Conquer Fear of Heights Using Virtual Reality Exposure Therapy With Cognitive Restructuring

Miftah Faizah, Neila Ramdhani, Muhana Sofiati Utami
(Submitted 22 September 2023)
(Published 31 May 2024)

Abstract


Acrophobia has traditionally been treated using exposure therapy; however, virtual reality technology has emerged as an alternative that minimizing security risks by presenting three-dimensional stimuli. This study aimed to investigate virtual reality exposure therapy-cognitive restructuring (VRET-CR) effectiveness in reducing acrophobia symptoms. In a pretest-posttest control group design, 27 participants were randomly assigned to the experimental group (n=13) and the control group (n=14). An independent sample t-test revealed a significant differences in the gain scores of the acrophobia questionnaire (AQ) 1 [t (17.08) = -6.173; p <0.05] and AQ 2 [t (25) = -4.250; p <0.05] between these groups. Scores on the State-Trait Anxiety Inventory (STAI) and Autonomic Perception Questionnaire (APQ) decreased after six exposure sessions, supporting these findings. Skin conductance and respiratory rate changes during therapy were less significant than heart rate changes. Overall, the results demonstrated the effectiveness of VRET-CR in reducing acrophobia symptoms.



Keywords


acrophobia; cognitive restructuring; virtual reality exposure therapy

Full Text: PDF

DOI: 10.22146/gamajpp.89156

References


Abbas, S., & Kiran, S. (2015). People with fear of height; Acrophobia. World Journal of Pharmaceutical and Medical Research, 1(1), 52-53.

Alsina-Jurnet, I., Gutiérrez-Maldonado, J., & Rangel-Gómez, M. (2011). The role of presence in the level of anxiety experienced in clinical virtual environments. Computers in Human Behavior, 27(1), 504-512.

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Arroll, B., Henwood, S., Sundram, F., Kingsford, D., Mount, V., Humm, S., . . . Pillai, A. (2017). A breif treatment for fear of heights. International Journal of Pyschiatry in Medicin, 52(1), 21-33.

Baker, A., Mystkowski, J., Culver, N., Yi, R., Mortazvi, A., & Craske, M. (2010). Does habituation matter? emotional processing theory and exposure therapy for acrophobia. Behaviour Research and Therapy, 48(11), 1139-1143.

Botella, C., Banos, R., Perpina, C., Villa, H., Alcaniz, M., & Rey, A. (1998). Virtual reality treatment of claustrophobia: a case report. Behaviur Research and Therapy, 239-246.

Botella, C., Bretón-López1,, J., Serrano, V., Gracia-Palacios, A., Quero, S., & Banos, R. (2014). Treatment of flying phobia using virtual reality exposure with or without cognitive restructuring: Participants' preferences. Revista de Psicopatología y Psicología Clínica, 19(3), 157-169.

Boudewyns, P. A., & Shipley, R. H. (1983). Flooding and Implosive Therapy. New York: Plenum Press.

Brahnam, S., & Lakhmi, C. (2011). Adcanced computational intelligence paradigms in healthcare 6: virtuall reality in psychotherapy, rehabilitation, and assessment. Berlin: Springer.

Carlson, N. (2013). Physiology of Behavior. Boston: Person Education, Inc.

Clark, D. (2014). Cognitive Restructuring. Dalam S. Hofmann, The Wiley Handbook of Cognitive Behavioral Therapy (hal. 23-44). New Jersey: Wiley-Blackwell.

Council on Tall Building and Urban Habitat. (2019). Indonesia Facts. Dipetik June 10, 2019, dari http://regions.ctbuh.org/indonesia

Depla, M., ten Have, M., can Balkom, A., & de Graaf, R. (2008). Specific fears and phobias in the general population: results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatric Epidemiology, 43(3), 200-8.

Eaton, W., Bienvenu, O., & Miloyan, B. (2018). Specific phobias. The Lancet Psychiatry, 5(8), 678-686.

Ferrer-Garcia , M., Pla-Sanjuanelo , J., Dakanalis, A., Vilalta-Abella , F., Riva, g., Fernandez-Aranda, F., . . . Gutiérrez-Maldonado, J. (2019). A randomized trial of virtual reality-based cue exposure second-level therapy and cognitive behavior second-Level therapy for bulimia nervosa and binge-eating disorder: outcome at six-month followup. Cyberpsychology, Behavior and Social Networking, 22(1), 60-69.

Figueira, I., Lopes, A., Gonçalves, R., Mendlowicz, M. V., Cautinho, E. S., & Ventura, P. (2014). Does D-Cycloserine Enhance Exposure Therapy for Anxiety Disorders in Humans? A Meta-Analysis. PLoS ONE, 9(7), 1-12.

Foa, E., & Kozak, M. (1986). Emotional processing of fear. Exposure to corrective information. Pyschological Bulletin, 99(1), 20-35.

Foa, E., Huppert, J., & Cahill, S. (2006). Emotional Processing Theory. Dalam B. Rothbaum, Pathological Anxiety: Emotional Processing in Etiology and Treatment (hal. 3-24). New York: Guilford Publication.

Hirsch, J. (2018). Integrating hypnosis with other therapies for treating specific phobias: A case series. The American Journal of Clinical Hypnosis, 60(4), 367-377.

Hüweler, R., Kandil, F., Alpers, G., & Gerlach, A. (2009). The impact of visual flow stimulation on anxiety, dizziness, and body sway in individuals with and without fear of heights. Behaviour Research and Therapy, 47(4), 345-352.

Kalat, J., & Shiota, M. (2011). Emotion (2th ed.). Belmont, CA: Wadsworth Publishing.

