• Bornas, X., Gelabert, J. M., Llabres, J., Balle, M., & Tortella-Feliu, M. (2011). Slope of change throughout exposure treatment for flight phobia: the role of autonomic flexibility. Journal of Clinical Psychology, 67(6), 550-560. doi:10.1002/jclp.20780; 10.1002/jclp.20780
    • This study tested the hypothesis that flight-phobic patients experience change at different rates even when they are receiving identical treatment. Faster within-session rates of change (WSRC) were expected for patients who required fewer exposure sessions. The study also tested the theoretical role of autonomic flexibility on WSRC. High flexibility should be associated with faster rates of change. Thirty-seven flight-phobic patients were successfully treated with a computer-assisted fear of flying treatment. A significant negative correlation was found between total number of sessions and WSRC: The fewer sessions patients attended, the faster their rate of change was. The role of autonomic flexibility was partially supported: A significant correlation between heart rate variability and WSRC revealed that flexible patients improved faster than less-flexible patients. (c) 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1-11, 2011.
  • 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.


  • Bornas, X., Noguera, M., Tortella-Feliu, M., Llabres, J., Montoya, P., Sitges, C., & Tur, I. (2010). Exposure induced changes in EEG phase synchrony and entropy: A snake phobia case report. International Journal of Clinical and Health Psychology, 10(1), 167-179.
    • 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.
  • Sitges, C., Bornas, X., Llabres, J., Noguera, M., & Montoya, P. (2010). Linear and nonlinear analyses of EEG dynamics during non-painful somatosensory processing in chronic pain patients. International Journal of Psychophysiology : Official Journal of the International Organization of Psychophysiology, 77(2), 176-183. 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.


  • Bornas, X., Muehlberger, A., Llabres, J., Wiedemann, G., & Pauli, P. (2009). 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, 9(1), 37-49.
    • 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 02 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. Furthermore these 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.


  • Bornas, X., Llabres, J., Tortella-Feliu, M., Fullana, M. A., Montoya, P., Lopez, A., . . . Gelabert, J. M. (2007). Vagally mediated heart rate variability and heart rate entropy as predictors of treatment outcome in flight phobia. Biological Psychology, 76(3), 188-195. 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.
  • Tortella-Feliu, M., Servera, M., & Llabres, J. (2007). Analysis of two learning-instruction strategies in Behaviour Therapy training. International Journal of Clinical and Health Psychology, 7(2), 547-558.
    • This quasi-experimental study analyzes the compared effectiveness of two teaching metholodologies, one based on seminars with frequent testing (group S), and the other based on lectures and a single final exam (group M) and students’ commitment and willingness to follow these teaching methodologies in a course on Behaviour Therapy included in the Psychology degree program. Group S students obtained higher academic achievement than the students that did not choose this teaching methodology. This is true both regarding the mean of marks and the pass/no pass rates. The students were divided homogeneously between the two groups, although an important number of students did not finish the course following the initially chosen teaching methodology. Group S students spent more time studying for the course. No significant relationship was found between time of study and academic achievement. These findings are discussed in terms of the current adaptation to European Higher Education Space.


