Evid Based Mental Health: first published as 10.1136/ebmh.4.3.86 on 1 August 2001. Downloaded from One 3 hour exposure session was as effective as 5 one hour sessions of either exposure or cognitive therapy for claustrophobia Öst LG, Alm T,Brandberg M, et al. One vs five sessions of exposure and five sessions of cognitive therapy in the treatment of claustrophobia. Behav Res Ther 2001 Feb;39:167–83. QUESTIONS: Is 1 session of exposure treatment (ET) effective in people with claustrophobia? Is 1 session of ET as effective as 5 sessions of ET or 5 sessions of cognitive therapy (CT)? Design did not differ among the 3 treatment groups after treat- Randomised (unclear allocation concealment*), un- ment or at 1 year. blinded*, controlled trial with 1 year of follow up. Conclusion Setting In people with claustrophobia, 1 session of exposure Uppsala and Stockholm counties, Sweden. treatment (ET) was as effective as 5 sessions of ET or 5 sessions of cognitive therapy. Patients *See glossary. 50 patients who were 18–60 years of age, were afraid of and avoided confined spaces, had claustrophobia for >1 year (mean duration 26 y), could not complete > 50% of the steps in behavioural tests, and had no psychotic or COMMENTARY organic illnesses or other psychiatric problems requir- Claustrophobia, a fear of enclosed spaces, has a lifetime ing immediate treatment. Follow up was 92% (mean age prevalence of about 4% and can be substantially handicap- 41 y, 91% women). ping in a proportion of cases.1 Of course, most people with fears of sufficient persistence and intensity to meet diagnos- Intervention tic criteria for specific phobia manage to find ways of living Patients were allocated to 1 of 4 groups: one 3 hour ses- with their fear and few seek professional help. For those who sion of ET (n = 10), 5 one hour sessions of ET (n = 11), 5 do, cognitive behaviour therapy using in vivo exposure and one hour sessions of CT (n = 11), or a waiting list for 5 therapeutic modelling can be effective and is clearly the weeks (n = 18). In the ET groups, patients were exposed treatment of choice; psychotropic medication, in contrast, is 2 to anxiety arousing situations. In the CT group, patients relatively ineffective. Öst et al have been at the forefront of developing were taught to recognise and challenge negative intensive, exposure based treatments, the most rapid of automatic thoughts and basic beliefs about the claustro- which consists of a single session of extended duration up to phobic situations, and they were not discouraged from 3 a maximum of 3 hours. Previous research has shown the http://ebmh.bmj.com/ practising in phobic situations between sessions. effectiveness of this approach with phobias of flying, injections, blood and injury, and spiders. Öst et al’s study Main outcome measures confirms that claustrophobia can also be treated in this way, Clinical improvement (statistically significant improve- and successfully too, with few dropouts (8%) and with almost ment in behavioural tests score plus score within normal all patients (80–100%) at 1 year follow up achieving a maxi- range or outside patient group range), self report meas- mum score on 1 of the behavioural outcome measures (eg, riding an elevator up and down a 9 storey building). Of par- ures of claustrophobia (the Claustrophobia Scale and ticular interest is the finding that exposure is broadly equiv- Source of funding: the Claustrophobia Questionnaire), and anxiety ratings alent to cognitive therapy based on the cognitive model of Swedish Medical during behavioural tests (elevator ride 9 floors up and 9 on September 25, 2021 by guest. Protected copyright. Research Council. panic. This may be because the cognitions in claustrophobia floors down, entering a small windowless room, and are similar to those in panic disorder.4 For correspondence: putting on a gas mask). The treatments in this study require experienced DrLGÖst, cognitive behaviour therapists. Clinicians should also note Department of Main results that, although clearly handicapped by their phobia, these Psychology, Stockholm Treatment groups did not differ for the number of patients had low scores on standard symptom inventories University, S-106 91 and no other complicating psychiatric conditions. Stockholm, Sweden. Fax patients who were clinically improved after treatment +468158342. (table) or after 1 year. Anxiety and claustrophobia scores Rob Durham, PhD Ninewells Hospital and Medical School Dundee, UK 1 exposure therapy (ET) session (ET1)v5ETsessions (ET5) v cognitive therapy (CT) for 1 Curtis GC, Magee WJ, Eaton WW, et al. Specific fears and claustrophobia† phobias. Epidemiology and classification. Br J Psychiatry 1998;173:212–7. Outcome at 5 weeks Comparisons Event rates RBR (95% CI) NNT 2 Fyer AJ. Simple phobia. Mod Probl Pharmacopsychiatry 1987;22:174–92. Clinical improvement ET1 v ET5 80% v 81% 1.5% (−47 to 35) Not significant 3 Öst LG. Rapid treatment of specific phobias. In: Davey GC, RBI (CI) NNT editor. Phobias: a handbook of theory, research and treatment. Chichester: Wiley, 1997:227–46. ET1 v CT 80% v 79% 1.8% (−59 to 33) Not significant 4 Rachman S, Levitt K, Lopatka C. Experimental analyses of − panic-III. Claustrophobic subjects. Behav Res Ther ET5 v CT 81% v 79% 3.4% ( 31 to 61) Not significant 1988;26:41–52. †RBR=relative benefit reduction. Other abbreviations defined in glossary; RBR, RBI, NNT, and CI calculated from data in article. 86 Volume 4 August 2001 EBMH www.ebmentalhealth.com Therapeutics.