Dylan Raymond, 11, loves playing baseball. But just a year ago if a bee flew onto the field: game over.
"He would come running into the house, and wouldn't go back outside until the next day," says his mother, Kim Raymond.
Raymond cannot pinpoint when or why her son's bee phobia began, but she had an idea of how to end it. As a bookkeeper in the psychology department at Virginia Tech, she had seen phobic children emerge from the university's child study center able to face their fears. After just three hours of treatment, one small girl led a large dog on a leash, when previously she couldn't even tolerate having the animal in the room. Another child--previously terrified of heights--climbed up a ladder without hesitation.
Hoping for similar results, Raymond brought her son to center director Thomas Ollendick, PhD, a psychology professor at the university.
Along with a staff of graduate-level clinicians, undergraduate assistants and three psychologists, Ollendick is running a five-year study of a new, single-session treatment for children's phobias. The project, funded by a $1.6 million grant from the National Institute of Mental Health (NIMH), seeks to give children a short-term exposure-based treatment developed by Lars-Göran Öst, PhD, a clinical psychology professor at Stockholm University in Sweden and co-investigator on the child phobia project. Öst has reported high success rates in adults, but at a fraction of the cost of multiple-week treatment programs.
Both long- and short-term phobia treatments can help 80 to 90 percent of adults overcome their fears, but few such programs have been proven to work with children, notes Ollendick.
Early intervention for debilitating fears could improve children's overall mental health, says Joel Sherrill, PhD, chief of the NIMH research program that houses Ollendick's grant. Research suggests that clinically significant phobias--which occur in about 5 percent of children--can lead to other disorders, such as anxiety and depression, he notes.
Children's phobias have immediate consequences as well, says Ollendick. As was the case for Dylan, an excessive fear of bees can make it difficult for children to participate in outdoor sports. Some children with dog phobia can't even walk to school for fear of encountering a canine along the way, says the psychologist. And children who fear the dark might miss out on camping or overnight sleepovers.
However, Ollendick's program holds promise for such youngsters. In fact, a full 60 percent lose their phobia diagnosis after participating in the treatment, which combines exposure, modeling, cognitive restructuring and education about the phobic object into a single three-hour session.
Ollendick and his colleagues pack a lot of therapy into those three hours. First, the clinician collaborates with the child to construct a fear hierarchy--a list of anxiety-provoking situations from least to worst. Looking at a small dog through a glass window might anchor the low end of the hierarchy for a child with dog phobia, while petting and feeding a large dog often tops the list. In the middle could be such activities as standing in the same room as the animal.
The therapist then leads the child through the items on the hierarchy. However, rather than simply exposing the children to their phobic objects and allowing the fear response to burn itself out, the therapist roots out what specifically the children fear will happen and allows them to test their own predictions.
For instance, many children who are afraid of dogs think that if they stand near a dog, the animal will knock them over and bite them, says Thompson Davis, PhD, formerly a therapist at the Virginia Tech children's phobia project. Davis asks children to test their predictions, perhaps by standing near the dog and noting whether it acts as they expected.
"It is almost a game; the children have fun completing the tasks," says Davis. "We don't want children crying or overwhelmed."
To avoid overwhelming the children, Davis and current therapists including research scientists Cristian Sirbu, PhD, and Melisa Chelf, PhD, proceed slowly through the fear hierarchy, and they do not move on without the children's consent. In some cases, they can spend a long time at a single stage in the hierarchy--perhaps 15 minutes standing five feet away from a dog. The therapist takes this opportunity to give children safety tips about what they fear. In the case of dogs, the therapist might instruct a child to ask the animal's owner if the pet is friendly before approaching a strange dog, Davis says. Similarly, when clinicians help children overcome a fear of storms--using a videotaped storm if the weather doesn't cooperate--they tell children how to stay safe from lightning.
At the end of the session, the children face their very worst fears, perhaps petting a dog or even walking one on a leash. At this point, the therapists often use modeling to help the children along. First, the therapist might touch the dog and ask the child to observe how the animal reacts. Then, the therapist might ask the child to touch his shoulder as he touches the dog. Later, the child may place his hand on the therapist's as he pets the animal. And finally, the child pets the dog without assistance.
The therapy doesn't end there, however. If there is time, the therapist then helps the children apply what they have learned to slightly different situations--perhaps by touching a different kind of dog or one that is unleashed and outdoors.
At the end of the session, most children have conquered at least half of their fear hierarchy, and 60 percent of them can do the very thing they feared most, says Ollendick. Moreover, at a one-year follow-up, the percentage of no-longer phobic children rises to 75 percent.
Those children who have not yet conquered their fears may need longer-term programs or could benefit from a different strategy, such as relaxation training or virtual reality treatment, Ollendick says.
However, the secret to the long-term efficacy of the treatment may be the children's parents, who can encourage the children to practice their newfound skills, says Davis. Children who try facing their fears, rather then avoiding them, probably do better in the long run than those who don't, he notes.
"A phobia that has existed for several years will not completely go away in three hours," says Davis. "But we can do a lot to put kids on the right track."
Staying on that track takes continued acts of bravery, notes Wendy Silverman, PhD, director of the child anxiety and phobia program at Florida International University.
"If the child is able to understand the importance of facing and confronting the dog or other phobic object, if they continue to gain positive experiences, the probability of relapsing is low," she says.
Currently, the clinicians ask parents to encourage their children to continue to face their fears, but they do not have a formal training program for parents. However, the team has applied for a new grant from NIMH, which, among other things, would allow them to implement such a program. With parental training added to the mix, they may see success rates of 80 to 90 percent--similar to those of single-session therapy with adults, says Ollendick.
At present, the program has helped more than 200 children overcome debilitating fears, with Dylan Raymond among them. After treatment, he easily ignored bees while at bat. However, a few months after the treatment, Dylan ran away from a bee near his mother's car.
"I said, 'Why are you doing that? You aren't afraid of bees anymore," says Kim Raymond. "He said, "'Oh yeah, right,' and climbed right into the car."
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