An investigation of computer-delivered treatment of spider phobia

LITERATURE REVIEW Specific phobias are persistent fears of circumscribed situations which lead to avoidance of those situations, impairing daily functioning, even though the fears are recognised as unreasonable (American Psychiatric Association, 1994). This literature review looks at the aetiological theories for specific phobias and the corresponding behavioural treatments that arise from these theories. Where possible research conducted into spider phobias will be highlighted. The literature suggests that the behavioural 'exposure' techniques such as systematic desensitisation and flooding, which require participants to remain in fearful situations until distress subsides, provide the most effective treatment outcomes. Exposure treatments can be administered in a number of different modalities, from invivo to imaginal to virtual reality. Exposure may also be modelled by another to further facilitate treatment efficacy. All of these modalities are based on the same principles, such as conditioning experiences and habituation/ extinction of anxiety responses, which arise from the aetiological theories . A recent trend has been to allow participants to direct their own exposure therapy as an effective, cost saving alternative (Marks, 1985). One method of self-directed exposure has been to follow instructions on self-help style manuals (Marks, 1980). Another modality for self-directed treatment delivery is computers. Initial research into computer-delivered treatments have shown statistically significant treatment efficacy. However this area of research is still relatively new, with interest only being generated from the late 1980s (Mruk, 1987). One example of computer-delivered treatment currently being validated is the Fearmaster program. This software has been based on the empirically validated techniques of modelling and teaches the principles of exposure therapy. While findings are preliminary, treatment outcomes have been positive enough to encourage future research. EMPIRICAL STUDY This study investigates the treatment efficacy of an interactive computer program, called 'Fearmaster', for the treatment of spider phobia, when administered at two different dosages (three treatment sessions versus six treatment sessions). The Fearinaster (Kirkby, Watson, & Daniels, 1991) is designed to teach the principles of self exposure via symbolic modelling technique by allowing participants to practise treating an 'on-screen' computer person. Thirty participants with spider phobia, meeting DSM-IV criteria for spider phobia and achieving a CIDI-A diagnosis of Specific phobia, were randomly allocated to receive either three or six treatment sessions within three weeks (n= 15 per treatment condition). Phobic symptom severity was measured at pre-treatment, post-treatment (on the same day as the final treatment session) and at one month follow-up assessment by Spider Questionnaire, Fear Questionnaire, Phobic Targets and Work Adjustment Rating Scales, and a live Behavioural Approach Test. The results showed significant symptom reduction for both groups across treatment, where participants were able to engage in approach behaviours with less anxiety. Statistically significant reductions occurred in self ratings of spider phobia symptoms, fear levels, anxiety levels and depression levels. Clinically significant improvements were obtained in depression levels and ability to perform approach behaviours towards the phobic stimulus. Results on the Behavioural Approach Test showed that additional sessions produced a greater treatment effect. A similar trend was observed on self ratings of spider phobia symptoms but did not reach significance. Thus six treatment sessions produced better treatment outcomes than three treatment sessions on behavioural measures. Results indicate further investigation into dosage effects, employing greater participant numbers is warranted.