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Pediatric Specific Phobia Treatment & Management

  • Author: William R Yates, MD, MS; Chief Editor: Caroly Pataki, MD  more...
 
Updated: Dec 04, 2015
 

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.

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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.[9]

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.

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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.[10]

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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.)

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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.

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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.

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Consultations

Consultation with a child behavioral psychologist and/or child and adolescent psychiatrist may be necessary.

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Long-Term Monitoring

Close, frequent monitoring of any patient treated with psychotropic medications is imperative.

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Contributor Information and Disclosures
Author

William R Yates, MD, MS Research Psychiatrist, Laureate Institute for Brain Research; Professor of Research, Department of Psychiatry, University of Oklahoma College of Medicine at Tulsa

William R Yates, MD, MS is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Kerim M Munir, MD, MPH, DSc Director of Psychiatry, Division of General Pediatrics, Developmental Medicine Center, Children's Hospital Boston

Kerim M Munir, MD, MPH, DSc is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Psychiatric Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Chet Johnson, MD Professor of Pediatrics, Associate Director and Developmental-Behavioral Pediatrician, KU Center for Child Health and Development, Shiefelbusch Institute for Life Span Studies; Assistant Dean, Faculty Affairs and Development, University of Kansas School of Medicine

Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Sandra L Friedman, MD, MPH and Marilyn T Erickson, PhD, to the development and writing of the source article.

References
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  8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: American Psychiatric Association; 2013.

  9. Zlomke K, Davis TE 3rd. One-session treatment of specific phobias: a detailed description and review of treatment efficacy. Behav Ther. 2008 Sep. 39(3):207-23. [Medline].

  10. 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. 2008 Aug. 49(8):886-93. [Medline].

  11. Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. 2006 Jan. 163(1):41-7. [Medline].

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