Question 1

What are the different types of phobias?

Thomas Ollendick · Accepted Answer

DSM-5 lists 5 major types:

Animal
Natural Environment
Blood-Injection-Injury
Situational
Other (e.g., costumed characters, loud sounds)

One Session Treatment has been used with each of these - both in adults and in children/adolescents.

Question 2

Can phobias ever be treated completely?

Thomas Ollendick · Accepted Answer

Well, this is a good and difficult question to answer because it is not clear exactly what "completely" means! We have verbal testimony, letters, photographs, and documentaries from several families that express their thanks and that their child is doing things he or she could never do before. Here I attach an email message from one family which I recently received:

"Hi Dr. Ollendick, I had to share one of the best days of my life!  Today I came home from work to be greeted by my daughter who was so excited to tell me that she was no longer afraid of dogs!  I cried! 
Today, she went to a friends house, that she knew had 2 dogs!  She said she went inside, they jumped on her but after a few minutes they became calm and she pet them!! OMG, my daughter pet a DOG, a live one at that!  I thought I would never see the day that she would be ok to be in house with dogs!"

"I truly believe that if we hadn't been part of your research program and received the treatment program, she wouldn't have ever been cured!  Amazing news! Thank you for accepting her into the program that proved your treatment of phobia works!"

This is but one example - I am not sure her phobia was "completely" cured, but she is doing so much better!

Question 3

Is there any available online training?

Thomas Ollendick · Accepted Answer

We have provided training in various venues and at national and international conferences. Individuals have been trained in several places. Due to limited resources and time availability we are not currently providing online training - our manuals and chapters providing much detail are available from us.

Question 4

Question 5

What level of parental involvement do you have in your one-session treatment protocol with kids?

Thomas Ollendick · Accepted Answer

In our standard treatment, the parents are not involved directly in treatment; however, they are asked to facilitate maintenance of change following treatment by arranging for their child to be exposed to the phobic stimulus in their home community. There is no prescribed set of activities, however.

In a subsequent study, we did involve the parents more directly. We had them observe their child being treated for the first two hours and then brought into the treatment session to "transfer control" from the therapist to the parent. in this condition, we also worked out a prescribed 4-week maintenance program. Surprisingly, this "augmentation" did not produce better outcomes. In fact, both the standard and the augmented performed equally well. There could be many reasons for this outcome - not the least of which might be that the standard treatment is generally effective when used alone.

Question 6

How does OST compare to standard CBT for phobias in children e.g., attrition rates and efficacy?

Thomas Ollendick · Accepted Answer

This is another excellent question. In our meta-analysis paper (2017), Professor Ost and I show that the two treatments are generally comparable; however, OST is preferred by a number of families due to the brevity of treatment and the ability to travel to receive the treatment in a circumscribed period of time. As for attrition, it may seem unbelievable, but we have had zero rates of attrition - it is only one session! No families have dropped out once they have agreed to treatment and begun treatment. We have had some families not agree to the treatment - across studies about 5%. It is rare for them to do so if we have done a good job explaining the treatment and the rationale for its use.

Question 7

When would you choose intensive one session treatment over standard CBT for a child presenting with a phobia?

Thomas Ollendick · Accepted Answer

This is an excellent question. We have published a paper called "Have Phobias will Travel" to illustrate its use and efficacy for families who live far away from our treatment center in Virginia. They have traveled up to 1,000 miles away. This allows them to come to treatment over a 2-day period in which the cognitive-behavioral assessment is undertaken the afternoon of the first day and the 3-hour treatment is enacted the morning of the second day. We have done it in one day (morning - assessment; afternoon - treatment) but this is somewhat more difficult with young children and children who are comorbid with ADHD or Autism Spectrum Disorder.  Our preference is for the 2-day approach as it allows us time to arrange for the phobic stimuli we need for the behavioral exposures and to give the child a "break" between the assessment and treatment.

In addition, my colleagues from Sweden (Lars-Goran Ost) and Australia (Lara Farrell) and I recently published a paper on stepped care in which we recommend that bibliotherapy be tried first, followed by this brief treatment for those who do not respond to bibliotherapy, and then standard CBT or even psychopharmacology if OST is not effective.  Bibliotherapy appears to work for about 25% of individuals and OST works for about 60%. The remainder then might benefit from standard CBT. However we have shown that OST works comparably to standard CBT in a major review paper.  Still, we need to be flexible and to take into consideration family/patient preferences.

Question 8

Has this approach been used for emetophobia?

Thomas Ollendick · Accepted Answer

We have not used this approach (OST) with emetophobia in children. I belive however my colleague in Sweden, Professor Lars-Goran Ost has sed it with adults. We have used it with blood phobias in children so I believe it could be used with children and adolescents; however, as noted, we have not done so at this time. Please let me know if you attempt it and how well it works for you. Thanks.

Question 9

Do you use virtual reality exposure for phobias that are difficult to treat in vivo?

Thomas Ollendick · Accepted Answer

Yes, we do.  In fact, in a study recently accepted for publication in Behavior Therapy, my long time colleagues in Australia and I tested the efficacy of virtual reality treatment with children who had a specific phobia of dogs using One Session Treatment (OST).  The work was conducted at Griffith University in Brisbane, under the leadership of Dr. Lara Farrell and her team. Eight children were treated. They were randomly assigned to a two-, three- or four-week baseline period and then treated virtually. The fear responses remained relatively stable over the baseline periods, and significant reductions were observed at post-treatment and one-month follow-up. Indeed, at one-month follow-up, 75% of the children were recovered and 88% completed a behavioral avoidance test they were not previously able to complete.  The study provides initial support for the effectiveness of VR OST.

At this time, other types of phobias have not been treated with virtual reality. We look forward to this being done in the future. This may be especially important given the effects of COVID-19 and use of telehealth procedures.

Question 10

Does one-session treatment for children include cognitive restructuring as well as exposure?

Thomas Ollendick · Accepted Answer

One Session Treatment (OST), originally pioneered by my good colleague in Sweden, Lars-Goran Ost, is a cognitive-behavioral intervention that utilizes exposure activities to elicit distorted cognitions that are then "tested" during the exposure activity. Distorted cognitions are ascertained through a cognitive-behavior analysis that precedes the actual treatment. For example, if a child who is afraid of spiders indicates that she thinks the spider will run toward her and jump up her arm or face, this thought can be tested with simple graduated exposure activities. Most spiders will not run toward you, they will move away from you if you put out your hand and "walk" your index finger toward them. They actually scurry away! Was her thought confirmed - no - it was disconfirmed by this experiment. Similar behavioral exposure experiments  are undertaken in the 3-hour treatment. Typically we have at least 3 different phobic stimuli for treatment - in this example 3 different spiders. To date we have used OST with all of the major types of specific phobias in randomized controlled trials and controlled single case design studies.  It is now considered an evidence-based treatment and is used in many countries and in both clinical and research settings. Original articles can be obtained by googling our respective names.

One final note. We do not consider this to truly be cognitive "restructuring" in that a Socratic dialogue is not used to test the cognitions - they are tested during the exposure activity. We have published studies that show the changed cognitions partially mediate changes in the phobic response. In my work with young children - I refer to this as "thought-ectomy."  It is like a removal of a distorted thought that is replaced by a more adaptive though.

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