Internet- and mobile-based interventions for the treatment of specific phobia: A systematic review and preliminary meta-analysis

Mor, Sonia; Grimaldos, Jorge; Tur, Cintia; Miguel, Clara; Cuijpers, Pim; Botella, Cristina; Quero, Soledad

doi:10.1016/j.invent.2021.100462

Cited by 9 publications

(9 citation statements)

References 52 publications

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“…On the internet and mobile-based interventions for a specific phobia, exposure was the main component of all interventions, and that animal phobia was the most common subtype. There was a significant reduction of specific phobia symptoms from pre to posttreatment [54]. App-based mindfulness training for GAD showed a significant decrease in anxiety compared with the control group at 2 months [55].…”

Section: Technology-delivered Therapymentioning

confidence: 86%

Update on treatments for anxiety-related disorders

Lee

Stein

2022

Current Opinion in Psychiatry

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Purpose of reviewThis review examines recent evidence that informs the treatment of anxiety-related disorders.Recent findingsIn addition to selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and benzodiazepines, agomelatine has demonstrated efficacy in treating generalized anxiety disorder (GAD). Other novel products, such as ketamine, psilocybin and cannabidiol, are in the process of gathering evidence in support of the treatment of anxiety disorders. In psychological therapy, various psychological treatments for anxiety disorders, such as mindfulness-based intervention, acceptance and commitment therapy, psychodynamic therapy, emotion-focused therapy and dialectical behavioural therapy, have been tried. Still, most therapies have not proven superior to cognitive behavioural therapy (CBT). In very preliminary findings: Repetitive transcranial magnetic stimulation (rTMS) was effective in GAD; transcranial direct current stimulation (tDCS) was effective for social anxiety disorder (SAD) and GAD and augmented exposure therapy for specific fears. Internet and mobile-based interventions have comparable efficacy to face-to-face therapy.SummaryPharmacotherapy of anxiety disorders is expanding to novel products. Despite trying other psychological therapies for anxiety disorders, most therapies were comparable to but not superior to CBT. rTMS and tDCS were also used and show early promise for GAD, but further studies are needed. Most internet or mobile app based psychological therapies were based on CBT, and some can be considered as alternatives to in-person face-to-face therapy.

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Section: Technology-delivered Therapymentioning

confidence: 86%

Update on treatments for anxiety-related disorders

Lee

Stein

2022

Current Opinion in Psychiatry

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“…Among the strengths of this study, to the best of our knowledge, this is the first Internet-based self-applied treatment for rat phobias that integrates a VTA that would guide the treatment with patients with low to middle phobia symptomatology, and that integrates various elements of multimedia exposure. Most of the research in the literature reports treatments for SP that use fixed elements of exposure such as images, 360° images, videos, and audios [ 7 , 11 , 30 ], while only Donker et al, (2019) report having used 360° videos as a treatment for acrophobia [ 52 ]. This allows for more significant interaction, immersion, and realism with the virtual environment and greater control over progressive exposure to the phobic stimulus.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to this, there is an imbalance between public spending on mental health and the broad treatment gap for mental disorders in Latin America [6]. To address the treatment gap for mental health problems in low-and middle-income countries, the use of Internet-based interventions has been proposed as a way to reduce cost and waiting time, and increase service availability, as these can be guided with a minimum amount of therapeutic attention, which allows a greater number of people to receive treatment and be benefited [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

An internet-based self-applied rat phobia treatment using a Virtual Therapy Assistant: Study protocol for a randomized controlled trial

et al. 2023

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Specific phobias are a common anxiety disorder that deteriorates the lives of people who suffer from them. To reduce the symptoms produced by this mental disorder exposure therapies have been used. However, low- and middle-income countries, including Mexico, have the lowest rate of treatment due to multiple barriers that prevent addressing mental health problems. Self-applied treatments have been explored in previous studies, nevertheless, high dropout rates are a common problem in this kind of treatment. An alternative is using immersive self-applied treatments that could help increase adherence to the treatment. This article aims to present a study protocol to explore the feasibility of an Internet self-applied exposure treatment for rat phobias, using four types of immersive multimedia elements: images, videos, video games, and 360° videos. Also, the satisfaction and perception of a Virtual Therapy Assistant (VTA) that provides information and support to the user are described. The study protocol will compare two groups of participants, one on the waiting list, and the other will receive the self-applied treatment for rat phobia supported by the VTA. For this study, 45 participants will be recruited and the evaluation measures will be taken at four different times: baseline, post-treatment, and follow-ups at 3 and 6 months. The levels of anxiety and avoidance of the user manifested during the exposure to the multimedia elements, the improvement of the user’s clinical symptoms, the level of satisfaction, the perception of effectiveness, and ease of use of the self-applied system will be evaluated. This study is expected to support the viability of self-applied treatment for rat phobias and the use of a VTA, showing the impact on treatment adherence. To the best of our knowledge, this is the first study to explore an exposure treatment for rats using different multimedia elements with the support of a VTA. The work will serve as a basis for the development of new virtual assistants that help in the treatment of other types of specific phobias. This research has been registered in Clinical Trials NCT (NCT05081323).

