Self-efficacy Enhancement and Exposure Therapy

Study Overview
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Brief Summary
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Self-efficacy refers to the perceived belief to cope effectively, by personal efforts, with challenging situations and problems (Bandura, 1977). Basic research has shown that increases in perceived self-efficacy can enhance the extinction of fear (Zlomuzica et al., 2015). This study is aimed at translating these findings into a useful clinical application to augment exposure-based treatment outcome.

Detailed Description
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In this study, the effects of self-efficacy enhancement on treatment outcome in patients with height phobia will be investigated. Participants will be randomly assigned to one of the following conditions: i) virtual reality exposure + self-efficacy enhancement; ii) virtual reality exposure + control intervention; iii) virtual reality exposure only. The amount of exposure is identical across groups (i.e. maximum of 1 hour of exposure). The self-efficacy and the control intervention involve the retrieval of the exposure session with or without a focus on personal mastery experiences/achievements, respectively. Treatment-induced changes as well as the effects of self-efficacy enhancement will be measured on the subjective level (i.e. in-vivo Behavioral Approach Tests, BATs; church tower), physiological level (heart rate during the BATs), and subjective level (subjective fear during the BATs as well as height-phobia related questionnaires) at each of the three assessments (i.e. pretreatment, after which the exposure will conducted on the same day, i.e. day 1; posttreatment, which is scheduled approximately 2-3 days after exposure, and follow-up assessment, which will take place 1-month after exposure).

Official Title
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Enhancing Exposure: the Impact of Self-efficacy Enhancement on Treatment Outcome

Conditions
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Specific Phobia

Intervention / Treatment
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* Other: Self-efficacy enhancement
* Other: Control intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: specific phobia (acrophobia) normal or corrected vision Exclusion Criteria: somatic or neurological disease personality disorder bipolar disorder acute drug- or alcoholabuse pharmacological treatment within the past 4 weeks mental retardation any schizophrenic disease

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 38 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: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Exposure + self-efficacy enhancement<br>After the virtual exposure session, participants will receive instructions to recall the exposure session with a focus on the personal mastery experiences/achievements made during exposure. | Other: Self-efficacy enhancement<br>* specific instructions regarding the retrieval of mastery experiences during exposure will be given (e.g., pointing out discrepancies between expected negative consequences and actual outcome during exposure; focus on achievements)<br>|
| Active Comparator: Exposure + control intervention<br>After the virtual exposure session, participants will receive instructions to recall the exposure session | Other: Control intervention<br>* specific instructions regarding the retrieval of the exposure session will be given without an emphasis on personal mastery experience (e.g., description of details regarding the virtual reality environment)<br>|
| No Intervention: Exposure only<br>Treatment as usual: no intervention after the exposure session will be given. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the Behavioral Approach Test (BAT) |  | from pretreatment through follow-up (i.e. baseline, approx. 2-3 days after treatment, 1 month after) | 
| Change in subjective fear during the BAT | Subjective fear during the BATs will be measured using the Subjective Units of Distress Scale (SUDS) | from pretreatment through follow-up (i.e. baseline, approx. 2-3 days after, 1 month after) | 
| Change in heart rate reactivity during the BAT |  | from pretreatment through follow-up (i.e. baseline, approx. 2-3 days after, 1 month after) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Acrophobia Questionnaire (AQ) |  | assessed from pre-treatment through follow-up (i.e. baseline, approx. 2-3 days after, 1 month after | 
| Change in Attitude Towards Heights Questionnaire (ATHQ) |  | assessed from pre-treatment through follow-up (i.e. baseline, approx. 2-3 days after, 1 month after | 
| Change in Danger Expectancy Scale (DES) |  | assessed from pre-treatment through follow-up (i.e. baseline, approx. 2-3 days after, 1 month after | 
| Change in Anxiety Expectancy Scale (AES) |  | assessed from pre-treatment through follow-up (i.e. baseline, approx. 2-3 days after, 1 month after | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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specific phobia, height phobia, exposure, virtual reality, extinction, self-efficacy