The DOI matches its Crossref record; 38 of the 38 references it cites were found in a registry or an index.
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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“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]
In the citing paper
“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]
In the citing paper
“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]
Citations
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,845
Diagnostic and Statistical Manual of Mental Disorders.
Widiger, T. A. (2000) · Oxford University Press eBooks · doi:10.1037/10518-009 · Cited by 19,766
Emotional processing of fear: Exposure to corrective information.
Foa, E. B., & Kozak, M. J. (1986) · Psychological Bulletin · doi:10.1037/0033-2909.99.1.20 · Cited by 5,396
Maximizing exposure therapy: An inhibitory learning approach
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.04.006 · Cited by 2,339
Context and Behavioral Processes in Extinction: Table 1.
Bouton, M. E. (2004) · Learning & Memory · doi:10.1101/lm.78804 · Cited by 1,808
Effects of an expanding-spaced vs massed exposure schedule on fear reduction and return of fear
Rowe, M. K., & Craske, M. G. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(97)10016-x · Cited by 1,782
Optimizing inhibitory learning during exposure therapy
Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.10.003 · Cited by 1,607
Lobbestael, J., Leurgans, M., & Arntz, A. (2011) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.693 · Cited by 1,124
Demmel, R. (1999) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026//0084-5345.28.1.68 · Cited by 1,010
Bouton, M. E., & King, D. A. (1983) · Journal of Experimental Psychology Animal Behavior Processes · doi:10.1037/0097-7403.9.3.248 · Cited by 796
Fear Extinction and Relapse: State of the Art
Vervliet, B., Craske, M. G., & Hermans, D. (2013) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050212-185542 · Cited by 671 · cited 1×
“Therefore, the long-term effect of treatment highly depends on the strength and retrievability of this new no-fear memory (for a review, please see Vervliet et al., 2013).”
BackgroundVirtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis
Opriş, D., Pintea, S., García-Palacios, A., Botella, C., Szamosközi, Ş., & David, D. (2012) · Depression and Anxiety · doi:10.1002/da.20910 · Cited by 636
(1992) · Cited by 464
Fear of spiders’ questionnaire
Szymanski, J., & O'Donohue, W. (1995) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/0005-7916(94)00072-t · Cited by 450
Cognitive and behavioral treatments for anxiety disorders: A review of meta‐analytic findings
Deacon, B. J., & Abramowitz, J. S. (2004) · Journal of Clinical Psychology · doi:10.1002/jclp.10255 · Cited by 400 · cited 1×
“Exposure-based treatment is well established and has been proven highly efficacious for anxiety disorders (Deacon & Abramowitz, 2004).”
BackgroundMeyerbröker, K., & Emmelkamp, P. M. G. (2010) · Depression and Anxiety · doi:10.1002/da.20734 · Cited by 290
Last observation carry‐forward and last observation analysis
Shao, J., & Zhong, B. (2003) · Statistics in Medicine · doi:10.1002/sim.1519 · Cited by 279
Grillon, C., Baas, J. M. P., Cornwell, B., & Johnson, L. (2006) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.03.072 · Cited by 209
Effects of varied-stimulus exposure training on fear reduction and return of fear
Rowe, M. K., & Craske, M. G. (1998) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(97)10017-1 · Cited by 202 · cited 2×
“We also expected an attenuation of ROF at follow-up in theMS conditions as had been demonstrated before by Rowe and Craske (1998b).”
BackgroundMethodArntz, A., Lavy, E., van den Berg, G., & van Rijsoort, S. (1993) · Advances in Behaviour Research and Therapy · doi:10.1016/0146-6402(93)90012-q · Cited by 192
Effect of multiple context exposure on renewal in spider phobia
Shiban, Y., Pauli, P., & Mühlberger, A. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.10.007 · Cited by 162 · cited 2×
“In line with previous results (Shiban et al., 2013; Vervliet et al., 2007), we expected low ROF for both MC exposure groups in the post-treatment test, but we had no hypotheses about the difference between the MS and MC groups regarding ROF.”
MethodResultSelf-citationMental Reinstatement of Context and Return of Fear in Spider-Fearful Participants
Mystkowski, J. L., Craske, M. G., Echiverri, A. M., & Labus, J. S. (2006) · Behavior Therapy · doi:10.1016/j.beth.2005.04.001 · Cited by 154
Extinction in multiple contexts does not necessarily make extinction less vulnerable to relapse
Bouton, M. E., Garcı́a-Gutiérrez, A., Zilski-Pineño, J. M., & Moody, E. W. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.07.007 · Cited by 138
Reliabilität und Validität dreier Instrumente zur Messung von Angst vor Spinnen
Rinck, M., Bundschuh, S., Engler, S., Müller, A., Wissmann, J., Ellwart, T., & Becker, E. S. (2002) · Diagnostica · doi:10.1026//0012-1924.48.3.141 · Cited by 124
Massive extinction treatment attenuates the renewal effect
Denniston, J. C., Chang, R. C., & Miller, R. R. (2003) · Learning and Motivation · doi:10.1016/s0023-9690(02)00508-8 · Cited by 120
Outcomes associated with virtual reality in psychological interventions: where are we now?
