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Comparing Acceptance and Refusal Rates of Virtual Reality Exposure vs. In Vivo Exposure by Patients with Specific Phobias


The present survey explored the acceptability of virtual reality (VR) exposure and in vivo exposure in 150 participants suffering from specific phobias. Seventy-six percent chose VR over in vivo exposure, and the refusal rate for in vivo exposure (27%) was higher than the refusal rate for VR exposure (3%). Results suggest that VR exposure could help increase the number of people who seek exposure therapy for phobias.
& B
Volume 10, Number 5, 2007
© Mary Ann Liebert, Inc.
DOI: 10.1089/cpb.2007.9962
Comparing Acceptance and Refusal Rates of Virtual
Reality Exposure vs. In Vivo Exposure by Patients
with Specific Phobias
The present survey explored the acceptability of virtual reality (VR) exposure and in vivo ex-
posure in 150 participants suffering from specific phobias. Seventy-six percent chose VR over
in vivo exposure, and the refusal rate for in vivo exposure (27%) was higher than the refusal
rate for VR exposure (3%). Results suggest that VR exposure could help increase the number
of people who seek exposure therapy for phobias.
of the most common mental dis-
In vivo exposure therapy is considered
the treatment of choice for phobias. This interven-
tion has received wide empirical support from nu-
merous clinical trials.
The American Psychological
Association (APA) report on empirically supported
treatments included exposure-based treatment
manuals for specific and social phobia.
Despite the
excellent efficacy data supporting in vivo exposure,
it unfortunately presents some limitations. Most
people who suffer phobias (around 60–80%) never
seek treatment,
and of those who do seek treat-
ment, approximately 25% either refuse exposure
therapy when they hear what it entails or drop out
of therapy.
One of the reasons for this refusal data
could be that the main feature of exposure is con-
fronting the feared stimuli, which some people may
find too frightening. New efforts are needed to in-
crease the number of phobia sufferers who benefit
from exposure therapy.
Some preliminary data from a nonclinical sample
supports the acceptability of VR exposure versus in
vivo exposure. Garcia-Palacios et al.
surveyed 777
undergraduate students who scored high in a fear
of spiders questionnaire. Participants strongly pre-
ferred VR exposure treatment to in vivo exposure
therapy. This work provided preliminary data
about the preference of VR exposure to in vivo ex-
posure in a nonclinical sample.
The aim of the present work is to conduct a sur-
vey to explore whether people with phobias would
prefer VR exposure to in vivo exposure in a clinical
sample of people suffering specific phobias and spe-
cific social phobias (fear of public speaking).
Universitat Jaume I, Castelló de la Plana, Spain.
Human Interface Technology Laboratory. University of Washington, Seattle, Washington.
Ciber Fisiopatologia Obesidad y Nutricion Instituto de Salud Carlos III, Spain.
Rapid Communication
The sample included 150 participants in two dif-
ferent samples who participated in different clinical
trials exploring the effectiveness of VR exposure in
the treatment of specific phobias. Some of the par-
ticipants (25, or 16.7%) belonged to a sample re-
cruited from the University of Washington in the
United States. Most of the participants (125, or
83.3%) were recruited from Universitat Jaume I in
Spain. The sample was composed of 73 people
(48.7%) diagnosed with specific phobias: animal
phobias (spiders, cockroaches, rats); 18 people (12%)
were diagnosed with a situational phobia (claus-
trophobia); 6 people (4%) were diagnosed with a
natural environment phobia (heights); and finally,
53 people (35.3%) were diagnosed with social pho-
bia (discrete subtype: fear of public speaking). Most
of the participants were women (86%). The mean
age of the participants was 27.43 years (SD 9.71)
ranging from 18 to 69; and 62.7% had an university
degree or were studying for a university degree,
30.6% had a high school education, and 6.7% had
an elementary school education.
Anxiety Disorders Interview Schedule (ADIS-IV).
We used different adaptations of the Behavioral
Avoidance Test (BAT) for the various fears. See Gar-
cia-Palacios et al.
for a description of the BAT for
specific phobia, animal type, and Botella et al.
for a
description of the BAT for claustrophobia. The BAT
for specific phobia, natural environment type
(heights), is an adaptation from Menzies and Clarke.
