Spider phobia questionnaire for children (SPQ-C): a psychometric study and normative data

Toward a reliable detection of arachnophobia: subjective, behavioral, and neurophysiological measures of fear response

Introduction

The administration of questionnaires presents an easy way of obtaining important knowledge about phobic patients. However, it is not well known how these subjective measurements correspond to the patient's objective condition. Our study aimed to compare scores on questionnaires and image evaluation to the objective measurements of the behavioral approach test (BAT) and the neurophysiological effect of spiders extracted from fMRI measurements. The objective was to explore how reliably subjective statements about spiders and physiological and behavioral parameters discriminate between phobics and non-phobics, and what are the best predictors of overall brain activation.

Methods

Based on a clinical interview, 165 subjects were assigned to either a "phobic" or low-fear "control" group. Finally, 30 arachnophobic and 32 healthy control subjects (with low fear of spiders) participated in this study. They completed several questionnaires (SPQ, SNAQ, DS-R) and underwent a behavioral approach test (BAT) with a live tarantula. Then, they were measured in fMRI while watching blocks of pictures including spiders and snakes. Finally, the respondents rated all the visual stimuli according to perceived fear. We proposed the Spider Fear Index (SFI) as a value characterizing the level of spider fear, computed based on the fMRI measurements. We then treated this variable as the "neurophysiological effect of spiders" and examined its contribution to the respondents' fear ratings of the stimuli seen during the fMRI using the redundancy analysis (RDA).

Results

The results for fear ranks revealed that the SFI, SNAQ, DS-R, and SPQ scores had a significant effect, while BAT and SPQ scores loaded in the same direction of the first multivariate axis. The SFI was strongly correlated with both SPQ and BAT scores in the pooled sample of arachnophobic and healthy control subjects.

Discussion

Both SPQ and BAT scores have a high informative value about the subject's fear of spiders and together with subjective emotional evaluation of picture stimuli can be reliable predictors of spider phobia. These parameters provide easy and non-expensive but reliable measurement wherever more expensive devices such as magnetic resonance are not available. However, SFI still reflects individual variability within the phobic group, identifying individuals with higher brain activation, which may relate to more severe phobic reactions or other sources of fMRI signal variability.

Using Motion Tracking to Measure Avoidance in Children and Adults: Psychometric Properties, Associations With Clinical Characteristics, and Treatment-Related Change

Avoidance is implicated in many areas of psychopathology, particularly anxiety and its disorders. Accurate, reliable, valid, and objective measurement of avoidance behavior poses methodological challenges. Two key technological advances, increased computing power and the advent of motion-tracking technology, offer novel solutions to these challenges. We describe a series of three studies using a novel motion-tracking system to measure avoidance in children and adults. The first study examined behavioral avoidance of spider stimuli in large samples of children and adults (N = 200 each; the adults were the mothers of the children). Behavioral avoidance was associated with self-rated fear of spiders and increased state anxiety from before to after the task. The second study examined avoidance of threat faces in children and adults (N = 35 each; the adults were the mothers of the children) and test-retest reliability in the adults. Avoidance of threat faces was associated with broadband anxiety symptom severity. Test-retest correlations in behavioral avoidance measured 6 weeks apart was high and significant. The third study examined behavioral avoidance of spiders in clinically anxious children (N = 25) before and after cognitive-behavioral therapy for childhood anxiety disorders. Behavioral avoidance was significantly reduced following cognitive-behavioral therapy and reduction in behavioral avoidance correlated significantly with improvement in child-rated anxiety symptoms. Taken together, these studies provide strong support for the promise of motion-tracking technology to enable a new phase of behavioral avoidance research with sensitive, valid, reliable, and cost- and time-effective measurement of behavioral avoidance across the lifespan.

Assessing anxiety disorders in children and adolescents

BACKGROUND

Given the relatively high prevalence of anxiety problems among young people and their adverse consequences if left untreated, it is important that clinicians and researchers have access to reliable and valid assessment tools to facilitate early detection, case formulation, treatment design and evaluation of outcomes.

METHOD

This paper presents the findings of a pragmatic review of the literature regarding the assessment of anxiety in young people in multiple contexts, including mental health services, school-based screening and research trials.

