Fear of spiders, or Arachnophobia, is one of the most common specific phobias. The gold standard treatment, in vivo exposure therapy, is effective, but comes with significant limitations, including ...restricted availability, high costs, and high refusal rates. Novel technologies, such as augmented reality, may help to overcome these limitations and make Exposure Therapy more accessible by using mobile devices. This study will use a Randomized Controlled Trial design to investigate whether ZeroPhobia: Arachnophobia, a 6-week Augmented Reality Exposure Therapy smartphone self-help application, can effectively reduce spider phobia symptoms. Additionally, we will examine user-friendliness of the application and the effect of usage intensity and presence on treatment outcome. This study is registered in the Netherlands Trial Registry under NL70238.029.19 (Trial NL9221). Ethical approval was received on October 11, 2019. One-hundred-twelve participants (age 18-64, score greater than or equal to 59) on the Fear of Spiders Questionnaire FSQ will be recruited from the general Dutch population and randomly assigned to a treatment or waitlist control group. The ZeroPhobia application can be accessed on users' smartphone. Baseline, post-test (i.e., at six weeks), 3- and 12-month follow-up assessments will be done, each including the Fear of Spiders Questionnaire as the main outcome measure as well as additional measures of anxiety, depression, user-friendliness, and presence as secondary measures and covariates. The study was funded on September 25, 2018. Data collection started in September 2021 and the study is expected to run until September 2022. Our study will improve our understanding of the efficacy and feasibility of providing Exposure Therapy for spider phobia using an Augmented Reality self-help application, with the intention of making mental health care more accessible.
Posttraumatic stress disorder (PTSD) is effectively treated with eye movement desensitization and reprocessing (EMDR) with patients making eye movements during recall of traumatic memories. Many ...therapists have replaced eye movements with bilateral beeps, but there are no data on the effects of beeps. Experimental studies suggest that eye movements may be beneficial because they tax working memory, especially the central executive component, but the presence/degree of taxation has not been assessed directly. Using discrimination Reaction Time (RT) tasks, we found that eye movements slow down RTs to auditive cues (experiment I), but binaural beeps do not slow down RTs to visual cues (experiment II). In an arguably more sensitive “Random Interval Repetition” task using tactile stimulation, working memory taxation of beeps and eye movements were directly compared. RTs slowed down during beeps, but the effects were much stronger for eye movements (experiment III). The same pattern was observed in a memory experiment with healthy volunteers (experiment IV): vividness of negative memories was reduced after both beeps and eye movements, but effects were larger for eye movements. Findings support a working memory account of EMDR and suggest that effects of beeps on negative memories are inferior to those of eye movements.
Evidence-based psychological interventions exist for individuals with obsessive-compulsive disorder (OCD), but many individuals with OCD are unable to access them because of barriers, such as ...geographical isolation, treatment cost, and stigma etc. Unguided self-help psychological intervention has emerged as a potential solution to this problem. However, there is limited research on its overall effectiveness. This study aimed to address this gap.
Comprehensive searches from inception to 1st Jan 2023 were conducted in both international (PubMed, Embase, PsycINFO, International clinical trials registry platform of WHO) and Chinese (China National Knowledge Infrastructure, WeiPu, WanFang, Chinese Clinical Trial Registry) databases. The registered protocol is accessible at https://doi.org/10.17605/OSF.IO/FKB5W. We included randomized controlled trials (RCTs) comparing unguided self-help psychological interventions to control groups for individuals with OCD. The primary outcome was OCD symptom severity, with Hedges' g calculated post-intervention. Heterogeneity was deemed to be low, moderate, and high if the I2 value was quantified 25%, 50%, and 75% respectively. Relative Risks (RRs) was calculated for dropout rates post-intervention. Random-effects models were used for all analyses.
