Evaluation of the Effectiveness of One- and Multi-Session Exposure-Based Treatments in Reducing Biological and Psychological Responses to Rat Phobia Among Students

Camellia Hemyari, Behrooz Dolatshahi, Ali Sahraian, Omid Koohi-Hosseinabadi, Kamiar Zomorodian, Camellia Hemyari, Behrooz Dolatshahi, Ali Sahraian, Omid Koohi-Hosseinabadi, Kamiar Zomorodian

Abstract

Background: Animal phobia is one of the most common forms of specific phobias. This anxiety disorder challenges the medical student working with animal models. Regarding this, the present study was conducted to investigate the effectiveness of one- and multi-session cognitive exposure-based treatments in students with rat phobia.

Methods: For the purpose of the study, a total of 40 female students with rat phobia were allocated into two groups of one- and multi-session cognitive exposure-based treatments. The data were collected using psychological measures, including state anxiety, rat phobia, and disgust questionnaires, which were completed in three stages, including the baseline, pre-treatment, and post-treatment. The gene expression levels of pro-inflammatory cytokines (ie, interleukin-1 [IL-1], nuclear factor-kappaB [NF-κB], and tumor necrosis factor-alpha [TNFα]) associated with acute stress, as well as the serum levels of IL-6 and cortisol, were determined using reverse transcription-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA) methods. This study was registered at the Iranian Registry of Clinical Trials (IRCT20171123037602N1).

Results: According to the results, both treatments yielded a significant reduction in almost all psychological measures and biological variables, except for IL-6. Rat phobia was the only variable that showed a statistically greater reduction in the multi-session treatment group. Furthermore, rat phobia and disgust reduction were maintained in both groups to the same extent during follow-up.

Conclusion: The findings of the present study were indicative of the incidence of habituation in psychological and biological factors following exposure therapy. Both one- and multi-session treatments reduced the factors associated with rat phobia almost to the same degree. As a result of the high levels of disgust, anxiety-related biological factors remained high in four students despite observing a significant reduction in their fear. This led to passive avoidance in this group. The OST enabled the students to handle rats in less than half a day. Accordingly, it could be applied as a half-day workshop for students in medical universities to avoid the incidence of associated anxiety-related disorders in this group.

Keywords: cortisol; exposure therapy; gene expression; habituation; specific phobia.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2020 Hemyari et al.

Figures

Figure 1
Figure 1
CONSORT flowchart of the study process.

