This week we will talk about a study published in the Journal of Behavior Therapy and Experimental Psychiatry that talks about Single Session Therapy used in the treatment of specific phobias in children.
The objective of the article, beyond the sharing of research data, is to learn how TSS can be applied in certain areas of intervention (e.g. work with children), with specific categories of problems (e.g. specific phobias) and with a particular approach or method of therapy, which in the specific case is represented by Cognitive Behavior Therapy (CBT) .
What exactly is the research about?
The study conducted in 2015 by a group of researchers consisting of SM Ryan , MV . Strege , TH and Ollendick from the Children’s Study Center of the Department of Psychology of the Polytechnic Institute and State University of Virginia (USA) and by EL Oar from the Center for Emotional Health of the Department of Psychology of Macquarie University (Australia), delve into the ‘ effective a of the One Session Treatment (OST) for children with specific phobias in comorbidity with other anxiety disorders (Ollendick et al., 2009, 2015).
But what is the One Session Treatment?
OST as a variant of Cognitive Behavior Therapy (CBT ) , consists of a single session lasting three hours in which graded hierarchical exposure techniques are applied in combination with elements of psycho-education.
As with other approaches to CBT, treatment consists of a series of behavioral experiments during which the child is encouraged to approach the stimulus as a “scientist” or “detective” testing the cognitive thinking distorted by the phobia.
The therapist, on the other hand, acts as a role model demonstrating how to handle the frightening situation, encouraging the child to participate in exposure exercises and providing positive reinforcement following successful behavior.
Who was involved in the research?
The data analyzed were obtained from two studies examining the efficacy of OST on an original sample of 18 children with specific phobia comorbid with a Social Anxiety Disorder (SAD) matched by age (7-15 years), gender and type of phobia treated (i.e. animal, situational, environmental) to 18 children with specific phobia diagnosed with Generalized Anxiety Disorder (GAD) and 18 children diagnosed with another Specific Phobia (PSO), but without SAD or GAD .
Participants were randomly assigned to receive the standard OST (Öst & Ollendick, 2001) or OST – A in which another family member was present (Öst; Ollendick, 2007).
How did the treatment take place?
During the three hour standard OST treatment session the child was gradually exposed to the phobic stimulus (eg, dogs, costumed characters, darkness) and the therapist helped him challenge the distorted cognitions associated with the feared stimulus.
In condition OST-A at least one parent participated in the treatment and together with a second doctor observed the treatment from behind a one-sided mirror. The parent was thus instructed on how to identify and manage his child’s avoidance behaviors, her discomfort and how to reinforce the appropriate behaviors.
Additionally, parents were assisted in designing a reinforcement system to engage their children in post-treatment exposure activities.
After the intervention, four weekly telephone checks were conducted with the parents lasting about 15 minutes , from which no difference emerged between the standard treatments and those with the parent under observation (Ollendick et al., 2015).
How were the therapists trained in treatment?
Each therapist received approximately 10 hours of intervention training by attending educational sessions , reviewing therapy tapes , and observing ongoing treatment cases . Additionally, all received weekly supervision by Dr. Ollendick.
What did the study find?
The data obtained showed that all groups demonstrated an improvement in the management of specific phobia after treatment.
the therapy was also shown to be equally effective regardless of co-occurring anxiety disorder , with improvement also for anxiety comorbid with specific phobia, although this effect was not equal between groups, e.g., group with Social Anxiety Disorder (SAD) did not show significant improvements compared with the post-treatment Generalized Anxiety Disorder (GAD) group.
However the study demonstrated that co-occurring anxiety disorders do not interfere with specific phobia treatment and OST , despite targeting a single specific phobia type, significantly reduces symptom comorbidity of multiple anxiety disorders .
Conclusions
The study presented therefore allowed us to know and learn one of the many ways in which Single Session Therapy can be declined and applied .
The specific example of treatment with a single session (OST) reported has also highlighted in practice how the TSS method can be integrated with certain therapeutic approaches, in this case with Cognitive Behavior Therapy (CBT) , without modifying the underlying principles, but enhancing their effectiveness.
Angelica Giannetti
Psychologist,
Team Psychotherapist of the Italian Center
for Single Session Therapy
Bibliography
Ollendick, T. H. (2007). Manual for augmented one-session treatment of specific phobias . A published manuscript. Available from: the Augmented Phobia Project. Blacksburg, VA 24060: Child Study Center, Virginia Tech.
Ollendick, TH, Halldorsdottir, T., Fraire, MG, Austin, KE, Noguchi, RJ, Lewis, KM, et al. (2015). Specific phobias in youth: A randomized controlled trial comparing one-session treatment to a parent-augmented one-session treatment . Behavior Therapy , 46(2), 141e155.
Ollendick, TH, & Muris, P. (2015). The scientific legacy of Little Hans and Little Albert: Future directions for research on specific phobias in youth. Journal of Clinical Child and Adolescent Psychology , 44, 689 and 706.
Ollendick, TH, s Öst, LG, Reuterskiold, L., Costa, N., Cederlund, R., Sirbu, C., et al. (2009). One-session treatment of specific phobias in youth: A randomized clinical trial in the United States and Sweden. Journal of Consulting and Clinical Psychology , 77(3), 504.
Öst, LG, & Ollendick, TH (2001). Manual for one-session treatment of specific phobias. Unpublished manuscript . (Available from: the Phobia Project. Blacksburg, VA 24060: Child Study Center, Virginia Tech.
Ryan, SM, Strege, MV, Oar, EL, & Ollendick, TH (2016). One session treatment for specific phobias in children: Comorbid anxiety disorders and treatment outcome. Journal of Behavior Therapy and Experimental Psychiatry , 54 (2017) 128 and 134.