Acceptance and Commitment Therapy to treat phobia of enclosed spaces: a randomized clinical trial

The MRI exams have been in considerable demand in various medical specialties to diagnose diseases. Although it is an effective diagnostic method, patients who are subjected to the exam might present high levels of discomfort due to the confined space of the device. The phobia of enclosed spaces is considered a type of specific phobia, according to the Diagnostic and Statistical Manual of Mental Disorders 5 (APA, 2013). OBJECTIVES: to check if a single session of Acceptance and Commitment Therapy is as effective as seven sessions of the same therapeutic model for the treatment of patients with fear of undergoing MRI exams and enclosed spaces phobia. METHODS: A randomized clinical trial study with two parallel groups was performed, one group underwent one session and the other group underwent seven sessions of Acceptance and Commitment Therapy. Participants were assessed at the beginning and at the end of treatment with the following instruments: Claustrophobia Inventory from Rachman and Taylor (1993), Beck Depression Inventory from beck et al. (1961) and Anxiety Inventory State - Trait from Spielberger, Gorsuch and Luschene (1970). The study was performed in a public hospital in the city of Sao Paulo with 30 patients. Main outcome: to remain in a MRI simulator for at least 30 minutes after each treatment. Secondary outcomes: compare the differences in the inventories of Claustrophobia, Beck Depression Inventory and the Anxiety Inventory Trait- State scores compared at the beginning and at the end of treatments. RESULTS: 92.9% of participants (N) on the seven sessions group were able to carry out the MRI exam simulator after treatment, while 50% of participants of the one session group were able carry out the post treatment session in the simulator (p = 0.033). From the participants who had better response to treatment, 78 % were male, 80 % were married, 78 % did not use psychiatric medication and 20 % had a diagnosis of specific MRI phobia, 80% had a diagnosis of enclosed spaces phobia. All subjects with the Specific Phobia of performing MRI exams diagnosis were able to perform at the simulator test without considering the number of treatment sessions. Those with phobia of enclosed spaces responded more to the seven sessions treatment (92 %, p = 0.009). The inventory of claustrophobia showed that individuals in the seven sessions group performed the treatment (p = 0.002), showing significant differences before and after treatment and the level of performance was the same three months later. The Beck Inventory showed that there was improvement in depressive symptoms at the end of treatment (p = 0.015), but there was no difference after three months. It was observed through the regression coefficients that the higher the score on the inventory of claustrophobia and Beck Depression Inventory, the lower the probability of performing in the simulator. However, doing at least seven sessions of therapy increases the likelihood of the desired positive outcome. The study also showed that seven therapy sessions were beneficial, because even with high scores of depressive symptoms patients were successful in the test of the MRI simulator