Juana Bretón-López, Miquel Tortella-Feliu, Antonio Riera del Amo, Rosa Baños, Jordi Llabrés, Joan M. Gelabert and Cristina Botella
This study analyses participants’ preferences regarding three computer- aided exposure treatments for fear of flying (FF): virtual reality exposure treatment assisted by a therapist (VRET), computer-aided exposure with a therapist present throughout exposure sessions (CAE-T), and self-administered computer-aided exposure (CAE-SA). Sixty participants with FF were randomly assigned to one of these treatments. At the end of a treatment, a demonstration of the other two treatment options was given and patients were asked to rate their preferences. At post-treatment, assessment data on treatment preferences were obtained from 48 participants (CAE-T n= 14; CAE-SA n= 16, and VRET n= 18). Participants favoured VRET as the most effective, the most recommended, but also they valued it as the most aversive. Attending to the specific treatment condition received by the participants, results showed that in VRET and CAE-T, participants assessed their own treatment as more preferred, more efficacious and more recommendable. Results suggest relevant features regarding the efficiency of computer-based treatments, and offer insights into improving computer-aided psychological interventions.
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, 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.
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.
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.
Nonlinear Dynamics Psychol Life Sci. 2006 Jul;10(3):301-18. Sample entropy of ECG time series of fearful flyers: preliminary results. Bornas X, Llabrés J, Noguera M, Pérez A.
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.
International Journal of Clinical and Health Psychology, 2005, 5, 273-284 ¿Caos en el electrocardiograma de estudiantes con miedo a volar? Un análisis de no linealidad Jordi Llabrés, Xavier Bornas, Miquel Noguera, Ana María López y Francesca Barceló
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 comnplexity, entropy, regularity, and so on.
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.
Análisis y Modificación de Conducta Valencia 1999, v.25, n.104; p. 865-907. Validación factorial del cuestionario de miedo a volar. Francesc Xavier Bornas Agustí, Miquel Tortella-Feliu, Gloria García de la Banda García, Miquel ángel Fullana Rivas, Jordi Llabrés
Se presenta la estructura factorial del cuestionario de miedo a volar (QPV) (Bornas y Tortella-Feliu, 1995), para una muestra de sujetos con y sin miedo a volar en avión. Para la muestra general, el análisis factorial (componentes principales, rotación varimax) aisla cuatro factores: 1.situaciones previas al vuelo, 2.incidentes durante el vuelo, 3. información de catástrofes y 4.situación de aterrizaje. Entre los sujetos del grupo con miedo, el análisis de componentes principales da lugar a los cuatro factores antes citados más un factor adicional denominado situaciones normales de vuelo. A partir de los resultados del análisis factorial, se presenta una nueva versión, más corta y con mayor apoyo empírico, del cuestionario (QPV-II). También se ofrecen datos relativos a la consistencia interna y a la validez discriminante del QPV y del QPV-II, Bibliografía p.904-905