RESULTS

Commonly used diagnostic interviews, questionnaire measures and alternative assessment methods are described, along with psychometric properties and practical issues. The review indicates the complexities of assessing anxiety problems given the high level of comorbidity between anxiety disorders and with depression. It also highlights the different approaches required for assessment across different age groups, the need for multiple informants and issues relating to the lack of agreement between reporters. There is a strong evidence-base for several diagnostic instruments and anxiety scales, although the accuracy of youth and parent report scales in forming clinical diagnoses is not sufficiently strong to justify their use in isolation for diagnostic purposes.

CONCLUSIONS

The assessment of youth anxiety should ideally include a multiinformant, multimethod approach, with measures tailored to the age of the child, and the purpose of the evaluation. There is now a sufficiently strong research base to enable clinicians and researchers to ensure that they select evidence-based instruments.

Clinical and cost-effectiveness of one-session treatment (OST) versus multisession cognitive-behavioural therapy (CBT) for specific phobias in children: protocol for a non-inferiority randomised controlled trial

INTRODUCTION

Specific phobias (intense, enduring fears of an object or situation that lead to avoidance and severe distress) are highly prevalent among children and young people. Cognitive-behavioural therapy (CBT) is a well-established, effective intervention, but it can be time consuming and costly because it is routinely delivered over multiple sessions during several months. Alternative methods of treating severe and debilitating phobias in children are needed, like one-session treatment (OST), to reduce time and cost, and to prevent therapeutic drift and help children recover quickly. Our study explores whether (1) outcomes with OST are 'no worse' than outcomes with multisession CBT, (2) OST is acceptable to children, their parents and the practitioners who use it and (3) OST offers good value for money to the National Health Service (NHS) and to society.

METHOD

A pragmatic, non-inferiority, randomised controlled trial will compare OST with multisession CBT-based therapy on their clinical and cost-effectiveness. The primary clinical outcome is a standardised behavioural task of approaching the feared stimulus at 6 months postrandomisation. The outcomes for the within-trial cost-effectiveness analysis are quality-adjusted life years based on EQ-5D-Y, and individual-level costs based of the intervention and use of health and social service care. A nested qualitative evaluation will explore children's, parents' and practitioners' perceptions and experiences of OST. A total of 286 children, 7-16 years old, with DSM-IV diagnoses of specific phobia will be recruited via gatekeepers in the NHS, schools and voluntary youth services, and via public adverts.

ETHICS AND DISSEMINATION

The trial received ethical approval from North East and York Research Ethics Committee (Reference: 17/NE/0012). Dissemination plans include publications in peer-reviewed journals, presentations in relevant research conferences, local research symposia and seminars for children and their families, and for professionals and service managers.

TRIAL REGISTRATION NUMBER

ISRCTN19883421;Pre-results.

Maternal Acceptance Moderates Fear Ratings and Avoidance Behavior in Children

Avoidance is a hallmark feature of anxiety disorders, and avoidance-related impairment is often key to meeting diagnostic criteria. In children and adolescents with anxiety disorders, levels of avoidance vary considerably. Using a novel motion-tracking measure of avoidance behavior, we examined whether maternal acceptance, characterized by warm and accepting responses to child feelings and behaviors, moderates the association between fear of spiders and behavioral avoidance of spider stimuli in 103 clinically anxious children. As hypothesized, maternal acceptance significantly moderated children's avoidance behavior. Child's fear of spiders was significantly associated with behavioral avoidance when mothers were low in acceptance, as rated by either mothers or children. When mothers were high in acceptance, as rated by either mothers or children, child self-rated fear of spiders was not significantly associated with child avoidance. These are the first results to empirically demonstrate the moderating role of maternal acceptance in anxious children's avoidance behavior.

Mother and Child Ratings of Child Anxiety: Associations With Behavioral Avoidance and the Role of Family Accommodation

OBJECTIVE

This study compared mother and child ratings of child anxiety to each other and to an objective measure of the child's avoidant behavior, using a novel motion-tracking paradigm. The study also examined the moderating role of family accommodation for the link between mother ratings of child anxiety and child behavioral avoidance.

DESIGN

Participants were 98 children (7- to 14-years-old) and their mothers. Children met criteria for a primary anxiety disorder. Measures included parent and child versions of the Multi-Dimensional Anxiety Scale for Children and the Screen for Child Anxiety Related Emotional Disorders. Children also completed the Spider Phobia Questionnaire for children and the Family Accommodation Scale for Anxiety-Child Report. The Yale Interactive Kinect Environment Software platform was used to measure children's behavioral avoidance of spider images.

