Cited by 141Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesVirtual Reality Applications and ImpactsDigital Mental Health Interventions

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Effect of combined multiple contexts and multiple stimuli exposure in spider phobia: A randomized clinical trial in virtual reality

Shiban, Youssef, Schelhorn, Iris, Pauli, Paul, Mühlberger, Andreas·2015·Behaviour Research and Therapy

DOI 10.1016/j.brat.2015.05.014

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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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Andreatta, M., Winkler, M. H., Collins, P., Gromer, D., Gall, D., Pauli, P., & Gamer, M. (2023) · Current topics in behavioral neurosciences · doi:10.1007/7854_2022_405 · Cited by 14
The effects of presenting additional stimuli resembling the CS+ during extinction on extinction retention and generalisation to novel stimuli
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Full Body Immersive Virtual Reality System with Motion Recognition Camera Targeting the Treatment of Spider Phobia
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Acceptability, feasibility, and user satisfaction of a virtual reality relaxation intervention in a psychiatric outpatient setting during the COVID-19 pandemic
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Neural correlates of fear conditioning are associated with treatment-outcomes to behavioral exposure in spider phobia – Evidence from magnetoencephalography
Roesmann, K., Toelle, J., Leehr, E. J., Wessing, I., Böhnlein, J., Seeger, F. R., Schwarzmeier, H., Siminski, N., Herrmann, M. J., Dannlowski, U., et al. (2022) · NeuroImage Clinical · doi:10.1016/j.nicl.2022.103046 · Cited by 12
Creating virtual environments for phobia treatment
Horváthová, D., & Siládi, V. (2016) · Open Computer Science · doi:10.1515/comp-2016-0012 · Cited by 11
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“I n t e r ac t i o n w i t h li v e t a r a n t u l a 16 was well allowed, as we had several types of spiders available in multiple colors, with the possibility of adjusting their size.”
Extinction in multiple contexts reduces the return of extinguished responses: A multilevel meta-analysis
Bustamante, J., Soto, M., Míguez, G., Quezada-Scholz, V. E., Angulo, R., & Laborda, M. A. (2023) · Learning & Behavior · doi:10.3758/s13420-023-00609-w · Cited by 14
“…to determine the mechanisms, for instance, behind contextual control (e.g., Harris et al., 2000; Miguez et al., 2014a, b); in the second case, the interest lies in applying its results to potential treatment for several psychological conditions (e.g., Quezada et al., 2018; Shiban et al., 2015).”
Transfer of exposure therapy effects to a threat context not considered during treatment in patients with panic disorder and agoraphobia: Implications for potential mechanisms of change.
Richter, J., Pané-Farré, C., Gerlach, A., Gloster, A., Wittchen, H., Lang, T., Alpers, G., Helbig-Lang, S., Deckert, J., Fydrich, T., et al. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.103886 · Cited by 12
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Effects of rhythmic eye movements during a virtual reality exposure paradigm for spider‐phobic patients.
Reitmaier, J., Schiller, A., Mühlberger, A., Pfaller, M., Meyer, M., & Shiban, Y. (2022) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12363 · Cited by 9
Self-citation
Acute stress reduces out-group related safety signaling during fear reinstatement in women
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Stable Individual Differences in Occasion Setting
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Expectancy violation during exposure therapy: A pilot randomized controlled trial
Buchholz, J. L., Blakey, S. M., Hellberg, S. N., Massing‐Schaffer, M., Reuman, L., Ojalehto, H. J., Friedman, J. B., & Abramowitz, J. S. (2022) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2021.12.004 · Cited by 11
Das Potenzial der virtuellen Realität in der Verhaltenstherapie
Diemer, J. (2019) · Nervenheilkunde · doi:10.1055/a-0928-0734 · Cited by 8
“[7] Shiban Y, Schelhorn I, Pauli P, Mühlberger A.”
Background
CBT for Anxiety Disorders
Huppert, J. D., Fradkin, I., & Cahill, S. P. (2020) · Oxford University Press eBooks · doi:10.1093/oso/9780190881511.003.0010 · Cited by 8
Angststörungen
Domschke, K., Kapfhammer, H., & Deckert, J. (2017) · Springer eBooks · doi:10.1007/978-3-662-49295-6_69 · Cited by 9
Confusing virtual reality with reality – An experimental study
Wiesing, M., Comadran, G., & Slater, M. (2025) · iScience · doi:10.1016/j.isci.2025.112655 · Cited by 8
“47,48 VR has also been used for therapy for social anxiety disorders including fear of public speaking.”
The impact of physical exercise on the consolidation of fear extinction memories
Jentsch, V. L., Wolf, O. T., Otto, T., & Merz, C. J. (2023) · Psychophysiology · doi:10.1111/psyp.14373 · Cited by 8
