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. 2019 Jul:118:130-140.
doi: 10.1016/j.brat.2019.04.004. Epub 2019 Apr 16.

Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: A randomized non-inferiority trial

Alexander Miloff  1 , Philip Lindner  2 , Peter Dafgård  3 , Stefan Deak  3 , Maria Garke  4 , William Hamilton  5 , Julia Heinsoo  3 , Glenn Kristoffersson  3 , Jonas Rafi  3 , Kerstin Sindemark  3 , Jessica Sjölund  3 , Maria Zenger  3 , Lena Reuterskiöld  3 , Gerhard Andersson  6 , Per Carlbring  7
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Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: A randomized non-inferiority trial

Alexander Miloff et al. Behav Res Ther. 2019 Jul.

Abstract

This study compared the efficacy of a technician-assisted single-session virtual reality exposure therapy (VRET) for the treatment of spider phobia featuring low-cost consumer-available hardware and novel automated software to gold-standard in-vivo one-session treatment (OST), using a parallel group randomized non-inferiority design. Method Participants (N = 100) were randomized to VRET and OST arms. Assessors blinded to treatment allocation evaluated participants at pre- and post-treatment as well follow-up (3 and 12 months) using a behavioral approach test (BAT) and self-rated fear of spider, anxiety, depression and quality-of-life scales. A maximum post-treatment difference of 2-points on the BAT qualified as non-inferiority margin. Results Linear mixed models noted large, significant reductions in behavioral avoidance and self-reported fear in both groups at post-treatment, with VRET approaching the strong treatment benefits of OST over time. Non-inferiority was identified at 3- and 12- months follow-up but was significantly worse until 12-months. There was no significant difference on a questionnaire measuring negative effects. Conclusions Automated VRET efficaciously reduced spider phobia symptoms in the short-term and was non-inferior to in-vivo exposure therapy in the long-term. VRET effectiveness trials are warranted to evaluate real-world benefits and non-specific therapeutic factors accruing from the presence of a technician during treatment. ClinicalTrials.gov (NCT02533310).

Keywords: Exposure therapy; One-session treatment; Spider phobia; Virtual reality.

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