RESULTS

Mother and child ratings of child anxiety were moderately correlated. Only child ratings of child anxiety were associated with child behavioral avoidance. Child-rated family accommodation moderated the association between parent ratings and child avoidance. When accommodation was low parent ratings correlated with child avoidance, but not when accommodation was high.

CONCLUSIONS

The findings contribute to understanding commonly reported discrepancies between mother and child ratings of child anxiety symptoms.

Anxiety sensitivity moderates behavioral avoidance in anxious youth

Individuals who are high in anxiety sensitivity (AS) are motivated to avoid sensations of anxiety. Consequently, AS is hypothesized to contribute to overall avoidance of any feared stimuli. No studies have yet examined whether fear of a stimulus is a stronger predictor of behavioral avoidance in individuals who are high in AS compared to individuals who are low in AS. We examined whether AS moderates the association between fear of spiders and behavioral avoidance of spider stimuli in 50 clinically anxious youth. Fear of spiders significantly predicted avoidance of spider stimuli in youth high in AS but not in youth low in AS. These results provide support for the role of AS in avoidant behavior and help to explain the link between AS and the anxiety disorders. The results have implications for exposure-based anxiety treatments and highlight the importance of increasing anxious patients' ability to tolerate sensations of anxiety.

Avoidance moderates the association between mothers' and children's fears: findings from a novel motion-tracking behavioral assessment

BACKGROUND

Fear and anxiety in children are associated with similar symptoms in parents. Parental modeling of fearful or avoidant behavior is believed to contribute to this association. We employed a novel motion-tracking experimentation platform to test the hypothesis that mothers' behavioral avoidance of spiders moderates the association between fear of spiders in mothers and children.

METHOD

Participants were 86 children (aged 7-17) presenting with an anxiety disorder, and their mothers. Children and mothers completed the Spider Phobia Questionnaire. Mothers completed a motion-tracking assessment of behavioral avoidance of spiders.

RESULTS

Fear of spiders in mothers was associated with fear of spiders in children (r85  = 0.48, 95%CI 0.30 - 0.63, P < 0.001). Two metrics of behavioral avoidance in mothers were associated with mothers' self-reported fear of spiders (r = -0.49, 95% CI 0.31-0.64, P < 0.001; and r = 0.42, 95%CI 0.23 - 0.58 P < 0.001). Mothers' behavioral avoidance moderated the association between fear of spiders in mothers and in children. When mothers' avoidance was intermediate or high the association was significant, and as mothers' behavioral avoidance increased the strength of the association increased. Fear of spiders in mothers with low behavioral avoidance was not associated with fear of spiders in their children.

CONCLUSIONS

The study demonstrates that behavioral avoidance can be measured using the motion-tracking platform and can be useful in understanding the links between symptoms of anxiety in mothers and children. Reducing parents' overt expressions of avoidance may lower the risk of fears being transmitted to children.

[The Spider Phobia Questionnaire for Children and Adolescents (SPQ-CA) - development and validation of a German short scale]

OBJECTIVE

Spider phobia is rather common in Western societies and mainly afflicts females. The disorder has a very early onset but is very rarely diagnosed and treated in children and adolescents. Thus, there is a need for a reliable, valid, and economic questionnaire for the assessment of the disorder in children and adolescents.

METHOD

For the development (exploratory and confirmatory factor analysis) and validation purposes, 816 children and adolescents aged between 7 and 15 years answered the questionnaire.

RESULTS

The resulting Spider Phobia Questionnaire for Children and Adolescents (SPQ-CA) consists of ten items and has a good internal consistency (Cronbach's α = .86). The scale correlates positively with overall anxiety, disgust proneness, and sensitivity.

CONCLUSIONS

The short scale SPQ-CA is a reliable, valid and economic instrument for the assessment of spider fear and is particularly well suited for application in psychotherapeutic studies.

Assessment of disgust sensitivity in children with an age-downward version of the Disgust Emotion Scale

The present study examined the psychometric properties of the Disgust Emotion Scale for Children (DES-C). Principal components analysis of the DES-C data revealed five factors reflecting disgust toward (a) rotting foods, (b) injection and blood, (c) odors, (d) mutilation and death, and (e) animals, which were largely in keeping with the intended subscales. The DES-C showed good reliability, excellent convergent validity (as established by correlations with an alternative self-report index of disgust), fairly good predictive validity (as assessed by correlations with measures of fear/anxiety and a behavioral index of disgust), and acceptable parent-child agreement (in particular with the mothers). Importantly, the DES-C proved to perform better on some psychometric indicators than an age-downward version of the Disgust Scale. These findings indicate that the DES-C should be regarded as the preferred scale for measuring disgust sensitivity and its role in the etiology and maintenance of anxiety problems in children.

