Abstract
OBJECTIVE: The essential feature of specific phobia is a persistent fear of clearly discernable, circumscribed objects or situations. The DSM-IV distinguishes four subtypes: animal, natural environment, blood-injection-injury, and situational. Specific phobias frequently co-occur. Specific phobia is one of the most common psychiatric disorders with a lifetime prevalence of 12.5% and is about twice as common in women as in men. Most phobias have a childhood onset except for the situational subtype which usually occurs during patients' twenties. It is well known that childhood anxiety increases the risk of psychiatric disorders such as depression and anxiety in later life, as well as the risk of suicide attempts and psychiatric hospitalization. Nonetheless, there are few studies on the psychobiology and pharmacotherapy of specific phobias. Neuroimaging studies have shown that specific phobia seems to be associated with amygdala (more specifically the right amygdala) and anterior cingulate cortex hyperactivation that is reduced after exposure therapy. The aim of this study is to propose the first systematic review of specific phobia treatment among children. METHOD: The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guidelines. Two databases (Medline and Web of Science) were searched combining the search terms: specific phobia and treatment. English and French language were imposed. There were no publication date or publication status limitations. Seventy-four studies met the inclusion criteria and 36 were included. RESULTS: The goal of treatment is to achieve habituation and eventual extinction of the phobic reaction. Treatments for children's anxiety have been suggested to work through diverse processes such as counter-conditioning, extinction, habituation, change in catastrophic cognitions, development of coping skills, increased self-efficacy, emotional processing, and changes in expectancies and perceptions of dangerousness. Most phobias respond robustly to in vivo exposure, but this approach is associated with high dropout rates and low treatment acceptance. One Session Treatment, 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. The limited data available on medication shows little promise. Finally, relapse is a common phenomenon, and little is known on the long-term outcome of the illness.