User:Ongmianli/Portfolios/Simple phobia

Demographic Information

This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of simple phobia that they are likely to see in their clinical practice.

Setting	Reference	Base Rate	Demography	Diagnostic Method
Mexican-American Prevalence and Service Survey (MAPSS) – adults 18+, all specific phobias	Vega et al., 1998	7.4%	California	CIDI/DSM-III-R
NCS replication, adults 18+, 12-month prevalence	Kessler et al., 2005	8.7%	All of US	CIDI/DSM-IV
National Comorbidity Survey (NCS); non-institutionalized adults between 18-54, all specific phobias	Kessler et al., 2005	11.3%	All of US	CIDI/DSM-III-R
National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), adults 18+, all specific phobias	Stinson et al., 2007	9.4%	All of US	AUDADIS-IV/DSM-IV
Adults 18+, all specific phobias	Robins et al., 1984	7.8%	New Haven, CT	Clinical interview/DSM-III
Adults 18+, all specific phobias	Robins et al., 1984	23.3%	Baltimore, MD	Clinical interview/DSM-III
Adults 18+, all specific phobias	Robins et al., 1984	11.1%	St. Louis, MI	Clinical interview/DSM-III
National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), adults 18+, all Specific Phobias	Grant et al., 2004	7.14%	All of US	AUDADIS-IV/DSM-IV

Diagnosis

Recommended Diagnostic Interviews

• Mini-International Neuropsychiatric Interview (MINI)
• Anxiety Disorders Interview Schedule (ADIS-IV)
• Structured Clinical Interview for DSM-IV Disorders (SCID)
• Composite International Diagnostic Interview (CIDI)

Recommended Screening Instruments

• Animal type: Spider Phobia Beliefs Questionnaire: see Appendix B
• Natural environment type: Acrophobia Questionnaire: see Appendix B
• Blood-injection injury type: Blood Injection Symptom Scale (BISS), Dental Anxiety Inventory
• Situational type: Claustrophobia Scale (CS)
• Other type: Specific Phobia of Vomiting Inventory (SPOVI): see Appendix B

(Appendix B found in actual PDF of portfolio)

Diagnostic Criteria

Diagnostic efficiency information for all included measures is based on criteria from DSM-IV or earlier. As of the compilation of this portfolio, there are no screening tools for all types of specific phobias with strong psychometric properties. The Fear Survey Schedule (FSS) has been popularly used but cannot accurately discriminate between phobics and fearful controls. Screening measures that are not included in the AUC curve table do not have current likelihood ratios available.

The DSM-V criteria for specific phobia has not changed from the DSM-IV. The criteria is as follows:

A. Marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g. flying, heights, animals, receiving an injection, seeing blood)

B. Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed panic attack. Note: in children, the anxiety may be expressed by crying, tantrums, freezing or clinging.

C. The person recognizes that the fear is excessive and unreasonable. Note: in children this feature may be absent.

D. The phobic situation is avoided or is endured with intense anxiety or distress.

E. The avoidance, anxious anticipation, or distress in the feared situation(s) interferes significantly with a person’s routine, occupational (or academic) functioning, or social activities or relationships or there is a marked distress about having the phobia.

F. In individuals under the age of 18 years the duration is at least 6 months.

G. The anxiety panic attacks or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder such as OCD (e.g. fear of dirt in someone with an obsession about contamination), post-traumatic stress disorder (e.g. avoidance of school), social phobia, panic disorder with agoraphobia or agoraphobia without history of panic disorder).

Areas Under the Curve (AUCs) and Likelihood Ratios for Potential Screening Measures for Specific Phobia

Screening Measure (Primary Reference)	AUC and Sample Size	LR+ (Score)	LR- (Score)	Citation	Clinical generalizability
Specific Phobia of Vomiting Inventory (SPOVI)	0.944 (N = 185)	24.3 (10+)	0.03 (<10)	(Veale et al., 2012)	High: able to distinguish between phobics and controls
The Claustrophobia Scale (CS) - Anxiety Subscale (Rachman and Taylor, 1993)	--- (N = 285)	49.0 (24+)	0.0002 (<24)	(Ost, 2007)	High: able to distinguish between phobics and controls
The Claustrophobia Scale (CS) - Avoidance Subscale (Rachman and Taylor, 1993)	--- (N = 285)	19.2 (9+)	0.0004 (<9)	(Ost, 2007)	High: able to distinguish between phobics and controls

• Note: “LR+” refers to the change in likelihood ratio associated with a positive test score, and “LR-” is the likelihood ratio for a low score. Likelihood ratios of 1 indicate that the test result did not change impressions at all. LRs larger than 10 or smaller than .10 are frequently clinically decisive; 5 or .20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation (Sackett et al., 2000).

Search terms: [specific phobia] AND [sensitivity OR specificity] in Google Scholar and PsycINFO

Treatment

Two treatments of specific phobia treatment include in-vivo exposure and virtual reality therapy. The former is most effective in specific phobias by hierarchically exposing the client to the fear-inducing stimulus and measuring anxiety response. The latter therapy is most effective in driving and height fears by using computer-generated, interactive virtual environments that the clinician manipulates.

Process and Outcome Measures

Clinically Significant Change Benchmarks with Common Instruments

Measure	A Cut Score	B Cut Score	C Cut Score	95% Critical Change (unstandardized scores)	90% Critical Change (unstandardized)	SE-difference critical change (unstandardized)
Dental Cognitions Questionnaire (1995 Norms)	9.1	16.4	41.2	4.2	3.6	2.2
The Claustrophobia Questionnaire (2001 Norms) - Total	18.6	67.7	41.2	11.	9.4	5.7
The Claustrophobia Questionnaire (2001 Norms) - Suffocation	7.0	24.9	16.2	5.0	4.3	2.6
The Claustrophobia Questionnaire (2001 Norms) - Restriction	8.4	45.5	24.3	6.9	5.8	3.5
Spider Phobia Questionnaire (1996 Norms)	15.1	20.7	17.3	3.0	2.5	1.5

• Note: “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean.

Search terms: [specific phobia] AND [adults] AND [clinical significance OR outcomes] in Google Scholar and PsycINFO

Process Measures

Two types of behavioral approach tests (BAT) can be used to observe patients in typically avoided situations. A progressive BAT gradually exposes the patient to a fear-inducing situation in a step-by-step manner, and responses to each step are recorded. A selective BAT allows the clinician to select one or more challenges from the patient’s hierarchy, and the patient is to complete each challenge to induce a phobic response and rate the inducing fear.