Finally, we used the BAT developed by Beidel et al.
for specific social phobia Self-report instruments in-
cluded a fear of spiders questionnaire, (FSQ,)
an in vivo versus VR exposure questionnaire.
Participants belonging to the United States sam-
ple were recruited from mass testing in an intro-
ductory psychology class. Participants completed
the FSQ. People scoring over 2 standard deviations
above the class mean in fear of spiders were invited
to participate in the study. Participants belonging to
the Spanish sample were recruited at Universitat
Jaume I through advertisements in the university
and local journals and posters around campus. The
criteria to participate in the study were as follows:
1. Meet DSM-IV
criteria for specific phobia or so-
cial phobia (fear of public speaking) according
to the judgment of two clinical psychologists, us-
ing the ADIS-IV interview.
2. Have a minimum of one-year duration of the
3. Be unable to complete a BAT.
4. Have no current alcohol or drug dependence.
5. Have no severe physical illness.
6. Read and sign a consent form previously ap-
proved by an Internal Review Board.
During the assessment, participants read and
completed the in vivo versus VR exposure ques-
tionnaire. This was done before starting the assess-
ment process and before they knew which treatment
they would receive. For example, participants re-
cruited at mass testing read the explanation and an-
swered the questions at mass testing; those coming
to the clinic directly did it in the first assessment
session before starting the diagnostic interview.
Results (on a scale from 1 to 7) showed that par-
ticipants were more willing to participate in a VR ex-
posure program (M 6.08, SD 1.31) than in an in
vivo exposure treatment (M 3.97, SD 1.89). The
difference between the means was statistically signif-
icant, t(149) 13.807, p 0.001. We also studied the
percentage of participants who refused to go through
the two different exposure programs: 27% refused in
vivo exposure, and 3% refused VR exposure. Using a
stricter definition of refusal, 14% of the participants
completely refused in vivo exposure, whereas none
of the participants completely refused VR exposure.
Regarding the preference between the two kinds
of exposure, 76% chose VR exposure, and 23.7%
chose in vivo exposure. We performed a binomial
test that showed that the difference between the per-
centage who chose in vivo and the percentage who
chose VR was statistically significant (p 0.001).
Most of those who chose VR exposure (90.4%)
said they chose it because they were too afraid of
confronting the real feared objects or situations.
Some (4.1%) chose VR because they thought it was
attractive and innovative; another 4.1% because
they thought it would be more difficult to control
real spiders; and 1.4% gave other reasons. On the
other hand, most of those who chose in vivo (57.7%)
said they chose this option because they considered
that “it is necessary to confront real spiders to over-
come the fear”; 23.1% chose in vivo because “the
computer-generated spiders won’t be able to make
me believe that I’m confronting real spiders.” Fi-
nally, 19.2% chose in vivo because “new technolo-
gies provoke distress in me.”
The present study provides the first clinical data
comparing acceptance of VR exposure vs. in vivo
exposure by participants suffering phobias. These
results support the use of VR exposure with the aim
to increase the acceptability of one of the most effi-
cacious techniques in clinical psychology: exposure
The research presented in this paper was funded
by Ministerio de Ciencia y Tecnología, grant
TIC2000-0184-P4-03, and Pla de Promocio de la In-
vestigacio, Fundacio Caixa Castello-Bancaixa 1999,
2000, and Ministerio de Educación y Ciencia, Spain.
Proyectos Consolider-C (SEJ2006-14301/PSIC).
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Address reprint requests to:
Dr. Azucena Garcia-Palacios
Universitat Jaume I
Dpt. Psicologia Basica
Clinica y Psicobiologia
Avda Vicent Sos Baynat, s/n
12071 Castelló de la Plana, Spain
... The feeling of confidence useful for progress because of this confidentiality, this security, the presence of the therapist, the feeling of absence of real threat and the relative awareness that the exposure does not happen in reality [13]; • ...
... Since the first ARET experience mentioned above in 2020, this type of phobia has benefited from a few studies, including controlled trials with a control group (no treatment) or with a group receiving standard exposure treatment. This early research effort on this phobia in particular can be explained by the economic stakes of large medical companies: annual loss for all international medical companies estimated at billions of euros in 2020 due to this phobia alone [13]. ...
