Psychotherapy at the point of a pistol

Although specific phobias are among the most prevalent and most treatable of the anxiety disorders, successful treatments for firearm phobias are seldom reported. The assessment and treatment of a phobia specific to firing the 9 mm service pistol is described. The case was identified during a Return to Australia Psychological Screening (RTAPS) evolution, following the operational deployment of a Royal Australian Navy warship. The screening package involved group based psychoeducation and standardised self report scales for detecting trauma experiences and sources of psychological distress. These were followed by semi-structured individual interviews. This process revealed a sailor with a phobia linked to a traumatic experience following an unauthorised discharge of a 9 mm pistol. A behavioural treatment regime was planned and conducted at sea under operational conditions. Live firing constituted the main intervention. The positive results suggest live firing is a safe and effective form of single session exposure, conditional on additional safety precautions to supplement regulated weapons handling procedures. (author abstract)