## 5 Review of Considered Study
### Animal-Specific Phobia
#### 5.1.1 Spider and Cockroach Phobia  
Cockroach phobia can be implemented easily using either augmented reality or virtual reality. The researchers developed a case study that uses augmented reality object detection, where the presence of a certain object will generate the 3D cockroaches. The application runs on a desktop with an external camera. Furthermore, it contains four different scenarios displayed to the patient including single static cockroaches, single dynamic cockroaches, multiple static cockroaches, and multiple dynamic cockroaches. An evaluation is done on eight cockroach phobia patients, with ages ranging between 20 and 23 years old. Moreover, the evaluation must be preceded by the Fear of Spiders Questionnaire (FSQ) [47] to determine the anxiety level of patients. During the evaluation, the Subjective Units of Discomfort  
Figure 3: Studies’ publication years. Figure 2: Filtering studies based on the title, abstract, and full text. Scale (SUD) is used to determine the anxiety level. Moreover, after the application testing, the patients must fill in a Slater-Usoh-Steed Questionnaire (SUS) that measures the realism of the application [35]. A marker-based augmented reality exposure therapy has been developed aiming to treat spider phobia (arachnoidnophobia). Increasing interactivity and decreasing arachnophobia are the main goals of the developed study. The Android application is based on four treatment stages related to the patient's spider fear level, ranging between high intermediate, diffuse, normal, and null. Each patient score in the Fear of Spider Questionnaire (FSQ) will determine the appropriate one of the four stages. Stage one includes a static spider, while stage two contains a moving spider. Moreover, stage three contains multiple static spiders, while multiple moving spiders are included in stage four. An evaluation is conducted from the beginning to determine the patient's fear level and the appropriate treatment stage using the FSQ. However, the evaluation was done on 16 arachnophobia patients with an age range between 18 and 20 years old. A daily session was carried out for one month followed by the same questionnaire to acknowledge the difference with different session times based on the patient responses [36]. A study conducted by [39] aims to compare the performance of virtual reality exposure therapy with the standard in vivo one-session treatment. However, the study relies on a single-session non-inferiority randomized trial. The evaluation was done on a total of 100 spider phobia participants randomized to either virtual reality exposure therapy or in vivo one-session treatment. A Behavioral Avoidance Test (BAT) was used pre-assessment and post-assessment and in the follow-up. For the in vivo one-session treatment, the participants were exposed to three spiders with different sizes gradually for three hours maximum, while rating their anxiety level using a Subjective Unit of Distress (SUD). Virtual reality exposure therapy was conducted using an app developed for the treatment called VIMSE. The app consists of eight levels with a spider that becomes more realistic, and it allows the user to pause the treatment while they also rate anxiety using a SUD [39]. A study has been developed aiming to treat both spider and cockroach phobias using augmented reality instead of the accepted treatment of virtual reality exposure therapy. Thus, a comparison between in vivo exposure therapy and augmented reality exposure therapy is needed to evaluate their acceptance and usefulness. The trial was randomized, controlled, and done using one-session guidelines. The evaluation achieved a total of 63 participants, with 31 patients assigned to the in vivo exposure therapy and 32 patients randomly assigned to the augmented reality therapy. However, the study used several measurements including the BAT, FSQ, Spider Phobia Beliefs Questionnaire (SBQ), Fear and Avoidance Scales, and the Clinician Severity Scale (CSS) on the pre-treatment, post-treatment, and follow-up stages.