12 RCTs comparing unguided self-help psychological interventions to control groups were identified, with a total of 20 comparisons and 769 OCD patients. Overall, unguided self-help psychological interventions demonstrated a significant moderate effect on reducing OCD symptom severity (g = −0.42; 95% CI −0.69; −0.14) compared to control groups, with a moderate heterogeneity (I2 = 59%; 95% CI 22.73; 78.38). This finding remained significant in sensitivity analyses for the self-rated Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; k = 7, g = −0.46; 95% CI −0.71; −0.2) and after removing an outlier (g = −0.37; 95% CI −0.55; −0.19), but not for the clinician-rated Y-BOCS (k = 4, g = −0.78; 95% CI −2.75; 1.19) and Obsessive Compulsive Inventory-Revised (k = 6, g = −0.26; 95% CI −0.53; 0). Subgroup analyses revealed a significant difference in effect size between studies conducting intention-to-treat and completers-only analyses (p = .01). The completers-only analyses demonstrated a moderate significant effect (g = −0.65; 95% CI −1.08; −0.21), whereas the effect of the intention-to-treat analyses was not significant (g = −0.18; 95% CI −0.36; 0). Participants in the unguided self-help groups exhibited a significantly higher dropout rate (RR = 2.08; 95% CI 1.53; 2.81) compared to control groups. Furthermore, participants recruited from the community had a higher likelihood of dropping out compared to those recruited from clinical settings (p < .001). Additionally, participants who received cognitive-behavioural therapy intervention were more likely to drop out than those who received other types of intervention (p < .001). Most trials (92%) were rated at a high risk of bias.
Unguided self-help psychological interventions demonstrate potential effectiveness in alleviating OCD symptom severity post-intervention. However, caution should be exercised when interpreting the results due to high risk of bias across trials and the relatively small sample size. And the considerable dropout rate might hinder treatment effects. Future studies with strict methodology should investigate the long-term effectiveness of unguided self-help psychological interventions for OCD, explore the reasons for high dropout rates, and improve intervention adherence.
•Unguided self-help psychological interventions is a promising way to treat OCD.•The way to handle missing data significantly affects treatment effect.•Unguided self-interventions exhibited significantly higher dropout rates.•Intervention type and participant recruitment method affect dropout rates
Eye Movement Desensitization and Reprocessing (EMDR) is an effective treatment for posttraumatic stress disorder (PTSD). During EMDR, patients make eye movements (EMs) while recalling traumatic ...memories, but recently therapists have replaced EMs by alternating beep tones. There are no outcome studies on the effects of tones. In an earlier analogue study, tones were inferior to EMs in the reduction of vividness of aversive memories. In a first EMDR session, 12 PTSD patients recalled trauma memories in three conditions: recall only, recall + tones, and recall + EMs. Three competing hypotheses were tested: 1) EMs are as effective as tones and better than recall only, 2) EMs are better than tones and tones are as effective as recall only, and 3) EMs are better than tones and tones are better than recall only. The order of conditions was balanced, each condition was delivered twice, and decline in memory vividness and emotionality served as outcome measures. The data strongly support hypothesis 2 and 3 over 1: EMs outperformed tones while it remained unclear if tones add to recall only. The findings add to earlier considerations and earlier analogue findings suggesting that EMs are superior to tones and that replacing the former by the latter was premature.
► EMDR is often used with beep tones instead of eye movements. ► There are no outcome data on the effects of tones. ► Theoretical considerations and earlier analogue findings suggest that tones are inferior. ► In 12 PTSD patients' tones and eye movements were compared. ► Eye movements outperformed tones.
Abstract This study investigated whether checking behavior, the most common safety behavior in obsessive–compulsive disorder (OCD), contributes to the development of OCD symptoms. Ninety healthy ...undergraduates spent a week between a pre- and posttest either actively engaging in clinically representative checking behavior on a daily basis (experimental group, n = 30), monitoring their normal checking behavior (monitor group, n = 30), or received no instructions on checking behavior (control group, n = 30). Cognitions about the severity of threat increased from pre- to posttest in the experimental group, but not in the monitor and control groups. Cognitions about the importance of checking decreased in the monitor group. The results indicate that checking behavior contributes directly to the exacerbation of OCD symptoms. Together with the findings of previous studies, this suggests that safety behavior may be involved in the development of anxiety disorders and OCD. Potential mechanisms of how engaging in safety behavior increases threat perception are discussed.
