Virtual reality versus computer-aided exposure treatments for fear of flying

Tortella-Feliu, M., Botella, C., Llabres, J., Breton-Lopez, J. M., del Amo, A. R., Banos, R. M., & Gelabert, J. M. (2011). Virtual reality versus computer-aided exposure treatments for fear of flying. Behavior Modification, 35(1), 3-30. doi:10.1177/0145445510390801

Evidence is growing that two modalities of computer-based exposure therapies–virtual reality and computer-aided psychotherapy–are effective in treating anxiety disorders, including fear of flying. However, they have not yet been directly compared. The aim of this study was to analyze the efficacy of three computer-based exposure treatments for fear of flying: virtual reality exposure therapy (VRET), computer-aided exposure with a therapist’s (CAE-T) assistance throughout exposure sessions, and self-administered computer-aided exposure (CAE-SA). A total of 60 participants with flying phobia were randomly assigned to VRET, CAE-T, or CAE-SA. Results indicate that the three interventions were effective in reducing fear of flying at posttreatment and at 1-year follow-up; furthermore, there were no significant differences between them in any of the outcome measure. Large within-group effect sizes were found for all three treatment conditions at both posttreatment and at follow-up. The results suggest that therapist involvement might be minimized during computer-based treatments and that CAE can be as effective as VRET in reducing fear of flying.

Linear and nonlinear analyses of EEG dynamics during non-painful somatosensory processing in chronic pain patients

Carolina Sitges, Xavier Bornas, Jordi Llabres, Miquel Noguera, Pedro Montoya, Linear and nonlinear analyses of EEG dynamics during non-painful somatosensory processing in chronic pain patients, International Journal of Psychophysiology, Volume 77, Issue 2, August 2010, Pages 176-183, ISSN 0167-8760, DOI: 10.1016/j.ijpsycho.2010.05.010.

The aim of our study was to characterize brain dynamics of affective modulation of somatosensory processing in chronic pain. We hypothesized that chronic pain patients will show abnormal EEG activity under negative mood conditions compared to healthy controls. Nineteen patients with chronic pain and 21 healthy subjects participated in the experiment. Multiscale entropy, fractal dimension, event-related potentials, and fast Fourier transform were used to analyze EEG data. A significant enhancement of entropy was found in pain patients at P4 compared to P3. Analysis of fractal dimension also revealed significantly higher values at P4 than P3 when pain patients were viewing unpleasant pictures. By contrast, no significant differences due to hemisphere or affective condition were found on nonlinear measures for healthy controls. Analyses of somatosensory ERPs showed that P50 amplitudes elicited by pleasant pictures were more reduced in chronic pain patients than in healthy controls. Finally, we observed that EEG band power was lower in pain patients than in healthy controls, in particular for theta and beta bands over sensorimotor cortices and temporal regions when viewing pleasant images. These findings suggest that sustained pain seems to be accompanied by an abnormal activation and dynamic of brain networks related to emotional processing of somatosensory information in chronic pain. Furthermore, our findings suggest that both linear and nonlinear measures of EEG time series may contribute to the understanding of brain dysfunction in chronic pain.

Exposure induced changes in EEG phase synchrony and entropy: A snake phobia case report

International Journal of Clinical and Health Psychology, 2010, 10, 167-179. Exposure induced changes in EEG phase synchrony and entropy: A snake phobia case report. Xavier Bornas (Universitat de les Illes Balears, Spain), Miquel Noguera (Universitat Politècnica de Catalunya, Spain), Miquel Tortella-Feliu (Universitat de les Illes Balears, Spain), Jordi Llabrés (Universitat de les Illes Balears, Spain), Pedro Montoya (Universitat de les Illes Balears, Spain), Carol Sitges (Universitat de les Illes Balears, Spain), and Inma Tur (Universitat de les Illes Balears, Spain)