Subjective fear, interference by threat, and fear associations independently predict fear-related behavior in children

BACKGROUND AND OBJECTIVES

Several information-processing models highlight the independent roles of controlled and automatic processes in explaining fearful behavior. Therefore, we investigated whether direct measures of controlled processes and indirect measures of automatic processes predict unique variance components of children's spider fear-related behavior.

METHOD

Seventy-seven children between 8 and 13 years performed an Affective Priming Task (APT) measuring associative bias, a pictorial version of the Emotional Stroop Task (EST) measuring attentional bias, filled out the Spider Anxiety and Disgust Screening for Children (SADS-C) in order to assess self-perceived fear, and took part in a Behavioral Assessment Test (BAT) to measure avoidance of spiders.

RESULTS

The SADS-C, EST, and APT did not correlate with each other. Spider fear-related behavior was best explained by SADS-C, APT, and EST together; they explained 51% of the variance in BAT behavior.

LIMITATIONS

No children with clinical levels of spider phobia were tested. The direct and the different indirect measures did no correlate with each other.

CONCLUSIONS

These results indicate that both direct and indirect measures are useful for predicting unique variance components of fear-related behavior in children. The lack of relations between direct and indirect measures may explain why some earlier studies did not find stronger color-naming interference or stronger fear associations in children with high levels of self-reported fear. It also suggests that children with high levels of spider-fearful behavior have different fear-related associations and display higher interference by spider stimuli than children with non-fearful behavior.

[Psychoeducation leads to a reduction in fear of spiders in 8- to 9-year-old children - a pilot study]

OBJECTIVE

In Western societies spiders are among the least liked of all arthropods, eliciting feelings of fear and disgust. The clinical manifestation of this fear - spider phobia - is a common anxiety disorder. In most cases the disorder has an early onset in childhood. The symptoms show a chronic course and can persist into adulthood if not treated. Etiological models emphasize the role of modeling and negative information transmission for the acquisition of the disorder. Even though powerful psychotherapeutic methods exist, referral to treatment is rather uncommon for children. Often spontaneous remission is expected, but that is atypical.

METHOD

The current study developed a psychoeducative program on spiders for elementary school children and evaluated it on a sample of 36 children aged 8 to 10 years. The main goal of this pilot study was to test the feasibility of the program.

RESULTS

The study showed a reduction of fear of spiders after psychoeducation in girls and boys with previously high or moderate fear of spiders.

CONCLUSIONS

The program could become a valuable contribution to the prevention of spider phobia and should be evaluated in future controlled trials.

Changes in facial electromyographic activity in spider-phobic girls after psychotherapy

Recent studies of spider phobia have indicated that disgust is a crucial disorder-relevant emotion and that the facial electromyogram (EMG) of the levator labii region is a reliable disgust indicator. The present investigation focused on EMG effects of psychotherapy in thirty girls (aged between 8 and 14 years) suffering from spider phobia. They were presented with phobia-relevant, generally fear-inducing, disgust-inducing and affectively neutral pictures in a first EMG session. Subsequently, patients were randomly assigned to either a therapy group or a waiting-list group. Therapy-group participants received a single session of exposure therapy in vivo. One week later a second EMG session was conducted. Patients of the waiting-list group received exposure therapy after the second EMG session. After therapy, the girls were able to hold a living spider in their hands and rated spiders more positive, and less arousing, fear- and disgust-inducing. Moreover, they showed a reduction of average levator labii activity in response to pictures of spiders, reflecting the reduction of feelings of disgust. A positive side effect of the therapy was a significant drop in overall disgust proneness and a decreased average activity of the levator labii muscle in response to generally disgust-inducing pictures. Results emphasize the role of disgust feelings in spider-phobic children and suggest that overall disgust proneness should also be targeted in therapy.

Exposure therapy leads to enhanced late frontal positivity in 8- to 13-year-old spider phobic girls

Neurobiological studies have demonstrated that psychotherapy is able to alter brain function in adults, however little exists on this topic with respect to children. This waiting-list controlled investigation focused on therapy-related changes of the P300 and the late positive potential (LPP) in 8- to 13-year-old spider phobic girls. Thirty-two patients were presented with phobia-relevant, generally disgust-inducing, fear-inducing, and affectively neutral pictures while an electroencephalogram was recorded. Participants received one session of up to 4h of cognitive-behavioral exposure therapy. Treated children showed enhanced amplitudes of the LPP at frontal sites in response to spider pictures. This result is interpreted to reflect an improvement in controlled attentional engagement and is in line with already existing data for adult females. Moreover, the girls showed a therapy-specific reduction in overall disgust proneness, as well as in experienced arousal and disgust when viewing disgust pictures. Thus, exposure therapy seems to have broad effects in children.

