Posted on 6 February 2023
Cognitive Behavioural Therapy (CBT) offered as a one-hour session every week for between four and 12 weeks, is the common method for treating severe phobias in children - fears that could prevent them from participating in common childhood activities, such as playing in the park or visiting friends.
Researchers at the University of York, in collaboration with the University of Sheffield, worked with 260 children across 27 UK mental health services in a five-year project, to understand whether instead of multiple sessions of CBT, which takes children away from their ‘normal’ life and can prove costly for the NHS, treatment could be offered just as effectively and more cheaply in one session, lasting around three hours.
There were three types of phobias that were common to approximately 84% of children that took part in the study - fear of animals, vomit, and blood, injury and injections. The researchers compared the success rate and cost of the current multi-session CBT method with the same method, adapted to last just three-hours.
The sessions included graded exposure therapy, which means that if I child has a fear of dogs, for example, they would first see a dog facing away from them with a handler through a window in a door, and when a child is noticeably ‘bored’ with this activity, the therapist coaches them to move on to opening the door, until gradually the child gets closer to the dog.
Professor Lina Gega, Director of the Institute of Mental Health Research at York, said: “We found that this single three-hour session reduced a child’s phobias and in most cases resolved them, at the same success-rate as multiple sessions did. Our method was based on the premise that the opposite of fear is boredom, and children can become bored quite quickly of a repeated activity.
“There are a number of issues with therapies that span across weeks for children, mainly the anxiety it causes the child each week ahead of the session, and the time it takes out of a child and a parent’s life, but also the cost to the NHS, and the limitations in access to the sessions.
“We often find that with multiple sessions, the drop-out rate is high, so now that we know that just one three-hour session can be just as effective in children, it could open up new opportunities for clinical services to reduce waiting lists, resolve attendance barriers, and save money.”
The study also acknowledged that severe phobias can often coexist with other health conditions, such as ADHD and depression, and therefore once a phobia is ‘cured’ other forms of therapy may still be needed to tackle those difficulties. Researchers suggested that resolving a phobia may help point to unidentified problems or improve other known conditions.
Professor Gega said: “Fears are actually a very rational part of what it means to be human; fears can protect us from getting hurt. It is only when these fears start to prevent us from doing things in daily life that they can become a clinical issue.
“You can imagine, however, how liberating it is for a child and a parent that after just one therapy session they are able to go to the park without fear of dogs, or go out to eat food with their friends without fear of getting sick, or able to get vaccines that can be life-saving.
“The next stage of this work is to disseminate our findings more widely among health professionals and offer support in how to adapt weeks if not months of CBT into a single condensed session, with the hope that this can become a standard treatment option for children with phobias.”
The research funded by the NIHR Health Technology Assessment Programme, supported by the NIHR, is published in the Journal of Child Psychology and Psychiatry.
Listen to Professor Lina Gega talk about the research on BBC Sounds.
For more information about the University's work in mental health visit our Institute of Mental Health Research website. Research at the Institute aims to improve the lives and care of people affected by mental health difficulties, and mitigate the impact on individuals, families, the NHS, the workplace and whole communities.
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