Virtual Reality Exposure Versus In Vivo Exposure for Fear of Heights

Study Overview
=================
Brief Summary
-----------------
This study randomly assigned 114 participants with significant fear of heights to one of three conditions: a) a single session of virtual reality exposure; b) a single session of in vivo exposure; or c) a control condition. The aim of this study was to compare the efficacy of virtual reality exposure to the efficacy of in vivo exposure or no exposure for participants with significant fear of heights.

Official Title
-----------------
Comparing the Efficacy of a Single-Session Virtual Reality Treatment for Fear of Heights to In Vivo Exposure and No Treatment

Conditions
-----------------
Fear of Heights, Acrophobia, Specific Phobia, Anxiety Disorder

Intervention / Treatment
-----------------
* Behavioral: Exposure Therapy (In Vivo)
* Behavioral: Exposure Therapy (Virtual Reality)


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Score >= 45 on the Acrophobia Questionnaire (AQ) Exclusion Criteria: Already receiving therapy specifically for fear of heights. Has any contraindications to using a virtual reality headset.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Eligible participants were randomly assigned to one of three conditions: a) single session virtual reality exposure; b) single session in vivo exposure; c) waitlist control
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Virtual Reality Exposure<br>Participants completed a single session of exposure administered via a virtual reality headset. The exposure exercise involved looking over virtual railings into an atrium at various floor levels (the virtual environment was designed to look like the atrium in the in vivo exposure condition). Exposure was conducted in six 6-minute trials for a total of 36 minutes of exposure. | Behavioral: Exposure Therapy (Virtual Reality)<br>* Participant completes a single session of exposure therapy for fear of heights by looking over railings into an atrium at various floor levels in a real environment.<br>|
| Experimental: In Vivo Exposure<br>Participants completed a single session of exposure administered in vivo. The exposure exercise involved looking over actual railings into an atrium at various floor levels. Exposure was conducted in six 6-minute trials for a total of 36 minutes of exposure. | Behavioral: Exposure Therapy (In Vivo)<br>* Participant completes a single session of exposure therapy for fear of heights by looking over railings into an atrium at various floor levels in a virtual environment.<br>|
| No Intervention: Waitlist Control<br>Participants watched a neutral video during the time participants in other conditions were completing the exposure exercise. Participants received no exposure-based intervention. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acrophobia Questionnaire (AQ) | Participants completed the anxiety subscale of the AQ, a 20-item questionnaire that assesses self-reported anxiety related to acrophobia. Scores for the subscale are summed, and totals range from 0 to 120, with higher scores indicating greater anxiety. | Immediately Post-Treatment (Controlling for Baseline Scores) | 
| Behavioral Approach Task (BAT) | Participants walked up a staircase until they reach the highest level they can complete, while stopping to look over the ledge toward the floor at each landing. During each BAT, fear response was assessed behaviorally (highest step reached) and subjectively (self reported levels of fear). | Immediately Post-Treatment (Controlling for Baseline Scores) | 
| Heights Interpretation Questionnaire (HIQ) | Participants completed the HIQ, a 16-item questionnaire that assesses self-reported interpretations of an imagined experience of heights. Items are summed scored, and totals ranged from 16 to 80, with higher scores indicating greater height fear-relevant interpretation bias. | Immediately Post-Treatment (Controlling for Baseline Scores) | 
| Acrophobia Questionnaire (AQ) | Participants completed the anxiety subscale of the AQ, a 20-item questionnaire that assesses self-reported anxiety related to acrophobia. Scores for the subscale are summed, and totals range from 0 to 120, with higher scores indicating greater anxiety. | 1-Week Post-Treatment (Controlling for Immediate Post-Treatment Scores) | 
| Behavioral Approach Task (BAT) | Participants walked up a staircase until they reach the highest level they can complete, while stopping to look over the ledge toward the floor at each landing. During each BAT, fear response was assessed behaviorally (highest step reached) and subjectively (self reported levels of fear). | 1-Week Post-Treatment (Controlling for Immediate Post-Treatment Scores) | 
| Heights Interpretation Questionnaire (HIQ) | Participants completed the HIQ, a 16-item questionnaire that assesses self-reported interpretations of an imagined experience of heights. Items are summed scored, and totals ranged from 16 to 80, with higher scores indicating greater height fear-relevant interpretation bias. | 1-Week Post-Treatment (Controlling for Immediate Post-Treatment Scores) |