One-session therapist-directed exposure vs. self-exposure in the treatment of spider phobia *

Thirty-four patients with spider phobia, fulfilling the DSM-IIIR criteria for simple phobia, were assessed with behavioral, physiological, and self-report measures. They were randomly assigned to therapist-directed exposure during one session (maximum 3 hours) or self-directed exposure via a specifically written manual (during a 2-week period). Results showed that therapist-directed exposure was significantly better than self-directed exposure, both at post-treatment and at a 1 year follow-up, on the specific spider phobia self-report measures, the behavioral measures, and clinician rating of phobic severity, while there were no differences on the physiological measures. Stringent criteria for clinically significant improvement were met by 71% of the therapistand 6% in the self-directed exposure group both at post-treatment and at follow-up. Some of the reasons for the poorer results of self-exposure in this study are discussed.