“Future studies comparing multiple cues and multiple contexts in a single experimental design (e.g., as realized in Shiban et al., 2015) as well as their modulation by physical exercise should test this possibility.”
Background
Outlook of applying of virtual reality (VR) technologies in the treatment of patients with mental disorders (review of foreign literature)
Freize, V. V., Malyshko, L. V., Grachev, G. I., Борисович, Д. В., Semenova, N. V., & Незнанов, Н. Г. (2021) · V M BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY · doi:10.31363/2313-7053-2021-1-18-24 · Cited by 7
A Survey on the Effectiveness of Virtual Reality-based Therapy and Pain Management
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“Other several VR interventions were developed and effectively used to treat other types of phobia such as fear of driving [34], [35], [36] and fear of spiders [37], [38], [39].”
Background
Technological Competence is a Precondition for Effective Implementation of Virtual Reality Head Mounted Displays in Human Neuroscience: A Technological Review and Meta-Analysis.Preprint
Kourtesis, P., Collina, S., Doumas, L. A. A., & MacPherson, S. E. (2021) · doi:10.36227/techrxiv.13858154 · Cited by 8
Virtuelle Expositionstherapie bei Angststörungen
Shiban, Y. (2018) · Der Nervenarzt · doi:10.1007/s00115-018-0596-z · Cited by 6
Self-citation
Effects of Exposure in Computer-Assisted Virtual Environments on Vocalists’ Performance Anxiety: A Quasi-Experimental Study
Choi, S., Kim, J., & Kim, S. (2023) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-023-00533-y · Cited by 6
“…including MPA and in improving performance quality (Bellinger et al., 2023; Bissonnette et al., 2016; Carl et al., 2019; Freitas et al., 2021; Klinger et al., 2005; Krijn et al., 2004; Lindner et al., 2021; Powers & Emmelkamp, 2008; Shiban et al., 2015; Wechsler et al., 2019; Van Zyl, 2020).”
Possibilities of using virtual reality as a means for therapy from fear of spiders
Musalek, M., & Vašek, L. (2019) · MATEC Web of Conferences · doi:10.1051/matecconf/201929201041 · Cited by 5
A Comparative Study Between Different Treatments for Spider Phobia
Ramírez-Fernández, C., Morán, A. L., & Meza-Kubo, V. (2021) · Mexican Conference on Human-Computer Interaction (MexIHC) · doi:10.1145/3492724.3492726 · Cited by 6
“In the aforementioned works, the main findings suggest that VRET: improves users’ interest in therapy with respect to IVET [20], significantly reduces fear with short and long term benefits when using 4 different spiders [28] and that there are significant differences in the Spider Beliefs Questionnaire subscale (SBQ-…”
BackgroundResult
Reduction of costly safety behaviors after extinction with a generalization stimulus is determined by individual differences in generalization rules
Wong, A. H. K., Lee, J. C., Engelke, P., & Pittig, A. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104233 · Cited by 5
Technological Advances in Treating Anxiety Disorders
Goetter, E. M., & Yuen, E. K. (2024) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2024.04.020 · Cited by 5
Eliciting and attenuating reinstatement of fear: Effects of an unextinguished CS
Krisch, K. A., Bandarian‐Balooch, S., Neumann, D. L., & Zhong, J. (2020) · Learning and Motivation · doi:10.1016/j.lmot.2020.101650 · Cited by 5
Towards a Taxonomy of Feedback Factors Affecting the User Experience of Augmented Reality Exposure Therapy Systems for Small-Animal Phobias
Ramírez-Fernández, C., Morán, A. L., & Meza-Kubo, V. (2018) · International Conference on Ubiquitous Computing and Ambient Intelligence · doi:10.3390/proceedings2191252 · Cited by 5
“In the aforementioned works, the main findings suggest that VRET improves users’ interest in therapy with respect to IVET [29], significantly reduces fear with short and long term benefits when using 4 different spiders [28] and that there are significant differences in the Spider Beliefs Questionnaire subscale (SBQ-F…”
Background
Nichtinvasive Hirnstimulation in Kombination mit Psychotherapie bei Angsterkrankungen
Herrmann, M. J., Cybinski, L. M., Unterecker, S., Deckert, J., & Polak, T. T. (2019) · Psychotherapeut · doi:10.1007/s00278-019-0349-x · Cited by 4
Virtual Reality and Augmented Reality in Psychiatric Disorders
Özkan, N., Duran, F., & Fidan, U. (2021) · Gazi Üniversitesi Fen Bilimleri Dergisi Part C Tasarım ve Teknoloji · doi:10.29109/gujsc.961331 · Cited by 4

Authors: Shiban, Y., Schelhorn, I., Pauli, P., & Mühlberger, A.
Affiliations: University of Regensburg (DE)
University of Würzburg (DE)
Corresponding author: Shiban, Youssef
ORCID: Shiban, Youssef
Schelhorn, Iris
Pauli, Paul
Mühlberger, Andreas
Venue: Behaviour Research and Therapy
Publisher: Elsevier BV
Published: 2015-08
Volume: 71
Pages: 45-53
ISSN: 0005-7967 (ISSN-L)
DOI: 10.1016/j.brat.2015.05.014
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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Effect of combined multiple contexts and multiple stimuli exposure in spider phobia: A randomized clinical trial in virtual reality

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