Large Group Exposure Treatment: A Feasibility Study of Exposure Combined with Diaphragmatic Breathing in Highly Dental Fearful Individuals

Abstract

A large-group one session treatment (LG-OST) combining exposure and diaphragmatic breathing as a bodily coping element was carried out to investigate its feasibility and effectiveness in a sample of 43 highly dental fearful individuals treated simultaneously. We assessed subjective dental fear, dysfunctional dental-related beliefs, and perceived control pre- and post-intervention and at four-month follow-up. Participants additionally performed a behavioural approach test (BAT) pre- and post-intervention. During the applied exposure exercises, four participants (9.3%) discontinued the program all reporting too high levels of distress. Regarding subjective dental fear and dysfunctional dental related beliefs post treatment effects, LG-OST showed medium to large effect sizes, ranging from Cohen’s d = 0.51 to d = 0.84 in the Intention-to-Treat analysis. Subjective dental fear improved clinically significantly in about one fourth (25.6%) of therapy completers. All post-treatment effects remained stable over time. Concerning the behavioral fear dimension, we observed a strong ceiling effect. Already at pre-assessment, participants accomplished more than six out of seven BAT-steps. Thus, behavioral approach did not increase significantly following treatment. Overall, the LG-OST protocol proved feasible and efficient. Compared to other one-session individual and multi-session group treatments the observed LG-OST effects were smaller. However, if LG-OST could match the efficacy of highly intensive short treatments delivered in an individual setting in the future, for example, by applying a wider array of exposure exercises, it could be a very useful treatment option as an intermediate step within a stepped care approach.

Day at the museum. A benchmarking and feasibility study for large group, one‐session exposure treatment for spider phobia

“…Our successful translation of individual to large group OST using direct exposure is consistent with Wannemueller et al's (, , ) studies, which found that exposure tasks modelled to large groups ( N = 40+) was effective in reducing fear, demonstrating that various formats of OST (direct or indirect exposure) are adaptable to large group delivery. While the group size in the current study may be considered modest compared to Wannemueller et al's studies (in which exposure to the feared stimuli was observational), they are the largest group size evaluated for treatments involving direct exposure and interaction with the feared stimuli (twice the size of Öst et al's (, 1997) original group evaluations).…”

Large-Group One-Session Treatment: A Feasibility Study of Exposure Combined With Applied Tension or Diaphragmatic Breathing in Highly Blood-Injury-Injection Fearful Individuals

“…In the Phase I study, we investigated the feasibility and effectiveness of the LG-OST protocol in a group of 40 participants and explored potential outcome-predictors of LG-OST. We hypothesized that the LG-OST would lead to a substantial reduction in BII-fear, analogous to the results observed in the spider- and dental-fear cohort ( Wannemueller et al, 2016 , 2017 ). Prior to treatment, we assessed trait anxiety as a potential outcome predictor, as trait anxiety has been identified to influence treatment outcome (e.g., Muris et al, 1998 ).…”

“…Encouraged by the positive reports of small group OSTs, Wannemueller et al (2016 , 2017 ) recently conducted two Phase I open trials applying one-session formats in large-group settings (LG-OSTs). LG-OST proved feasible in a sample of N = 78 spider fearful individuals as well as in a sample of N = 43 dental fearful individuals.…”

The Return of Fear: Variation of the Serotonin Transporter Gene Predicts Outcome of a Highly Standardized Exposure-Based One-Session Fear Treatment

“…However, we did not apply fixed cut-off scores which in case of falling short would have led to exclusion. Nevertheless, mean scores of specific fear questionnaires applied to all cohorts were comparable to those reported in high fear cohorts or cohorts of individuals diagnosed with a specific phobia [for a more detailed description, see 32,33].…”

“…During the individual 1-session treatments the very same contents (video clips, etc.) as in the large-group settings were administered by the same clinical psychologists for exactly the same length [for further information concerning the contents of treatments, see 32,33]. Because 8 participants (3.6% of total; 3LL/3LS/2SS) reported to take selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors, they were excluded from our genotype comparisons.…”