The U.S National Institute of Mental Health had stated that there were about 10% of people who suffered from specific phobia, 7.1% from social phobia and 0.9% from agoraphobia. Phobia, an anxiety disorder, if being retarded from its treatment, would become uncontrollable which results to the incompetent in carrying normal routine and become socially isolated. This is because phobia accounts to the avoidance of particular places, situations, or objects due to its irrational fear. Generally, people have difficulties to distinguish between phobia and normal fear. Thus, psychologists had specified that fear is an unpleasant feelings and will be experienced by every human beings in response to danger (Marks, 1987) whilst phobia is beyond the ordinary fear in which it is more intense and long-lasting in nature (Turner and Romanczyk, 2012).

The majority of people are diagnosed with anxiety disorder prior to age 21, and it can be studied through the average age of phobias’ onset in which specific phobias are in the early childhood and adolescence for the complex phobia such as social phobia (social anxiety disorder) and agoraphobia. According to a report from Office National Statistics Psychiatric Morbidity, 2011, men are half times less likely to be diagnosed with anxiety disorders or only about 40% from phobias compared to women. Both men and women who suffer from phobias would experience several physical and psychological symptoms. The physical symptoms includes chest pain, faster heart beat, losing one’s balance, excessive shaking, etc while the feelings of fear, panic, ill and likely to die soon are the psychological symptoms.

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A talk therapy that has showed to have high success rate in dealing with phobias is Cognitive Behavioral Therapy (CBT) which works by incorporating both cognitive and the behavioral therapies. This therapy is available to treat patients individually, in groups, via computer or internet in a short time by involving several techniques during the sessions such as Socratic questioning, behavioral experiments, thought records, situational exposure hierarchies, etc. Thus, this treatment tend to be carried in structure so that the sessions time can be used efficiently and lead to successful collaborations between patients and therapists in order to achieve its goals which are for cognitive restructuring and behavioural activation. Furthermore, the most important and the main CBT concept that patients and therapists should understand is that thoughts, feelings and behaviors are interconnected so if one modality is changed, others will be affected (Ellis, 2001).

In this paper, the discussion on how far does CBT effective in treating phobia will be explored find out when it is effective or not to treat its phobia as well as to inform decision makers and clinicians that CBT may help patients to reduce its phobia but just to an extent as according to David A.Yusko, not all phobias can be cured with CBT. Hence, this essay will be examining: “How effective is cognitive behavioral therapy play a role in the treatment of phobias”?

Discussion
The psychological studies above support the discussion on the effectiveness of CBT in the treatment of phobias and have suggested that CBT is effective as it helps to alter the patients negative thoughts or beliefs by motivating them to think about the positive statements that may assist them to handle themselves when they are exposed to phobic places or other behavioral experiments requested, thereof, this makes them tend to have strong good feelings that leads to better self-efficacy or possibilities of no longer possess its phobia. From the biological perspective, the patients may also acquire several changes such as the decreasement in volume of amygdala’s grey matter unto how a healthy amygdala supposed to be and since their amygdala which responsible for emotions or the fear are being controlled, therefore they tend to respond positively to the stimuli. When comparing both CBT and treatment as usual, CBT is considered to be better especially on the treatment planning because the involvement of parental education outside the treatment sessions may help to catalyse the patients’ rate of improvement as they could be trained not only in the settings by the therapists but instead anytime with their parents. Moreover, few studies also showed that CBT has succeeded in achieving its goals of modifying the patient’s distorted thinking after going through homework assignments, behavioral experiments, and the evaluating or identifying the dysfunctional thinking or belief techniques, which lead them to become less likely experiencing unreasonable fears to their phobic situations as they could behave accordingly to what they think.

However, it becomes insignificant if it was being delivered individually, briefly and traditionally to SAD or agoraphobia patients as in brief CBT, there is no psychoeducation offered and the treatment was only carried for 6 sessions therefore their phobia tend to relapse because they were treated in short period of time as well as their families did not receive information on how to interact with the patients and knowledge on what the patients can do or should avoid. In comparison with VRET, VRET is far more effective because the patients get to undergo same behavioral experiment as the traditional CBT with the addition of exposure to various reality environments therefore they tend not to have big concerns if the treatment was over as they had learnt how to overcome their discomfort in various real-life environments. Furthermore, if the CBT therapist and patient has cross-cultural issue, the outcome obtained after treatment may not be maximal, although the treatment was delivered individually, because their language barrier as well as the difference in cultural dimensions do play a major contribution during the treatment. Thus, they might have an odd collaboration because an individualists tend to be independent and have an open communication during discussions while a collectivists would feel uncomfortable to open oneself freely as individual especially to the outgroup member because they have the sense of interdependence and prefer to have indirect communication to maintain harmonious interpersonal relations (Adair ; Brett 2005).

Nevertheless, the above results cannot be fully relied upon as the studies were limited with similar limitations. From its methodology, there are two correlational study that showed CBT and phobia are only related as there are no manipulation in independent variable affects the dependent variables so cause-and-effect relationship cannot be demonstrated in which it would be difficult to determine whether CBT treatment really effective to treat phobia or not because there might be third variables exists between them and cause CBT to be effective. Also, most studies had used more than one questionnaires in gathering facts to make conclusion because the researchers could collect many data in short time and obtained objective response from the patients as it is a standardised survey. However, questionnaire may lead to social desirability effect as the patients may answer it not based on facts because they think those answers are what the researchers expected therefore it would decrease the results’ accuracy. To reduce this bias, the questions or instructions should be modified in more positive ways that could make them to answer honestly. Another noticeable, since the patients have known the aim of the study so they may display demand characteristics throughout the experiment or when answering the self-reported questionnaires which leads to less accurate results being obtained.
Moreover, there was a research that was conducted in laboratory where the situation involved is somewhat artificial and well-controlled therefore it has low ecological validity which means the results may not be generalised to natural settings as different outcome may be obtained. Since, in those studies, the patients were needed to undergo interview to ensure that their phobia met its phobia’ criteria therefore the studies only contained small sample size. Having small sample size tend to establish lack of population validity, which means the findings may not represent the wider population as few studies showed to only involved the eastern culture so it may not be relevant if it was used to represent the western culture as well as since the age range used were restricted therefore different outcome might be obtained if different ages of patients were being examined. To make the findings become more representative, large groups of patients with different ages and cultures would be required depending on who the research objectives are.

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