... Our research groups received treatment sessions either in augmented reality, or in vivo exposure, which here represents the reference treatment. These studies found superior therapeutic efficacy of ARET compared to the control group and an equivalent effect compared to standard exposure treatment [9,12,13]. These positive changes lasted for a few months and the children did virtual workshops afterwards. ...
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Augmented reality has been increasingly used as a therapeutic tool in psychiatry. In particular, augmented reality exposure therapy (ARET) has been developed from and proposed as an alternative to standard cognitive behavioral therapy (CBT) for the treatment of phobic disorders. Using real-time 3D model and visual displays, the child is immersed in different computer-generated virtual environments designed for different types of phobia. As imaginative or in vivo exposure therapy, ARET consists in a gradual presentation of phobic stimuli. The desensitization through ARET has been found to be efficient in different types of anxiety disorder, and in particular in phobic disorders. The endeavor of this work is to examine researches done in the field of AR applied to children With Disorders. Thus, we will try to verify whether the use of these techniques makes useful or not an intervention in the case of children with disorder. The work presented aims at a reflection on the introduction of the use of AR in the treatment of these children by means of current researches. We will also observe, throughout this work, the involvement of NICTs such as augmented reality in changing the activities made with these tools on the didactic and methodological level.
... Durch die virtuelle Realität kann die Rate der Patienten reduziert werden, die eine Konfrontationstherapie ablehnen. In einer Studie betrug die Verweigerungsrate bei in-vivo-Exposition 27% und nur 3% bei der virtuelle Realität-Exposition (Garcia-Palacios et al., 2007). ...
... ). In einer Studie verweigerten 27% die in-vivo-Exposition(Garcia-Palacios et al., 2007) − Mögliche Stigmatisierung, wenn das Umfeld eine ambulante oder stationäre Psychotherapie mitbekommt − Gefühl der Abhängigkeit von der Psychotherapeutin oder dem Psychotherapeuten − Als stärkster Risikofaktor für einen therapeutischen Misserfolg gilt eine problematische Beziehung zur Psychothera-Ein wesentlicher Bestandteil der Verhaltenstherapie ist die Konfrontation mit Angst auslösenden Situationen bzw. Stimuli. ...
... Despite this limitation, when VRET can be used, the advantages are substantial. Specifically, traditional exposure therapy can have substantial time, cost, and risk associated with it (e.g., driving on a busy highway with the patient), and has a 25% rejection rate when introduced as a treatment option [45]. In contrast, VRET has a rejection rate of only 3% and in comparing preference for the two treatment options, 70% of participants expressed a preference for VRET over ET [45]. ...
... Specifically, traditional exposure therapy can have substantial time, cost, and risk associated with it (e.g., driving on a busy highway with the patient), and has a 25% rejection rate when introduced as a treatment option [45]. In contrast, VRET has a rejection rate of only 3% and in comparing preference for the two treatment options, 70% of participants expressed a preference for VRET over ET [45]. Although the current price point of many VR systems and corresponding lack of widespread adoption emerge as barriers, a final advantage of VRET over traditional exposure therapy is the ease with which the former could deployed through telehealth. ...
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Purpose of Review This review explores advances in the utilization of technology to address perinatal mood and anxiety disorders (PMADs). Specifically, we sought to assess the range of technologies available, their application to PMADs, and evidence supporting use. Recent Findings We identified a variety of technologies with promising capacity for direct intervention, prevention, and augmentation of clinical care for PMADs. These included wearable technology, electronic consultation, virtual and augmented reality, internet-based cognitive behavioral therapy, and predictive analytics using machine learning. Available evidence for these technologies in PMADs was almost uniformly positive. However, evidence for use in PMADs was limited compared to that in general mental health populations. Summary Proper attention to PMADs has been severely limited by issues of accessibility, affordability, and patient acceptance. Increased use of technology has the potential to address all three of these barriers by facilitating modes of communication, data collection, and patient experience.
... The tool was developed in a free way, that is, it is capable of treating any type of specific phobia, just developing specific 3D models for the phobia. In addition, it is capable of using any type of relaxation during the application of the DS technique, not being limited to the progressive relaxation of Jacobson (GARCIA-PALACIOS et al., 2007). ...