Childhood Fears and Phobias: Advances in Assessment and Treatment

The specific phobias in children, such as night-time fears and animal phobias, should not be underestimated since they cause personal distress to the child and also much interference with daily activities. Intervention plans should be informed by multimethod assessment, using tools that are empirically sound and developmentally sensitive. This article selectively reviews a number of assessment tools including structured diagnostic interview schedules, standardised instruments such as anxiety or fear self-report questionnaires, and behavioural tasks. An overview is given of the main intervention approaches, from a behavioural perspective, including traditional behavioural intervention procedures such as systematic desensitisation and its variants, cognitive–behavioural therapy, and behavioural family therapy. The authors also present recent developments in psychodynamic treatment for phobic and anxious children. Finally, we present conclusions on the empirical standing of the various treatment approaches and also examine the important issue of treatment outcome prediction.

Anxiety and the Processing of Threat in Children: Further Examination of the Cognitive Inhibition Hypothesis

The present study examined the cognitive inhibition hypothesis (Kindt, Bierman, & Brosschot, 1997) which asserts that young children lack the ability to inhibit the processing of threat, but develop this with age. To examine this issue, high spider fearful children (N = 170) and low spider fearful children (N = 215) aged 7—11 years were tested by means of an emotional Stroop task. It was hypothesised that a processing bias for spider-related stimuli would be present in all 8- and 9-year-old children. That is, it was expected that responses to spider words would be slower compared to responses to control words. Furthermore, it was hypothesised that this processing bias would decrease with age in low fearful children, whereas it would persist in high fearful children. No support was found for these hypotheses. Instead of the predicted processing bias, data showed the reverse pattern; that is, children responded faster to spider words compared to control words. It is proposed that the reverse bias results from avoidance. More precisely, children may evade the processing of spider stimuli through fast responding.

Approach and Avoidance Tendencies in Spider Fearful Children: The Approach-Avoidance Task

Fear in children is associated with the tendency to avoid situations related to the fear. In this study, the Approach-Avoidance Task (AAT) was evaluated as a test of automatic behavioral avoidance tendencies in children. A sample of 195 children aged between 9 and 12 years completed an AAT, a Behavioral Assessment Task (BAT), and two spider fear questionnaires. The results indicate that all children showed an automatic avoidance tendency in response to spider pictures, but not pictures of butterflies or neutral pictures. Girls who reported more fear of spiders on the self-reports and behaved more anxiously during the BAT also showed a greater avoidance tendency in the AAT. These relationships were absent in boys.

Development and initial validation of an abbreviated Spider Phobia Questionnaire using item response theory

An abbreviated Spider Phobia Questionnaire (SPQ) was developed using methods based in item response theory. Fifteen of the 31 SPQ items that demonstrated good to excellent discrimination along the spider fear continuum were retained in Study 1 that consisted of 1,555 nonclinical and clinical participants. The SPQ-15 demonstrated good internal consistency and correlated highly with the full SPQ. Structural equation modeling revealed that the SPQ-15 demonstrated excellent convergent validity, with strong associations with small animal disgust and other phobic symptoms. Supportive evidence was also found for divergent validity in relation to panic-related symptoms. The SPQ-15 was uniquely predictive of avoidance behavior and fear and disgust responding towards spiders in nonclinical, analogue, and treatment-seeking samples in Studies 2, 3, and 4. Lastly, in Study 5, the SPQ-15 was sensitive to the effects of exposure-based treatment. These findings suggest that the SPQ-15 has considerable strengths, including decreased assessment and scoring time while retaining high reliability, validity, and sensitivity.

