## 5 Conclusions  
This study explored the feasibility and preliminary efficacy of P-ARET for adults with cockroach phobia. Key findings include a lack of preference for treatment modalities among participants, but they considered the MS version more effective, showed high adherence to the Emotional Monitor app, and showed significant efficacy of P-ARET in several outcomes. This study highlights the usefulness of mixed realities in exposure therapy, suggesting its effectiveness in managing phobias in the long term. Despite limitations, the present study shows the importance of variability in conducting exposure treatment for cockroach phobia.  
The use of VR and AR offers a higher level of specificity, allowing for controlled and personalized exposure to phobic stimuli. This technology enables the selection of not only the necessary stimulus but also the associated details, such as color, size, and movement.  
Such personalized interaction enhances validity by replicating real-world scenarios in a safe environment while providing greater control over each step of the exposure intensity during treatment. This level of control makes the treatments more replicable, a feature that cannot be achieved with real stimuli.  
Additionally, VR and AR could contribute to a more gradual exposure to feared stimuli, potentially reducing the aversion that patients feel when exposed to what they fear. This approach may help to lower the high rates of treatment abandonment, while also enhancing the effectiveness of each step within the exposure hierarchy and improving the overall treatment experience for patients.  
Conceptualization, J.B.-L., J.G., D.C. and S.Q.; Data curation, M.P.-B. and S.Q.; Formal analysis, C.S.-R., A.G.-P. and S.Q.; Funding acquisition, J.B.-L. and S.Q.; Investigation, M.P.-B., J.B.-L., J.G., C.S.-R., A.G.-P. and S.Q.; Methodology, M.P.-B., J.B.-L., J.G. and C.S.-R.; Project administration, J.B.-L. and S.Q.; Resources, D.C.; Software, D.C. and A.G.-P.; Supervision, [PERSON]-L., [PERSON]-R., [PERSON] and S.Q.; Visualization, M.P.-B.; Writing--original draft, M.P.-B.; Writing--review and editing, M.P.-B., [PERSON]-L., J.G., [PERSON] and S.Q. All authors have read and agreed to the published version of the manuscript. Funding for this study was provided by Grant Ministerio de Ciencia, Innovacion y Universidades (Spain) (Programa Estatal I + D + i RTI2018-100993-B-I00) funded by MCIN/AEI/10.13039/501100011033 and by \"ERDF A way of making Europe\", by the \"European Union\". Institutional Review Board Statement: The Research Ethics Committee of Universitat Jaume I (Castellon, Spain) approved this study on 13 December 2019 (CD/64/2019). It was carried out following the Helsinki Declaration and the Madrid Declaration of the World Psychiatric Association. Informed Consent Statement: Informed consent was obtained from all subjects involved in this study. Data Availability Statement: Data will be made available upon request.  
The current project was supported by Plan 2021 de Promocion de la Investigacion de la Universitat Jaume I [UJI-B2021-47], CIBEROBN, an initiative of the ISCIIII [CB06 03/0052], by the Grant Prometeo Programme for Research Groups of Excellence [CIPROM/2021/041--Project \"IMPULSA\"] (Conselleria d'Innovacio, Universitats, Ciencia i Societat Digital; Generalitat Valenciana) and Convocatoria 2023 d'ajudes a grups d'investigacio activis en captacio de recursos del pia estatal d d 1 + D + i (reference numbers: GACUJIMB/2023/15 and GACUJIMB/2023/19). The authors declare no conflicts of interest. References