None listed
Conditions
Brief summary
Research has shown that exposure-based treatments are the most effective in treating anxiety and fear-based disorders. However, this treatment has been stuck with its improvement in efficacy for years and more than one third of patients do not respond to treatment or experience a relapse of symptoms. Evidence from human and animal studies have shown that acute stress has the potential to add value to these exposure-based treatments by enhancing the learning and memory process. That is, heightened stress states (induced via pharmacological or behavioural interventions) have been shown to enhance treatment outcomes ( reduce fear symptoms). There is evidence from laboratory studies that stress-related adjuncts to therapy can generalize learning and reduce relapse. However, this has not been investigated in clinical patients and the mechanisms of these effects are unknown. Therefore, this research aims to investigate the use of stress enhancers to optimising exposure therapy for anxiety disorders and it’s potential to reduce relapse. It will aim to investigate the mechanisms of these effects in order to inform their clinical application. In this study we will determine whether stress may aid psychotherapy of fear and anxiety disorders by modulating attentional processes, stimulating emotional arousal systems (noradrenaline and cortisol) and by acting as an excitatory stimulus to maximise learning (increasing prediction error) . Therefore, this research offers a promising therapeutic tool to improve symptom remission, relapse rates and cost of psychotherapy for anxiety and fear-based disorders.
Interventions
Virtual Reality Exposure Therapy to spiders
2 individual, face-to-face weekly treatment sessions will be conducted using virtual reality (VR) goggles. The total duration of the intervention will be three weeks (including 2 exposure treatments, as well as pre- and post-assessment procedures). Follow-Up assessment will be conducted 3 months later. Exposure will involve a set of guided exposure tasks to VR spiders for approx. 1 hour each session. This will be administered individually by a traine
Virtual Reality Exposure Therapy to spiders 2 individual, face-to-face weekly treatment sessions will be conducted using virtual reality (VR) goggles. The total duration of the intervention will be three weeks (including 2 exposure treatments, as well as pre- and post-assessment procedures). Follow-Up assessment will be conducted 3 months later. Exposure will involve a set of guided exposure tasks to VR spiders for approx. 1 hour each session. This will be administered individually by a trained psychologist. On the first treatment day, exposure tasks will include the observation of a virtual spider in a virtual kitchen and participants will be asked to approach the spider as closely as they can using their 3D wand to navigate through the virtual world. Participants will then be required to touch the virtual spider with their virtual hand and the spider will respond by fleeing (without tactile feedback). On the second treatment day (one week later), participants will be encouraged to pick a vase where an animated spider with wiggly legs will drift to the floor of the virtual kitchen. They will then be required to touch the virtual spider image with their cyberhand to explore the virtual spider. Simultaneously, their real hand will explore a toy spider attached in order to allow the spider to feel furry and more tangible (adapted from Hoffmans, 2002). SUDs (subjective units of distress) ratings will be reported every 30 seconds. SUDS < 30 will be the criterion used to define the completion of an exposure task. Participants will be instructed not to use cognitive avoidance strategies and this will be measured with several questions afterwards. Adherence to the treatment will be monitored via clinical observation and clinician's ratings of client's engagement, the severity of fear and avoidance. Psychoeducative material about exposure therapy will be provided orally and using a handout designed specifically for this study. It will involve discussion of the purpose and benefits of exposure therapy, the role of avoidance and safety behaviours in maintaining anxiety/fear in the long term and the evidence for VR exposure treatment. This condition will include a stress manipulation, the Socially Evaluated Cold Presser Task (SECPT) 20 minutes prior to exposure therapy. The SECPT is designed to elevate cortisol (stress hormone levels). It involves the immersion of one's dominant hand into a basin with ice-cold water (0-2 degrees Celsius) for 3 minutes whilst being recorded by a video camera and observed by a researcher. Participants will be instructed to submerge their hand including their wrist and they will not be informed of the duration of the SECPT.
Sponsors
University of Sydney
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
Participants between the ages of 18 and 60 who diagnostic criteria for a specific phobia of spiders (DSM-V).
Exclusion criteria
- Currently engaged in other active psychological or pharmacological treatment - Comorbid disorder that is more primary or distressing - Presence of serious or chronic medical illness - Substance abuse problems - Psychosis - Pregnant and lactating
Outcome results
None listed