Gamification in the Treatment of Spider Phobia

Study Overview
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Brief Summary
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Mobile applications are more and more considered when implementing programs for treating mental disorders. The study aims to reduce avoidance and fear of spiders in spider-fearful individuals by combining exposure principles with gamification elements (e.g. narrative background, level progression, points, feedback). We investigate the efficacy of the gamified app in a remote online-therapy context.

Official Title
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Testing a Gamified App to Reduce Avoidance and Fear of Spiders in Spider Phobia

Conditions
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Spider Phobia

Intervention / Treatment
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* Behavioral: 7-day exposure therapy via self-developed app according to (Haberkamp et al., submitted)
* Behavioral: Therapist-guided one-session online exposure therapy according to (Öst, 1989)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants must be 18 years or older, SPQ score ≥ 14 BDI-II score ≤ 18 Exclusion Criteria: Participants will be deemed ineligible if they do not meet the above inclusion criteria or are allergic to spiders or bee stings, are currently undergoing psychotherapeutic and/or psychopharmacological treatments, are experiencing current psychosis, mania, or substance abuse, or successfully complete 8 or more of 12 possible BAT steps at baseline (to ensure that participants are indeed spider fearful) are at higher risk from Covid-19 or participated in a pilot study in 2019.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Spider gamification app<br>Participants play the spider gamification app twice a day for 7 days | Behavioral: 7-day exposure therapy via self-developed app according to (Haberkamp et al., submitted)<br>* Confrontation with spiders via gamified app<br>* Other names: Spider Gamification App;|
| Experimental: Online exposure + spider gamification app<br>Participants receive a therapist-guided one-session online exposure therapy and play the spider gamification app twice a day for 7 days | Behavioral: 7-day exposure therapy via self-developed app according to (Haberkamp et al., submitted)<br>* Confrontation with spiders via gamified app<br>* Other names: Spider Gamification App;Behavioral: Therapist-guided one-session online exposure therapy according to (Öst, 1989)<br>* Massed exposure therapy over the course of one single session, applied in a remote-online context<br>* Other names: Online exposure;|
| Active Comparator: Online exposure + non-spider gamification app<br>Participants receive a therapist-guided one-session online exposure therapy and play a non-spider gamification app twice a day for 7 days | Behavioral: Therapist-guided one-session online exposure therapy according to (Öst, 1989)<br>* Massed exposure therapy over the course of one single session, applied in a remote-online context<br>* Other names: Online exposure;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in avoidance behavior (Behavioral Approach Task; BAT) | Scores range from 0 (participant refuses to enter the room with spider) to 12 (participant holds the spider at least for 20 sec). | Baseline; (after one-session exposure if applied); Post-treatment (1-week after baseline); 3-week follow-up (4-weeks after baseline) | 
| Change in spider fear (Spider Phobia Questionnaire; SPQ) | The scale ranges from 0-31. High scores reflect high subjective levels and low scores low subjective levels of spider fear. | Baseline; Post-treatment (1-week after baseline); 3-week follow-up (4-weeks after baseline) | 
| Change in spider fear: Spider-Anxiety Questionnaire (FAS) | The scale ranges from 0-108. High scores reflect high subjective levels and low scores low subjective levels of spider fear. | Baseline; Post-treatment (1-week after baseline); 3-week follow-up (4-weeks after baseline) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in disgust before and after playing the app | Seven-point rating scale scoring from 0 to 6: high scores reflect high levels and low scores low levels of experienced disgust; participants play twice a day (between 8 - 11 am and 4 - 7 pm); ratings are part of the app | Before starting and immediately after completing the game | 
| Change in arousal before and after playing the app | Seven-point rating scale scoring from 0 to 6: high scores reflect high levels and low scores low levels of experienced arousal; participants play twice a day (between 8 - 11 am and 4 - 7 pm); ratings are part of the app | Before starting and immediately after completing the game | 
| Change in anxiety before and after playing the app | Seven-point rating scale scoring from 0 to 6: high scores reflect high levels and low scores low levels of experienced anxiety; participants play twice a day (between 8 - 11 am and 4 - 7 pm); ratings are part of the app | Before starting and immediately after completing the game | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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App, Gamification, Anxiety Disorder, Avoidance