# Evidence-based assessment/Simple phobia/Extended version

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## What is a "portfolio"?

* For background information on what assessment portfolios are, click the link in the heading above.
* Feels like too much information? There's an condensed version of this page here.

## Preparation phase
### Base rates of simple phobia in different populations and clinical settings

This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of simple phobia that they are likely to see in their clinical practice.
* To see prevalence rates across multiple disorders, click here.
| Demography | Setting | Base Rate | Diagnostic Method |
| California | Mexican-American Prevalence and Service Survey (MAPSS) – adults 18+, all specific phobias | 7.4% | CIDI/DSM-III-R |
| All of US | NCS replication, adults 18+, 12-month prevalence | 8.7% | CIDI/DSM-IV |
| All of US | National Comorbidity Survey (NCS); non-institutionalized adults between 18-54, all specific phobias | 11.3% | CIDI/DSM-III-R |
| All of US | National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), adults 18+, all specific phobias | 9.4% | AUDADIS-IV/DSM-IV |
| New Haven, CT | Adults 18+, all specific phobias | 7.8% | Clinical interview/DSM-III |
| Baltimore, MD | Adults 18+, all specific phobias | 23.3% | Clinical interview/DSM-III |
| St. Louis, MI | Adults 18+, all specific phobias | 11.1% | Clinical interview/DSM-III |
| All of US | National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), adults 18+, all Specific Phobias | 7.14% | AUDADIS-IV/DSM-IV |
| All of US | Different age groups, all specific phobias | Community Prevalence: 7-9% Children: 5% 13- to 17- year olds: 16% Older Adults: 3-5% Note: Females are more frequently affected than males at a rate of 2:1 | DSM-V |
| | Outpatient clinic (DAU) | 6% (specific) | |
| | Outpatient clinic (SDI) | 15% (specific) | |
| | General Population | 19% specific | |

## Prediction phase
### Psychometric properties of screening instruments for simple phobia

The following section contains a list of screening and diagnostic instruments for simple phobia. The section includes administration information, psychometric data, and PDFs or links to the screenings.
* Screenings are used as part of the prediction phase of assessment; for more information on interpretation of this data, or how screenings fit in to the assessment process, click here.
* For a list of more broadly reaching screening instruments, click here.
Screening measures for simple phobia :
| Measure | Format (Reporter) | Age Range | Administration/ Completion Time | Inter-rater reliability | Test-retest reliability | Construct validity | Content validity | Where to access |
| Fear Survey Schedule for Children-Revised (FSSC-R) | Questionnaire (self-report) | 7-16 years | 19-20 minutes | NA | G | G | E | Yes (article PDF link) |
| Fear of Spiders Questionnaire (FSQ) | Questionnaire (self-report) | 13 years-adult | 5 minutes | NA | A | G | A | Yes (article PDF link) |
| Snake Anxiety Questionnaire (SNAQ) | Questionnaire (self-report) | 13 years-adult | 30 minutes-3 hours | G | G | A | G | Yes (article PDF link) |
| Dental Anxiety Inventory (DAI) | Questionnaire (self-report) | 5 years-adult | 8 minutes | NA | A | G | A | Yes (Questionnaire PDF) |
| Disgust Scale | Questionnaire (self-report) | 16 years-adult | 8 minutes | NA | U | G | E | Yes (Questionnaire homepage and PDF) |
| Spider Phobia Beliefs Questionnaire | Questionnaire (self-report) | 17 years-adult | | | | | | |
| Acrophobia Questionnaire | Questionnaire (self-report) | 14 years-adult | | | | | | |
| Blood Injection Symptom Scale (BISS) | Questionnaire (self-report) | | | | | | | |
| Claustrophobia Scale (CS) | | | | | | | | |
| Specific Phobia of Vomiting Inventory (SPOVI) | | | | | | | | |
| Revised Children’s Anxiety and Depression Scale (RCADS) | Questionnaire (Child) | 6-18 | 12 minutes | G | G | G | | RCADS homepage Assessment Center Online Child Self Report Version Assessment Center Online Child Parent Report Version PDFs for RCADS RCADS Child Self-reported (8-18 years) RCADS Parent-reported Child Scoring Aid Parent Scoring Aid Subscales Social Anxiety/Phobia Self-reported Social Anxiety/Phobia Parent-reported Panic Self-Report Panic Parent-Report Translations User Guide |
Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

### Likelihood ratios and AUCs of screening measures for simple phobia

* For a list of the likelihood ratios for more broadly reaching screening instruments, click here.
| Screening Measure (Primary Reference) | AUC and Sample Size | LR+ (Score) | LR- (Score) | Clinical generalizability |
| Specific Phobia of Vomiting Inventory (SPOVI) | 0.944 (N = 185) | 24.3 (10+) | 0.03 (<10) | High: able to distinguish between phobics and controls |
| The Claustrophobia Scale (CS) - Anxiety Subscale (Rachman and Taylor, 1993) | --- (N = 285) | 49.0 (24+) | 0.0002 (<24) | High: able to distinguish between phobics and controls |
| The Claustrophobia Scale (CS) - Avoidance Subscale (Rachman and Taylor, 1993) | --- (N = 285) | 19.2 (9+) | 0.0004 (<9) | High: able to distinguish between phobics and controls |
Search terms: [specific phobia] AND [sensitivity OR specificity] in Google Scholar and PsycINFO

### Interpreting specific phobia screening measure scores

* For information on interpreting screening measure scores, click here.