... Während Metaanalysen den Nutzen von VRET im Rahmen der PTBS-Behandlung im allgemeinen unterstützen, fehlen noch Studien, die zwischen verschiedenen Traumatypen differenzieren [12,13]. Obwohl VRET der traditionellen Exposition in vivo nicht überlegen ist, erscheint VRET aufgrund ihrer leichteren Durchführbarkeit und der Patientenpräferenz als Erweiterung der Therapiemöglichkeiten sinnvoll [8,19]. In der Behandlung von Patienten mit einer psychotischen Störung gibt es vor allem positive Daten für persistierendes Stimmenhören. ...
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Background: Virtual reality (VR) enables immersion in an interactive digital world with realistic experiences, that can be applied for controlled and personalized interventions. This review summarizes the current research on VR in the treatment of mental disorders. Methods: Selective literature search in PubMed and Google Scholar. Results: An increasing number of publications report the therapeutic application of VR for the treatment of mental disorders. Most VR applications are based on established therapy approaches, such as exposure therapy. According to meta-analytic data, virtual exposure therapy (VRET) for specific phobia and agoraphobia with panic disorder is as effective as traditional in vivo exposure therapy. VRET for the treatment of social phobia is significantly more effective than waitlist and placebo control groups with, however, currently inconsistent metanalytic results when compared to in vivo exposure therapy. VRET for the treatment of posttraumatic stress disorder (PTSD) is similar in effectiveness compared to active psychotherapy. For psychosis, positive results have been reported for the VR-based treatment of auditory verbal hallucinations. For patients with a substance use disorder, VR can induce craving, with still unverified diagnostic and therapeutic relevance. Conclusions: VRET can broaden the psychotherapy options for anxiety disorders. Encouraging results of VR-based treatments for psychosis and PTSD indicate the need for further research concerning its effectiveness and safety. In the field of substance use disorders, evaluation of clinical-orientated VR applications is needed.
... This study demonstrates that the oVRcome self-guided mobile app, which incorporates VR and cognitive behavioural therapy, reduces the severity of symptoms of five specific phobias and treatment effects persist at 6-week follow-up. The app utilised 360° VR video and showed a large effect size comparable to more expensive VR devices typically only available in research or clinical settings, usually with much higher level of clinician involvement (Botella et al., 2016;Emmelkamp et al., 2002;Garcia-Palacios et al., 2007;Krijn et al., 2004;Michaliszyn et al., 2010;Muhlberger et al., 2003). The long duration of reported symptoms (mean 26 years) and female preponderance in this study is consistent with lifetime persistence and incidence rates reported internationally (Wardenaar et al., 2017). ...
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Objective Mobile health applications for mental health are widely accessible but most have had limited research evaluation. Virtual reality exposure therapy is an emerging treatment for specific phobias. Most virtual reality studies have investigated high-end virtual reality devices, typically only available in research and limited clinical settings for a single phobia. This study evaluated the effectiveness of oVRcome, a mobile health application combining self-guided virtual reality exposure and cognitive behaviour therapy, for five specific phobias. Methods This is a 2-arm 6-week randomised controlled trial, with a waitlist control group and follow-up at week 12. Participants were required to live in New Zealand; be aged 18–64 years; have a fear of flying, heights, spiders, dogs and needles; score above 4 on the Brief Standard Self-rating scale for phobic patients; and have access to a smartphone and Internet. oVRcome consists of six modules of psychoeducation, relaxation, mindfulness, cognitive techniques, exposure through virtual reality and relapse prevention over 6 weeks. The primary outcome was the change from baseline to week 6 on the Severity Measures for Specific Phobia – Adults. All analyses were performed on intention-to-treat set. Results A total of 126 participants were randomised, and 109 completed the follow-up at week 6, for a retention rate of 86.5%. The mean change in Severity Measures for Specific Phobia – Adults score from baseline to week 6 was greater in the active group compared with the waitlist group (active group −20.53 [standard deviation = 8.24]; waitlist group: − 12.31 [standard deviation = 10.66]; p < 0.001). The effect size for this difference was 0.86. Conclusion Self-guided use of the oVRcome app was effective at reducing severity of specific phobia symptoms in a sample of people with a self-reported fear of flying, heights, spiders, dogs or needles. Trial registry NCT04909177.
