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Concept: Phobias

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There are relatively few existing studies examining neuropsychological functioning in social phobia (SP), which collectively yield mixed results. Interpretation of results is further complicated by a number of methodological inconsistencies across studies, including the examination of neuropsychological domains in relative isolation from one another. The present study utilized a broader collection of neuropsychological tests to assess nine domains of functioning in 25 individuals diagnosed with generalized SP and 25 nonpsychiatric controls (NC). A mixed ANOVA revealed neither a significant group by domain interaction, nor a significant main effect of group. Furthermore, no significant group differences emerged between the SP and NC groups within each specific neuropsychological domain. These findings suggest that underlying neuropsychological deficits are not likely to account for the information processing biases observed in the empirical literature, and appear to be consistent with current theoretical models which argue for the specificity of these biases to social information.

Concepts: Scientific method, Generalized anxiety disorder, Fear, Fight-or-flight response, Social anxiety disorder, Panic attack, Phobias, Specific social phobia

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Numerous imaging studies have confirmed the amygdala as prominent within a neural network mediating specific phobia, including arachnophobia. We report the case of a patient in whom arachnophobia was abolished after left temporal mesial lobectomy, with unchanged fear responses to other stimuli. The phenomenon of abolition of specific phobia after amygdala removal has not, to our knowledge, been previously reported.

Concepts: 2006 albums, Fear, Social anxiety disorder, Phobia, Specific phobia, Phobias, Acrophobia

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Phobias are usually described as irrational and persistent fears of certain objects or situations, and causes of such fears are difficult to identify. We describe an unusual but common phobia (trypophobia), hitherto unreported in the scientific literature, in which sufferers are averse to images of holes. We performed a spectral analysis on a variety of images that induce trypophobia and found that the stimuli had a spectral composition typically associated with uncomfortable visual images, namely, high-contrast energy at midrange spatial frequencies. Critically, we found that a range of potentially dangerous animals also possess this spectral characteristic. We argue that although sufferers are not conscious of the association, the phobia arises in part because the inducing stimuli share basic visual characteristics with dangerous organisms, characteristics that are low level and easily computed, and therefore facilitate a rapid nonconscious response.

Concepts: Fear, Paranoia, Phobia, Phobias, Claustrophobia, Panic, Arachnophobia, Ophidiophobia

14

Trypophobia refers to the fear of, or aversion to, clusters of holes. We assessed clinical features of trypophobia and investigated whether it most resembled a specific phobia or obsessive-compulsive disorder.

Concepts: Anxiety, Fear, Anxiety disorders, Obsessive–compulsive disorder, Phobia, Specific phobia, Phobias, Acrophobia

10

Although in vivo exposure is the treatment of choice for specific phobias, some acceptability problems have been associated with it. Virtual Reality exposure has been shown to be as effective as in vivo exposure, and it is widely accepted for the treatment of specific phobias, but only preliminary data are available in the literature about the efficacy of Augmented Reality. The purpose of the present study was to examine the efficacy and acceptance of two treatment conditions for specific phobias in which the exposure component was applied in different ways: In vivo exposure (N = 31) versus an Augmented Reality system (N = 32) in a randomized controlled trial. “One-session treatment” guidelines were followed. Participants in the Augmented Reality condition significantly improved on all the outcome measures at post-treatment and follow-ups. When the two treatment conditions were compared, some differences were found at post-treatment, favoring the participants who received in vivo exposure. However, these differences disappeared at the 3- and 6-month follow-ups. Regarding participants' expectations and satisfaction with the treatment, very positive ratings were reported in both conditions. In addition, participants from in vivo exposure condition considered the treatment more useful for their problem whereas participants from Augmented Reality exposure considered the treatment less aversive. Results obtained in this study indicate that Augmented Reality exposure is an effective treatment for specific phobias and well accepted by the participants.

Concepts: Randomized controlled trial, In vivo, Efficacy, Virtual reality, Phobia, Specific phobia, Phobias, Augmented reality

7

Cognitive behavioral therapy (CBT) is an evidence-based method for treating specific phobias, but access to treatment is difficult, especially for children and adolescents with dental anxiety. Psychologist-guided Internet-based CBT (ICBT) may be an effective way of increasing accessibility while maintaining treatment effects.

Concepts: Psychology, Cognitive behavioral therapy, Behaviorism, Social anxiety disorder, Phobia, Specific phobia, Phobias

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Traditional one-session exposure therapy (OST) in which a patient is gradually exposed to feared stimuli for up to 3 h in a one-session format has been found effective for the treatment of specific phobias. However, many individuals with specific phobia are reluctant to seek help, and access to care is lacking due to logistic challenges of accessing, collecting, storing, and/or maintaining stimuli. Virtual reality (VR) exposure therapy may improve upon existing techniques by facilitating access, decreasing cost, and increasing acceptability and effectiveness. The aim of this study is to compare traditional OST with in vivo spiders and a human therapist with a newly developed single-session gamified VR exposure therapy application with modern VR hardware, virtual spiders, and a virtual therapist.

