Facing Your Fear in Immersive Virtual Reality: Avoidance Behavior in Specific Phobia

Abstract

Specific phobias are the most common anxiety disorder and are characterized by avoidance behavior. Avoidance behavior impacts daily function and is proposed to impair extinction learning. However, despite its prevalence, its objective assessment remains a challenge. To this end, we developed a fully automated experimental procedure using immersive virtual reality. The procedure contained a behavioral search, forced-choice, and an approach task with varying degrees of freedom and task relevance of the stimuli. In this study, we examined the sensitivity and feasibility of these tasks to assess avoidance behavior in patients with specific phobia. We adapted the tasks by replacing the originally conditioned stimuli with a spider and a neutral animal and investigated 31 female participants composed of 15 spider-phobic and 16 non-phobic participants. As the non-phobics were quite heterogeneous in terms of their Fear of Spiders Questionnaire (FSQ) scores, we subdivided them into six “fearfuls” that had elevated FSQ scores, and 10 “non-fearfuls” that had no fear of spiders. The phobics successfully managed to complete the procedure and showed consistent avoidance behavior across all behavioral tasks. Compared to the non-fearfuls, which did not show any avoidance behavior at all, the phobics looked at the spider much more often and clearly directed their body toward it in the search task. In the approach task, they hesitated most when they were close to the spider, and their difficulty to touch the spider was reflected in a strong increase in right hand acceleration changes. The fearfuls showed avoidance behavior depending on the tasks: strongest in the search task and weakest in the approach task. Additionally, we identified subjective valence ratings of the spider as the main influence on both objective avoidance behavior and subjective well-being after exposure, mediating the effect of the FSQ. In summary, the behavioral tasks are well suited to assess avoidance behavior in phobic participants and provide detailed insights into the process of avoidance.

Virtual Reality Exposure Therapy for Treating Fear of Contamination Disorders: A Systematic Review of Healthy and Clinical Populations

“…The effectiveness of iVRET in addressing disgust, particularly within the context of contamination fears, has been analyzed in several studies on both healthy [25][26][27][28][29] and clinical populations [17][18][19][20][21][22][23][24]. Among the studies conducted on healthy populations, investigations by Inozu et al [25,26] stand out, demonstrating VRET's potential to significantly reduce contamination fear, disgust, and hand-washing urges; in particular, we found large effects size (see Table 2) for iVRET effectiveness on disgust outcomes in the experimental group compared to controls.…”

“…From automated immersive experiences to the application of tactile and haptic feedback, the selected studies represent the forefront of technology-assisted therapy in managing SP. Binder et al [18] highlights significant avoidance behavior in individuals with SP when exposed to virtual simulations of spiders. Through iVR tasks designed to measure avoidance, such as "Fishing" (a behavioral search task), "Path-Choice" (a forced-choice task), and "Touch the Enemy" (a behavioral approach task), the study observed that phobic participants exhibited pronounced avoidance behaviors and physiological responses indicative of negative emotions (i.e., fear and disgust).…”

“…The classic exposure therapy approach, as well as recent approaches that implement VRET, have a strong impact on the extinction of this aberrant sense of disgust, as reported by several studies on clinical populations [17][18][19][20][21][22][23][24] and even on at-risk healthy populations [25][26][27][28][29]. VRET uses virtual reality technology to expose patients to situations that may trigger feelings of disgust, helping them manage their emotions.…”

Being in Virtual Reality and Its Influence on Brain Health—An Overview of Benefits, Limitations and Prospects

“…2022 [74] Researchers developed a fully automated experimental procedure using immersive VR involving behavioral search, forced-choice and an approaching task with varying degrees of freedom and stimulus relevance. In this study, scientists examined the sensitivity and feasibility of these tasks to assess avoidance behavior in patients with specific phobias.…”

“…Table 1 presents and indicates examples of neuroscientific areas of using virtual environments and tools, including pain management [31,[56][57][58], improvement of brain injury patients [5,26,[59][60][61], post-stroke [10,20,25,33,[65][66][67], prevention, and diagnosis and therapy of many serious illnesses. Examples include diseases such as neurodevelopmental disorders (e.g., attentiondeficit hyperactivity disorder, ADHD [22,80,81]); schizophrenia spectrum disorders (e.g., schizophrenia [82,83]); autism spectrum disorders (e.g., autism [84,85]); mood (e.g., depressive disorders [86,87]), anxiety (e.g., panic and phobias [74][75][76]), trauma-and stressorrelated (e.g., post-traumatic stress disorder, PTSD [73]), neurocognitive (e.g., Parkinson's or Alzheimer's and memory cognitive impairment diseases [23,24,47,[69][70][71][72][77][78][79]) and neuromuscular disorders (e.g., multiple sclerosis [32,[62][63]…”