References

    1. APA. Diagnostic and Statistical Manual of Mental Disorders. 4 ed. Arlington, VA, US: American Psychiatric Publishing, Inc; 1994.
    1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62(6):593–602. doi:10.1001/archpsyc.62.6.593
    1. Craske M, Barlow D, Clark D, et al. Specific (simple) phobia. DSM-IV Sourcebook. 1996;2:473–506.
    1. Magee W, Eaton W, Wittchen H. Agoraphobia, simple phobia, and social phobia in the national comorbidity survey. Year Bk Psychiatr Appl Ment Health. 1997;1997:369.
    1. Stinson FS, Dawson DA, Chou SP, et al. The epidemiology of DSM-IV specific phobia in the USA: results from the national epidemiologic survey on alcohol and related conditions. Psychol Med. 2007;37(7):1047–1059. doi:10.1017/S0033291707000086
    1. Fink G. Stress: Concepts, Cognition, Emotion, and Behavior: Handbook of Stress Series. Vol. 1 Academic Press; 2016.
    1. Badyal DK, Desai C. Animal use in pharmacology education and research: the changing scenario. Indian J Pharmacol. 2014;46(3):257. doi:10.4103/0253-7613.132153
    1. Britain G, Commission CQ. The State of Health Care and Adult Social Care in England in 2011/12. Stationery Office; 2012.
    1. Choy Y, Fyer AJ, Lipsitz JD. Treatment of specific phobia in adults. Clin Psychol Rev. 2007;27(3):266–286. doi:10.1016/j.cpr.2006.10.002
    1. Foa EB, Blau JS, Prout M, Latimer P. Is horror a necessary component of flooding (implosion)? Behav Res Ther. 1977;15(5):397–402. doi:10.1016/0005-7967(77)90043-2
    1. Gauthier J, Marshall W. The determination of optimal exposure to phobic stimuli in flooding therapy. Behav Res Ther. 1977;15(5):403–410. doi:10.1016/0005-7967(77)90044-4
    1. Hellström K, Öst L-G. One-session therapist directed exposure vs two forms of manual directed self-exposure in the treatment of spider phobia. Behav Res Ther. 1995;33(8):959–965. doi:10.1016/0005-7967(95)00028-V
    1. Hepner A, Cauthen NR. Effect of subject control and graduated exposure on snake phobias. J Consult Clin Psychol. 1975;43(3):297. doi:10.1037/h0076740
    1. Muris P, Mayer B, Merckelbach H. Trait anxiety as a predictor of behaviour therapy outcome in spider phobia. Behav Cogn Psychother. 1998;26(1):87–91. doi:10.1017/S1352465898000095
    1. Öst L-G. One-session group treatment of spider phobia. Behav Res Ther. 1996;34(9):707–715. doi:10.1016/0005-7967(96)00022-8
    1. L-G Ö, Ferebee I, Furmark T. One-session group therapy of spider phobia: direct versus indirect treatments. Behav Res Ther. 1997;35(8):721–732. doi:10.1016/S0005-7967(97)00028-4
    1. L-G Ö, Salkovskis PM, Hellström K. One-session therapist-directed exposure vs. self-exposure in the treatment of spider phobia. Behav Ther. 1991;22(3):407–422. doi:10.1016/S0005-7894(05)80374-0
    1. Rentz TO, Powers MB, Smits JA, Cougle JR, Telch MJ. Active-imaginal exposure: examination of a new behavioral treatment for cynophobia (dog phobia). Behav Res Ther. 2003;41(11):1337–1353. doi:10.1016/S0005-7967(03)00041-X
    1. Öst L-G. One-session treatments for a case of multiple simple phobias. Cogn Behav Ther. 1987;16(4):175–184.
    1. Öst L-G. One-session treatment for specific phobias. Behav Res Ther. 1989;27(1):1–7. doi:10.1016/0005-7967(89)90113-7
    1. Öst L-G. Rapid treatment of specific phobias In: Davey GCL, editor. Phobias: A handbook of Theory, Research, and Treatment. New York: John Wiley and Sons; 1997.
    1. Zlomke K, Davis TE 3rd. One-session treatment of specific phobias: a detailed description and review of treatment efficacy. Behav Ther. 2008;39(3):207–223. doi:10.1016/j.beth.2007.07.003
    1. Bouton ME. Context, time, and memory retrieval in the interference paradigms of Pavlovian learning. Psychol Bull. 1993;114(1):80. doi:10.1037/0033-2909.114.1.80
    1. Craske MG, Treanor M, Conway CC, Zbozinek T, Vervliet B. Maximizing exposure therapy: an inhibitory learning approach. Behav Res Ther. 2014;58:10–23. doi:10.1016/j.brat.2014.04.006
