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.
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.
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.
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.
Xavier Bornas, Jordi Llabres, Miquel Noguera, Ana M[feminine ordinal indicator] Lopez, Francesca Barcelo, Miquel Tortella-Feliu, Miquel Angel Fullana, Looking at the heart of low and high heart rate variability fearful flyers: self-reported anxiety when confronting feared stimuli, Biological Psychology, Volume 70, Issue 3, December 2005, Pages 182-187, ISSN 0301-0511, 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.
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.
International Journal of Clinical and Health Psychology, 2003, 3, 477-487. Estilo de afrontamiento y resultados del tratamiento de exposición en sujetos con fobia a volar. Jordi Miró, Gloria García de la Banda, M. Angeles Martínez-Abascal, Miquel Tortella-Feliu, Xavier Bornas y Jordi Llabrés (Universitat de les Illes Balears, España)
El objetivo de este trabajo cuasi-experimental es doble. Por una parte, se trata de estudiar si el estilo de afrontamiento de los pacientes (buscadores y evitadores de información; monitoring y blunting ) está relacionado con los efectos de la terapia de exposición; por otra, examinar si este estilo está relacionado con sesgos de atención. Aplicamos el CAFFT (Computer Assisted Fear of Flying Treatment), esto es, un programa de exposición asistido por ordenador, a una muestra de 17 personas con miedo a volar en avión. Para la evaluación del estilo de afrontamiento empleamos la versión española de la Miller Behavioural Style Scale, mientras que los sesgos de atención fueron valorados mediante el test Stroop . Los resultados muestran que el tratamiento fue efectivo, y si bien no detectan relación con el estilo de afrontamiento, se observa que el estilo de búsqueda de información (por ejemplo, monitoring ) está asociado con mayores trastornos antes del tratamiento, aunque éstos desaparecen tras el mismo. Nuestros datos también muestran una relación estadísticamente significativa entre sesgo de atención y estilo de afrontamiento.
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.