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Although fear can protect us from harm and prepare us for danger, disproportionately extreme fear can turn into a specific phobia when it leads to extreme avoidance of and distress in feared situations, thereby interfering with our lives and mental well-being. This chapter gives instructions and examples of how an assessment and mini formulation for specific phobias can help to construct a ‘fear hierarchy’ and to understand which ‘safety behaviors’ can maintain phobias. With case illustrations, the chapter describes how to apply exposure therapy, the cornerstone CBT method for specific phobias, in which an individual gradually confronts each trigger in the fear hierarchy while refraining from safety behaviors. The chapter also outlines how to overcome common difficulties with exposure therapy and how to measure therapy outcomes. Finally, cognitive restructuring is discussed as a CBT approach for specific phobias in which exposure-based activities are used to test and challenge exaggerated or unhelpful ideas about feared situations.
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