Cognitive treatment of phobia.

Despite the seeming phenomenological importance of maladaptive cognitions in phobic disorders, review of the literature does not support the utilization of cognitive treatments with this client population. Although preliminary analog investigations yielded promising findings, studies employing clinical phobics as subjects suggest that cognitive techniques are relatively ineffective when administered alone, when compared to standard behavioral treatment. In addition, cognitive treatments appear to be of no additional therapeutic value when combined with behavioral techniques. Several possible reasons for this poor showing of cognitive treatments have been reviewed. While it is plausible that cognitive modification was not actually achieved in treatment outcome studies, failure to measure cognitive change precludes evaluation of this hypothesis. However, because preliminary evidence suggests the unreliability of cognitive assessment procedures, substantially more research will need to address the development of psychometrically sound cognitive measurement techniques before cognitive change can be evaluated in future investigations. Given the failure of cognitive treatments with phobics, what directions remain for future research in this area? While many would argue against conducting any further research, it appears that several important issues remain to be explored, the results of which may have a profound impact on our current understanding and delivery of behavior therapy to phobic clients. As mentioned above, the development and utilization of reliable and valid cognitive measures are critical to evaluation of the efficacy of cognitive treatments. As such, the utility and psychometric properties of more structured cognitive measures (e.g., self-efficacy ratings, attitudinal scales), as well as specific cognitive measures delineated in this article, need to be investigated. The use of these measures in future investigations will aid in determining whether, and which, cognitive therapies actually engender constructive cognitive change. Such studies must be conducted before cognitive techniques can be dismissed as ineffective. Similarly, cognitive measurement also should be used to assess cognitive changes during behavioral, exposure-based treatment of phobias. Although exposure treatments clearly are considered to be the treatment of choice for phobic disorders (Marks, 1978; Mavissakalian & Barlow, 1981), the process or mechanism of action by which exposure works remains unclear. Systematic testing of alternative hypotheses, including cognitive change, may shed light on this complicated issue and aid in increasing the efficacy of our present treatment