Feasibility of an Online Modeled Exposure in Spider Fearful Individuals

Study Overview
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Brief Summary
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The effectiveness of an optimized group exposure treatment is investigated in spider-fearful individuals. Participants will undergo an optimized standardized exposure treatment. After receiving information about the treatment and the phobic stimulus (spider) through a psychoeducation video, participants will observe an exposure treatment of another fearful person, either live or by watching a movie of an exposure treatment online. Subsequently, participants will undergo a live in vivo exposure treatment conducted in a group setting. The effectiveness of the treatment is measured by symptom improvement according to online behavioral avoidance tests and subjective ratings immediately after training and one week later.

Detailed Description
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The treatment of various anxiety disorders often involves exposure therapy. However, a considerable number of patients do not benefit or experience a resurgence of anxiety following successful treatment. Vicarious safety learning (i.e., modeled exposure) presents a promising avenue to improve therapeutic outcome. Previous evidence indicates that vicarious safety learning can diminish previously acquired fear associations, thereby reducing behavioral avoidance. While single-session interventions have implemented modeled exposure, specific mechanisms of observational learning have not been extensively investigated. Due to high dropout rates in specific phobias, modeled exposure could be utilized as an additional treatment method, potentially yielding better outcomes trough additional learning experience. This study aims to investigate the applicability of observational learning and its sustainability through mental retrieval cues. Specifically, the study is going to assess the feasibility of modeled exposure conveyed either live or online via video, offering a practical approach within a stepped-care framework. The modeled exposure treatment will be followed by a group exposure treatment to assess the influence of modeled exposure in spider-fearful individuals. Physically healthy spider-fearful individuals will be either treated with an online or live modeled standardized exposure followed by a group exposure treatment. Half of the participants will receive a mental retrieval cue before the group exposure treatment one day after the modeled exposure treatment. The research aims to determine if long-term reduction of spider fear is achievable through online modeled exposure via video compared to in-person modeled exposure.

Official Title
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Group Exposure Treatment: Feasibility of an Online Modeled Exposure in Spider Fearful Individuals

Conditions
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Spider Fear, Arachnophobia

Intervention / Treatment
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* Behavioral: online psychoeducation video + modeled exposure
* Behavioral: live psychoeducation video + modeled exposure
* Behavioral: group exposure
* Behavioral: mental retrieval cue


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - Elevated score on Spider Phobia Questionnaire (SPQ) >= 17 Exclusion Criteria: Severe allergies to bees/spiders/insects Current psychiatric/psychotherapeutic treatment Past psychotherapeutic/psychiatric treatment due to anxiety problems Current or past psychotic symptoms Current suicidal intent Experience with exposure-based treatment Current psychopharmacological medication Severe respiratory, neurological or cardiovascular diseases

Ages Eligible for Study
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Minimum Age: 18 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: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: online modeled exposure + mental retrieval cue group exposure<br>online modeled exposure training followed by group exposure training, including mental retrieval cue with five standardized exposure steps | Behavioral: online psychoeducation video + modeled exposure<br>* Participants will watch a short psychoeducation video online. This will be followed by a modeled exposure online. In this modeled exposure participants watch a film of an exposure treatment (about 45min) conducted with one participant and the therapist. The exposure training consists of five exposure steps (step 1: describing the spider, step 2: catching the spider with a glass, step 3: describing the spider, step 4: touching the spider with the dominant index finger, step 5: letting the spider walk on the participant hands; the following steps have to be repeated up to four times: 2,4,5).<br>Behavioral: group exposure<br>* Exposure training in the group is conducted live (1 spider per participant, one therapist and co-trainers). In this group exposure participants complete exposure training (about 45 min) with five exposure steps (step 1: describing the spider, step 2: catching the spider with a glass, step 3: describing the spider, step 4: touching the spider with the dominant index finger, step 5: letting the spider walk on the participant hands; the following steps have to be repeated up to three times: 2,4,5).<br>Behavioral: mental retrieval cue<br>* Before the group exposure, participants are asked to remember the modeled exposure they had observed the day before. Therefore, the participants are asked to recall the location where they have been during the modeled exposure and the reaction of the patient during the exposure (e.g., fear decline).<br>|
| Active Comparator: live modeled exposure + mental retrieval cue group exposure<br>live modeled exposure training followed by group exposure training, including mental retrieval cue with five standardized exposure steps | Behavioral: live psychoeducation video + modeled exposure<br>* Participants will watch a short psychoeducation video. This will be followed by a live modeled exposure. In this modeled exposure participants watch an exposure treatment (about 45min) conducted live with one participant and the therapist. The exposure training consists of five exposure steps (step 1: describing the spider, step 2: catching the spider with a glass, step 3: describing the spider, step 4: touching the spider with the dominant index finger, step 5: letting the spider walk on the participant hands; the following steps have to be repeated up to four times: 2,4,5).<br>Behavioral: group exposure<br>* Exposure training in the group is conducted live (1 spider per participant, one therapist and co-trainers). In this group exposure participants complete exposure training (about 45 min) with five exposure steps (step 1: describing the spider, step 2: catching the spider with a glass, step 3: describing the spider, step 4: touching the spider with the dominant index finger, step 5: letting the spider walk on the participant hands; the following steps have to be repeated up to three times: 2,4,5).<br>Behavioral: mental retrieval cue<br>* Before the group exposure, participants are asked to remember the modeled exposure they had observed the day before. Therefore, the participants are asked to recall the location where they have been during the modeled exposure and the reaction of the patient during the exposure (e.g., fear decline).<br>|
| Active Comparator: online modeled exposure + standardized group exposure<br>online modeled exposure training followed by group exposure training with five standardized exposure steps | Behavioral: online psychoeducation video + modeled exposure<br>* Participants will watch a short psychoeducation video online. This will be followed by a modeled exposure online. In this modeled exposure participants watch a film of an exposure treatment (about 45min) conducted with one participant and the therapist. The exposure training consists of five exposure steps (step 1: describing the spider, step 2: catching the spider with a glass, step 3: describing the spider, step 4: touching the spider with the dominant index finger, step 5: letting the spider walk on the participant hands; the following steps have to be repeated up to four times: 2,4,5).<br>Behavioral: group exposure<br>* Exposure training in the group is conducted live (1 spider per participant, one therapist and co-trainers). In this group exposure participants complete exposure training (about 45 min) with five exposure steps (step 1: describing the spider, step 2: catching the spider with a glass, step 3: describing the spider, step 4: touching the spider with the dominant index finger, step 5: letting the spider walk on the participant hands; the following steps have to be repeated up to three times: 2,4,5).<br>|
| Active Comparator: live modeled exposure + standardized group exposure<br>live modeled exposure training followed by group exposure training with five standardized exposure steps | Behavioral: live psychoeducation video + modeled exposure<br>* Participants will watch a short psychoeducation video. This will be followed by a live modeled exposure. In this modeled exposure participants watch an exposure treatment (about 45min) conducted live with one participant and the therapist. The exposure training consists of five exposure steps (step 1: describing the spider, step 2: catching the spider with a glass, step 3: describing the spider, step 4: touching the spider with the dominant index finger, step 5: letting the spider walk on the participant hands; the following steps have to be repeated up to four times: 2,4,5).<br>Behavioral: group exposure<br>* Exposure training in the group is conducted live (1 spider per participant, one therapist and co-trainers). In this group exposure participants complete exposure training (about 45 min) with five exposure steps (step 1: describing the spider, step 2: catching the spider with a glass, step 3: describing the spider, step 4: touching the spider with the dominant index finger, step 5: letting the spider walk on the participant hands; the following steps have to be repeated up to three times: 2,4,5).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Spider Phobia Questionnaire (SPQ) | 31-Item true/false questionnaire assessing symptoms of arachnophobia. Scores range from 0 to 31, with greater scores representing greater subjective fear of spiders, where lower scores reflect low subjective fear of spiders | Change from baseline to immediately post treatment 1 (after modeled exposure), immediately post treatment 2 (group exposure) and follow-up (7 days after group exposure - post treatment 2) | 
| Change in avoidance behavior (online virtual Behavioral Approach Task, vBATon) | Scores range from 0 (participant refuses entering the room with the spider) to 12 (participant holds the spider for at least 20 seconds) | Change from baseline to immediately post treatment 1 (after modeled exposure), immediately post treatment 2 (group exposure) and follow-up (7 days after group exposure - post treatment 2) | 
| Change in spider fear: Spider Anxiety Questionnaire (FSQ/SAF) | 14-item questionnaire on a 7-point Likert-Scale (0 = I don´t agree at all; 6 = I completely agree) to assess symptoms of arachnophobia. Total score can range from 0 to 98 Greater scores representing worse symptom severity of arachnophobia | Change from baseline to immediately post treatment 1 (after modeled exposure), immediately post treatment 2 (group exposure) and follow-up (7 days after group exposure - post treatment 2) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in spider phobia belief questionnaire (SBQ) | Assessment of spider phobia dysfunctional beliefs; 48 items on a scale from 0% (no approval) to 100% (full approval); higher scores indicate more dysfunctional beliefs about the danger of spiders and own coping abilities regarding spiders | Change from baseline to immediately post treatment 1 (after modeled exposure), immediately post treatment 2 (group exposure) and follow-up (7 days after group exposure -- post treatment 2) | 
| Change in Spider Anxiety Screening (SAS) | Assessment of the four criteria for specific phobia (DSM-IV) with 4 items on a scale from 0 (does not apply at all) to 6 (fully applies), Total score range: 0 to 24, higher scores indicating worse severity of symptoms of arachnophobia | Change from baseline to immediately post treatment 1 (after modeled exposure), immediately post treatment 2 (group exposure) and follow-up (7 days after group exposure- post treatment 2) | 
| Global success rating (GSR) | Self-report measure of subjective state changes on a 7-likert scale from 1 (much worse) to 7 (much better) | Change from immediately post treatment 1 (after modeled exposure) to immediately post-treatment 2 (after group exposure) and follow-up (7 days after group exposure- post treatment 2) |