    1. Myers KM, Davis M. Mechanisms of fear extinction. Mol Psychiatry. 2007;12(2):120–150.
    1. Marks I, Tobena A. Learning and unlearning fear: a clinical and evolutionary perspective. Neurosci Biobehav Rev. 1990;14(4):365–384. doi:10.1016/S0149-7634(05)80059-4
    1. Joels M, Baram TZ. The neuro-symphony of stress. Nat Rev Neurosci. 2009;10(6):459–466. doi:10.1038/nrn2632
    1. Besharat MA, Behpajooh A, Poursharifi H, Zarani F. Personality and chronic fatigue syndrome: the role of the five-factor model. Asian J Psychiatr. 2011;4(1):55–59. doi:10.1016/j.ajp.2010.12.001
    1. Elenkov IJ, Wilder RL, Chrousos GP, Vizi ES. The sympathetic nerve – an integrative interface between two supersystems: the brain and the immune system. Pharmacol Rev. 2000;52(4):595–638.
    1. Sapolsky RM, Romero LM, Munck AU. How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions. Endocr Rev. 2000;21(1):55–89. doi:10.1210/edrv.21.1.0389
    1. Dickerson SS, Kemeny ME. Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. Psychol Bull. 2004;130(3):355. doi:10.1037/0033-2909.130.3.355
    1. Kiecolt-Glaser JK, Preacher KJ, MacCallum RC, Atkinson C, Malarkey WB, Glaser R. Chronic stress and age-related increases in the proinflammatory cytokine IL-6. Proc Natl Acad Sci. 2003;100(15):9090–9095. doi:10.1073/pnas.1531903100
    1. Cole SW, Hawkley LC, Arevalo JM, Sung CY, Rose RM, Cacioppo JT. Social regulation of gene expression in human leukocytes. Genome Biol. 2007;8(9):R189. doi:10.1186/gb-2007-8-9-r189
    1. Miller GE, Chen E, Sze J, et al. A functional genomic fingerprint of chronic stress in humans: blunted glucocorticoid and increased NF-κB signaling. Biol Psychiatry. 2008;64(4):266–272. doi:10.1016/j.biopsych.2008.03.017
    1. Murphy MO, Loria AS. Sex-specific effects of stress on metabolic and cardiovascular disease: are women at higher risk? Am J Physiol Regul Integr Comp Physiol. 2017;313(1):R1–r9. doi:10.1152/ajpregu.00185.2016
    1. McInnis CM, Wang D, Gianferante D, et al. Response and habituation of pro- and anti-inflammatory gene expression to repeated acute stress. Brain Behav Immun. 2015;46:237–248. doi:10.1016/j.bbi.2015.02.006
    1. Brown TA, Barlow DH, DiNardo PA. Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV): Client Interview Schedule. Graywind Publications Incorporated; 1994.
    1. Koch EI, Spates CR, Himle JA. Comparison of behavioral and cognitive-behavioral one-session exposure treatments for small animal phobias. Behav Res Ther. 2004;42(12):1483–1504. doi:10.1016/j.brat.2003.10.005
    1. Brown TA, Di Nardo PA, Lehman CL, Campbell LA. Reliability of DSM-IV anxiety and mood disorders: implications for the classification of emotional disorders. J Abnorm Psychol. 2001;110(1):49. doi:10.1037/0021-843X.110.1.49
    1. Mohammadi A, Birashk B, Gharaie B. Comparison of the effect of group transdiagnostic therapy and group cognitive therapy on anxiety and depressive symptoms. Iran J Public Health. 2013;42(1):48.
    1. Cochrane A, Barnes-Holmes D, Barnes-Holmes Y. The perceived-threat behavioral approach test (PT-BAT): measuring avoidance in high-, mid-, and low-spider-fearful participants. Psychol Rec. 2008;58(4):585–596. doi:10.1007/BF03395639
    1. Muris P, Merckelbach H. A comparison of two spider fear questionnaires. J Behav Ther Exp Psychiatry. 1996;27(3):241–244. doi:10.1016/S0005-7916(96)00022-5
    1. Wagener AL, Zettle RD. Targeting fear of spiders with control-, acceptance-, and information-based approaches. Psychol Rec. 2011;61(1):77–91. doi:10.1007/BF03395747
    1. Ayre C, Scally AJ. Critical values for Lawshe’s content validity ratio: revisiting the original methods of calculation. Meas Eval Couns Dev. 2014;47(1):79–86. doi:10.1177/0748175613513808
