Evidence-Based Assessment and Treatment of Specific Phobias in Adults

Specific phobias are among the most common psychological problems (Kessler et al. 2005); however, specific phobias are seldom the primary reason that individuals seek treatment (Brown et al. 2001b). Because specific phobias are rarely the focus of clinical attention, there is a common—though in many cases mistaken—perception that specific phobias are straightforward and uncomplicated. In addition, because the fear associated with specific phobias is typically limited to the phobic stimuli and rarely associated with pervasive anxiety outside of the phobic situation, some believe that specific phobias are necessarily less severe than other anxiety disorders. The clinical picture of specific phobias, however, can be very different. Individuals with specific phobias can incur serious life impairment, such as failure to obtain necessary medical care, interference with social activities, and lost time and reduced productivity at work. In some cases, the impairment is comparable to that seen in other mental disorders (Wittchen et al. 1998). In addition, phobias are sometimes associated with complex symptom profiles, including physiological symptoms, extensive coping and avoidance behaviors, and unhelpful or distorted cognitions. Therefore, a thorough assessment using multiple methods is important to evaluate the idiosyncrasies of each client’s presentation. The purpose of this chapter is to review the elements of a comprehensive, evidence-based assessment and treatment plan for specific phobia. It will provide an overview of diagnostic and clinical features of specific phobia, review the empirical status of commonly used assessment and treatment methods, and conclude with recommendations for assessment and intervention.