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Treatment of Anxiety Disorders: Specific Phobia
An adjustment disorder occurs when an individual has challenges in coping with specific stressors or life event (O’Donnell et al., 2019). Adjustment disorder (AD) is also referred to as situational depression. To be diagnosed with an adjustment disorder, the individual must:
Have been exposed to a stressor (break-up, divorce, death or a friend/close relative, pandemic, isolation, or any other significant life stressor)
Exhibit emotional/behavioral symptoms within three months of exposure
Symptoms must be clinically significant and out of proportion to the stressor
Symptoms significantly impair the individual’s social or occupational functioning
On the other hand, individuals with anxiety disorders have a lengthy and consistent history of anxiety, fear, and worrying. Unlike individuals with adjustment disorders who only experience symptoms in response to a change or specific stressor, anxiety disorders are caused by a combination of genetic, behavioral, and developmental factors (O’Donnell et al., 2019).
Diagnostic Criteria for Specific Phobia
Individuals with specific phobia are fearful of specific objects or situations. When exposed to the object or situation, they exhibit avoidance, fear, or anxiety. In the U.S, the prevalence of specific phobia is approximately 7% to 9% (American Psychiatric Association, 2013). The DSM-V criteria for specific phobia disorder include:
Criterion A: A marked fear of a specific object or situation (animals, flying, injections, sight of blood, heights, or rejection).
Criterion B: The phobic object or situation provokes immediate fear and anxiety.
Criterion C: Individual exhibits avoidant behavior or endures the object/ situation with fear/anxiety.
Criterion D: Fear/anxiety is not proportional to the actual danger of the situation or object.
Criterion E: Fear/anxiety/avoidance is persistent – often lasting for six or more months.
Criterion F: Causes clinically significant distress and impairments in different spheres of life.
Criterion G: Symptoms cannot be explained by other conditions, including anxiety disorders, OCD, agoraphobia, or social anxiety.
(American Psychiatric Association, 2013).
The most common specific phobias include fear of animals (spiders, insects, and dogs), natural environments such as heights, water, storms, and blood injection injuries. According to the American Psychiatric Association (2013), it is common for individuals to have more than one specific phobia. In such scenarios, multiple phobia diagnoses are given.
Evidenced-Based Psychotherapy and Psychopharmacologic Treatment Specific Phobia
According to Eaton et al. (2018), only one in four individuals with specific phobia eventually receive treatment. A commonly adopted psychological treatment approach for individuals with specific phobias is exposure therapy. The approach involves imaging approaches and is a viable treatment for specific phobias. Other psychotherapeutic approaches that have been used effectively to treat specific phobia include CBT with psychoeducation, CBT with systematic desensitization, and internet-delivered CBT. During CBT sessions, clients are introduced to situations that provoke immediate fear and anxiety and taught relaxation techniques and strategies to challenge their maladaptive behaviors (Eaton et al., 2018).
A general view to psychopharmacologic interventions in treating specific phobias is that they are of limited benefit. A meta-analysis by Rodrigues et al. (2014) investigated the use of D-cycloserine in the treatment of anxiety disorders and specific phobia and concluded that although “D-cycloserine (DCS) enhances the effects of exposure therapy in anxiety disorders”, its effects were only modest. Evidence shows that in patients with severe specific phobia, exposure therapy and D-cycloserine combination therapy can improve patient outcomes. Rodrigues et al. (2014) found that when D-cycloserine was administered at low doses (50 mg) a “limited number of times, and immediately before (1 or 2 hours) or after exposure therapy” and CBT, patients reported better outcomes.
American Psychiatric Association. [APA]. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author.
Eaton, W. W., Bienvenu, O. J., & Miloyan, B. (2018). Specific phobias. The Lancet. Psychiatry, 5(8), 678–686. https://doi.org/10.1016/S2215-0366(18)30169-X
O’Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment disorder: Current developments and future directions. International Journal of Environmental Research and Public Health, 16(14), 2537. https://doi.org/10.3390/ijerph16142537
Rodrigues, H., Figueira, I., Lopes, A., Gonçalves, R., Mendlowicz, M. V., Coutinho, E. S., & Ventura, P. (2014). Does D-cycloserine enhance exposure therapy for anxiety disorders in humans? A meta-analysis. PloS One, 9(7), e93519. https://doi.org/10.1371/journal.pone.0093519