Enhancing Exposure Therapy for Snake and Spider Phobias

Phase 1

Completed

• Conditions: Specific Phobia
• Interventions: Behavioral: Therapist-guided Exposure Therapy; Behavioral: Exposure Therapy with Retrieval; Behavioral: Exposure Therapy with Retrieval and Compound Extinction; Behavioral: Exposure Therapy with Compound Extinction

• Registration Number: NCT02160470
• Lead Sponsor: University of Texas at Austin

Brief Summary

This study tests whether exposure therapy for fear of snakes or spiders is enhanced by the addition of a brief fear retrieval trial prior to treatment, and the use of compound extinction during treatment. The goal of the study is to determine whether these behavioral techniques enhance the efficacy of exposure therapy, one of the most empirically supported treatments for anxiety disorders.

Detailed Description

This study tests whether exposure therapy for fear of snakes or spiders is enhanced by the addition of a brief fear retrieval trial prior to treatment, and the use of compound extinction during treatment. The goal of the study is to determine whether these behavioral techniques enhance the efficacy of exposure therapy, one of the most empirically supported treatments for anxiety disorders. Individuals between the ages of 18-65 with elevated fear of spiders or fear of snakes are randomly assigned to one of four treatment conditions (1) standard exposure therapy, (2) exposure therapy with fear retrieval augmentation, (3) exposure therapy with compound extinction augmentation, and (4) exposure therapy with fear retrieval and compound extinction augmentations. All participants undergo an online prescreen and a face-to-face screening assessment to determine eligibility and baseline (pre-treatment) symptom severity. Participants additionally complete assessments directly after treatment (post-treatment), and approximately one week after treatment (follow-up). The pre-treatment assessment occurs 1-14 days prior to treatment, the post-treatment assessment occurs during the treatment visit as soon as the treatment procedure is complete, and the follow-up assessment occurs within a window of 6-14 days after the completion of treatment. Participants complete two behavioral approach tests (in the treatment context and in the generalization context) at pre-treatment, post-treatment, and follow-up. Participants complete a battery of self-report questionnaires at pre-treatment and follow-up.

Study Timeline

• Study Start: 2012-08
• Study First Submitted: 2014-01-22
• Study First Submitted QC: 2014-06-06
• Study First Posted: 2014-06-10
• Primary Completion: 2019-12
• Study Completion: 2019-12
• Status Verified: 2020-12
• Last Update Submitted: 2020-12-04
• Last Update Posted: 2020-12-08

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 120

Inclusion Criteria

1. Age 18 to 65.
2. Speaks English fluently.
3. A score of 70 or higher on the Fear of Snakes/Spiders Questionnaire.
4. Demonstrates avoidance during behavioral approach tests (defined as inability to put palm flat on the bottom of a tank containing a snake/spider, and inability to touch a snake/spider with a bare finger).

Exclusion Criteria

1. Unstable dose of psychotropic medications during the 4 weeks prior to baseline assessment.
2. Currently receiving exposure-based treatment for snake/spider phobia.
3. Currently at risk for suicide.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
Therapist-Guided Exposure Therapy	Therapist-guided Exposure Therapy	Therapist-guided Exposure Therapy
Exposure with Retrieval	Exposure Therapy with Retrieval	Exposure Therapy with Retrieval
Exposure with Retrieval and Compounding	Exposure Therapy with Retrieval and Compound Extinction	Exposure Therapy with Retrieval and Compound Extinction
Exposure with Compounding	Exposure Therapy with Compound Extinction	Exposure Therapy with Compound Extinction

Primary Outcome Measures

Name	Time	Method
Change in peak subjective fear (0 - 100), behavioral approach (0 - 4), and heart rate reactivity to a live snake/spider not used during treatment (generalization context) from pre-treatment to follow-up	pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)

Secondary Outcome Measures

Name	Time	Method
Change in peak subjective fear (0 - 100), behavioral approach (1 - 8), and heart rate reactivity to a live snake/spider used during treatment (treatment context) from pre-treatment to follow-up	pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)
Change in Fear of Snakes/Spiders Questionnaire from pre-treatment to follow-up	pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)
Change in Agoraphobic Cognitions Questionnaire for Snake/Spider Phobia from pre-treatment to follow-up	pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)
Change in peak subjective fear (0 - 100), behavioral approach (1 - 8), and heart rate reactivity to a live snake/spider used during treatment (treatment context) from pre-treatment to post-treatment	pre-treatment (window of 1-14 days prior to treatment); post-treatment (directly after the treatment procedure is completed)
Change in Armfield and Mattiske Disgust Questionnaire from pre-treatment to follow-up	pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)
Change in peak subjective fear (0 - 100), behavioral approach (0 - 4), and heart rate reactivity to a live snake/spider not used during treatment (generalization context) from pre-treatment to post-treatment.	pre-treatment (window of 1-14 days prior to treatment); post-treatment (directly after the treatment procedure is completed)
Change in Snake/Spider Belief Questionnaire from pre-treatment to follow-up	pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)
Change in Self-Efficacy Questionnaire for Spider/Snake Phobia from pre-treatment to follow-up	pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)
Change in Lab for the Study of Anxiety Disorders Specific Phobia Diagnostic Questionnaire from pre-treatment to follow-up	pre-treatment (window of 1-14 days prior to treatment); follow-up (window of 6-14 days after treatment)	change from pre-treatment in current phobic diagnostic status and in level of phobic-related distress and impairment

Trial Locations

Locations (1)

University of Texas at Austin; 🇺🇸 Austin, Texas, United States