Turner, W. A., & Casey, L. M. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.10.003 · Cited by 116 · cited 1×
“…method for specific phobia (Shiban, Brütting, Pauli, & Mühlberger, 2015; for reviews, please see Meyerbroker & Emmelkamp, 2010; Opris et al., 2012; Turner & Casey, 2014), we conducted an exposure treatment analogue study in virtual reality (VR) with a sample of spider-phobic patients which were…”
MethodEffects of a context shift and multiple context extinction on reactivity to alcohol cues.
MacKillop, J. M., & Lisman, S. A. (2008) · Experimental and Clinical Psychopharmacology · doi:10.1037/a0012686 · Cited by 93
Neumann, D. L., Lipp, O. V., & Cory, S. E. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.02.001 · Cited by 90
Extinction treatment in multiple contexts attenuates ABC renewal in humans
Bandarian‐Balooch, S., Neumann, D. L., & Boschen, M. J. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.06.003 · Cited by 80
Initial and sustained brain responses to contextual conditioned anxiety in humans
Andreatta, M., Glotzbach-Schoon, E., Mühlberger, A., Schulz, S. M., Wiemer, J., & Pauli, P. (2015) · Cortex · doi:10.1016/j.cortex.2014.09.014 · Cited by 73
Self-citationShiban, Y., Brütting, J., Pauli, P., & Mühlberger, A. (2015) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2014.09.009 · Cited by 60
Self-citationEnhanced discrimination between threatening and safe contexts in high-anxious individuals
Glotzbach-Schoon, E., Tadda, R., Andreatta, M., Tröger, C., Ewald, H., Grillon, C., Pauli, P., & Mühlberger, A. (2013) · Biological Psychology · doi:10.1016/j.biopsycho.2013.01.011 · Cited by 57
Laborda, M. A., & Miller, R. R. (2012) · Behavior Therapy · doi:10.1016/j.beth.2012.11.001 · Cited by 53
Concurrent excitors limit the extinction of conditioned fear in humans
Vervliet, B., Vansteenwegen, D., Hermans, D., & Eelen, P. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.01.009 · Cited by 42
Extensive extinction in multiple contexts eliminates the renewal of conditioned fear in rats
Thomas, B. L., Vurbic, D., & Novak, C. (2008) · Learning and Motivation · doi:10.1016/j.lmot.2008.10.002 · Cited by 42
Reliability and validity of German versions of three instruments measuring fear of spiders
Rinck, M., Bundschuh, S., Engler, S., Müller, A. V., Wissmann, J., Ellwart, T., & Becker, E. (2002) · Cited by 40
Glautier, S., Elgueta, T., & Nelson, J. B. (2013) · Learning & Behavior · doi:10.3758/s13420-013-0109-7 · Cited by 34
Dysfunktionale Überzeugungen bei Spinnenangst
Pössel, P., & Hautzinger, M. (2003) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/0084-5345.32.1.24 · Cited by 14
Research works printed but not linked: 2
- MacKillop, 2005, Improving generalizability of extinction to alcohol cues via exposure in multiple contexts, Alcoholism-Clinical and Experimental Research, 29
- Pössel, 2002, Validation of the German version of the Fear of Spiders Questionnaire, Zeitschrift Fur Klinische Psychologie Psychiatrie Und Psychotherapie, 50, 207
Cited by
Sorted by citations
Virtual Reality in the Assessment, Understanding, and Treatment of Mental Health Disorders
Freeman, D., Reeve, S., Robinson, A., Ehlers, A., Clark, D., Spanlang, B., & Slater, M. (2017) · Psychological Medicine · doi:10.1017/s003329171700040x · Cited by 1,428
“Detailed studies of how best to present stimuli in VR are warranted but in our opinion have been far too rare (e.g. Shiban et al .”
BackgroundLonsdorf, T. B., Menz, M. M., Andreatta, M., Fullana, M. A., Golkar, A., Haaker, J., Heitland, I., Hermann, A., Kuhn, M., Kruse, O., et al. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2017.02.026 · Cited by 837
“Likewise, an approach combining multiple cues and multiple contexts during exposure has recently been used in spider phobics (Shiban et al., 2015a): indeed, multiple stimuli led to beneficial effects compared to a single stimulus in the long run.”
Self-citationValmaggia, L. R., Latif, L., Kempton, M. J., & Rus-Calafell, M. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.01.015 · Cited by 500
“…(Malbos et al., 2013; Meyerbroeker et al., 2013; Pelissolo et al., 2012; Penate-Castro et al., 2014; Pitti et al., 2015); social anxiety and fear of public speaking (Anderson et al., 2013; Safir et al., 2012); and spider phobia (Shiban et al., 2015a; Shiban et al., 2013; Shiban et al., 2015b).”
BackgroundRiva, G., Baños, R. M., Botella, C., Mantovani, F., & Gaggioli, A. (2016) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00164 · Cited by 425
“Recent studies show that VR exposure to multiple contexts reduces the recurrence of fear to a greater extent than exposure to only one scenario (87); in the same way, return of fear at posttreatment was significantly reduced by the use of multiple stimuli contexts during exposure (33, 88).”
BackgroundWechsler, T. F., Kümpers, F., & Mühlberger, A. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01758 · Cited by 282
Self-citation
Metadata
- 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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