Psychology
Exposure Therapy for Fear of Spiders in an Adult with Learning Disabilities: A Case Report
Introduction
Past research has shown that people with learning disabilities are prone to a higher extent of being susceptible to phobias of various types. Exposure therapy is a type of treatment for phobias, where subjects are repeatedly exposed to the thing they are afraid of till the latent fear subsides, primarily as a result of the subjects associating non-threatening cues with the objects creating phobias. Past research has depended upon behavioral indices to determine success, overlooking the fact that people with learning disabilities could self-report their measures of fear.
Accordingly, the researchers, Cowdrey and Walz, identified S, a 39 year old female suffering from learning disability due to Down syndrome, as a suitable candidate to assess the efficacy of exposure therapy to mitigate phobias. S had been undergoing mindfulness training when identified for the study. S suffered from a fear of spiders. The fear ran in S’ family, with her mother and grandmother also affected. S’s fear of spiders became more pronounced when she moved out of her mother’s house to live on her own. This period also coincided with the death of a close friend who had also suffered from Down syndrome. S would seek help from her apartment staff whenever she felt there was a spider in her room, which happened mostly in the evenings (Cowdrey & Walz, 2014).
Main Body
Hypothesis
Based on interaction with the apartment staff and with S’s mother, the researchers formed two hypotheses: -
S’ fear of spiders became clinically significant when she moved out to live independently.
Significant life events, such as the death of her friend, left S feeling vulnerable; this contributed to her phobia.
Aim
The researchers aimed to investigate whether an exposure-based intervention would lead to a reduction of S’s spider phobia.
Methodology
The researchers employed an A-B single case experimental design, with A denoting the baseline and B denoting the intervention phase. To arrive at the baseline of S’s phobia, the researchers put S through a self-reported Spider Phobia Questionnaire (SPQ-15). The intervention framework was designed using predisposing, precipitating, perpetuating and protective factors (Cowdrey & Walz, 2014).
According to J, S’s mother, S’s learning disability may have made her vulnerable to stresses without social support which could have led to the phobia. S’s family history of spider phobia may have played a part. S’s recent history of losing a friend may have precipitated her phobia. S perpetuated her fears by relying on props like acorns to deter spiders, and by calling her apartment staff for help (Cowdrey & Walz, 2014).
Accordingly, the intervention of exposure therapy consisted of three phases- assessment and formulation, cognition and behavior change, and relapse prevention. The researchers adopted a ‘think-feel-do’ resource pack to enable S to recognize her emotions, link the emotions to situations and to be aware of the process through cognitive mediation. The researchers exposed S to varying stimuli regarding spiders, commencing with pictures and videos, and progressing to dead spiders, small spiders and finally large spiders. Throughout the process of interacting with such stimuli, S was exposed to breathing space meditation techniques to enhance mindfulness. S was also encouraged to write into a ‘feel good book’ to express herself. The ‘feel good book’ exercise brought out that S was disturbed due to her friend’s death, and wished to talk about it. To avoid relapse, S was made to summarize her emotions about her interactions with spiders, along with self reported assessments about how much of the stimuli she could handle on her own without calling for the staff or her mother (Cowdrey & Walz, 2014).
Result/ Discussion
Over the three-week period of the experiment, it was seen that S’s fear of spiders reduced considerably when compared to the baseline data. By the end of the sessions, S was able to manage small spiders in her flat on her won. However, she continued to reflect fear of large spiders (Cowdrey & Walz, 2014).
The fact that S’s exposure to spiders in the experiment led to a reduced fear, hypothesis #1 was supported. S could not identify any link between the trauma she felt on the death of her friend and her spider phobia. Therefore, hypothesis #2 was not proven. The researchers felt that relaxation interventions might have altered the results (Cowdrey & Walz, 2014).
The researchers are cautious about recommending exposure therapy as given to S to the broader generalized population. The fact that S had recently completed a mindfulness-skills group might have helped her cope better with the exposure therapy. The researchers could not be sure that it was the exposure therapy alone that caused the change. There was no follow up period of the study to determine if the results were sustained. The efficacy of the SPQ-15 questionnaire for use with people with learning disabilities was also suspect (Cowdrey & Walz, 2014).
Conclusion
The researchers have been astute in connecting learning disabilities with phobias. As learning disabilities are related to neurological disorders, it is likely that the same disorders accentuate certain thought processes in the brain, leading to heightened psychological reactions to stimuli from objects that cause phobias. The research was done in a scientific manner. The use of SPQ-15 was effective in establishing a baseline and monitoring progress and effectiveness of the exposure therapy. However, a lack of follow up lends the study to be incomplete, as it was not established whether S was able to sustain her break from fear of spiders.
The study is relevant to society, as a validation of the exposure therapy would vindicate a longstanding practice of parents to expose children to the things they feared in order to make them overcome it. I remember my father forcing me to jump across drains to overcome my fear of chasms. As a result of the early exposure therapy, I am confident on walking along the Grand Canyon walkway.
The applicability of the study to people with learning disabilities, however, needs further research, primarily because S’s case was not generic. The fact that S had an exposure to a mindfulness exercise prior to the experiment might have skewed the results in favor of the perceived efficacy of the treatment.
Therefore, further research is recommended before generalizing the efficacy of exposure therapy on people with learning disabilities.
Reference
Cowdrey, F.A., & Walz, L. (2014). Exposure therapy for fear of spiders in an adult with learning disabilities: a case report. British Journal of Learning Disabilities 43: 75-82. doi: 10.1111/bld.12106.