## Prescription phase
### Gold standard diagnostic interviews

For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

### Recommended diagnostic instruments for simple phobia

Diagnostic instruments for simple phobia :
| Measure | Format (Reporter) | Age Range | Administration/ Completion Time | Interrater Reliability | Test-Retest Reliability | Construct Validity | Content Validity | Where to access |
| Anxiety Disorders Interview Schedule for Children (ADIS-C) | Child | 6 years-adult | 90 minutes | E | E | G to E | N/A | Purchase |
| Anxiety Disorders Interview Schedule for Children (ADIS-P) | Parent | 6 years-adult | 90 minutes | E | E | E | N/A | Purchase |
| Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) *not free | Interview (clinician) | 6 years-adult | 90 minutes | A | NA | A | A | Purchase |
| Structured Clinical Interview for DSM-IV-TR for Axis I Disorders (SCID-I/P) *not free | | 6-17 years | 1-2 hours | A | NA | A | A | Website and purchase |
| Structured Clinical Interview for DSM-IV-TR for Axis II Disorders (SCID-II) *not free | | 6-17 years | 1-2 hours | E | NA | U | U | Website and purchase |
| Structured Clinical Interview for DSM-IV (SCID-IV) *not free | | 6-17 years | 1-2 hours | A | A | E | E | Website and purchase |
| Diagnostic Interview Schedule for Children and Adolescents (DICA) | Interview (clinician) | 6-17 years | 1-2 hours | A | G | G | G | |
Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

### Severity interviews for simple phobia

| Measure | Format (Reporter) | Age Range | Administration/ Completion Time | Interrater Reliability | Test-Retest Reliability | Construct Validity | Content Validity | Highly Recommended | Where to access |
Note: L = Less than adequate; A = Adequate; G = Good; E = Excellent; U = Unavailable; NA = Not applicable

## Process phase

The following section contains a list of process and outcome measures for simple phobia. The section includes benchmarks based on published norms for several outcome and severity measures, as well as information about commonly used process measures. Process and outcome measures are used as part of the process phase of assessment. For more information of differences between process and outcome measures, see the page on the process phase of assessment.

### Process measures

   Two types of behavioral approach tests (BAT) can be used to observe patients in typically avoided situations.
   * A progressive BAT gradually exposes the patient to a fear-inducing situation in a step-by-step manner, and responses to each step are recorded.
   * A selective BAT allows the clinician to select one or more challenges from the patient’s hierarchy, and the patient is to complete each challenge to induce a phobic response and rate the inducing fear.

### Outcome and severity measures

This table includes clinically significant benchmarks for simple phobia specific outcome measures
* Information on how to interpret this table can be found here.
* Additionally, these vignettes might be helpful resources for understanding appropriate adaptation of outcome measures in practice.
* For clinically significant change benchmarks for the CBCL, YSR, and TRF total, externalizing, internalizing, and attention benchmarks, see here.
Clinically significant change benchmarks (based on published norms) :
| Measure | Subscale | Cut-off scores | Cut-off scores | Cut-off scores | Critical Change (unstandardized scores) | Critical Change (unstandardized scores) | Critical Change (unstandardized scores) |
| Measure | Subscale | A | B | C | 95% | 90% | SE$_{difference}$ |
| Dental Cognitions Questionnaire (1995 Norms) | | 9.1 | 16.4 | 41.2 | 4.2 | 3.6 | 2.2 |
| The Claustrophobia Questionnaire (2001 Norms) - Total | | 18.6 | 67.7 | 41.2 | 11. | 9.4 | 5.7 |
| The Claustrophobia Questionnaire (2001 Norms) - Suffocation | | 7.0 | 24.9 | 16.2 | 5.0 | 4.3 | 2.6 |
| The Claustrophobia Questionnaire (2001 Norms) - Restriction | | 8.4 | 45.5 | 24.3 | 6.9 | 5.8 | 3.5 |
| Spider Phobia Questionnaire (1996 Norms) | | 15.1 | 20.7 | 17.3 | 3.0 | 2.5 | 1.5 |
| Anxiety Disorder Interview Schedule (ADIS) | | 5.9 | 4.4 | 5.2 | 0.2 | 0.2 | 0.1 |
| Fear Survey Schedule for Children-Revised (FSSC-R) | | 77.8 | 159 | 118.4 | 6.3 | 5.3 | 3.2 |
Note: “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean. Search terms: [specific phobia] AND [adults] AND [clinical significance OR outcomes] in Google Scholar and PsycINFO

### Treatment

Two treatments of specific phobia treatment include in-vivo exposure and virtual reality therapy. The former is most effective in specific phobias by hierarchically exposing the client to the fear-inducing stimulus and measuring anxiety response. The latter therapy is most effective in driving and height fears by using computer-generated, interactive virtual environments that the clinician manipulates.
* Please refer to the page on simple phobia for more information on available treatment or go to Effective Child Therapy for a curated resource on effective treatments for simple phobia.
* For information on conducting Exposure Therapy for anxiety disordered youth, see www.BravePracticeForKids.com

## External Resources

* ICD-10 diagnostic criteria
* Find-a-Therapist (a curated list of find-a-therapist websites where you can find a provider)
* NIMH entry about anxiety disorders
* Effective Child Therapy(guide about anxiety symptoms, treatment, and more)
* OMIM (Online Mendelian Inheritance in Man) for simple phobia
** 608251
* eMedicine entry about phobic disorders
* Society of Clinical Child and Adolescent Psychology
* EffectiveChildTherapy.Org information on fear, worry, and anxiety
* For information on conducting Exposure Therapy for anxiety disordered youth, see www.BravePracticeForKids.com