Automated mobile virtual reality cognitive behavior therapy for aviophobia in a 
natural setting: a randomized controlled trial

Donker, T.; Fehribach, J. R.; Van Klaveren, C.; Cornelisz, I.; Toffolo, M. B. J.; Van Straten, A.; Van Gelder, Jean-Louis

doi:10.1017/ S0033291722003531

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Journal Article

Automated mobile virtual reality cognitive behavior therapy for aviophobia in a natural setting: a randomized controlled trial

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Van Gelder, Jean-Louis
Criminology, Max Planck Institute for the Study of Crime, Security and Law, Max Planck Society;

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automated_mobile_virtual_reality_cognitive_behavior_therapy_for_aviophobia_in_a_natural_setting_a_randomized_controlled_trial.pdf
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Citation

Donker, T., Fehribach, J. R., Van Klaveren, C., Cornelisz, I., Toffolo, M. B. J., Van Straten, A., et al. (2023). Automated mobile virtual reality cognitive behavior therapy for aviophobia in a natural setting: a randomized controlled trial. Psychological Medicine, 53, 6232-6241. doi:10.1017/ S0033291722003531.

Cite as: https://hdl.handle.net/21.11116/0000-000B-9BB8-7

Abstract

Background:
Access to evidence-based psychological treatment is a challenge worldwide. We assessed the effectiveness of a fully automated aviophobia smartphone app treatment delivered in combination with a $5 virtual reality (VR) viewer.

Methods:
In total, 153 participants from the Dutch general population with aviophobia symptoms and smartphone access were randomized in a single-blind randomized controlled trial to either an automated VR cognitive behavior therapy (VR-CBT) app treatment condition (n = 77) or a wait-list control condition (n = 76). The VR-CBT app was delivered over a 6-week period in the participants' natural environment. Online self-report assessments were completed at baseline, post-treatment, at 3-month and at 12-month follow-up. The primary outcome measure was the Flight Anxiety Situations Questionnaire (FAS). Analyses were based on intent-to-treat.

Results:
A significant reduction of aviophobia symptoms at post-test for the VR-CBT app compared with the control condition [p < 0.001; d = 0. 98 (95% CI 0.65–1.32)] was demonstrated. The dropout rate was 21%. Results were maintained at 3-month follow-up [within-group d = 1.14 (95% CI 0.46–1.81)] and at 12-month follow-up [within-group d = 1.12 (95% CI 0.46–1.79)]. Six participants reported adverse effects of cyber sickness symptoms.

Conclusions:
This study is the first to show that fully automated mobile VR-CBT therapy delivered in a natural setting can maintain long-term effectiveness in reducing aviophobia symptoms. In doing so, it offers an accessible and scalable evidence-based treatment solution that can be applied globally at a fraction of the cost of current treatment alternatives.