Journal of Behavior Therapy and Experimental Psychiatry 34 (2003) 219–224 An unusual case of a wasp phobic June S.L. Brown a, *, Sharon Abrahams a , Matthew Helbert b a Psychology Department, Institute of Psychiatry, University of London, De Crespigny Park, London SE5 8AF, UK b St. Bartholomew’s Hospital, London, UK Received 18 September 2000; received in revised form 14 August 2001; accepted 21 September 2001 Abstract This study concerns a woman with a very specific phobia of free-flying wasps. Her underlying and disabling belief was that she was allergic to wasp venom and, if stung, would certainly die. A behavioural approach, such as systematic desensitization and exposure, was not thought suitable because of the patient’s pattern of fear. Instead, the treatment of choice was an allergy test to directly challenge her belief. The allergy test was negative and led to a dramatic improvement which was maintained 1 year after treatment. r 2003 Elsevier Ltd. All rights reserved. 1. Introduction It has been thought that the processes underlying phobias and their treatment were largely non-cognitive and behavioural treatment should be the treatment of choice. In particular, exposure in vivo has been seen to be the most efficient and effective method of treating specific phobias (Emmelkamp, 1994). In addition, imaginal systematic desensitisation has also been found to be effective (Bedell, Archer, & Rosmann, 1979). However, the cognitionless view of phobias has come to be questioned. McNally and Steketee (1985) found that their animal phobics seemed to fear their own reactions to the feared object (self-related) more than the object itself (object- related). Similarly, Arntz, Lavy, van den Berg, and van Rijsoort (1993) found self- related (e.g. I will lose control) and spider related (e.g. the spider jumps onto me) fears among their spider phobics. Additionally, Thorpe and Salkovskis (1995) ARTICLE IN PRESS *Corresponding author. Tel.: +44-207-8485004. E-mail address: june.brown@iop.kcl.ac.uk (J.S.L. Brown). 0005-7916/$-see front matter r 2003 Elsevier Ltd. All rights reserved. doi:10.1016/j.jbtep.2001.09.001