A mobile virtual reality system, equipped with built-in variables such as heart rate (HR), gaze-down data, and subjective fear rating, can allow individuals with a fear of heights to overcome it by self-training. This study aimed to verify the efficacy and safety of the training program. Forty-eight volunteers completed the four-session self-training program over 2 weeks. They were allocated into either low- or high-fear group by the Acrophobia Questionnaire (AQ)-anxiety scores, and then the changes of the built-in variables and AQ-anxiety scores were analyzed between the groups. The safety was assessed using the Simulator Sickness Questionnaire (SSQ). The AQ-anxiety scores were significantly decreased after self-training in both groups, and the degree of decrease was significantly greater in the high-fear group than in the low-fear group. Gaze-down percentage and subjective fear rating showed a significant group difference, but HR did not. The SSQ scores were within the acceptable level. These results suggest that the training effect was greater in the high-fear group than in the low-fear group. This mobile program may be safely applicable to self-training for individuals with high scores on the fear of heights by repeated exposure to virtual environments with the embedded feedback system.
Get full access to this article
View all access options for this article.
References
1.
American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders (DSM-5). Washington, DC: American Psychiatric Association.
2.
HuppertD, GrillE, BrandtT. Down on heights? One in three has visual height intolerance. Journal of Neurology, 2013; 260:597–604.
3.
DeplaMF, ten HaveML, van BalkomAJ, et al.Specific fears and phobias in the general population: results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Social Psychiatry and Psychiatric Epidemiology, 2008; 43:200–208.
4.
CraskeMG, TreanorM, ConwayCC, et al.Maximizing exposure therapy: an inhibitory learning approach. Behaviour Research and Therapy, 2014; 58:10–23.
5.
FoaEB. Prolonged exposure therapy: present, and future. Depression and Anxiety, 2011; 28:1034–1047.
6.
BotellaC, OsmaJ, Garcia-PalaciosA, et al.Treatment of flying phobia using virtual reality: data from a 1-year follow-up using a multiple baseline design. Clinical Psychology and Psychotherapy, 2004; 11:311–323.
7.
NorthMM, NorthSM, CobleJR. Virtual reality therapy: an effective treatment for psychological disorders. Studies in Health Technology and Informatics, 1997; 44:59–70.
8.
AndersonPL, PriceM, EdwardsSM, et al.Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 2013; 81:751–760.
9.
WallachHS, SafirM, Bar-ZviM. Virtual reality cognitive behavior therapy for public speaking anxiety: a randomized clinical trial. Behavior Modification, 2009; 33:314–333.
10.
MalbosE, RapeeRM, KavakliM. A controlled study of agoraphobia and the independent effect of virtual reality exposure therapy. Australian and New Zealand Journal of Psychiatry, 2013; 47:160–168.
11.
ShibanY, SchelhornI, PauliP, et al.Effect of combined multiple contexts and multiple stimuli exposure in spider phobis: a randomized clinical trial in virtual reality. Behaviour Research and Therapy, 2015; 71:45–53.
12.
Rus-CalafellM, Gutiérrez-MaldonadoJ, BotellaC, et al.Virtual reality exposure and imaginal exposure in the treatment of fear of flying: a pilot study. Behavior Modification, 2013; 37:568–590.
13.
WiederholdBK, JangDP, GevirtzRG, et al.The treatment of fear of flying: a controlled study of imaginal and virtual reality graded exposure therapy. IEEE Transactions on Information Technology in Biomedicine, 2002; 6:218–223.
14.
CoelhoCM, SilvaCF, SantosJA, et al.Contrasting the effectiveness and efficiency of virtual reality and real environments in the treatment of acrophobia. Psychnology, 2008; 6:203–216.
15.
EmmelkampPM, BruynzeelM, DrostL, et al.Virtual reality treatment in acrophobia: a comparison with exposure in vivo. CyberPsychology & Behavior, 2001; 4:335–339.
16.
EmmelkampPM, KrijnM, HulsboschAM, et al.Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia. Behaviour Research and Therapy, 2002; 40:509–516.
17.
JangDP, KuJH, ChoiYH, et al.The development of virtual reality therapy (VRT) system for the treatment of acrophobia and therapeutic case. IEEE Transactions on Information Technology in Biomedicine, 2002; 6:213–217.
18.