According to the Proust phenomenon, olfactory memory triggers are more evocative than other-modality triggers resulting in more emotional and detailed memories. An experimental paradigm was used to ...investigate this in aversive memories, similar to those experienced by patients with posttraumatic stress disorder. Seventy healthy participants watched an aversive film, while simultaneously being exposed to olfactory, auditory and visual triggers, which were matched on intensity, valence, arousal and salience. During a second session one week later, participants were randomly exposed to one of the three triggers, and asked to think back about the film and to rate the resulting memory. Results revealed that odour-evoked memories of aversive events were more detailed, unpleasant and arousing than memories evoked by auditory, but not visual, triggers.
Abstract Patients with obsessive-compulsive disorder (OCD) not only respond to obsessions with perseverative checking, but also engage in more general checking, irrespective of their obsessive ...concerns. This study investigated whether general checking is specific to OCD and exacerbated when only mild uncertainty is induced. Thirty-one patients with OCD, 26 anxiety- and 31 healthy controls performed a visual search task with eye-tracking and indicated in 50 search displays whether a target was “present” or “absent”. Target-present trials were unambiguous, whereas target-absent trials induced mild uncertainty, because participants had to rely on not overlooking the target. Checking behavior was measured by assessing search time and the number of fixations, measured with an eye-tracker. Results showed that in both target-present and target-absent trials patients with OCD searched longer and made more fixations than healthy and anxiety controls. However, the difference in checking behavior between patients with OCD and the control groups was larger in target-absent trials (where mild uncertainty was induced). Anxiety and healthy controls did not differ in checking behavior. Thus, mild uncertainty appears to specifically promote checking in patients with OCD, which has implications for treatment.
Abstract Background and objectives Safety behaviours are widely held to impede the beneficial effects of exposure, certainly in OCD. Recently, Rachman, Radomsky, Shafran, and Zysk (2011) challenged ...this view. Healthy volunteers repeatedly touched a contaminant in two sessions. Half of the participants did not engage in safety behaviours after touching (exposure + response prevention), while the other half did (exposure + safety behaviours, i.e., cleaning hands with a hygienic wipe). Scores of contamination, fear, danger, and disgust decreased in both sessions and the effects were not impeded by safety behaviours. Three potential artefacts were identified in the Rachman et al. study: a no-treatment control group was lacking, the stop rules for ending exposure differed between conditions, and positive expectations may have been induced in the safety behaviours group. We tried to critically replicate the main findings. Method The Rachman et al. (2011) study was replicated, with 44 volunteers but stop rules and expectations were similar between treatments, and effects were also assessed in a no-intervention control group. Results Relative to the control condition, both exposure interventions induced reliable decreases in feelings of contamination, fear, danger, and disgust. The decline followed an exponential curve with the largest gains at the first trials of each session. Limitations Findings were obtained from a non-clinical sample. Conclusion The findings attest to the robustness of the Rachman et al. findings, and challenge the notion that safety behaviours should be dismissed categorically in exposure treatments.
Abstract Background and objectives Extensive research has shown that repeated checking causes memory distrust. Therefore, it has been suggested that people may subsequently get into a vicious cycle ...of decreased memory confidence and increased checking behavior, which may play a role in the maintenance and development of OCD. This study investigated in two experiments how repeated checking influences memory distrust over multiple checking episodes. Methods In experiment 1, 70 healthy undergraduates performed two sessions of a virtual checking task with a 30 min break in between. In experiment 2, 41 healthy undergraduates performed two sessions of the checking task on a real kitchen stove and sink. Results Results of experiment 1 showed that memory confidence for checking the stove decreased after repeated checking in session 1, and remained low in session 2, but memory vividness and detail decreased in both sessions and recovered in between. In experiment 2, all three meta-memory ratings for checking the stove decreased after repeated checking in both sessions, but recovered in between. Limitations Future research may include patients with OCD. To further investigate the development of memory distrust over time, more checking episodes may be included and the time between sessions may be increased. Although replication is needed, the findings of experiment 2 seem more informative. Conclusions Repeated checking may decrease memory vividness and detail (and, in turn, presumably also decrease memory confidence) each time this counterproductive strategy is used, which may have implications for using this paradigm as a behavioral experiment in cognitive-behavioral therapy.
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