... When compared to psychological placebos and wait-lists (WL), VRET is a highly effective treatment intervention with effects generalized to real life (Morina et al., 2015, Powers & Emmelkamp, 2008 and a low deterioration rate (Fernández-Álvarez et al., 2019). It represents a cost-efficient approach (Wood et al., 2009), highly preferred among young individuals (Garcia-Palacios et al., 2001) or individuals affected by specific phobias (Garcia-Palacios et al., 2007). ...
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This is the protocol for a Campbell systematic review. The objectives are as follows: (a) to quantify the effect sizes for virtual reality exposure therapy (VRET) in the treatment of social anxiety disorder (SAD), targeting primary social anxiety symptoms, comorbid anxiety and depression symptoms and improvements in quality of life, when compared to WL, information control, care‐as‐usual and placebo; (b) to compare VRET to in vivo cognitive and cognitive‐behavioral interventions in treating SAD, at posttest and follow‐up, using between‐group design; (c) to identify the key features which are linked to beneficial outcomes in the two formats in treating SAD and (d) to collect and interpret information on differences in treatment uptake, adherence and attrition, as well as clinical significance and therapist‐time in both treatment formats.
Introduction: Generalized anxiety disorder (GAD) is a chronic uncontrollable excessive anxiety towards a variety of topics. It is one of the most prevalent anxiety diseases, affecting approximately 6% worldwide. Virtual reality (VR) based interventions have received much attention from researchers for the management of mental health problems. This systematic review was conducted to assess the effects of immersive virtual reality techniques and non-immersive techniques in treating patients with GAD. Methods: An extensive systematic literature review was implemented, from inception up to 9 July 2021. Comparative clinical studies that assessed the outcomes of VRT in patients with GAD were included for meta-analysis. Single arm studies were included for systematic review only. Results: A total of six articles with 239 participants with GAD were included in systematic review. The mean age of the included participants ranged from 38.33 to 59.87 years. There was no statistically significant difference between VRT and control groups regarding the anxiety levels (SMD 0.01; 95%CI −0.52, 0.54; P = 0.97), mean depression scores (SMD 1.34; 95%CI −0.80, 3.49; P = 0.22), PSWQ (MD −4.26; 95%CI −10.93, 2.40; P = 0.21), and discomfort status (MD −1.41; 95%CI −3.86, 1.05; P = 0.22). Conclusions: VR improved relatively the manifestations of GAD, reflecting on the patient's quality of life. However, the existing evidence is inconclusive to support the superiority of VR as a substitute for traditional therapies.
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Background Fear of spiders, or Arachnophobia, is one of the most common specific phobias. The gold standard treatment, in vivo exposure therapy, is effective, but comes with significant limitations, including restricted availability, high costs, and high refusal rates. Novel technologies, such as augmented reality, may help to overcome these limitations and make Exposure Therapy more accessible by using mobile devices. Objective This study will use a Randomized Controlled Trial design to investigate whether ZeroPhobia: Arachnophobia, a 6-week Augmented Reality Exposure Therapy smartphone self-help application, can effectively reduce spider phobia symptoms. Additionally, we will examine user-friendliness of the application and the effect of usage intensity and presence on treatment outcome. Methods This study is registered in the Netherlands Trial Registry under NL70238.029.19 (Trial NL9221). Ethical approval was received on October 11, 2019. One-hundred-twelve participants (age 18–64, score ≥ 59) on the Fear of Spiders Questionnaire [FSQ] will be recruited from the general Dutch population and randomly assigned to a treatment or waitlist control group. The ZeroPhobia application can be accessed on users’ smartphone. Baseline, post-test (i.e., at six weeks), 3- and 12-month follow-up assessments will be done, each including the Fear of Spiders Questionnaire as the main outcome measure as well as additional measures of anxiety, depression, user-friendliness, and presence as secondary measures and covariates. Results The study was funded on September 25, 2018. Data collection started in September 2021 and the study is expected to run until September 2022. Conclusions Our study will improve our understanding of the efficacy and feasibility of providing Exposure Therapy for spider phobia using an Augmented Reality self-help application, with the intention of making mental health care more accessible.