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“…Therapist-guided ICBT for fears and anxieties consists of a base of web-based material that conveys information and concrete exercises to reduce the patient’s fears, and the patient receives support from a psychologist through a web-based chat or email function. ICBT has been found to be effective for children with specific phobias [ 20 , 21 ] and children and adolescents with DP [ 22 ]. These studies have used parents as coaches guiding the child through the treatments.…”

Section: Introductionmentioning

confidence: 99%

Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental or Injection Phobia: Randomized Controlled Trial

Schibbye,

Hedman-Lagerlöf,

Kaldo

et al. 2024

J Med Internet Res

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Background Dental phobia (DP) and injection phobia (IP) are common in children and adolescents and are considered some of the biggest obstacles to successful treatment in pediatric dentistry. Cognitive behavioral therapy (CBT) is an evidence-based treatment for anxiety and phobias. As the availability of CBT in dentistry is low, internet-based CBT (ICBT) was developed. Open trials have shown that ICBT is a promising intervention, but randomized trials are lacking. Objective This randomized controlled trial tests whether therapist-guided ICBT supported by a parent could reduce fear, allowing children and adolescents with DP or IP to receive dental treatment. Methods We enrolled 33 participants (mean age 11.2, SD 1.9 y) whom a clinical psychologist had diagnosed with DP, IP, or both. After inclusion, participants were randomized to either ICBT (17/33, 52%) or a control group of children on a waitlist (16/33, 48%). ICBT was based on exposure therapy and comprised a 12-week at-home program combined with visits to their regular dental clinic. Participants corresponded weekly with their therapist after completing each module, and 1 parent was designated as a coach to support the child in the assignments during treatment. All participants completed measurements of the outcome variables before treatment start and after 12 weeks (at treatment completion). The measurements included a structured diagnostic interview with a clinical psychologist. Our primary outcome measure was the Picture-Guided Behavioral Avoidance Test (PG-BAT), which assesses the ability to approach 17 dental clinical procedures, and a positive clinical diagnosis. Secondary outcome measures included self-report questionnaires that measured self-efficacy and levels of dental and injection anxiety. The children and their parents completed the questionnaires. Results All participants underwent the 12-week follow-up. After treatment, 41% (7/17) of the participants in the ICBT group no longer met the diagnostic criteria for DP or IP, whereas all participants in the control group did (P=.004). Repeated-measure ANOVAs showed that ICBT led to greater improvements on the PG-BAT compared with the control group; between-group effect sizes for the Cohen d were 1.6 (P<.001) for the child-rated PG-BAT and 1.0 (P=.009) for the parent-rated PG-BAT. Reductions in our secondary outcomes—dental fear and anxiety (P<.001), negative cognitions (P=.001), and injection fear (P=.011)—as well as improvements in self-efficacy (P<.001), were all significantly greater among children in the ICBT group than in the controls. No participants reported adverse events. Conclusions ICBT seems to be an effective treatment for DP and IP in children and adolescents. It reduced fear and anxiety and enabled participants to willingly receive dental treatment. ICBT should be seriously considered in clinical practice to increase accessibility; this therapy may reduce the need for sedation and restraint and lead to better dental health in children and adolescents. Trial Registration ClinicalTrials.gov NCT02588079; https://clinicaltrials.gov/study/NCT02588079

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Internet- and mobile-based interventions for the treatment of specific phobia: A systematic review and preliminary meta-analysis

Cited by 9 publications

References 52 publications

Update on treatments for anxiety-related disorders

Update on treatments for anxiety-related disorders

An internet-based self-applied rat phobia treatment using a Virtual Therapy Assistant: Study protocol for a randomized controlled trial

Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental or Injection Phobia: Randomized Controlled Trial

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