Editing Specific phobia (section)

==Treatment==
There are a variety of treatment options available for specific phobias, most of which focus on [[psychosocial interventions]].<ref name="Katzman_2014" /> Different psychological treatments have varying levels of effects depending on the specific phobia being addressed.<ref name="Katzman_2014" />

=== Cognitive behavioral therapy (CBT) ===
{{Main|Cognitive behavioral therapy}}
[[Cognitive behavioral therapy]] is a short term, skills-focused therapy that aims to help people diffuse unhelpful emotional responses by helping people consider them differently or change their behavior. CBT represents the gold standard and first line of therapy in specific phobias.<ref name=":8" /><ref name="Katzman_2014" /> CBT is effective in treating specific phobias primarily through exposure and cognitive strategies to overcome a person's anxiety.<ref name=":8">{{cite journal | vauthors = David D, Cristea I, Hofmann SG | title = Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy | journal = Frontiers in Psychiatry | volume = 9 | pages = 4 | date = 2018 | pmid = 29434552 | pmc = 5797481 | doi = 10.3389/fpsyt.2018.00004 | doi-access = free }}</ref><ref name="Katzman_2014" /> Computer-assisted treatment programs, self-help manuals, and delivery by a trained practitioner are all methods of accessing CBT. A single session of CBT in one of these modalities can be effective for individuals who have a specific phobia.<ref name=":7" />

=== Exposure therapy ===
{{Main|Exposure therapy}}
[[Exposure therapy#:~:text=Exposure therapy is a technique,overcome their anxiety or distress.|Exposure therapy]]{{Broken anchor|date=2025-05-12|bot=User:Cewbot/log/20201008/configuration|target_link=Exposure therapy#:~:text=Exposure therapy is a technique,overcome their anxiety or distress.|reason= }} is a particularly effective form of CBT for many specific phobias, however, treatment acceptance and high drop-out rates have been noted as concerns.{{Medical citation needed|date=November 2021}} In addition, a third of people who complete exposure therapy as a treatment for specific phobia may not respond, regardless of the type of exposure therapy.<ref name=":3">{{cite journal | vauthors = Böhnlein J, Altegoer L, Muck NK, Roesmann K, Redlich R, Dannlowski U, Leehr EJ | title = Factors influencing the success of exposure therapy for specific phobia: A systematic review | journal = Neuroscience and Biobehavioral Reviews | volume = 108 | pages = 796–820 | date = January 2020 | pmid = 31830494 | doi = 10.1016/j.neubiorev.2019.12.009 | s2cid = 208988502 }}</ref> Other interventions have been successful for particular types of specific phobia, such as [[Virtual reality therapy|virtual reality exposure therapy]] (VRET) for spider, dental, and height phobias, applied muscle tension (AMT) for needle phobia, and [[psychoeducation]] with relaxation exercises for fear of childbirth.{{Medical citation needed|date=November 2021}} With exposure therapy, a type of cognitive-behavioural therapy, clinically significant improvement was experienced by up to 90% of patients.<ref name=":7">{{Cite web|date=2021-10-28|title=Phobias - Symptoms, diagnosis and treatment {{!}} BMJ Best Practice|url=https://bestpractice.bmj.com/topics/en-gb/693|access-date=2021-11-28|website=bestpractice.bmj.com}}</ref> While very long-term outcomes remain unknown, many of the benefits of exposure therapy persisted after one year.<ref name=":7" /> Treatment may be more successful at reducing symptoms in people with low trait anxiety, high motivation, and high [[self-efficacy]] entering exposure therapy. In addition, high cortisol levels, high heart rate variation, evoking disgust, avoiding relaxation, focusing on cognitive changes, context variation, sleep, and memory-enhancing drugs can also reduce symptoms following exposure therapy.<ref name=":3" />