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Development of this Resource The Division 12 (Clinical Psychology) Task Force on Psychological Interventions has worked for several years to establish and revise criteria for judging whether a treatment may be considered to be empirically supported. Several lists of examples of "well-established" and "probably efficacious" treatments have been published. Please see those reports (Chambless et al., in press; Chambless et al., 1996; Task Force on Promotion and Dissemination of Psychological Procedures, 1995) for complete details. To assist clinicians and educators in learning more about these treatments with scientific support, the Task Force on Psychological Interventions has also endeavored to publicize information about how to obtain manuals detailing those treatments considered to be well-established (Sanderson & Woody, 1995). The present resource represents an updated list of manuals that have been published or are available from the author(s). What qualifies as a manual? In building this resource, we attempted to locate materials that provide sufficient detail to allow a trained clinician to replicate the treatment. Of course, no treatment manual is adequate in the absence of solid theoretical grounding and supervised training in the particular approach. Recognizing this, we have also included, when available, information about training in these approaches. We specifically excluded conference workshops as a training resource, because these workshops typically do not offer the opportunity for supervised experience. This resource listing of manuals is based on the most recent Task Force report (in press). We wrote to leading investigators in well-established areas of treatment research, particularly those scientists whose work formed the basis for judging a particular treatment to be efficacious. These investigators provided citations for manuals that have been published. Many authors offered to provide copies of unpublished manuals to clinicians, although requests must be accompanied by a check to cover the costs of photocopying and postage. Because this resource is based on the judgments of the Task Force on Psychological Interventions, it is necessarily limited to those areas that have been thoroughly reviewed by the Task Force. We have included manuals corresponding to treatments judged to be well-established as a service to professionals who wish to learn more about scientifically supported treatments. No judgment about treatments or manuals not appearing on the list is implied. Careful readers may notice that some treatments that appeared on the 1995 listing of manuals do not appear in this edition; these deletions are due to revisions in the Task Force's list of examples of well-established treatments.
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This article is the presentation of the main phobia data from the Epidemiologic Catchment Area (ECA) program, with a sample size of n = 18.571. Work on this article was initiated in 1981 at the beginning of the ECA study, but publication has been delayed a decade. Phobias are determined from information from the Diagnostic Interview Schedule (DIS), classified according to DSM III. Phobias are found to be the most common psychiatric disorder in the community, more common than major depression or alcohol abuse or dependence in the month prior to interview. The one month prevalence is between 4.0 and 11.1%, with the estimated prevalence in the United States being 6.2%. There were nine community surveys of the prevalence of phobia that pre-dated the ECA studies, which found a wide range of prevalence rates from 1.2% to 26.1%. By far the strongest risk factor associated with phobias is the presence of another psychiatric disorder. Prevalence rates of simple phobia and agoraphobia are found in the ECA studies to be significantly higher in women; social phobia, which is less prevalent, has no significant sex difference. The prevalence rates are higher in younger age groups, and in those with low socioeconomic status (SES). The onset of phobias occurs primarily in the childhood or teenage years, and they tend to be chronic conditions. Less than a quarter of phobics receive treatment.
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The success rate for treating phobias with in vivo exposure is high. Unfortunately, few phobics (less than 15-20%) ever seek treatment. Virtual reality (VR) exposure therapy is also proving to be highly effective. The present surveys assessed 162 students high in fear of spiders. In Study 1, when asked to choose between multisession in vivo exposure vs. multisession VR exposure therapy, 81% chose VR. In Study 2, comparing one-session in vivo versus multisession VR exposure therapy, 89% chose VR. Results suggest that VR exposure therapy may prove valuable for increasing the number of phobics who seek treatment.
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This study explored whether virtual reality (VR) exposure therapy was effective in the treatment of spider phobia. We compared a treatment condition vs. a waiting list condition in a between group design with 23 participants. Participants in the VR treatment group received an average of four one-hour exposure therapy sessions. VR exposure was effective in treating spider phobia compared to a control condition as measured with a Fear of Spiders questionnaire, a Behavioural Avoidance Test (BAT), and severity ratings made by the clinician and an independent assessor. Eighty-three percent of patients in the VR treatment group showed clinically significant improvement compared with 0% in the waiting list group, and no patients dropped out. This study shows that VR exposure can be effective in the treatment of phobias.
As part of a pretreatment assessment battery, social phobics were required to participate in two impromptu speech tasks, scheduled one week apart. The reliability of psysiological, cognitive, and behavioral variables collected during the speech was assessed. The results indicated that the data collected during this task were consistent across the two assessment periods, indicating the reliability of this procedure for the behavioral assessment of social phobia. The results are discussed in terms of the usefulness of this procedure in assessing various dimensions of social phobia.
