Effect of combined multiple contexts and multiple stimuli exposure in spider phobia: A randomized clinical trial in virtual reality
Abstract
Background Our previous study indicated that treatment in multiple contexts (MC) improved the outcome of exposure treatment by reducing return of fear. This effect was evident when the test was conducted immediately post treatment. In the present study, we conducted a treatment analogue study where we investigated whether an exposure to multiple stimuli (MS) and a combination of both MS and MC would further improve treatment efficacy in the short and long terms.Method Spider-phobic patients (N = 58) were randomly allocated to one of four groups. Each group received virtual reality (VR) exposure treatment in either one or four different contexts and was exposed to either one or four different spiders. All participants completed both a VR test with a novel spider in a novel context and an in vivo behavioral avoidance test (BAT) pre-, post-treatment and at follow-up.Results Short-term but not long-term return of fear was attenuated by multiple context exposure in VR. Long-term effect of fear attenuation was observed only in the MS single context group. In the BAT, the multiple stimuli condition seemed to be more beneficial in both the short and long term. Notably, there was no evidence for superiority of the combined multiple stimuli and contexts condition.Conclusion Change of contexts during exposure significantly reduced return of fear post treatment; however, similar results could not be observed with a follow-up test. The implementation of multiple stimuli during exposure seems to have both short-term and long-lasting beneficial effects on the treatment outcome. We recommend further investigation of this phenomenon and introduce further possible improvements to our paradigm.
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VR/AR facilitates exposure to different contexts, producing a positive effect in terms of fear renewal and generalization of results.
“Regarding this last strategy, as mentioned above, VR/AR facilitates the exposure to different contexts, producing a positive effect in terms of fear renewal and generalization of results [75,76,87].”
From In Vivo versus augmented reality exposure in the treatment of small animal phobia: A randomized controlled trial (2016) · cites this paper as [76]
Exposure to multiple virtual contexts and multiple virtual phobic stimuli reduces the recurrence of fear to a greater extent than exposure to only one scenario and the same stimuli, making it possible to generalize the results.
“Results showed that exposure to multiple virtual contexts and multiple virtual phobic stimuli reduced the recurrence of fear to a greater extent than exposure to only one scenario and the same stimuli, making it possible to generalize the results.”
From In Vivo versus augmented reality exposure in the treatment of small animal phobia: A randomized controlled trial (2016) · cites this paper as [76]
The data from this study coincide with findings from studies where VR was used to treat specific phobia (animal subtype), where VR was effective in reducing fear and avoidance.
“Similarly, data from the present study also coincide with findings from studies where VR was used to treat SP (animal subtype), such as those by [31, 33–35,75,76]; where VR was effective in reducing the fear and avoidance experienced by the participants.”
From In Vivo versus augmented reality exposure in the treatment of small animal phobia: A randomized controlled trial (2016) · cites this paper as [76]
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- Authors
- Shiban, Y., Schelhorn, I., Pauli, P., & Mühlberger, A.
- Affiliations
- University of Regensburg (DE)
- University of Würzburg (DE)
- Corresponding author
- Shiban, Youssef
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 71
- Pages
- 45-53
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W431605710
- Cited by
- 141
- References
- 38
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 8 · 2023: 11 · 2022: 10 · 2021: 26 · 2020: 14 · 2019: 23 · 2018: 13 · 2017: 11 · 2016: 7 · 2015: 2
- FWCI
- 16.59
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- University of Regensburg Publication Server (University of Regensburg) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- spider phobia, virtual reality exposure therapy, return of fear, fear extinction, phobia treatment
- MeSH terms
- Adolescent, Adult, Animals, Avoidance Learning, Fear, Female, Galvanic Skin Response, Humans, Male, Phobic Disorders, Spiders, Young Adult, Virtual Reality Exposure Therapy
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