Disgust sensitivity and psychopathological symptoms in non-clinical children

There is clear evidence in the adult literature that disgust sensitivity is implicated in various psychopathological syndromes. The current study examined the link between disgust sensitivity and psychopathological symptoms in youths. In a sample of non-clinical children aged 9-13 years, disgust sensitivity was assessed by two self-report questionnaires (i.e., the Disgust Scale and the Disgust Sensitivity Questionnaire) and a behavioural test. Furthermore, children completed scales for measuring the personality trait of neuroticism and various types of psychopathological symptoms. Results showed that disgust measures had sufficient to good convergent validity. Further, significant positive correlations were found between disgust sensitivity and symptoms of specific phobias (i.e., spider phobia, blood-injection phobia, small-animal phobia), social phobia, agoraphobia, obsessive-compulsive disorder (OCD), and eating problems, and these links were not attenuated when controlling for neuroticism. The possible role of disgust sensitivity in the aetiology of child psychopathology is discussed.

The influence of animal fear on attentional capture by fear-relevant animal stimuli in children

The present study demonstrated that pictures of fear-relevant animals, snakes and spiders, presented among backgrounds of other animal stimuli captured attention and interfered in the detection of a neutral target to the same extent in a large sample of unselected children (N=81). Moreover, detection of a neutral target animal was slowed more in the presence of a feared fear-relevant distracter, e.g., a snake for snake fearful children, than in the presence of a not feared fear-relevant distracter, e.g., a spider for snake fearful children. These results indicate attentional capture by phylogenetically fear-relevant animal stimuli in children and the selective enhancement of this effect by fear of these animals. These findings are consistent with current models of preferential processing of phylogenetically prepared threat stimuli and with cognitive models of anxiety that propose an enhancing effect of fear in the processing of fear-related stimuli.

Spider fear and covariation bias in children and adolescents

Covariation bias can be defined as phobic people's tendency to overestimate the association between fear-relevant stimuli and negative outcomes. The current article presents two studies that examined this type of cognitive bias in children and adolescents aged 8-16 years. Study 1 was concerned with a thought experiment during which youths (N=150) were asked to imagine that they participated in an experiment during which they had to view a series of pictures showing spiders, guns, and flowers, that were occasionally followed by a negative outcome (i.e., a mild electric shock). Participants were asked to estimate the relation between each type of picture and the negative outcome. The results indicated that youths with higher levels of spider fear displayed a specific tendency to relate spider pictures to a negative outcome. In Study 2, youths (N=220) actually participated in a computer game during which they were confronted with pictures of spiders, guns, and flowers, each of which was equally often followed by a negative (i.e., losing candy), positive (i.e., winning candy), or neutral outcome. After the game, participants had to estimate the relation between each type of picture and various outcomes. It was found that youths with higher levels of spider fear estimated more negative and less positive outcomes in relation to spider pictures. Taken together, these findings provide support for a fear-related covariation bias in youths. Further developmental analyses indicated that this type of cognitive bias seems to be more consistently present among adolescents than among children.

Childhood Fears and Phobias: Assessment and Treatment

The specific phobias in children, such as night-time fears and animal phobias, should not be underestimated since they cause personal distress to the child and also much interference with daily activities. Intervention plans should be informed by multi-method assessment, using tools that are empirically sound and developmentally sensitive. We selectively review a number of assessment tools, including structured diagnostic interview schedules, standardised instruments such as anxiety or fear self-report questionnaires, and behavioural tasks. We provide an overview of the main intervention approaches, from a behavioural perspective, including traditional behavioural intervention procedures such systematic desensitisation and its variants, cognitive-behavioural therapy, and behavioural family therapy. We also present recent developments in psychodynamic treatment for phobic and anxious children. Medications are also discussed because of their possible use with psychosocial interventions. Finally, we present our conclusions on the empirical standing of the various treatment approaches and also examine the important issue of treatment outcome prediction.

An experimental study of spider-related covariation bias in 8- to 13-year-old children

Covariation bias can be defined as phobic subjects' tendency to overestimate the association between phobic stimuli and aversive outcomes. The current study presents two experiments that examined this type of cognitive bias in children aged 8-13 years (N=147 in Experiment 1, N=240 in Experiment 2). Children completed a self-report questionnaire for measuring spider fear and then participated in a card game in which fear-relevant (i.e., spider) and fear-irrelevant (i.e., weapon and Pokémon) pictures were equally paired with negative and positive outcomes (respectively losing and winning candy). No evidence was found for a relationship between children's level of spider fear and the tendency to link negative consequences to fear-relevant pictures. Various methodological and theoretical explanations for this null finding are discussed.

