درمان فشرده هراس های خاص در کودکان و نوجوانان

One-session treatment (OST), a variant of cognitive-behavioral therapy, combines graduated in vivo exposure, participant modeling, reinforcement, psychoeducation, cognitive challenges, and skills training in an intensive treatment model. Treatment is maximized to one 3-hour session. In this paper, we review the application of OST for specific phobia in youth and highlight practical matters related to OST and its use in a clinical setting. We also briefly review results of treatment outcome studies and suggest future directions for clinical research and practice. We conclude that OST is an efficient and efficacious treatment.

It has been suggested that if a clinician is thinking about using cognitive-behavioral therapy (CBT) with anxious youth the clinician should “think exposures” (Kendall et al., 2005). Beyond this initial advice, however, conducting exposure therapy with children and adolescents is more complicated than one might “think.” Many questions are evident. What kind of exposure should be used (in vivo, in imagination, on audio/video tape, or in virtual reality)? Precisely what materials and stimuli will be needed? How will they be obtained? Where will they be kept? Can I do it myself or do I need an assistant? What length of exposure (i.e., brief or prolonged) should I use? At what dose (spaced or massed)? How does one plan and conduct an exposure? Does one need to get specialized training or supervision to ensure competence? As a result, “thinking exposure” with anxious youth is complicated and requires a rich understanding of developmental psychopathology and familiarity with increasingly intensive and efficacious treatment formats (cf. Davis, 2009 and Ollendick et al., in press). In this paper, we will focus on a host of practical issues associated with using exposure therapy for the treatment of specific phobia in children and adolescents. In doing so, we briefly review the literature, which has brought exposure therapy for child phobia from a multi-session downward extension of adult therapy to a more developmentally informed, intensive, single session of cognitive-behavioral therapy (CBT) termed “One-Session Treatment” (OST; cf. Öst, 1987a, Öst, 1989, Öst, 1997 and Ollendick et al., in press). In addition, in as much as a systematic review of the conceptual underpinnings of OST and its treatment efficacy has recently been published (Zlomke & Davis, 2008), we will focus more on the actual implementation of OST with children in this paper and on extending the techniques described in the unpublished OST manual for children (Öst & Ollendick, 2001).

Although considerably more research must be undertaken before OST can be viewed as a “well-established” and evidence-based treatment with youth, it shows much promise. In the studies conducted to date, the treatment has been shown to be effective with a wide range of phobias and in a relatively brief period of time. Surprisingly, although the treatment has been available for some years (Öst, 1989 and Öst, 1997), it has not enjoyed widespread use, likely due to problems with treatment dissemination (Ollendick & Davis, 2004). In the hands of skilled clinicians, it works well and is an efficient and seemingly cost-effective treatment. Additional research will need to examine the moderators associated with OST in its standard format using in vivo exposure, as well as clarify its generalized effects on comorbid diagnoses. It will also be important to examine which components of the multicomponent procedure are most critical for behavior change via controlled componential analyses studies. It will also be desirable to examine more critically the format of its delivery. For example, the intensive exposures could be delivered imaginally (imaginal exposure) or through virtual reality (VR exposure), as has been done in the treatment of phobias with adults (Antony & Barlow, 2002). This may be particularly useful with certain phobias that are more difficult or impractical to treat via in vivo exposure (e.g., storms, flying). Although much remains to be accomplished, it is nonetheless evident that OST is a valuable addition to our clinical armamentarium.