Concepts: Fear, Virtual reality, Phobia, Specific phobia, Phobias, Acrophobia, Arachnophobia, Trypanophobia

3

Introduction The aim of this study was to conduct an exploration of differences in oral health behaviour and outcome between dentally phobic and non-phobic participants in the UK Adult Dental Health Survey (ADHS, 2009). The null hypotheses for this study were that there are no differences in oral health status of non-phobic and dental phobic individuals.Methods The ADHS survey covered the adult population in England, Wales and Northern Ireland and was commissioned by the NHS Information Centre for Health and Social Care (NHS IC). Dental anxiety was defined using the Modified Dental Anxiety (MDAS) with the cut-off point set at 19 and above as indicating dental phobia. Descriptive statistics were calculated and the chi-square test was used to compare both groups in terms of their demographics, oral health, oral health-related behaviour and attitudes, and treatment.Results More women (16.8% [1,023]) than men (7% [344]) reported dental phobia. Generally, people with dental phobia were in routine occupations (648 [47.7%]), single (402 [29.4%]) and with lower educational attainment (858 [80.9%]). They were irregular attendees (798 [58.5%]), had a less restored dentition, increased numbers of one or more teeth with caries (292 [39.9%]), and were more likely to have PUFA (puss, ulceration, fistulae, abscess) scores of one or more (89 [12.2%]) in comparison to the non-phobic group (314 [5.6%]). However, people with and without dental phobia had similar numbers of sound and missing teeth (34.5% of the phobic group had 20 or more sound teeth in comparison to 31.7% of the non-phobic group). There were significant differences (p <0.001) between the phobic group's and non-phobic group's Oral Health Impact Profile-14 (OHIP) and Oral Impacts on Daily Performance (OIDP) scores with phobic participants having generally higher scores. Additionally, the phobic group responded negatively more commonly about their most recent dental treatment in terms of dentists' ability to listen to their concerns, explaining the reasons for their dental care while paying full attention to their needs by treating them with respect and dignity. The difference between the two groups was statistically significant (p <0.001).Conclusions Participants reporting dental phobia are mostly females, irregular attendees and have a greater treatment need with increased caries levels.

Concepts: Statistical significance, Ronald Fisher, Statistical hypothesis testing, Fear, Dentistry, Null hypothesis, Dental surgery, Phobias

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BACKGROUND: Evidence from animal and human studies imply the amygdala as the most critical structure involved in processing of fear-relevant stimuli. In phobias, the amygdala seems to play a crucial role in the pathogenesis and maintenance of the disorder. However, the neuropathology of specific phobias remains poorly understood. In the present study, we investigated whether patients with spider phobia show altered amygdala volumes as compared to healthy control subjects. METHODS: Twenty female patients with spider phobia and twenty age-matched healthy female controls underwent magnetic resonance imaging to investigate amygdala volumes. The amygdalae were segmented using an automatic, model-based segmentation tool (FSL FIRST). Differences in amygdala volume were investigated by multivariate analysis of covariance with group as between-subject factor and left and right amygdala as dependent factors. The relation between amygdala volume and clinical features such as symptom severity, disgust sensitivity, trait anxiety and duration of illness was investigated by Spearman correlation analysis. RESULTS: Spider phobic patients showed significantly smaller left amygdala volume than healthy controls. No significant difference in right amygdala volume was detected. Furthermore, the diminished amygdala size in patients was related to higher symptom severity, but not to higher disgust sensitivity or trait anxiety and was independent of age. CONCLUSIONS: In summary, the results reveal a relation between higher symptom severity and smaller left amygdala volume in patients with spider phobia. This relation was independent of other potential confounders such as the disgust sensitivity or trait anxiety. The findings suggest that greater spider phobic fear is associated with smaller left amygdala. However, the smaller left amygdala volume may either stand for a higher vulnerability to develop a phobic disorder or emerge as a consequence of the disorder.

Concepts: Amygdala, Fear, Fight-or-flight response, Panic attack, Phobia, Specific phobia, Phobias, Arachnophobia

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Specific phobias are among the most common anxiety disorders. Exposure therapy is the treatment of choice for specific phobias. However, not all patients respond equally well to it. Hence, current research focuses on therapeutic add-ons to increase and consolidate the effects of exposure therapy. One potential therapeutic add-on is biofeedback to increase heart rate variability (HRV). A recent meta-analysis shows beneficial effects of HRV biofeedback interventions on stress and anxiety symptoms. Therefore, the purpose of the current trial is to evaluate the effects of HRV biofeedback, which is practiced before and utilized during exposure, in spider-fearful individuals. Further, this trial is the first to differentiate between the effects of a HRV biofeedback intervention and those of a low-load working memory (WM) task.

Concepts: Epidemiology, Randomized controlled trial, Fear, Social anxiety, Anxiety disorders, Phobia, Specific phobia, Phobias