Emotional reasoning and parent-based reasoning in normal children

A previous study by Muris, Merckelbach, and Van Spauwen demonstrated that children display emotional reasoning irrespective of their anxiety levels. That is, when estimating whether a situation is dangerous, children not only rely on objective danger information but also on their own anxiety-response. The present study further examined emotional reasoning in children aged 7-13 years (N = 508). In addition, it was investigated whether children also show parent-based reasoning, which can be defined as the tendency to rely on anxiety-responses that can be observed in parents. Children completed self-report questionnaires of anxiety, depression, and emotional and parent-based reasoning. Evidence was found for both emotional and parent-based reasoning effects. More specifically, children's danger ratings were not only affected by objective danger information, but also by anxiety-response information in both objective danger and safety stories. High levels of anxiety and depression were significantly associated with the tendency to rely on anxiety-response information, but only in the case of safety scripts.

Spider phobia interaction of disgust and perceived likelihood of involuntary physical contact

After reading vignettes, a group of spider-phobic girls (n = 18) and a group of nonphobic girls (n = 18) rated the subjective probability of spiders entering their private living space, their tendency to approach and make physical contact, and the subjective probability of spiders doing physical harm. In addition, they indicated their eagerness to eat a favorite food item before as well as after it had been shortly contacted by spiders. In support of the idea that spider phobia results from the convergence of spiders' disgusting properties and the subjective probability of involuntary contact, phobic girls reported relatively high ratings concerning: (a) the probability of spiders entering their room; (b) spiders' tendency to approach and make physical contact; and (c) spiders' disgust-evoking status. Finally, regression analysis indicated that spiders' disgust-evoking status is the single best predictor of spider phobia, whereas the independent contribution of the perceived probability of spiders doing physical harm was found to be negligible. All in all, the present findings strongly support the idea that spider phobia essentially reflects a fear of physical contact with a disgusting stimulus.

Phobia of self-injecting and self-testing in insulin-treated diabetes patients: opportunities for screening

AIMS

To define clinically relevant cut-off points for severe fear of self-injecting (FSI) and self-testing (FST) (phobia) in insulin-treated patients with diabetes, and to estimate the magnitude of these phobias in our research population.

METHODS

FSI and FST were assessed in a cross-sectional survey using the Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ). A sample of 24 insulin-treated adult diabetic patients was selected from the high-scorers on FSI and/or FST (> or = 95th percentile). FSI and FST were re-assessed, after which patients participated in a behavioural avoidance test (BAT), thereby determining the current level of avoidance of either self-injecting or self-testing. FSI and FST scores were linked to the outcome of the BATs. Cut-off scores for severe FSI/FST were determined and extrapolated to the total study population (n = 1275).

RESULTS

Seven patients participated in the self-injecting BAT: two patients refused to perform an extra injection. In the self-testing BAT (n = 17) four patients declined to perform the extra blood glucose self-test. Extrapolation of FSI and FST cut-off scores to the total research population showed that 0.2-1.3% of the population scored in the severe FSI range. In FST, 0.6-0.8% of the total study population obtained scores in the cut-off range.

CONCLUSIONS

Severe FSI and FST, characterized by emotional distress and avoidance behaviour, seems to occur in a small group of insulin-treated patients with diabetes. The D-FISQ can be of use to health care professionals (physicians, nurse specialists) in quickly providing valuable information on levels of FSI and FST in diabetes patients.

Computer-aided vicarious exposure versus live graded exposure for spider phobia in children

The efficacy of computer-aided vicarious exposure (CAVE) for the treatment of spider phobia in children was evaluated in a single blind, randomised, controlled trial. Twenty-eight participants, aged 10-17 years, received three 45-min sessions of either Live graded exposure (LGE), CAVE or were assigned to a Waitlist. Phobic symptomatology was measured at pre- and post-treatment, and at one month follow-up on a range of behavioural and subjective assessments. The results showed the superiority of the LGE treatment over the CAVE and Waitlist conditions. Effect sizes support CAVE treatment as being superior to the Waitlist and resulting in reductions of phobic symptomatology.

Considering the clinical utility of performance-based measures of childhood anxiety

Examines general issues regarding the clinical utility of performance-based measures and specifically considers the utility of performance measures relevant to childhood anxiety and fear. First, we discuss the limitations of questionnaire and interview measures of childhood anxiety and the ways in which performance-based measures may compensate for or augment the use of such measures. Second, we review the major groups of performance-based measures that are potentially relevant to childhood anxiety and discuss evidence regarding their reliability and validity. Third, in the context of a general discussion of the various ways in which an assessment procedure may have clinical utility, we discuss the extent to which the performance-based techniques reviewed possess utility. Although many of these measures show promise of one or more types of clinical utility, none currently possess sufficient documented utility to warrant their dissemination for clinical use. We conclude by recommending directions for future research to demonstrate and improve the utility of such measures.

