One 3 hour exposure session was as effective as 5... hour sessions of either exposure or cognitive therapy

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One 3 hour exposure session was as effective as 5... hour sessions of either exposure or cognitive therapy
Downloaded from ebmh.bmj.com on September 9, 2014 - Published by group.bmj.com
One 3 hour exposure session was as effective as 5 one
hour sessions of either exposure or cognitive therapy
for claustrophobia
Öst LG, Alm T, Brandberg M, et al. One vs five sessions of exposure and five sessions of cognitive therapy in the treatment of
claustrophobia. Behav Res Ther 2001 Feb;39:167–83.
QUESTIONS: Is 1 session of exposure treatment (ET) effective in people with
claustrophobia? Is 1 session of ET as effective as 5 sessions of ET or 5 sessions of
cognitive therapy (CT)?
Design
Randomised (unclear allocation concealment*), unblinded*, controlled trial with 1 year of follow up.
did not differ among the 3 treatment groups after treatment or at 1 year.
Conclusion
Uppsala and Stockholm counties, Sweden.
In people with claustrophobia, 1 session of exposure
treatment (ET) was as effective as 5 sessions of ET or 5
sessions of cognitive therapy.
Patients
*See glossary.
Setting
50 patients who were 18–60 years of age, were afraid of
and avoided confined spaces, had claustrophobia for >1
year (mean duration 26 y), could not complete > 50% of
the steps in behavioural tests, and had no psychotic or
organic illnesses or other psychiatric problems requiring immediate treatment. Follow up was 92% (mean age
41 y, 91% women).
Intervention
Patients were allocated to 1 of 4 groups: one 3 hour session of ET (n = 10), 5 one hour sessions of ET (n = 11), 5
one hour sessions of CT (n = 11), or a waiting list for 5
weeks (n = 18). In the ET groups, patients were exposed
to anxiety arousing situations. In the CT group, patients
were taught to recognise and challenge negative
automatic thoughts and basic beliefs about the claustrophobic situations, and they were not discouraged from
practising in phobic situations between sessions.
Main outcome measures
Source of funding:
Swedish Medical
Research Council.
For correspondence:
Dr L G Öst,
Department of
Psychology, Stockholm
University, S-106 91
Stockholm, Sweden. Fax
+46 8 15 83 42.
Clinical improvement (statistically significant improvement in behavioural tests score plus score within normal
range or outside patient group range), self report measures of claustrophobia (the Claustrophobia Scale and
the Claustrophobia Questionnaire), and anxiety ratings
during behavioural tests (elevator ride 9 floors up and 9
floors down, entering a small windowless room, and
putting on a gas mask).
Main results
Treatment groups did not differ for the number of
patients who were clinically improved after treatment
(table) or after 1 year. Anxiety and claustrophobia scores
1 exposure therapy (ET) session (ET1) v 5 ET sessions (ET5) v cognitive therapy (CT) for
claustrophobia†
Outcome at 5 weeks Comparisons Event rates
Clinical improvement
ET1 v ET5
80% v 81%
RBR (95% CI)
NNT
1.5% (−47 to 35) Not significant
RBI (CI)
COMMENTARY
Claustrophobia, a fear of enclosed spaces, has a lifetime
prevalence of about 4% and can be substantially handicapping in a proportion of cases.1 Of course, most people with
fears of sufficient persistence and intensity to meet diagnostic criteria for specific phobia manage to find ways of living
with their fear and few seek professional help. For those who
do, cognitive behaviour therapy using in vivo exposure and
therapeutic modelling can be effective and is clearly the
treatment of choice; psychotropic medication, in contrast, is
relatively ineffective.2
Öst et al have been at the forefront of developing
intensive, exposure based treatments, the most rapid of
which consists of a single session of extended duration up to
a maximum of 3 hours.3 Previous research has shown the
effectiveness of this approach with phobias of flying,
injections, blood and injury, and spiders. Öst et al’s study
confirms that claustrophobia can also be treated in this way,
and successfully too, with few dropouts (8%) and with almost
all patients (80–100%) at 1 year follow up achieving a maximum score on 1 of the behavioural outcome measures (eg,
riding an elevator up and down a 9 storey building). Of particular interest is the finding that exposure is broadly equivalent to cognitive therapy based on the cognitive model of
panic. This may be because the cognitions in claustrophobia
are similar to those in panic disorder.4
The treatments in this study require experienced
cognitive behaviour therapists. Clinicians should also note
that, although clearly handicapped by their phobia, these
patients had low scores on standard symptom inventories
and no other complicating psychiatric conditions.
Rob Durham, PhD
Ninewells Hospital and Medical School
Dundee, UK
1
2
3
NNT
ET1 v CT
80% v 79%
1.8% (−59 to 33) Not significant
ET5 v CT
81% v 79%
3.4% (−31 to 61) Not significant
4
Curtis GC, Magee WJ, Eaton WW, et al. Specific fears and
phobias. Epidemiology and classification. Br J Psychiatry
1998;173:212–7.
Fyer AJ. Simple phobia. Mod Probl Pharmacopsychiatry
1987;22:174–92.
Öst LG. Rapid treatment of specific phobias. In: Davey GC,
editor. Phobias: a handbook of theory, research and treatment.
Chichester: Wiley, 1997:227–46.
Rachman S, Levitt K, Lopatka C. Experimental analyses of
panic-III. Claustrophobic subjects. Behav Res Ther
1988;26:41–52.
†RBR=relative benefit reduction. Other abbreviations defined in glossary; RBR, RBI, NNT, and CI calculated
from data in article.
86 Volume 4 August 2001 EBMH
www.ebmentalhealth.com
Therapeutics
Downloaded from ebmh.bmj.com on September 9, 2014 - Published by group.bmj.com
One 3 hour exposure session was as effective
as 5 one hour sessions of either exposure or
cognitive therapy for claustrophobia
Evid Based Mental Health 2001 4: 86
doi: 10.1136/ebmh.4.3.86
Updated information and services can be found at:
http://ebmh.bmj.com/content/4/3/86.full.html
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References
This article cites 4 articles, 1 of which can be accessed free at:
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