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The evidence-base for exposure therapy in people with learning disabilities experiencing specific phobias is sparse. This case study describes the assessment, formulation and treatment of spider phobia in a woman with learning disabilities using an exposure-based intervention augmented with mindfulness practice and bereavement work. To evaluate the intervention, a self-report measure of spider phobia was employed and completed during a baseline (A) and intervention (B) phase. Results demonstrate a reduction in self-reported fear after 11 sessions. This case study illustrates how in some cases modified self-report measures can be used to evaluate psychological treatments in people with learning disabilities and also highlights the importance of being formulation-led and creative when designing exposure-based interventions for specific phobias.

There is evidence that common processes underlie psychological disorders transdiagnostically. A challenge for the transdiagnostic movement is accounting for such processes theoretically. Theories of psychological disorders are traditionally restricted in scope, often explaining specific aspects of a disorder. The alternative to such 'micro-theories' is developing frameworks which explain general human cognition, so called 'macro-theories', and applying these systematically to clinical phenomena. Interacting Cognitive Subsystems (ICS) [Teasdale, J.D., & Barnard, P.J. (1993). Affect, cognition and change: Re-modelling depressive thought, Lawrence Erlbaum Associates, Hove] is a macro-theory which aims to explain aspects of information processing. The aim of this review is to examine whether ICS provides a useful platform for understanding common processes which maintain psychological disorders. The core principles of ICS are explained and theoretical papers adopting ICS to explain a particular psychological disorder or symptom are considered. Dysfunctional schematic mental models, reciprocal interactions between emotional and intellectual beliefs, as well as attention and memory processes, are identified as being important to the maintenance of psychological disorders. Concrete examples of how such variables can be translated into novel therapeutic strategies are given. The review concludes that unified theories of cognition and emotion have the potential to drive forward developments in transdiagnostic thinking, research and treatment. [ABSTRACT FROM AUTHOR]