Treatment of specific phobias with Eye Movement Desensitization and Reprocessing (EMDR): protocol, empirical status, and conceptual issues

This paper considers the current empirical status of Eye Movement Desensitization and Reprocessing (EMDR) as a treatment method for specific phobias, along with some conceptual and practical issues in relation to its use. Both uncontrolled and controlled studies on the application of EMDR with specific phobias demonstrate that EMDR can produce significant improvements within a limited number of sessions. With regard to the treatment of childhood spider phobia, EMDR has been found to be more effective than a placebo control condition, but less effective than exposure in vivo. The empirical support for EMDR with specific phobias is still meagre, therefore, one should remain cautious. However, given that there is insufficient research to validate any method for complex or trauma related phobias, that EMDR is a time-limited procedure, and that it can be used in cases for which an exposure in vivo approach is difficult to administer, the application of EMDR with specific phobias merits further clinical and research attention.

The etiology of childhood spider phobia

Twenty-six girls with a clinical spider phobia and 26 matched control girls were interviewed about conditioning, modeling, and negative information experiences in connection with spiders. In addition, parents of the phobic girls were independently interviewed about the origins of their child's phobia. Phobic children more often reported aversive conditioning experiences with spiders than did control children. Also, in a number of cases, conditioning events described by the phobic children were confirmed by their parents, a result that replicates the findings of Merckelbach, Muris and Schouten (1996; Behaviour Research and Therapy, 34, 935-938). Taken together, the results contradict a strong version of the non-associative account of phobias and suggest that in at least some cases, conditioning events may contribute to the development of (childhood) spider phobia.

Eye movement desensitisation and reprocessing versus exposure in vivo. A single-session crossover study of spider-phobic children

BACKGROUND

Eye movement desensitisation and reprocessing (EMDR) is a relatively new therapeutic technique that has been proposed as a treatment for post-traumatic stress disorder and other anxiety complaints.

METHOD

We compared the efficacy of EMDR with that of exposure in vivo in the treatment of a specific phobia. Twenty-two spider-phobic children who met the DSM-III-R criteria for specific phobia participated in the study. Children were treated with one session of exposure in vivo and one session of EMDR in a crossover design. Treatment outcome was evaluated by self-report measures, a behavioural avoidance test and a physiological index (skin conductance level).

RESULTS

Results showed positive effects of EMDR, but also suggest that it is especially self-report measures that are sensitive to EMDR. Improvement on a behavioural measure was less pronounced, and exposure in vivo was found to be superior in reducing avoidance behaviour. With regard to skin conductance level, EMDR and exposure in vivo did not differ.

CONCLUSIONS

EMDR has no additional value in treatment of this type of animal phobia, for which exposure in vivo is the treatment of choice.

Spider phobia in children: disgust and fear before and after treatment

Fear of spiders, disgust sensitivity, and spiders' disgust-evoking status were assessed in a group of spider phobic girls (n = 22) who applied for treatment, in a group of non-phobic girls (n = 21), and in the parents of both groups of children. The phobic girls were tested both before and after behavioural treatment which consisted of 1.5 hr eye movement desensitization and reprocessing and 1.5 hr exposure in vivo. Findings support the idea that disgust is an important aspect of spider phobia: (a) spider phobic girls exhibited higher levels of disgust sensitivity and considered spiders per se as more disgusting than non-phobic girls; (b) there was a parallel decline of spider fear and spiders' disgust-evoking status as a result of treatment; and (c) spiders' disgust-evoking status was relatively strong in mothers of spider phobic girls. The latter finding may indicate, that the acquisition of spider fear is facilitated by specific parental disgust reactions when confronted with spiders.

Pathways to fear in spider phobic children

Twenty-two children with spider phobia were interviewed about the origins of their fear. More specifically, children were asked about conditioning events, modeling experiences, and negative information transmission. To evaluate the reliability of the information provided by the children, parents were independently interviewed about the origins of their children's phobias. While 46% of the children claimed to have always been afraid, 41% ascribed the onset of their fear to aversive conditioning events. The large majority of these events were confirmed by parents. These findings cast doubts on a strong version of the non-associative account of spider phobia, i.e. the idea that spider phobia is acquired in the complete absence of learning experiences.