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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Virtual Reality Exposure | Experimental | 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. |
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| In Vivo Exposure | Experimental | 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. |
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| Waitlist Control | No Intervention | Participants watched a neutral video during the time participants in other conditions were completing the exposure exercise. Participants received no exposure-based intervention. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Exposure Therapy (In Vivo) | Behavioral | 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. |
| 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). |
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| Measure | Description | Time Frame |
|---|---|---|
| Anxiety Sensitivity Index (ASI) | The ASI is a 16 item measure assessing participants' fear of and sensitivity to physiological symptoms of anxiety. Scores range from 0-64, with higher scores indicating higher levels of anxiety sensitivity. | Baseline, Immediately Post-Treatment; 1 Week Post-Treatment |
| Affective Control Scale (ACS) - Anxiety Subscale |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jennifer L Hames, Ph.D. | University of Notre Dame | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Notre Dame | Notre Dame | Indiana | 46556 | United States |
Study protocols and de-identified data will be shared at the request of other researchers.
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| ID | Term |
|---|---|
| C000719188 | Acrophobia |
| C562465 | Phobia, Specific |
| D001008 | Anxiety Disorders |
| ID | Term |
|---|---|
| D001523 | Mental Disorders |
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| ID | Term |
|---|---|
| D007171 | Implosive Therapy |
| D063367 | Virtual Reality Exposure Therapy |
| ID | Term |
|---|---|
| D003887 | Desensitization, Psychologic |
| D001521 | Behavior Therapy |
| D011613 | Psychotherapy |
| D004191 | Behavioral Disciplines and Activities |
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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
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| Exposure Therapy (Virtual Reality) | Behavioral | 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. |
|
| 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) |
The 13-item anxiety subscale of the ACS measures participants' fear tolerance. Scores range from 13-91, with higher scores indicating lower levels of anxiety fear tolerance. |
| Baseline, Immediately Post-Treatment; 1 Week Post-Treatment |
| High Place Phenomenon Index (HPPI) | The HPPI is a 3-item measure that assesses participants' self-reported experience of the high place phenomenon. Scores range from 3-21, with higher scores indicating more frequent experience of the high place phenomenon. | Baseline, Immediately Post-Treatment; 1 Week Post-Treatment |
| Patient Health Questionnaire (PHQ) - 8 item version | The PHQ is traditionally a 9 item measure, but this study used an 8 item version that did not include item 9 (assessing suicidality). Scores on this version range from 0 to 24, with higher scores indicating higher levels of depressive symptoms. | Baseline, Immediately Post-Treatment; 1 Week Post-Treatment |
| DSM-5 (Diagnostic and Statistical Manual of Mental Disorders - 5) Severity Measure for Specific Phobia (Adapted for Acrophobia) | Participants completed the DSM-5 Severity Measure, a 10-item questionnaire that assesses the severity of DSM-5 symptoms of specific phobias. Total scores range from 0 to 40, with higher scores indicating higher levels of specific phobia symptomology. | Baseline, Immediately Post-Treatment; 1 Week Post-Treatment |