KrijnM, EmmelkampPM, BiemondR, et al.Treatment of acrophobia in virtual reality: the role of immersion and presence. Behaviour Research and Therapy, 2004; 42:229–239.
19.
BohilCJ, AliceaB, BioccaFA. Virtual reality in neuroscience research and therapy. Nature Review Neuroscience, 2011; 12:752–762.
20.
KniffinTC, CarlsonCR, EllzeyA, et al.Using virtual reality to explore self-regulation in high-risk settings. Trauma, Violence, & Abuse, 2014; 15:310–321.
21.
EmmelkampPM, FeltenM. The process of exposure in vivo: cognitive and physiological changes during treatment of acrophobia. Behaviour Research and Therapy, 1985; 23:219–223.
22.
CornwellBR, JohnsonL, BerardiL, et al.Anticipation of public speaking in virtual reality reveals a relationship between trait social anxiety and startle reactivity. Biological Psychiatry, 2006; 59:664–666.
23.
MühlbergerA, BülthoffHH, WiedemannG, et al.Virtual reality for the psychophysiological assessment of phobic fear: responses during virtual tunnel driving. Psychological Assessment, 2007; 19:340.
24.
SimeonovPI, HsiaoH, DotsonBW, et al.Height effects in real and virtual environments. Human Factors, 2005; 47:430–438.
25.
WilhelmFH, PfaltzMC, GrossJJ, et al.Mechanisms of virtual reality exposure therapy: the role of the behavioral activation and behavioral inhibition systems. Applied Psychophysiology and Biofeedback, 2005; 30:271–284.
26.
van DijkET, WesterinkJH, BeuteF, et al.In sync: the effect of physiology feedback on the match between heart rate and self-reported stress. Biomed Research International, 2015; 2015:134606.
27.
PeiraN, FredriksonM, PourtoisG. Controlling the emotional heart: heart rate biofeedback improves cardiac control during emotional reactions. International Journal of Psychophysiology, 2014; 91:225–231.
28.
JonesCL, MinatiL, NagaiY, et al.Neuroanatomical substrates for the volitional regulation of heart rate. Frontiers in Psychology, 2015; 6:300.
29.
RepettoC, RivaG. From virtual reality to interreality in the treatment of anxiety disorders. Neuropsychiatry, 2011; 1:31–43.
30.
CohenDC. Comparison of self-report and behavioral procedures for assessing acrophobia. Behavior Therapy, 1977; 8:17–23.
31.
KennedyRS, LaneNE, BerbaumKS, et al.Simulator Sickness Questionnaire: an enhanced method for quantifying simulator sickness. International Journal of Aviation Psychology, 1993; 3:203–220.
32.
SteinmanSA, TeachmanBA. Cognitive processing and acrophobia: validating the Heights Interpretation Questionnaire. Journal of Anxiety Disorders, 2011; 25:896–902.
33.
DiemerJ, LohkampN, MühlbergerA, et al.Fear and physiological arousal during a virtual height challenge—effects in patients with acrophobia and healthy controls. Journal of Anxiety Disorders, 2016; 37:30–39.
34.
BrandtT, KuglerG, SchnieppR, et al.Acrophobia impairs visual exploration and balance during standing and walking. Annals of the New York Academy of Sciences, 2015; 1343:37–48.
35.
Gálvez-GarcíaG, HayM, GabaudeC. Alleviating simulator sickness with galvanic cutaneous stimulation. Human Factors, 2015; 57:649–657.
36.
WibiramaS, HamamotoK. Investigation of visually induced motion sickness in dynamic 3D contents based on subjective judgment, heart rate variability, and depth gaze behavior. Proceedings of the 36th Annual International Conference of the IEEE EMBS2014; 2014:4803–4806.
37.
MossJD, MuthER. Characteristics of head-mounted displays and their effects on simulator sickness. Human Factors, 2011; 53:308–319.
38.
KennedyRS, StanneyKM, DunlapWP. Duration and exposure to virtual environments: sickness curves during and across sessions. Presence: Teleoperators and Virtual Environments, 2000; 9:463–472.
39.
MalbosE, RapeeRM, KavakliM. Behavioral presence test in threatening virtual environments. Presence: Teleoperators and Virtual Environments, 2012; 21:268–280.
40.
KeshavarzB, StelzmannD, PaillardA, et al.Visually induced motion sickness can be alleviated by pleasant odors. Experimental Brain Research, 2015; 233:1353–1364.
