Virtual Reality for Fear of Heights

Overseen By Michael Otto, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Boston University Charles River Campus

Disqualifiers: Previous participation

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

44 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment for fear of heights?

Research shows that virtual reality exposure therapy (VRET) is effective for treating specific phobias, with patients showing significant improvement in real-life situations after treatment. VRET is also preferred by many patients over traditional exposure methods, making it a valuable option for increasing treatment accessibility. ^{1 2 3 4 5}

Is virtual reality exposure therapy safe for humans?

Virtual reality exposure therapy (VRET) is generally considered safe for humans, with studies showing no difference in dropout rates compared to traditional exposure therapy, indicating similar tolerability. ^{1 2 3 4 6}

How is the treatment 'Exposure Intervention Plus Music Induction' for fear of heights different from other treatments?

This treatment is unique because it combines virtual reality exposure therapy (VRET) with music induction, which may enhance the emotional processing and habituation (getting used to) of fear by creating a more immersive and engaging experience compared to traditional exposure therapies. ^{1 7 8 9 10}

What is the purpose of this trial?

Exposure-based cognitive behavior therapy is an efficacious treatment for acrophobia (fear of heights) and has been delivered effectively in a virtual reality (VR) environment. The present study is designed to evaluate the effects of liked, non-lyrical background music on the efficacy of a brief VR exposure intervention.

Research Team

Laura Long, PhD

Principal Investigator

Boston University

Eligibility Criteria

This trial is for adults over 18 who are students at Boston University, can read English, and are comfortable using a computer or touchscreen device. For the second phase, they must have a significant fear of heights as indicated by scoring at least 45.45 on the Acrophobia Questionnaire Anxiety Subscale.

Inclusion Criteria

I am currently enrolled at Boston University.

I can read English and understand the consent form.

My fear of heights score is 45.45 or higher.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Assessment and Intervention

In-person assessment and brief VR exposure intervention for participants with elevated acrophobia

1 day

1 visit (in-person)

Follow-up

Participants are monitored for acrophobia outcomes one week after the intervention

1 week

1 visit (online)

Treatment Details

Interventions

• Exposure Intervention Plus Music Induction
• Exposure Intervention With No Music Induction

Trial Overview The study tests if adding non-lyrical music to a VR exposure therapy helps people overcome their fear of heights more effectively than just the VR therapy alone.

Participant Groups

Group I: Exposure Intervention without Background Music Experimental Treatment 1 Intervention

Participants will undergo VR heights exposure without background music.

Group II: Exposure Intervention with Non-Lyrical, Liked Background Music Experimental Treatment 1 Intervention

Participants will be presented with a list of instrumental songs without lyrics from popular movies. Participants will then rank the songs in order of those they would like to hear the most. During VR heights exposure the participants' highest-ranked songs will be played in the background at a low volume.

Who Is Running the Clinical Trial?

Boston University Charles River Campus

Lead Sponsor

Trials

125

Recruited

14,100+

Findings from Research

In a study involving 31 participants with specific phobias, both cognitive-behavioral therapy (CBT) combined with virtual reality exposure therapy (VRET) and CBT with real image exposure significantly reduced anxiety and phobia levels, with effects maintained at a 3-month follow-up.

Despite the reduction in subjective anxiety, brain imaging (fMRI) revealed that certain brain areas still showed signs of fear response, particularly the amygdala, indicating that while therapy was effective, some fear responses persisted at the neural level.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changes in Brain Activation through Cognitive-Behavioral Therapy with Exposure to Virtual Reality: A Neuroimaging Study of Specific Phobia. Álvarez-Pérez, Y., Rivero, F., Herrero, M., et al.[2021]

A survey of 162 students with a high fear of spiders showed that a significant majority (81% in Study 1 and 89% in Study 2) preferred virtual reality (VR) exposure therapy over traditional in vivo exposure therapy.

The findings suggest that VR exposure therapy could be an effective way to encourage more individuals with phobias to seek treatment, potentially increasing access to effective therapeutic options.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Redefining therapeutic success with virtual reality exposure therapy. Garcia-Palacios, A., Hoffman, HG., See, SK., et al.[2022]

In a study involving 55 patients with panic disorder and agoraphobia, both virtual reality exposure therapy (VRET) and traditional exposure in vivo were found to be significantly more effective than no treatment, but VRET did not outperform exposure in vivo on most measures.

While VRET and exposure in vivo showed similar therapeutic processes, exposure in vivo was slightly more effective, suggesting that VRET may not be the best option for treating agoraphobia at this time due to its higher costs and lack of long-term follow-up data.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual reality exposure therapy does not provide any additional value in agoraphobic patients: a randomized controlled trial. Meyerbroeker, K., Morina, N., Kerkhof, GA., et al.[2019]

This study will compare the effectiveness of traditional one-session exposure therapy (OST) with a new gamified virtual reality (VR) exposure therapy for treating spider phobia in 100 participants, assessing outcomes at multiple time points up to a year after treatment.

