Anxiety: A Very Short Introduction - Daniel Freeman, Jason Freeman 2012

CBT for phobias
Treatment

CBT has been used very successfully to tackle a wide range of phobias. One notable example is the programme developed by Lars-Göran Öst, Professor of Psychology at the University of Stockholm, to treat people with a spider phobia. The programme is extremely brief, comprising just a one-hour assessment followed by a three-hour exposure session.

During those three hours, Öst guides the individual through a series of increasingly demanding tasks. As is normal in CBT exposure, Öst models the required behaviour for the client. Letting the person see exactly what’s involved before they attempt a task helps encourage and relax them.

First, the person is taught to catch a small spider in a glass bowl; then to touch the spider; and finally to let the spider walk on their hand. Before the second task, the person is asked what they expect will happen. Öst notes: ’Almost 100 per cent of our patients say that the spider will crawl up on their hands, up the arm and underneath the clothes.’ But the individual soon discovers that their interpretation is mistaken: in fact, the spider runs away.

Once the client has completed the three tasks, they repeat them with a series of increasingly large spiders. By the end of the session, the person will have the two biggest spiders walking around on their hands — a pretty remarkable achievement considering how they felt about spiders just a few hours previously.

Öst has developed a similar treatment for people suffering from blood-injection-injury phobias. In this case, clients are shown a series of increasingly gory images of wounds, operations, and the like. But these phobias are unlike any others: rather than the individual’s blood pressure rising when confronted by the feared object or situation, it drops. And so, to prevent the person fainting when they see blood, Öst teaches them to detect the earliest signs of a fall in blood pressure and to respond by repeatedly tensing their muscles. This ’applied tension’ increases the individual’s blood pressure, thus enabling them to proceed with the exposure task.