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.
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.
Anxiety, Stress & Coping. Volume 17, Issue 4, 2004, 331-339. Self-implication and heart rate variability during simulated exposure to flight-related stimuli. DOI:10.1080/10615800512331328777. Xavier Bornas, Jordi Llabrés, Miquel Noguera, Ana M. López, Francesca Barceló, Miquel Tortella-Feliu & Miquel Àngel Fullana
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.
Xavier Bornas, Miquel Tortella-Feliu, Jordi Llabrés, Andreas Mühlberger, Paul Pauli, and Francesca Barceló (2002) Clinical Usefulness of a Simulated Exposure Treatment for Fear of Flying International Journal of Clinical and Health Psychology, 2002, 2, 247-262
The aim of this paper is to assess the clinical usefulness of a computer assisted exposure treatment for fear of flying, which already proved to be effective in laboratory, controlled conditions. Two studies, one in Mallorca (S1, N= 12) and the other one in Germany (S2, N=8), were conducted. Patients were recruited using advertisements in the airport (S1) or in local newspapers (S2), and they were individually treated. Data on fear of flying were collected before treatment, after computer assisted exposure, and after a post-treatment actual flight. Several results corroborated the clinical usefulness of the treatment: (a) effective exposure time was quite similar in both studies; (b) nineteen out of 20 patients completed treatment and took the actual flight; (c) the main fear reductions were found after computer exposure and before taking the flight; and (d) therapeutic changes were clinically significant in most cases: 91.7% of patients in S1, and 87.5% in S2 improved or recovered. We conclude that the clear structure of the computer assisted program facilitates its application in very different settings. Moreover, therapists need only little training to use the program succesfully.
Psychotherapy Research. Volume 11, Issue 3, 2001, 259-273. Computer-Assisted Exposure Treatment for Flight Phobia: a Controlled Study. DOI:10.1080/713663983. X. Bornas, M. Tortella-Feliu, J. Llabrés & M.A. Fullana
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.
Xavier Bornas, Miquel A. Fullana, Miquel Tortella-Feliu, Jordi Llabres, Gloria Garcia de la Banda, Computer-assisted therapy in the treatment of flight phobia: A case report, Cognitive and Behavioral Practice, Volume 8, Issue 3, Summer 2001, Pages 234-240, ISSN 1077-7229, DOI: 10.1016/S1077-7229(01)80058-4
The efficacy of computer-assisted exposure (CAE) 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 he had flown three times without anxiety. The implications of CAE for treatment of flight phobia are discussed.