The use of VR therapy aims to improve accessibility and engagement in treatment, potentially making it a more effective and acceptable option for individuals reluctant to seek traditional therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Single-session gamified virtual reality exposure therapy for spider phobia vs. traditional exposure therapy: study protocol for a randomized controlled non-inferiority trial. Miloff, A., Lindner, P., Hamilton, W., et al.[2019]

A meta-analysis of 14 clinical trials showed that virtual reality exposure therapy (VRET) significantly improves behavioral assessments in patients with specific phobias, with a strong effect size of g = 1.23 after treatment.

VRET was found to be as effective as traditional in vivo exposure therapy, indicating that it can produce meaningful behavior changes in real-life situations, making it a valuable treatment option for specific phobias.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments. Morina, N., Ijntema, H., Meyerbröker, K., et al.[2018]

Virtual reality exposure therapy (VRET) significantly outperforms waitlist controls in treating anxiety disorders, indicating its effectiveness as an intervention.

When compared to traditional evidence-based treatments, VRET shows similar efficacy and stability of results over time, suggesting it can be a viable alternative or complement to existing therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis. Opriş, D., Pintea, S., García-Palacios, A., et al.[2012]

Virtual Reality Exposure Therapy (VRET) shows promising effectiveness for treating anxiety disorders, PTSD, and phobias, comparable to traditional in-person exposure therapies, based on various studies.

VRET offers advantages such as easier access to therapy, enhanced patient anonymity, and greater therapist control over exposure scenarios, although further research is needed to address existing limitations in the current studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Virtual reality exposure therapy for post-traumatic stress disorders, obsessive-compulsive disorders and anxiety disorders: Indications, added value and limitations]. Lognoul, M., Nasello, J., Triffaux, JM.[2021]

Virtual reality exposure therapy (VRET) is an innovative approach to treating specific phobias, such as fear of flying or driving, using three-dimensional computer simulations to help patients gradually desensitize to their fears.

Over the past 15 months, nearly 500 VRET sessions have been conducted, demonstrating the potential effectiveness of this method in helping patients habituate to phobic stimuli, building on established principles of exposure therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical observations during virtual reality therapy for specific phobias. Wiederhold, BK., Wiederhold, MD.[2009]

Virtual reality exposure therapy (VR therapy) is an effective treatment for specific phobias, including dental anxiety, as it allows patients to confront their fears in a controlled virtual environment.

Research shows that after undergoing VR therapy, patients with dental anxiety experienced reduced treatment anxiety and avoidance, and six months later, they no longer exhibited signs of specific phobia, enabling them to receive standard dental care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Are VR headsets effective in reducing dental anxiety?] Borsjé, C.[2022]

In a study with 23 participants, virtual reality (VR) exposure therapy significantly reduced spider phobia symptoms, with 83% of participants showing clinically significant improvement after an average of four one-hour sessions.

The VR treatment was effective compared to a waiting list control group, which showed no improvements, and importantly, there were no dropouts from the VR therapy, indicating good participant retention and safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual reality in the treatment of spider phobia: a controlled study. Garcia-Palacios, A., Hoffman, H., Carlin, A., et al.[2019]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

Changes in Brain Activation through Cognitive-Behavioral Therapy with Exposure to Virtual Reality: A Neuroimaging Study of Specific Phobia. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Redefining therapeutic success with virtual reality exposure therapy. [2022]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Virtual reality exposure therapy does not provide any additional value in agoraphobic patients: a randomized controlled trial. [2019]

4. England pubmed.ncbi.nlm.nih.gov

Single-session gamified virtual reality exposure therapy for spider phobia vs. traditional exposure therapy: study protocol for a randomized controlled non-inferiority trial. [2019]

5. England pubmed.ncbi.nlm.nih.gov

Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments. [2018]

6. United States pubmed.ncbi.nlm.nih.gov

Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis. [2012]

7. France pubmed.ncbi.nlm.nih.gov

[Virtual reality exposure therapy for post-traumatic stress disorders, obsessive-compulsive disorders and anxiety disorders: Indications, added value and limitations]. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Clinical observations during virtual reality therapy for specific phobias. [2009]

9. Netherlands pubmed.ncbi.nlm.nih.gov

[Are VR headsets effective in reducing dental anxiety?] [2022]

10. England pubmed.ncbi.nlm.nih.gov

Virtual reality in the treatment of spider phobia: a controlled study. [2019]