    1. van Overveld M, de Jong PJ, Peters ML. Differential UCS expectancy bias in spider fearful individuals: evidence toward an association between spiders and disgust-relevant outcomes. J Behav Ther Exp Psychiatry. 2006;37(1):60–72. doi:10.1016/j.jbtep.2005.09.007
    1. Zanjani Z, Yaghubi H, Fata L, Shairi M, Gholami Fesharaki M. Psychometric properties of disgust propensity and sensitivity scale in Iranian sample. Clin Psychol Pers. 2016.
    1. Spielberger C, Gorsuch R, Lushene R, Vagg P, Jacobs G. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press; 1983.
    1. Mahram B. Spielberger test Standardization in Mashhad[master thesis]. Tehran, Iran: Allameh Tabatabaei University; 1994.
    1. Sadeghi S. Standardization Spielberger Test [master thesis]. Tehran, Iran: Islamic Azad University; 2002.
    1. Marsland AL, Walsh C, Lockwood K, John-Henderson NA. The effects of acute psychological stress on circulating and stimulated inflammatory markers: a systematic review and meta-analysis. Brain Behav Immun. 2017;64:208–219. doi:10.1016/j.bbi.2017.01.011
    1. Livak KJ, Schmittgen TD. Analysis of relative gene expression data using real-time quantitative PCR and the 2−ΔΔCT method. Methods. 2001;25(4):402–408. doi:10.1006/meth.2001.1262
    1. Öst L-G. Manual for the 1-Session Treatment of Specific Phobias 2010. Located at: Unpublished Manuscript. Stockholm, Sweden: Department of Psychology, Stockholm University; 1997.
    1. Thorpe SJ, Salkovskis PM. Phobic beliefs: do cognitive factors play a role in specific phobias? Behav Res Ther. 1995;33(7):805–816. doi:10.1016/0005-7967(95)00022-P
    1. Hellström K, Fellenius J. One versus five sessions of applied tension in the treatment of blood phobia. Behav Res Ther. 1996;34(2):101–112. doi:10.1016/0005-7967(95)00060-7
    1. L-G Ö, Brandberg M, Alm T. One versus five sessions of exposure in the treatment of flying phobia. Behav Res Ther. 1997;35(11):987–996. doi:10.1016/S0005-7967(97)00077-6
    1. Hisa CC. Four day cognitive behavioral treatment of a rat phobic. Cuad Hispanoam Psicol. 2003;3(1):17–22.
    1. Olatunji BO, Cisler J, McKay D, Phillips ML. Is disgust associated with psychopathology? Emerging research in the anxiety disorders. Psychiatry Res. 2010;175(1–2):1–10. doi:10.1016/j.psychres.2009.04.007
    1. Smits J, Telch M, Randall P. An examination of the decline in fear and disgust during exposure-based treatment. Behav Res Ther. 2002;40(11):1243–1253. doi:10.1016/S0005-7967(01)00094-8
    1. Huijding J, de Jong PJ. Beyond fear and disgust: the role of (automatic) contamination-related associations in spider phobia. J Behav Ther Exp Psychiatry. 2007;38(2):200–211. doi:10.1016/j.jbtep.2006.10.009
    1. Olatunji BO, Deacon B. Specificity of disgust sensitivity in the prediction of fear and disgust responding to a brief spider exposure. J Anxiety Disord. 2008;22(2):328–336. doi:10.1016/j.janxdis.2007.03.007
    1. Matchett G, Davey GC. A test of a disease-avoidance model of animal phobias. Behav Res Ther. 1991;29(1):91–94. doi:10.1016/S0005-7967(09)80011-9
    1. Davey GC, Bickerstaffe S, MacDonald BA. Experienced disgust causes a negative interpretation bias: a causal role for disgust in anxious psychopathology. Behav Res Ther. 2006;44(10):1375–1384. doi:10.1016/j.brat.2005.10.006
    1. Mathews A, Mackintosh B. Induced emotional interpretation bias and anxiety. J Abnorm Psychol. 2000;109(4):602. doi:10.1037/0021-843X.109.4.602
    1. Charash M, McKay D. Attention bias for disgust. J Anxiety Disord. 2002;16(5):529–541. doi:10.1016/S0887-6185(02)00171-8
    1. Cisler JM, Olatunji BO, Lohr JM, Williams NL. Attentional bias differences between fear and disgust: implications for the role of disgust in disgust-related anxiety disorders. Cogn Emot. 2009;23(4):675–687. doi:10.1080/02699930802051599
    1. Muris P, Mayer B, Huijding J, Konings T. A dirty animal is a scary animal! Effects of disgust-related information on fear beliefs in children. Behav Res Ther. 2008;46(1):137–144. doi:10.1016/j.brat.2007.09.005
