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

Abstract

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.
C
YBER
P
SYCHOLOGY
& B
EHAVIOR
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
A. GARCIA-PALACIOS, Ph.D.,
1,3
C. BOTELLA, Ph.D.,
1,3
H. HOFFMAN, Ph.D.,
2
and S. FABREGAT, B.A.
1
ABSTRACT
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.
INTRODUCTION
P
HOBIAS ARE SOME
of the most common mental dis-
orders.
1
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.
2
The American Psychological
Association (APA) report on empirically supported
treatments included exposure-based treatment
manuals for specific and social phobia.
3
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,
1,4,5
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.
6,7
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.
8
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).
1
Universitat Jaume I, Castelló de la Plana, Spain.
2
Human Interface Technology Laboratory. University of Washington, Seattle, Washington.
3
Ciber Fisiopatologia Obesidad y Nutricion Instituto de Salud Carlos III, Spain.
722
Rapid Communication
METHOD
Participants
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.
Measures
Anxiety Disorders Interview Schedule (ADIS-IV).
9
We used different adaptations of the Behavioral
Avoidance Test (BAT) for the various fears. See Gar-
cia-Palacios et al.
10
for a description of the BAT for
specific phobia, animal type, and Botella et al.
11
for a
description of the BAT for claustrophobia. The BAT
for specific phobia, natural environment type
(heights), is an adaptation from Menzies and Clarke.
12
Finally, we used the BAT developed by Beidel et al.
13
for specific social phobia Self-report instruments in-
cluded a fear of spiders questionnaire, (FSQ,)
14
and
an in vivo versus VR exposure questionnaire.
Procedure
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
15
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
phobia.
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
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.”
VR EXPOSURE VS. IN VIVO EXPOSURE
723
DISCUSSION
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
therapy.
ACKNOWLEDGMENTS
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).
REFERENCES
1. Magee WJ, Eaton WW, Wittchen HU, McGonagle KA,
Kessler RC. Agoraphobia, simple phobia, and social
phobia in the National Comorbidity Survey. Archives
of General Psychiatry1996; 53:159–68.
2. Antony MM. Swinson RP. (2000) Specific phobia. In:
Antony MM, Swinson RP, eds. Phobic disorders and
panic in adults: guide to assessment and treatment. Wash-
ington, DC: American Psychological Association, pp.
79–104.
3. Woody SR. Sanderson WC. Manuals for empirically
supported treatments: 1998 update. The Clinical Psy-
chologist 1998; 51:17–21.
4. Agras S, Sylvester D, Oliveau D. The epidemiology of
common fears and phobia. Comprehensive Psychia-
try 1969; 10:151–6.
5. Boyd JH, Rae DS, Thompson JW, Burns BJ, Bourdon
K, Locke BZ, Regier DA. Phobia: prevalence and risk
factors. Social Psychiatry and Psychiatric Epidemiol-
ogy 1990; 25:314–23.
6. Marks IM. (1978) Behavioral psychotherapy of adult
neurosis. In: Gardfield SL, Bergin AE, eds. Handbook
of psychotherapy and behavior change, 2nd ed. New York:
Wiley.
7. Marks IM. (1992) Tratamiento de exposision en la ago-
rafobia y el panico. In: Echeburua E, ed. Avances en el
tratamiento psicologico de los trastornos de ansiedad.
Madrid: Piramide.
8. Garcia-Palacios A, Hoffman HG, See SK, Tsay A,
Botella C. Redefining therapeutic success with virtual
reality exposure therapy. CyberPsychology & Behav-
ior 2001; 4:341–8.
9. Di Nardo PA, Brown TA, Barlow DH. (1994) Anxiety
disorders interview schedule for DSM-IV: lifetime version
(ADIS-IV). San Antonio, TX: Psychological Corpora-
tion.
10. Garcia-Palacios A, Hoffman HG, Carlin A, Furness III
T, Botella C. Virtual reality and tactile augmentation
in the treatment of spider phobia: a controlled study.
Behaviour Research and Therapy 2002; 40, 983–93.
11. Botella C, Banos R, Villa H, Perpina C, Garcia-Pala-
cios A. Virtual reality in the treatment of claustro-
phobia: a controlled multiple baseline design. Behav-
ior Therapy 2000; 31:583–95.
12. Menzies RG, Clarke JC. Danger expectancies and in-
sight in acrophobia. Behavior Research and Therapy
1995; 33:215–21.
13. Beidel DC, Turner SM, Jacob RG, Cooley MR. As-
sessment of social phobia: Reliability of an im-
promptu speech task. Journal of Anxiety Disorders
1989; 3:149–58.
14. Szymanski J, O’Donohue W. Fear of spiders ques-
tionnaire. Journal of Behavioral Therapy and Experi-
mental Psychiatry 1995; 26:31–4.
15. American Psychiatric Association. (2000) Diagnostic
and statistical manual of mental disorders, 4th ed.
Washington, DC: American Psychiatric Association.
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
E-mail: azucena@psb.uji.es
GARCIA-PALACIOS ET AL.
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... 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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... 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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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.
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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.
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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.
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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.
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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.