Many outcome studies have been conducted to assess the efficacy of virtual reality in the treatment of specific phobias. However, most studies used self-report data. The addition of objective measures of arousal and information processing mechanisms would be a valuable contribution in order to validate the usefulness of virtual reality in the treatment of anxiety disorders. The goal of this study was to document the impact of virtual reality exposure (VRE) on cardiac response and automatic processing of threatening stimuli. Twenty-eight adults suffering from arachnophobia were assessed and received an exposure-based treatment using virtual reality. General outcome and specific processes measures included a battery of standardized questionnaires, a pictorial emotional Stroop task, a behavioral avoidance test and a measure of participants’ inter-beat intervals (IBI) while they were looking at a live tarantula. Assessment was conducted before and after treatment. Repeated measures ANOVAs revealed that therapy had a positive impact on questionnaire data, as well as on the behavioral avoidance test. Analyses made on the pictorial Stroop task showed that information processing of spider-related stimuli changed after treatment, which also indicates therapeutic success. Psychophysiological data also showed a positive change after treatment, suggesting a decrease in anxiety. In sum, VRE led to significant therapeutic improvements on objective measures as well as on self-report instruments.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington APA.
Arntz, A., Lavy, E., van der Berg, G., & van Rijsoort, S. (1993). Negative beliefs of spider phobics: A psychometric evaluation of the spider phobia beliefs questionnaire. Advances in Behaviour Research and Therapy, 15(4), 257–277.
Constantine, R., McNally, R. J., & Hornig, C. D. (2001). Snake fear and the pictorial emotional Stroop paradigm. Cognitive Therapy and Research, 25(6), 757–764.
Côté, S., & Bouchard, S. (2003). The perceived self-efficacy towards spiders questionnaire: A psychometric evaluation. Poster presented at the Advancement of Behavior Therapy Convention, Boston, November 2003.
De Ruiter, C., & Brosschot, J. F. (1994). The emotional Stroop interference effect in anxiety: Attentional bias or cognitive avoidance? Behaviour Research and Therapy, 32(3), 315–319.
Emmelkamp, P. M. G., Krijn, M., Hulsbosch, L., de Vries, S., Schuemie, M. J., & van der Mast, C. A. P. G. (2002). Virtual reality treatment versus exposure in vivo: A comparative evaluation in acrophobia. Behaviour Research and Therapy, 40(5), 509–516.
First, M. B., Spitzer, R., Gibbon, M., & Williams, J. B. W. (1996). Structured clinical interview for DSM-IV axis-I disorders—Patient version. New York: Biometrics Research Department, New York State Psychiatric Institute.
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35.
Hellström, K., Fellenius, J., & Öst, L.-G. (1996). One versus five sessions of applied tension in the treatment of blood phobia. Behaviour Research and Therapy, 34(2), 101–112.
Johnstone, K. A., & Page, A. C. (2004). Attention to phobic stimuli during exposure: The effect of distraction on anxiety reduction, self-efficacy and perceived control. Behaviour Research and Therapy, 42, 249–275.
Kennedy, R. S., Lane, N. E., Berbaum, K. S., & Lilienthal, M. G. (1993). Simulator Sickness Questionnaire: An enhanced method for quantifying simulator sickness. International Journal of Aviation Psychology, 3(3), 203–220.
Kindt, M., & Brosschot, J. F. (1997). Phobia-related cognitive bias for pictorial and linguistic stimuli. Journal of Abnormal Psychology, 106(4), 644–648.
Lacey, J., & Lacey, B. (1962). The law of initial value and the longitudinal study of autonomic constitution. Annals of the New York Academy of Science, 98, 1257–1290, 1322–1326.
Lang, P. J. (1968). Fear reduction and fear behavior: Problems in treating a construct. In J. M. Shlien (Ed.), Research in psychotherapy (Vol. 3). Washington, DC: American Psychological Association.
Lang, P. J., Davis, M., & Öhman, A. (2000). Fear and anxiety: Animal models and human cognitive psychophysiology. Journal of Affective Disorders, 61, 137–159.
