This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Cognitive behavioural therapy (CBT) is a talking therapy that can help children and young people overcome fears (phobias). It is routinely delivered over multiple sessions. A new study showed that one-session treatment is as effective as multi-session CBT, and is cheaper.
Phobias are intense fears of everyday objects or situations (such as dogs or having injections) that have a severe impact on children’s ability to enjoy everyday life. Multiple session CBT is effective, but it is expensive, takes time, and appointments can be hard to get.
Researchers explored whether one-session treatment could be an alternative. It works in a similar way to CBT but takes place in one main 3-hour session. They compared one-session treatment with multi-session CBT as usually delivered to children with phobias.
The treatments were equally effective. One-session treatment was also, on average, £300 cheaper per person. Children, their parents or guardians, and therapists found it acceptable. The researchers recommend clinicians and NHS commissioners consider one-session treatment for children and young people with phobias, where appropriate.
This was the first trial to compare one-session treatment to multi-session CBT in a clinical setting, the researchers say. The pandemic meant CBT had to be delivered online for some children (instead of face-to-face) and some treatments were paused, delayed, or cancelled.
For more information on phobias in children and young people, visit the NHS website.
The issue: one-session treatment versus multi-session CBT for children with phobias
The distress caused by phobias can lead children to avoid the object of their fear and limit their day-to-day activities and quality of life. This can affect their mental health and development. Phobias are common and affect up to 1 in 10 children and young people.
CBT is a well-established talking treatment; it aims to change the way people think and behave. Over multiple sessions, people with phobias are exposed to the object or situation they fear, and the unhelpful thoughts and behaviours that maintain their phobia are addressed.
People with phobias usually have 4 – 20 sessions of CBT. This is expensive, time-consuming, and appointments can be hard to get. An alternative is one-session treatment. It uses similar techniques but involves an initial assessment to plan treatment (lasting up to 1 hour) and a single 3-hour treatment session.
Researchers explored whether one-session treatment was as effective as multi-session CBT for children and young people with phobias. They also examined which treatment offered better value for money.
What’s new?
The study included 268 children and young people (aged 7–16) with phobias from 12 NHS trusts in England. Half were randomly chosen to receive one-session treatment; the others received multi-session CBT. Overall, 197 children completed the study but only 149 provided results for the main outcome: how close a child could get to the object of their fear 6 months after treatment (the behavioural avoidance test). This was largely because the pandemic limited the face-to-face contact required for the test.
The researchers found that:
- one-session treatment was as effective as multi-session CBT in improving children’s ability to get closer to the object of their fear
- children’s anxiety and everyday functioning improved similarly in both groups
- one-session treatment was acceptable to children, their parents and guardians, and clinicians
- one-session therapy cost roughly £300 less per person and was highly likely to offer better value for money than multi-session CBT.
Interviews with clinicians revealed that treatment for phobias was variable across England. Several clinicians were unaware that CBT was available for children and young people with phobias. Clinicians said that scheduling the 3-hour long, one-session treatment, could be challenging and hard to fit in around other appointments. School-based services, which have to fit sessions into the school day, could also find this difficult. Clinicians said they would need training before one-session treatment could be implemented across the UK.
Why is this important?
One-session treatment for phobias was as effective as multi-session CBT in this study, and highly likely to be cost-saving.
The study was carried out during the COVID-19 pandemic. This reduced service availability and meant that face-to-face treatments were moved online. Some children paused, delayed, or did not receive treatment. The researchers say the relatively small saving compared with multi-session CBT (£300 per person) may have been larger at other times.
Most participants were White, so the findings may not be applicable to children and young people from ethnic minority backgrounds.
What’s next?
The researchers recommend that clinicians and NHS commissioners consider one-session treatment for children and young people with phobias, where appropriate. It is quicker to deliver than multi-session CBT and could save money for the NHS.
Some areas of England routinely provide treatment for children and young people with phobias, but others offered none. The researchers highlighted this variation in care, along with the importance of providing CBT for phobias within mental health services. As a result, many services have started to identify and treat people with phobias who might otherwise have been missed, and approximately 170 clinicians have received training in one-session treatment. The researchers hope that commissioners and NHS decision-makers will work to standardise care across England.
Clinicians in the study said that implementing one-session treatment across the UK would require resources. Adequate numbers of clinicians, with sufficient time and training, plus administrative support would be needed. Future research could explore the best ways to implement one-session treatment, and increase access.
You may be interested to read
This Alert is based on: Wright B, and others. One-session treatment compared with multisession CBT in children aged 7–16 years with specific phobias: the ASPECT non-inferiority RCT. Health Technology Assessment 2022;26: 1-174.
An animated video about the study on the researchers' website.
A lecture about the study hosted on YouTube.
A radio interview about children with phobias and CBT on the BBC Sounds Website.
A podcast about CBT and mental health from The Association for Child and Adolescent Mental Health.
Funding: This study was funded by the NIHR Health and Technology Assessment Programme.
Conflicts of Interest: Thompson Davis received royalties from Intensive One-Session Treatment of Specific Phobias and received fees for training on one-session treatment for specific phobias.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