Exposure can be "live"(in real life) or imaginal (in ones imagination) and can involve:
* ''Systematic desensitization''—A therapy that exposes the person to increasing levels of vivid stimuli gradually and frequently, while instructed to relax.<ref name=":6">{{Cite book|url=https://www.worldcat.org/oclc/988106757|title=Kaplan & Sadock's comprehensive textbook of psychiatry|date=2017| vauthors = Sadock BJ, Sadock SA, Ruiz P |isbn=978-1-4963-8915-2|edition=Tenth|location=[Philadelphia]|oclc=988106757}}</ref>
* ''Flooding''—A therapy that exposes the person with a specific phobia to the most fearful stimulus first (i.e. the most intense part of the phobia). Patients are at great risk for dropping out of treatment as this method repeatedly exposes the patient to the fear.<ref name=":6" />
* ''Modeling''—This method includes the clinician approaching the feared stimuli while the patient observes and tries to repeat the approach themselves.
Exposures that are imaginal are less effective.{{Medical citation needed|date=November 2021}}

Specifically for acrophobia, in-vivo exposure (exposure to real-world height-scenarios while maintaining anxiety at controlled levels) has been shown to significantly improve measures of anxiety in the short-term, but this effect decreased over a longer term. Likewise, virtual reality exposure was statistically significant in some measures of anxiety reduction, but not others.<ref>{{cite journal | vauthors = Arroll B, Wallace HB, Mount V, Humm SP, Kingsford DW | title = A systematic review and meta-analysis of treatments for acrophobia | journal = The Medical Journal of Australia | volume = 206 | issue = 6 | pages = 263–267 | date = April 2017 | pmid = 28359010 | doi = 10.5694/mja16.00540 | s2cid = 9559825 }}</ref>

=== Pharmacotherapeutics ===
As of late 2020, there is limited evidence for the use of pharmacotherapy in the treatment of specific phobia. Pharmacological treatments are typically used in combination with behaviorally-focused psychotherapy, as introducing pharmacological interventions independently may result in relapsing of symptoms.<ref name=":4">{{cite book | vauthors = Reus VI | chapter = Anxiety Disorders |date=2018 |url= http://accessmedicine.mhmedical.com/content.aspx?aid=1177607751| title = Harrison's Principles of Internal Medicine| veditors = Jameson JL, Fauci AS, Kasper GL, Hauser SL |edition=20|place=New York, NY|publisher=McGraw-Hill Education|access-date=2021-11-29}}</ref>
The [[Selective serotonin reuptake inhibitor|selective serotonin re-uptake inhibitors]] (SSRIs), [[paroxetine]] and [[escitalopram]], have shown preliminary efficacy in small randomized controlled clinical trials.<ref name="Katzman_2014">{{cite journal | vauthors = Katzman MA, Bleau P, Blier P, Chokka P, Kjernisted K, Van Ameringen M, Antony MM, Bouchard S, Brunet A, Flament M, Grigoriadis S, Mendlowitz S, O'Connor K, Rabheru K, Richter PM, Robichaud M, Walker JR | display-authors = 6 | title = Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders | journal = BMC Psychiatry | volume = 14 | issue = Suppl 1 | pages = S1 | date = 2014 | pmid = 25081580 | pmc = 4120194 | doi = 10.1186/1471-244X-14-S1-S1 | doi-access = free }}</ref> However, these trials were too small to show any definitive benefits of [[anxiolytic]] medication alone in treating phobia.<ref name=":0">{{cite journal | vauthors = Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, Christmas DM, Davies S, Fineberg N, Lidbetter N, Malizia A, McCrone P, Nabarro D, O'Neill C, Scott J, van der Wee N, Wittchen HU | display-authors = 6 | title = Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology | journal = Journal of Psychopharmacology | volume = 28 | issue = 5 | pages = 403–439 | date = May 2014 | pmid = 24713617 | doi = 10.1177/0269881114525674 | s2cid = 28893331 | url = https://tud.qucosa.de/api/qucosa%3A35384/attachment/ATT-0/ }}</ref> [[Benzodiazepine]]s are occasionally used for acute symptom relief, but have not been shown to be effective for long-term treatment.<ref name=":0" /> There are some findings suggesting that adjuvant use of the NMDA receptor partial agonist, [[d-cycloserine]], with virtual reality exposure therapy may improve specific phobia symptoms more than virtual reality exposure therapy alone. As of 2020, studies on the use of adjunct d-cycloserine are inconclusive.<ref name=":0" />