Lavy, E., & van den Hout, M. (1993). Selective attention evidenced by pictorial and linguistic Stroop tasks. Behavior Therapy, 24, 645–657.
Lavy, E., van den Hout, M., & Arntz, A. (1993). Attentional bias and spider phobia: Conceptual and clinical issues. Behaviour Research and Therapy, 31(1), 17–24.
Ledoux, J. (1996). The emotional brain: The mysterious underpinnings of emotional life. New York: Touchstone.
Marks, I. M. (1984). Fears, phobias and rituals. Oxford: Oxford University Press.
McGlynn, F. D., Rose, M. P., & Lazarte, A. (1994). Control and attention during exposure influence arousal and fear among insect phobics. Behavior Modification, 18(4), 371–388.
Mohlman, J., Mangels, J., & Craske, M. G. (2004). The spider phobia card sorting test: An investigation of phobic fear and executive functioning. Cognition and Emotion, 18(7), 939–960.
Riva, G., Wiederhold, B. K., & Molinari, E. (1998). Virtual environments in clinical psychology and neuroscience: Methods and techniques in advanced patient–therapist interaction. Washington: IOS Press.
Rothbaum, B. O., Hodges, L., Anderson, P. L., Price, L., & Smith, S. (2002). Twelve-month follow-up of virtual reality and standard exposure therapies for the fear of flying. Journal of Consulting and Clinical Psychology, 70(2), 428–432.
Schwartz, C., Houlihan, D., Krueger, K. F., & Simon, D. A. (1997). The behavioral treatment of a young adult with post traumatic stress disorder and a fear of children. Child and Family Behavior Therapy, 19(1), 37–49.
Spielberger, C. D. (1983). Test manual for the State-Trait Anxiety Inventory. Palo Alto: Consulting Psychology Press.
Szymanski, J., & O’Donoghue, W. (1995). Fear of spiders questionnaire. Journal of behaviour Therapy and Experimental Psychiatry, 26(1), 31–34.
Teachman, B. A., & Woody, S. R. (2003). Automatic processing in spider phobia: Implicit fear associations over the course of treatment. Journal of Abnormal Psychology, 112(1), 100–109.
Thorpe, S. J., & Salkovskis, P. M. (1997). The effect of one-session treatment for spider phobia on attentional bias and beliefs. British Journal of Clinical Psychology, 36, 225–241.
Van den Hout, M., Tenney, N., Huygens, K., & de Jong, P. (1997). Preconscious processing bias in specific phobia. Behaviour Research and Therapy, 35(1), 29–34.
Walshe, D. G., Lewis, E. J., Kim, S. I., O’Sullivan, K., & Wiederhold, B. K. (2003). Exploring the use of computer games and virtual reality in exposure therapy for fear of driving following a motor vehicle accident. CyberPsychology and Behavior, 6(3), 329–334.
Watts, F. N., McKenna, F. P., Sharrock, R., & Trezise, L. (1986). Colournaming of phobia-related words. British Journal of Psychology, 77, 97–108.
Wiederhold, B. K., Gevirtz, R., & Spira, J. L. (2001). Virtual reality exposure therapy vs. Imagery desensitization therapy in the treatment of flying phobia. In G. Riva & C. Galimberti (Eds.), Towards cyberpsychology: Mind, cognition and society in the internet age. Amsterdam, Antilles: IOS Press.
Williams, J. M. G., Mathews, A., & MacLeod, C. (1996). The emotional Stroop task and psychopathology. Psychological Bulletin, 120(1), 3–24.
Witmer, B. G., & Singer, M. J. (1998). Measuring presence in virtual environments: A presence questionnaire. Presence, 7(3), 225–240.
About this article
Cite this article
Côté, S., Bouchard, S. Documenting the Efficacy of Virtual RealityExposure with Psychophysiological andInformation Processing Measures. Appl Psychophysiol Biofeedback 30, 217–232 (2005). https://doi.org/10.1007/s10484-005-6379-x
- information processing
- heart rate
- virtual reality