Background: Specific phobias are common across the lifespan. Although exposure-based
therapies have the most evidence of efficacy, reviews have cautioned that evaluations of some
interventions are limited in number and have pointed to the need for more research. Furthermore,
several permitted the inclusion of non-randomized clinical trials or samples exhibiting elevated fear
but not necessarily a full diagnosis. We sought to update the literature on the empirical support of
psychological treatments for specific phobias in adults through the selection of studies that met
stringent criteria along with application of the system developed by Chambless and Hollon [1998: J
Consult Clin Psychol 66: 7-18], which had not in isolation been done so previously.
Methods: Electronic searches of the PubMed and PsycINFO databases were conducted in February 2014 to identify
suitable randomized clinical trials. Thirty-eight met our inclusion criteria.
Results: In vivo exposure was the most researched psychological therapy and found to be efficacious and specific. The
evidence for virtual reality exposure was less strong though it had a similar level of empirical support. Several other
therapies, including applied tension for blood phobia, were found to be possibly efficacious pending replication by other
Conclusions: Exposure-based therapy is the optimal treatment for specific phobias, but several gaps remain in the
literature. Most studies investigated interventions for spider phobia. More clinical trials conducted by independent
research teams are needed on therapies for other subtypes. There is a dearth of literature on the treatment of phobic
disorders in older adults and medically unwell patients. This needs to be a priority on research agendas since we have an
aging population. Moreover, failure to address blood-injection-injury phobia in a timely manner in patients who are under
the care of medical services may affect adherence to recommendations and lead to a deterioration in health.