In this case study the electroencephalographic (EEG) activity of a 23 years old snake phobic patient was recorded one week before treatment, one week after successful one-session exposure therapy, and one year later. EEG recordings were obtained at rest and during exposure to pictures of snakes, pictures of equivalent arousing power, and emotionally neutral images, all of them taken from the International Affective Pictures System. Measures of brain dynamics were sample entropy (SampEn) for each EEG signal/channel and phase synchronization between pairs of EEG channels. Results showed dramatic changes in both measures one week after treatment: SampEn increased and phase synchrony decreased at all sites and pairs of channels respectively. At follow-up, however, we found patterns of entropy and synchrony change across conditions that were similar to the pre-treatment ones, while the patient did not report any fear at all. Despite the limitations of single case studies, these results suggest that the exposure-induced changes in EEG entropy and synchronization are large but transient. The transient increase of the brain’s flexibility could be one of the working neurophysiological mechanisms of exposure therapy.

Looking for traces of phylogenetic fears: Differences in EEG slow oscillations and complexity between spider- and flight phobic subjects

International Journal of Clinical and Health Psychology, 2009, 9, 37-49. Looking for traces of phylogenetic fears: Differences in EEG slow oscillations and complexity between spiderand flight phobic subjects. Xavier Bornas (Universitat de les Illes Balears, Spain), Andreas Mühlberger (University of Wurzburg, Germany), Jordi Llabrés (Universitat de les Illes Balears, Spain), Georg Wiedemann (University of Frankfurt, Germany), and Paul Pauli (University of Wurzburg, Germany)

Phylogenetic fears involve stimuli representing a real or potential threat to the species¿ evolutionary ancestors. We tested whether individuals with a phylogenetic fear (spider phobics, n = 17) differed in EEG general activity (delta band power) of the oldest brain system and in complexity from individuals with a non-phylogenetic fear (flight phobics, n = 15) during eyes open and eyes closed resting states. Delta band power was higher during the eyes-closed condition at central sites FZ, CZ and PZ as well as at frontal sites FP1, FP2, and F4. No differences existed in the upper bands theta, alpha, and beta. The EEG complexity was significantly lower among individuals with spider phobia. Differences were found under both eyes closed and eyes open conditions at FZ, F4, CZ, and C4. Lower complexity was also found at PZ and O2 during eyes open. In general, the results of this ex post facto study lend support to the hypothesized prevalence of slow oscillations in phylogenetic fears. Furthermorethese results show that the EEG output of spider phobic participants is less complex than the output from flight phobic participants. The prevalence of slow brain oscillations and the lowered EEG complexity could be interpreted as traces of phylogenetic fears.

Vagally mediated heart rate variability and heart rate entropy as predictors of treatment outcome in flight phobia

Xavier Bornas, Jordi Llabres, Miquel Tortella-Feliu, Miquel A. Fullana, Pedro Montoya, Ana Lopez, Miquel Noguera, Joan M. Gelabert, Vagally mediated heart rate variability and heart rate entropy as predictors of treatment outcome in flight phobia, Biological Psychology, Volume 76, Issue 3, October 2007, Pages 188-195, ISSN 0301-0511, DOI: 10.1016/j.biopsycho.2007.07.007.

In the present study a computer-assisted exposure-based treatment was applied to 54 flight phobics and the predictive role of vagally mediated heart rate (HR) variability (high frequency, 0.15-0.4 Hz band power) and heart rate entropy (HR time series sample entropy) on treatment outcome was investigated. Both physiological measures were taken under controlled breathing at 0.2 Hz and during exposure to a fearful sequence of audiovisual stimuli. Hierarchical regression analyses were conducted to assess the predictive power of these variables in these conditions on treatment self-report measures at the end of treatment and at 6 months follow-up, as well as on the behavioral treatment outcome (i.e. flying at the end of treatment). Regression models predicting significant amounts of outcome variance could be built only when HR entropy was added to the HR variability measure in a second step of the regression analyses. HR variability alone was not found to be a good predictor of neither self-reported nor behavioral treatment outcomes.

