Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: A randomized non-inferiority trial. (July 2019)

• Record Type: Journal Article
• Authors: Miloff, Alexander; Lindner, Philip; Dafgård, Peter; Deak, Stefan; Garke, Maria; Hamilton, William; Heinsoo, Julia; Kristoffersson, Glenn; Rafi, Jonas; Sindemark, Kerstin; Sjölund, Jessica; Zenger, Maria; Reuterskiöld, Lena; Andersson, Gerhard; Carlbring, Per
• Is Part Of: Behaviour research and therapy. Volume 118(2019)
• Page Start: 130
• Page End: 140
• Publication Date: 2019-07
• Subjects: Exposure therapy -- One-session treatment -- Virtual reality -- Spider phobia; Cognitive therapy -- Periodicals; Psychotherapy -- Periodicals; 616.891
• DOI: 10.1016/j.brat.2019.04.004
• Languages: English
• ISSNs: 0005-7967

Abstract

Abstract: Objective: This study compared the efficacy of a technician-assisted single-session virtual reality exposure therapy (VRET) for the treatment of spider phobia featuring low-cost consumer-available hardware and novel automated software to gold-standard in-vivo one-session treatment (OST), using a parallel group randomized non-inferiority design. Method Participants (N = 100) were randomized to VRET and OST arms. Assessors blinded to treatment allocation evaluated participants at pre- and post-treatment as well follow-up (3 and 12 months) using a behavioral approach test (BAT) and self-rated fear of spider, anxiety, depression and quality-of-life scales. A maximum post-treatment difference of 2-points on the BAT qualified as non-inferiority margin. Results Linear mixed models noted large, significant reductions in behavioral avoidance and self-reported fear in both groups at post-treatment, with VRET approaching the strong treatment benefits of OST over time. Non-inferiority was identified at 3- and 12- months follow-up but was significantly worse until 12-months. There was no significant difference on a questionnaire measuring negative effects. Conclusions Automated VRET efficaciously reduced spider phobia symptoms in the short-term and was non-inferior to in-vivo exposure therapy in the long-term. VRET effectiveness trials are warranted to evaluate real-world benefits and non-specific therapeutic factors accruing from the presence of a technician during treatment. ClinicalTrials.gov (NCT02533310). Highlights: Non-inferiority of virtual reality exposure therapy (VRET) for spider phobia tested. Patients (N = 100) were randomized to VRET or in-vivo one-session treatment (OST). Technician-assisted automated VRET significantly reduced fear of spider self-report. Non-inferiority obtained at 3- and 12-months according to behavioral approach test. Future studies warranted to evaluate real-world effectiveness in self-help format.