It’s not unusual for children to be wary of spiders, dogs or needles. But what if that fear becomes a more serious phobia which starts to have an impact on everyday life?
The usual treatment for severe phobias is Cognitive Behavioural Therapy (CBT) which is delivered in a series of sessions by specially-trained therapists.
But now researchers at York are evaluating a new type of therapy which aims to help children tackle their worst phobias – in just one session.
One Session Treatment (OST) is based on CBT techniques – but it is delivered in one three-hour session, rather than over a number of weeks, making it potentially a more efficient, less time-consuming way of helping children.
Building an evidence base
“OST is less disruptive for children and offers the potential for more efficient use of NHS therapies at a time when budgets are under pressure,” explained Lucy Tindall who is co-ordinating the research trial in our Department of Health Sciences.
The Alleviating Specific Phobias Experienced by Children Trial (ASPECT) trial at York is recruiting over 280 children aged 7 to 16-years-old across a number of NHS trusts and other services in the North of England, Norfolk and Suffolk.
It is run in conjunction with Leeds and York Partnership NHS Foundation Trust and the University of Sheffield.
Studies in the US show that up to ten per cent of children have a severe specific phobia. This can mean missing school, avoiding activities, or even being afraid to leave the house. It can have an impact on family life, limiting outings and influencing what parents do to avoid making their child anxious.
Barry Wright, Professor of Child Mental Health at York is leading the trial. He explained that OST is not widely used because there are no large randomised control trials in children and none at all in the UK, so there is no evidence base. The York-led study is filling this gap.
The treatment works by helping children and young people get close to the object or situation they have a fear of.
Exposure therapy
Dogs, spiders or whatever the child is scared of may be brought to the therapy session. The session might start with a dog behind a closed door: the child will be encouraged to get closer to the door, open it and perhaps even touch the dog - a process known as 'exposure therapy'.
The child’s catastrophic thoughts such as: 'If I touch this dog it will bite me,' are explored and challenged - and there’s lots of praise and encouragement throughout the session.
Sometimes the therapist will recreate the feared situation – perhaps showing a video of a thunder storm, or an aircraft flight.
Professor Wright said: “The aim is for children to learn that the object or situation is not frightening – a process known as habituation. They learn new coping strategies.
“Young people can set their own goals, such as being able to remove a spider from the room in a glass jar or being able to sleep in a room even though they know a spider is under the bed.”
Confidence building
After the therapy session, children are encouraged to build their confidence at home by continuing to confront the situations that make them anxious.
The three-hour therapy session is preceded by a one-hour assessment to find out more about the phobia and what may have caused it. Six months after entering the study, there will be follow-up sessions to check if the therapy has been effective.
Professor Wright says phobias are nature’s way of protecting us and helping us survive.
“In some environments, having a phobia of spiders and the shape of spiders may be protective. It may mean we are less likely to be poisoned. The problem is that a phobia like this is less helpful in environments where spiders cause no risk, for example in the UK.”
Life experiences
He says phobias are also caused or made worse by our experiences - being bitten by a dog or stung by a wasp. Sometimes it can be caused by the information we receive, perhaps a child watching news coverage of hurricanes and severe storms.
He added: “We also know that children learn from the behaviour of their parents, for example a parent running away from a mouse.
“Research shows that phobias can be treated successfully with CBT – our trial aims to find out if OST could be an effective alternative option for children.”
The ASPECT trial is recruiting until July 2019.
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