    1. Liu Y-Z, Wang Y-X, Jiang C-L. Inflammation: the common pathway of stress-related diseases. Front Hum Neurosci. 2017;11:316. doi:10.3389/fnhum.2017.00316
    1. Miller AH, Maletic V, Raison CL. Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol Psychiatry. 2009;65(9):732–741. doi:10.1016/j.biopsych.2008.11.029
    1. Brydon L, Edwards S, Jia H, et al. Psychological stress activates interleukin-1β gene expression in human mononuclear cells. Brain Behav Immun. 2005;19(6):540–546. doi:10.1016/j.bbi.2004.12.003
    1. Chen X, Gianferante D, Hanlin L, et al. HPA-axis and inflammatory reactivity to acute stress is related with basal HPA-axis activity. Psychoneuroendocrinology. 2017;78:168–176. doi:10.1016/j.psyneuen.2017.01.035
    1. Huang C-J, Stewart JK, Franco RL, et al. LPS-stimulated tumor necrosis factor-alpha and interleukin-6 mRNA and cytokine responses following acute psychological stress. Psychoneuroendocrinology. 2011;36(10):1553–1561. doi:10.1016/j.psyneuen.2011.04.009
    1. Thoma MV, Gianferante D, Hanlin L, Fiksdal A, Chen X, Rohleder N. Stronger hypothalamus-pituitary-adrenal axis habituation predicts lesser sensitization of inflammatory response to repeated acute stress exposures in healthy young adults. Brain Behav Immun. 2017;61:228–235. doi:10.1016/j.bbi.2016.11.030
    1. von Känel R, Kudielka BM, Preckel D, Hanebuth D, Fischer JE. Delayed response and lack of habituation in plasma interleukin-6 to acute mental stress in men. Brain Behav Immun. 2006;20(1):40–48. doi:10.1016/j.bbi.2005.03.013
    1. Boyle NB, Lawton C, Arkbage K, et al. Stress responses to repeated exposure to a combined physical and social evaluative laboratory stressor in young healthy males. Psychoneuroendocrinology. 2016;63:119–127. doi:10.1016/j.psyneuen.2015.09.025
    1. Wust S, Federenko IS, van Rossum EF, Koper JW, Hellhammer DH. Habituation of cortisol responses to repeated psychosocial stress-further characterization and impact of genetic factors. Psychoneuroendocrinology. 2005;30(2):199–211. doi:10.1016/j.psyneuen.2004.07.002
    1. Kolmus K, Tavernier J, Gerlo S. β2-Adrenergic receptors in immunity and inflammation: stressing NF-κB. Brain Behav Immun. 2015;45:297–310. doi:10.1016/j.bbi.2014.10.007
    1. Fitzgerald D, Meade K, McEvoy A, et al. Tumour necrosis factor-a (TNF-a) increases nuclear factor kB (NFkB) activity in and interleukin-8 (IL-8) release from bovine mammary epithelial cells. Vet Immunol Immunopathol. 2007;116(1–2):59–68. doi:10.1016/j.vetimm.2006.12.008
    1. Renard P, Zachary M-D, Bougelet C, et al. Effects of antioxidant enzyme modulations on interleukin-1-induced nuclear factor kappa B activation. Biochem Pharmacol. 1997;53(2):149–160. doi:10.1016/S0006-2952(96)00645-4
    1. L-G Ö, Hellström K, Kåver A. One versus five sessions of exposure in the treatment of injection phobia. Behav Ther. 1992;23(2):263–281. doi:10.1016/S0005-7894(05)80385-5
    1. L-G Ö, Alm T, Brandberg M, Breitholtz E. One vs five sessions of exposure and five sessions of cognitive therapy in the treatment of claustrophobia. Behav Res Ther. 2001;39(2):167–183. doi:10.1016/S0005-7967(99)00176-X
    1. Arntz A, Lavy E. Does stimulus elaboration potentiate exposure in vivo treatment? Two forms of one-session treatment of spider phobia. Behav Cogn Psychother. 1993;21(1):1–12. doi:10.1017/S0141347300017754
    1. Gotestam K, Hokstad A. One session treatment of spider phobia in a group setting with rotating active exposure. Eur J Psychiatry. 2002;16(3):129–134.
    1. Wolitzky-Taylor KB, Horowitz JD, Powers MB, Telch MJ. Psychological approaches in the treatment of specific phobias: a meta-analysis. Clin Psychol Rev. 2008;28(6):1021–1037. doi:10.1016/j.cpr.2008.02.007

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe