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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.
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).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Exposure + self-efficacy enhancement | Experimental | 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. |
|
| Exposure + control intervention | Active Comparator | After the virtual exposure session, participants will receive instructions to recall the exposure session |
|
| Exposure only | No Intervention | Treatment as usual: no intervention after the exposure session will be given. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Self-efficacy enhancement | Other | 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) |
| 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) |
| 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 |
| Measure | Description | Time Frame |
|---|---|---|
| Change in perceived self-efficacy | Changes in perceived self-efficacy will be measures with visual analogue scales (VAS) | assessed three times on day 1: before and after the exposure session as well as after the intervention; assessed once at posttreatment (window: 2-3 days after exposure treatment); assessed once at follow-up (window: 1 month after treatment) |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Armin Zlomuzica, Dr. | Ruhr-University Bochum | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Mental Health Research and Treatment Center | Bochum | North Rhine-Westphalia | 44787 | Germany |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26528152 | Background | Zlomuzica A, Preusser F, Schneider S, Margraf J. Increased perceived self-efficacy facilitates the extinction of fear in healthy participants. Front Behav Neurosci. 2015 Oct 16;9:270. doi: 10.3389/fnbeh.2015.00270. eCollection 2015. | |
| 847061 | Background | Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977 Mar;84(2):191-215. doi: 10.1037//0033-295x.84.2.191. No abstract available. |
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| ID | Term |
|---|---|
| C562465 | Phobia, Specific |
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| Control intervention | Other | 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) |
|
| 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 |
| Becks Depression Inventory II (BDI II) | assessed at pre-treatment (day 1) |
| State-Trait Anxiety Inventory (STAI) | assessed at pre-treatment (day 1) |
| Emotion Regulation Questionnaire (ERQ) | assessed at pre-treatment (day 1) |
| General Self-efficacy Scale (GSE) | assessed at pre-treatment (day 1) |
| Self-efficacy Scale (SES) | assessed at pre-treatment (day 1) |
| Resilience Appraisal Scale (RAS) | assessed after the intervention on day 1 |
| Salivary cortisol | assessed twice at each of the three assessments, i.e. pretreatment, posttreatment, follow-up (windows: pretreatment on day 1; approx. 2-3 days after; 1 month after) |
| Changes in "Test zum kognitiven Schätzen" (TKS) | assessed twice on day 1: before and after exposure treatment |