  • Bornas, X., Llabres, J., Noguera, M., Lopez, A. M., Gelabert, J. M., & Vila, I. (2006). Fear induced complexity loss in the electrocardiogram of flight phobics: a multiscale entropy analysis. Biological Psychology, 73(3), 272-279. doi:10.1016/j.biopsycho.2006.05.004
    • In this study we explored the changes in the variability and complexity of the electrocardiogram (ECG) of flight phobics (N=61) and a matched non-phobic control group (N=58) when they performed a paced breathing task and were exposed to flight related stimuli. Lower complexity/entropy values were expected in phobics as compared to controls. The phobic system complexity as well as the heart rate variability (HRV) were expected to be reduced by the exposure to fearful stimuli. The multiscale entropy (MSE) analysis revealed lower entropy values in phobics during paced breathing and exposure, and a complexity loss was observed in phobics during exposure to threatening situations. The expected HRV decreases were not found in this study. The discussion is focused on the distinction between variability and complexity measures of the cardiac output, and on the usefulness of the MSE analysis in the field of anxiety disorders.
  • Bornas, X., Llabres, J., Noguera, M., & Pez, A. (2006). Sample entropy of ECG time series of fearful flyers: preliminary results. Nonlinear Dynamics, Psychology, and Life Sciences, 10(3), 301-318.
    • Research within the framework of the nonlinear dynamical systems (NDS) in the field of anxiety disorders has shown that greater irregularity/complexity appears in the output from healthy systems. In this study we measured the Heart rate variability (HRV) and the sample sntropy (SampEn) of the ECG mV time series of fearful flyers (N = 15) and a matched control group (N = 15) when confronted with three combinations of feared stimuli (pictures, sounds, and pictures with sounds) as well as relaxing stimuli (pictures and sounds). Fearful flyers had lower SampEn than controls in all conditions, including baseline. Non-phobics showed significant entropy decreases from baseline in two out of three exposure conditions. No differences on HRV were found between groups, and HRV was not sensitive to condition changes. The main finding of the study is that the SampEn calculated on very short ECG mV recordings (10 to 60 seconds, easy to obtain in clinical settings) may be a useful diagnostic measure since it can distinguish fearful from non-fearful flyers.
  • Bornas, X., Tortella-Feliu, M., & Llabres, J. (2006). Do all treatments work for flight phobia? Computer-assisted exposure versus a brief multicomponent nonexposure treatment. Psychotherapy Research, 16(1), 41-50. doi:10.1080/10503300500091058
    • 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.
  • Bornas, X., Llabres, J., Noguera, M., Lopez, A. M., Tortella-Feliu, M., Angel Fullana, M., . . . Vila, I. (2006). 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, 6(3), 549-563.
    • 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.

  • Bornas, X., Llabres, J., Noguera, M., Lopez, A. M., Barcelo, F., Tortella-Feliu, M., & Fullana, M. A. (2005). Looking at the heart of low and high heart rate variability fearful flyers: self-reported anxiety when confronting feared stimuli. Biological Psychology, 70(3), 182-187. doi:10.1016/j.biopsycho.2005.01.002
    • Previous research has shown that phobic subjects with low heart rate variability (HRV) are less able to inhibit an inappropriate response when confronted with threatening words compared to phobic subjects with high HRV [Johnsen, B.H., Thayer, J.F., Laberg, J.C., Wormnes, B., Raadal, M., Skaret, E., et al., 2003. Attentional and physiological characteristics of patients with dental anxiety. Journal of Anxiety Disorders, 17, 75-87]. The aim of this study was to evaluate changes in self-reported anxiety when low HRV and high HRV fearful flyers (N=15) and a matched control group (N=15) were exposed to flight-related pictures, flight-related sounds or both pictures and sounds. We hypothesized that sounds would be crucial to evoke fear. Also, low HRV fearful flyers were expected to report higher anxiety than high HRV fearful flyers assuming anxiety as their inappropriate response. Decreases on HRV measures were also predicted for a subgroup of phobic participants (N=10) when confronted with the feared stimuli. Our data supported the hypothesis that sounds are crucial in this kind of phobia. Low HRV fearful flyers reported higher anxiety than high HRV fearful flyers in two out of three aversive conditions. The predicted HRV decreases were not found in this study. Results are discussed in the context of avoidance of exposure-based treatments.
  • Llabres, J., Bornas, X., Noguera, M., Lopez, A. M., & Barcelo, F. (2005). Is there chaos in the electrocardiogram of fearful flyers? Analyzing nonlinearity. International Journal of Clinical and Health Psychology, 5(2), 273-284.
    • Chaos theory provides a new way to analyze the psychophysiological functioning of anxiety disordered people. However, in order to apply any of the nonlinear analysis techniques, nonlinearity tests must be performed and nonlinearity must be found in the psychophysiological signal. In this experimental study we use the surrogate data method to analyze the nonlinearity of the ECG time series of students with and without fear of flying under several stressing conditions. The prediction errors of the surrogate data were found to be much higher than the prediction errors of the ECG signals (p < .05) in all the experimental conditions as well as during the baseline period. We conclude that nonlinear properties are in fact in the ECGs of the participants, and therefore it would be possible to analyze these signals with nonlinear techniques to get knowledge about their cormplexity, entropy, regularity, and so on.


