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.