Análisis de dos estrategias de enseñanza-aprendizaje en la docencia de Terapia de Conducta

International Journal of Clinical and Health Psychology, 2007, 7, 547-558. Análisis de dos estrategias de enseñanza-aprendizaje en la docencia de Terapia de Conducta. Miquel Tortella-Feliu, Mateu Servera y Jordi Llabrés (Institut Universitari d’Investigacions en Ciències de la Salut, Universitat de les Illes Balears, España)

Este estudio cuasi-experimental analiza la eficacia de una metodología docente basada en seminarios y evaluación continua (grupo S) respecto a la basada en clases magistrales y una única prueba de evaluación final (grupo M), y la disposición del alumnado a seguir estas metodologías y su grado de implicación en la asignatura Terapia de Conducta de los estudios de Psicología. Los alumnos del grupo S obtuvieron un mayor rendimiento académico que los estudiantes que no optaron por esa metodología docente, tanto en lo que respecta a la calificación media obtenida como al porcentaje de aprobados. La distribución del alumnado en la selección de grupo fue bastante homogénea aunque un porcentaje importante de alumnos no completó el curso con la metodología elegida inicialmente. Los alumnos del grupo S dedicaron más tiempo a la preparación de la asignatura. No se encontró relación significativa entre el tiempo de estudio y el rendimiento académico. Los resultados se discuten en el marco de la adaptación al Espacio Europeo de Educación Superior.

Changes in heart rate variability of flight phobics during a paced breathing task and exposure to fearful stimuli

International Journal of Clinical and Health Psychology, 2006, 6, 549-563. Changes in heart rate variability of flight phobics during a paced breathing task and exposure to fearful stimuli. Xavier Bornas, Jordi Llabrés, Miquel Noguera, Ana María López, Miquel Tortella-Feliu, Miquel Ángel Fullana, Pedro Montoya, Joan Miquel Gelabert, and Irene Vila

The aim of this experiment was to explore changes in the vagally mediated heart rate variability (HRV) of flight phobics during exposure to feared stimuli. A paced breathing task was included to control for respiration effects. Sixty-one flight phobics (40 women) with a mean age of 39.07 years (SD = 11.24) participated in the study. The root mean of the squared successive interbeat intervals differences (RMSSD) was taken as the time domain measure of HRV. High frequency (HF: 0.15-0.4 Hz) and low frequency (LF: 0.04-0.15 Hz) band power was calculated on the ECG recordings obtained during free breathing baseline (BL), paced breathing (PB), and exposure (E) to fearful stimuli. Heart rate unexpectedly increased from BL to PB, and decreased from PB to E, while no differences were found between BL and E. No changes in the RMSSD were seen across conditions. HF band power increased, as expected, from BL to PB, and a significant decrease was found from PB to E. LF band power, as well as the LF/HF ratio, increased from BL to E. Discussion focuses on (a) the role of the parasympathetic and the sympathetic nervous systems in fear-related situations, and (b) the effects of paced breathing in preparing the system to cope with threat.

Do all treatments work for flight phobia? Computer-assisted exposure versus a brief multicomponent nonexposure treatment

Psychotherapy Research. Volume 16, Issue 1, 2006, 41-50. Do all treatments work for flight phobia? Computer-assisted exposure versus a brief multicomponent nonexposure treatment. DOI:10.1080/10503300500091058. Xavier Bornas, Miquel Tortella-Feliu & Jordi Llabrés

Computer-assisted treatments have proven to be effective in the treatment of several anxiety disorders and depression, but the role of exposure remains unclear. This study compares the efficacy of a computer-assisted exposure treatment (CAE) with a brief multicomponent nonexposure treatment (MNE) for flight phobia. Outcome measure assessments were conducted at posttreatment and at 6-month follow-up. No differences were found between CAE and MNE in reducing fear of flying. In both conditions patients improved significantly and clinically meaningfully, and results were maintained at 6- month follow-up. These findings challenge the idea that exposure is essential in reducing phobic anxiety and support the idea that specific phobias may be well suited for brief cognitive–behavioral treatments.