  • Bornas, X., Llabres, J., Noguera, M., Lopez, A. M., Barcelo, F., Tortella-Feliu, M., & Fullana, M. A. (2004). Self-implication and heart rate variability during simulated exposure to flight-related stimuli. Anxiety Stress and Coping, 17(4), 331-339. doi:10.1080/10615800512331328777
    • In the present study, the relationship between self-implication during simulated exposure to feared stimuli and Heart Rate Variability (HRV) was explored within the framework of the dynamical systems model of emotion regulation proposed by Thayer and Lane (Thayer, J.F., and Lane, R.D. (2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders, 61 , 201-216.). An analogue sample of flight phobics ( n =15) and a matched non-phobic control group ( n =15) were presented with flight-related pictures, flight-related sounds or flight-related pictures and sounds. Significant differences on self-implication during exposure to flight-related sounds were found between low and high HRV fearful flyers, the former being more self-implied. However, the expected HRV decreases in the phobic participants exposed to feared stimuli were not found. These results emphasize the need to distinguish between high and low HRV fearful flyers in order to make a better use of the simulated exposure treatments.


  • Bornas, X., Fullana, M. A., Tortella-Feliu, M., Llabres, J., & de la Banda, G. G. (2001). Computer-assisted therapy in the treatment of flight phobia: A case report. Cognitive and Behavioral Practice, 8(3), 234-240.
    • The efficacy of computer-assisted exposure (C-AE) therapy for the treatment of flight phobia was examined. The subject was a 34-year-old man with severe fear and almost complete avoidance of flying. Six 50-minute CAE sessions and two 20-minute booster sessions were conducted over a period of 1 month. All self-reported measures of the fear of flying decreased following CAE, and before the subject took a one-hour flight with minimal distress. A follow-up after 6 months revealed that lie had flown three times without anxiety. The implications of CAE for treatment of flight phobia are discussed.
  • Bornas, X., Tortella-Feliu, M., Llabres, J., & Fullana, M. A. (2001). Computer-assisted exposure treatment for flight phobia: A controlled study. Psychotherapy Research, 11(3), 259-273.
    • This study examines the efficacy of computer-assisted exposure (CAE) treatment in helping to overcome flight phobia and analyzes the role of relaxation and information-related components in the reduction of fear. Fifty flight phobics were randomly assigned to 1 of 3 methods of treatment: (a) CAE; (b) a multicomponent method of treatment of information, relaxation, and CAE (IRCAE); and (c) waiting list control treatment. At the end of the treatment, an actual flight was chartered. The results showed that the first 2 methods of treatments were more effective than the waiting list control treatment. The CAE group showed the greatest reduction in fear. According to data from the IRCAE group, no reduction in flight phobia was observed after the information-relaxation phase. Follow-up data showed that improvements in anxiety self-assessment rates remained constant.


  • Bornas, X., Servera, M., Llabres, J., & Matas, B. (1999). Influence of the computer assisted modelling speed on the drawing of writing related figures. Psicologia Conductual, 7(1), 75-84.
    • This study analyzes the influence of the modeling speed on the process of drawing/copying writing related figures. Thirty first grade students copied four simple figures. The drawing time was measured and the fastest children were assigned to a slow modeling group (SM, n=15) while the slowest children were assigned to the fast modeling group (FM, n=15). Each group received three computer assisted modeling sessions. During each session children looked at the model and tried to draw the same figure. Figures were similar to those used in the initial evaluation. The computer modeling time was set to 30 seconds for the SM group and 10 seconds for the FM group. Results showed significant changes in the drawing time. Changes followed the expected direction: SM group increased time and FM group decreased time. An explanation for the greater effects of modeling on the FM group is given in terms of the enhancement of the natural learning process which tends to reduce drawing time. Other implications of these results in order to use modeling in schools are discussed.


  • Bornas, X., Servera, M., & Llabres, J. (1997). Impulsivity prevention and strategic behavior in children. Psicologia Conductual, 5(1), 133-146.
    • Differences among reflective and impulsive children are analyzed concerning two general aspects: school achievement and the problem-solving strategies used in a specific and frequently accomplished task in the school (puzzles). The study is carried out with preschool children (a group of age little treated in similar studies) with the objective of drawing the bases for an impulsivity-related school problems’ program prevention. The results concerning school achievement are similar to those obtained by other studies with older children, that is, impulsives show an inferior achievement than reflectives. Concerning the problem solving strategies, a greater percentage of impulsives use more rudimentary strategies, while a greater percentage of reflectives use more specialized strategies. These differences increase with the age and they reach statistical meaning in the group of 5 years old children. Results are discussed within a self-regulation theoretical framework.

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