Perceived helpfulness of treatment for specific phobia: findings from the World Mental Health Surveys

Ymkje Anna de Vries, Meredith G. Harris, Daniel Vigo, Wai Tat Chiu, Nancy A. Sampson, Ali Al-Hamzawi, Jordi Alonso, Laura H. Andrade, Corina Benjet, Ronny Bruffaerts, Brendan Bunting, José Miguel Caldas de Almeida, Giovanni de Girolamo, Silvia Florescu, Oye Gureje, Josep Maria Haro, Chiyi Hu, Elie G. Karam, Norito Kawakami, Viviane Kovess-MasfetySing Lee, Jacek Moskalewicz, Fernando Navarro-Mateu, Akin Ojagbemi, José Posada-Villa, Kate Scott, Yolanda Torres, Zahari Zarkov, Andrew Nierenberg, Ronald C. Kessler, Peter de Jonge

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Background Although randomized trials show that social phobia treatments can be effective, it is unclear whether patients experience treatment as helpful in clinical practice. We investigated this issue by assessing perceived treatment helpfulness for specific phobia in a cross-national epidemiological survey.

Methods Cross-sectional population-based WHO World Mental Health (WMH) surveys in 24 countries (n=112,507) assessed lifetime specific phobia. Respondents who met lifetime criteria were asked whether they ever received treatment they considered helpful and the number of professionals seen up to the time of receiving helpful treatment. Discrete-event survival analysis was used to calculate conditional-cumulative probabilities of obtaining helpful treatment across number of professionals seen and of persisting in help-seeking after prior unhelpful treatment. 

Results 23.0% of respondents reported receiving helpful treatment from the first professional seen, whereas cumulative probability of receiving helpful treatment was 85.7% after seeing up to 9 professionals. However, only 14.7% of patients persisted in seeing up to 9 professionals, resulting in the proportion of patients ever receiving helpful treatment (47.5%) being much lower than it could have been with persistence in help-seeking. Few predictors were found either of perceived helpfulness or of persistence in help-seeking after earlier unhelpful treatments.

Limitations Retrospective recall and lack of information about either types of treatments received or objective symptomatic improvements limit results. Conclusions Despite these limitations, results suggest that helpfulness of specific phobia treatment could be increased, perhaps substantially, by increasing patient persistence in help-seeking after earlier unhelpful treatments. Improved understanding is needed of barriers to help-seeking persistence.
Original languageEnglish
JournalJournal of Affective Disorders
Early online date20 Apr 2021
Publication statusE-pub ahead of print - 20 Apr 2021


  • Helpfulness of treatment
  • Simple phobia
  • Specific phobia
  • World Mental Health Surveys


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