Kapfhammer, H.-P., Fitz, W., Huppert, D., Grill, E., & Brandt, T. (2016). Visual height intolerance and acrophobia: distressing partners for life. Journal of Neurology, 263(10), 1946-1953.

Koerner, N., & Fracalanza, K. (2012). The Role of Anxiety Control Strategies. Dalam P. Neudeck, & H. Wittchen, Exposure Therapy: Rethinking the Model - Refining the Method (hal. 204). New York: Springer.

Kreibig, S. (2010). Autonomic nervous system activity in emotion: A review. Biological Psychology, 84, 394-421.

Kulkarni, B., Rane, R., & Pawar, S. (2020). Anxiety as a causal factor in the development of phobias. The International Journal of Indian Psychology, 8(1)

Leaman, S., Rothbaum, B. O., Difede, J., Cukor, J., Gerardi, M., & Rizzo, A. (2013). Treating Combat-Related PTSD With Virtual Reality Exposure Therapy. Dalam J. Coll, A. Rubin, & E. Weiss, Handbook of Military Social Work (hal. 113-140). Hoboken: John Wiley & Son, Inc.

Lindner, P., Miloff, A., Bergman, C., Andersson, G., Hamilton, W., & Carlbring, P. (2020, March 3). Gamified, automated virtual reality exposure therapy for fear of spiders: A single-subject trial under simulated real-world conditions. Frontiers in Psychiatry, 11, 116.

Maples-Keller, J. L., Bunnell, B. E., Kim, S.-J., & Rothbaum, B. O. (2017). The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders. Harv Rev Psychiatry, 25(3), 103-113.

Menzies, R., & Clarke, J. (1995). The etiology of acrophobia and its relationship to severity and individual response patterns. Behaviour Research and Therapy, 33(7), 795-803.

Milosevic, I., & McCabe, R. (2015). Phobias: The psychology of irrational fear. Santa Barbara: Greenwood.

Mühlberger, A., Wiedemann, G., & Pauli, P. (2003). Efficacy of a one-session virtual reality exposure treatment for fear of flying. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 13(3), 323-336.

Orman, E. (2003). Effect of virtual reality graded exposure on heart rate and self-reported anxiety levels of performing saxophonists. Journal of Research in Music Educarion, 51(4), 302-315.

Peñate, W., Pitti, C., Bethencourt, J., Fuente, J., & Gracia, R. (2008). The effects of a treatment based on the use of virtual reality exposure and cognitive-behavioral therapy applied to patients with agoraphobia. International Journal of Clinical and Health Psychology, 8(1), 5-22.

Rakel, D. (2018). Integrative Medicine (4th ed.). Philadelphia, PA: Saunders Elsevier.

Rimer, E., Husby, L. V., & Solem, S. (2021). Virtual Reality Exposure Therapy for Fear of Heights: Clinicians’ Attitudes Become More Positive After Trying VRET. Frontiers in Psychology, 12.

Robillard, G., Bouchard, S., Dumoulun, S., & Guitard, T. (2011). The development of the SWEAT questionnaire: A scale measuring costs and efforts inherent to conducting exposure sessions. Studies in Health Technology and Indormatics, 167(1), 105-110.

Safir, M., Wallach, H., & Bar-Zvi, M. (2012). Virtual Reality Cognitive-Behavior Therapy for Public Speaking Anxiety: One-Year Follow-Up. Behavior Modification, 36(2), 235-246.

Sandi, C. (2011). Healing anxiety disorders with glucocorticoids. Proc Natl Acad Sci U S A, 6343-6344.

Shadish, W. R., Cook, T. D., & Campbell, D. T. (2002). Experimental and Quasi-Experimental Designs for Generelized Causal Inference. Boston: Houghton Mifflin Company.

Shiban, Y., Diemer, J., Müller, J., Brütting-Schick, J., Pauli, P., & Mühlberger, A. (2017). Diaphragmatic breathing during virtual reality exposure therapy for aviophobia: functional coping strategy or avoidance behavior? a pilot study. BMC Psychiatry, 17(29), 1-10.

Sripada, R., & Rauch, S. (2015). Between-session and within-session habituation in prolonged exposure therapy for posttraumatic stress disorder: A hierarchical linear modeling approach. Journla of Anxiety Disorders, 30, 81-87.

Sundel, M., & Sundel, S. (2018). Behavior Change: Behavioral and Cognitive Priciples and Applications. Los Angeles: SAGE Publications.

Thought Technology Ltd. (2010, February). Basics of Heart Rate Variabulity: Applied to Psychophysiology. Montreal, Canada.

Vincelli, F., Anolli, L., Bouchard, S., Wiederhold, B., Zurloni, V., & Riva, G. (2003). Experiential cognitive therapy in the treatment of panic disorders with agoraphobia: A controlled study. Cyberpsychology & Behavior, 6(3), 321-328.

Vitriana, A. (2017). Increase in land value due to spatial transformation in the northern part of the Bandung – Cimahi peri-urban region. Journal of Regional and City Planning, 28(1), 70.

Zhang, T., Booth, R., Jean-Louis, R., Chan, R., Yeung, A., Gratzer, D., et al. (2020, October 28). A primer on usability assessment approaches for health-related applications of virtual reality. JMIR Serious Games, 8(4)

Zhao, N., Fan, L., Zeng, J., Ran, L., Zhang, C., Wang, J., & Yu, C. (2023, December 5). Virtual reality in managing dental pain and anxiety: A comprehensive review. Frontiers in Medicine (Lausanne), 10


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