Distraction versus focusing during VR exposure therapy for acrophobia: A randomized controlled trial

Diemer, Julia and Muehlberger, Andreas and Yassouridis, Alexander and Zwanzger, Peter (2023) Distraction versus focusing during VR exposure therapy for acrophobia: A randomized controlled trial. JOURNAL OF BEHAVIOR THERAPY AND EXPERIMENTAL PSYCHIATRY, 81: 101860. ISSN 0005-7916, 1873-7943

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Abstract

Background and Objectives: The therapeutic mechanisms of exposure therapy are not well understood. Research suggests that focusing on the most feared aspect might not be necessary, and that distraction with a low cognitive load (e.g., conversation) might enhance exposure. We aimed at systematically testing the efficacy of exposure therapy with focusing vs. conversational distraction, hypothesizing that distracted exposure would yield superior effects. Methods: Thirty-eight patients with acrophobia (specific phobia of heights; clinician-determined) (free from relevant somatic or other mental disorders) were randomly assigned (1:1) to one virtual reality (VR) session of either focused (n = 20) or distracted exposure (n = 18). This monocentric trial took place at a psychiatric university hospital.Results: Both conditions resulted in a significant reduction of acrophobic fear and avoidance, and a significant increase of self-efficacy (primary outcome variables). However, condition did not have a significant effect on any of these variables. Effects were stable at four-week follow-up. Heart rate and skin conductance level indicated significant arousal, but did not differ between conditions. Limitations: Eye-tracking was unavailable, nor did we assess emotions other than fear. Power was limited due to sample size. Conclusions: A balanced exposure protocol combining attention to fear cues with conversational distraction, while not being superior, might be as effective as focused exposure for acrophobia, at least during the initial stages of exposure therapy. These results support previous findings. This study demonstrates how VR can be exploited for therapy process research, as VR supports dismantling designs and the incorporation of online process measures.

Item Type: Article
Uncontrolled Keywords: VIRTUAL-REALITY EXPOSURE; IN-VIVO EXPOSURE; PHYSIOLOGICAL AROUSAL; ANXIETY REDUCTION; SELF-EFFICACY; FEAR; ATTENTION; DISORDERS; AVOIDANCE; STIMULI; Exposure therapy; Virtual reality; Distraction; Anxiety disorders
Subjects: 600 Technology > 610 Medical sciences Medicine
Divisions: Medicine > Lehrstuhl für Psychiatrie und Psychotherapie
Depositing User: Dr. Gernot Deinzer
Date Deposited: 31 Jan 2024 12:37
Last Modified: 31 Jan 2024 12:37
URI: https://pred.uni-regensburg.de/id/eprint/60584

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