The aim of this study was to determine the effectiveness of virtual reality (VR) exposure in the treatment of claustrophobic fear. We evaluated the intervention following a controlled, multiple-baseline design across 4 participants with claustrophobic fear who sought psychological help in our anxiety disorders clinic. The treatment consisted of 8 individual VR graded exposure sessions. Data were obtained at pretreatment, posttreatment, and 3-month follow-up on several clinical measures: Behavioral Avoidance Test, Self-Efficacy Toward Closed Spaces, Problem-Related Impairment Questionnaire, Beck Depression Inventory (Beck, 1978), and Anxiety Sensitivity Index (Peterson & Reiss, 1992). Results support the effectiveness of the VR procedure for the treatment of claustrophobic fear. An important change appeared in all measures after treatment completion. It can be concluded that VR exposure was effective in reducing fear and avoidance in closed spaces and in increasing self-efficacy in claustrophobic situations. Moreover, changes were maintained at 3-month follow-up.
Differences between phobic and normal subject perceptions of danger were examined. Fifty-nine height phobic patients and a matched set of normal controls gave danger ratings before and during a height avoidance test on a triple extension ladder. Before the test acrophobic patients: (1) gave higher estimates of the probability of falling from the ladder than normals did; (2) gave higher estimates of the injuries that would result from falling, and; (3) believed their excessive levels of anticipated anxiety were more reasonable and appropriate to the demands of the situation than did normals. In addition, during the height avoidance test the differences between the two groups grew as phobic danger estimates increased while control group estimates did not. Finally, moderate, but inconsistent, relationships were obtained between phobic danger ratings and anxiety and avoidance. The implications of these findings for expectancy models of anxiety are discussed. The results challenge the view that phobic patients have complete insight into the inappropriateness of their own distress.
Incidence and prevalence data for common fears and phobia based on a probability sample of the general population show the frequency of mild phobia to be 76:9/1000 and of severe phobia to be 2.2/1000. Clinical samples are not representative of the distribution of phobia in the general population, agoraphobia being over-represented. The most frequent reason for consulting a physician is for him to minimize a severe fear or phobia of a medical procedure. Psychiatrists tend to see only the more severe phobics, although only a quarter of this group were found to be in treatment.
The Fear of Spiders Questionnaire (FSQ), an 18-item self-report questionnaire assessing spider phobia, was developed in an attempt to complement the information provided by the Spider Phobia Questionnaire (SPQ). Data obtained from 338 undergraduates revealed that the FSQ was able to discriminate phobics from nonphobics, and indicated decrements in phobic responding from pretest to posttest following cognitive therapy. Test-retest data, obtained from non-treatment control groups, indicated that scores on the FSQ are stable over a one month period. The FSQ also demonstrated adequate convergent validity due to its significant correlations with the SPQ and a behavioral avoidance test. Finally, a factor analysis revealed two factors accounting for 55% of the variance. It is argued that, compared to the SPQ, items on the FSQ are more explicit regarding the time period to be assessed, and may be more sensitive to differences between phobics and nonphobics and decrements in phobic responding following treatment.
Data are presented on the general population prevalences, correlates, comorbidities, and impairments associated with DSM-III-R phobias. Analysis is based on the National Comorbidity Survey. Phobias were assessed with a revised version of the Composite International Diagnostic Interview. Lifetime (and 30-day) prevalence estimates are 6.7% (and 2.3%) for agoraphobia, 11.3% (and 5.5%) for simple phobia, and 13.3% (and 4.5%) for social phobia. Increasing lifetime prevalences are found in recent cohorts. Earlier median ages at illness onset are found for simple (15 years of age) and social (16 years of age) phobias than for agoraphobia (29 years of age). Phobias are highly comorbid. Most comorbid simple and social phobias are temporally primary, while most comorbid agoraphobia is temporally secondary. Comorbid phobias are generally more severe than pure phobias. Despite evidence of role impairment in phobia, only a minority of individuals with phobia ever seek professional treatment. Phobias are common, increasingly prevalent, often associated with serious role impairment, and usually go untreated. Focused research is needed to investigate barriers to help seeking.