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.
Xavier Bornas, Jordi Llabres, Miquel Noguera, Ana M Lopez, Joan Miquel Gelabert, Irene Vila, Fear induced complexity loss in the electrocardiogram of flight phobics: A multiscale entropy analysis, Biological Psychology, Volume 73, Issue 3, October 2006, Pages 272-279, ISSN 0301-0511, 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.
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.
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.
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.