapist in collaboration with the child and parents.
Exposure to the feared stimulus may be conducted in real-life or imaginary contexts, in which the child is requested to visualize the feared object or situation. The longer the child is exposed to the aversive stimulus, the greater the likelihood that habituation occurs and anxiety decreases.
Cognitive-Behavioral Therapy
These procedures are used when the therapist determines that the maintenance of the phobia may have a significant cognitive component. Procedures may include those in which the child is taught skills for contingency management, modeling management, and self-control. Applied tension and relaxation may be introduced, as well as improvement of specific skill deficits.
No significant differences in outcome have been reported comparing individual cognitive behavioral therapy with group cognitive behavioral therapy, with improvements noted in both types of therapeutic settings.[7]
Psychopharmacology
This type of therapy is generally felt to have limited use in the treatment of specific phobia, with behavioral therapy being the main route of intervention. In some instances, selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, fluvoxamine, citalopram, and paroxetine, have been reported to be effective. SSRIs have been used as adjunctive therapy, because patients may have coexisting anxiety disorders. (See Medication.)
Computer Technology
Virtual reality exposure therapy, using a computer to provide graded exposures, has been reported. However, use of this technology has not been well studied in children.
Psychotherapy
Psychotherapy is not generally used to treat the specific phobia. However, the presence of an increasingly complex or disabling profile may require individual and family psychotherapy.
Consultations
Consultation with a child behavioral psychologist and/or child and adolescent psychiatrist may be necessary.
Long-Term Monitoring
Close, frequent monitoring of any patient treated with psychotropic medications is imperative.
Biel MG, Klein RG, Mannuzza S, et al. Does major depressive disorder in parents predict specific fears and phobias in offspring?. Depress Anxiety. 2008;25(5):379-82. [Medline].
Cooke LJ, Haworth CM, Wardle J. Genetic and environmental influences on children's food neophobia. Am J Clin Nutr. Aug 2007;86(2):428-33. [Medline].
NIMH. Anxiety disorders. National institutes of Mental Health. Available at http://www.nimh.nih.gov/health/publications/anxiety-disorders/complete-index.shtml. Accessed Last accessed January 13, 2006.
Robinson J, Sareen J, Cox BJ, Bolton J. Self-medication of anxiety disorders with alcohol and drugs: Results from a nationally representative sample. J Anxiety Disord. Mar 22 2008;[Medline].
American Psychiatric Association. Anxiety disorders. In: Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: APA; 1994:393-444.
Zlomke K, Davis TE 3rd. One-session treatment of specific phobias: a detailed description and review of treatment efficacy. Behav Ther. Sep 2008;39(3):207-23. [Medline].
Liber JM, Van Widenfelt BM, Utens EM, et al. No differences between group versus individual treatment of childhood anxiety disorders in a randomised clinical trial. J Child Psychol Psychiatry. Aug 2008;49(8):886-93. [Medline].
Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. Jan 2006;163(1):41-7. [Medline].
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