Anti-phobic and Safety Behaviors in the Treatment of Acrophobia

Not Applicable

• Conditions: Specific Phobia
• Interventions: Behavioral: EXP; Behavioral: EXP + SBF; Behavioral: EXP + SBF + AA

• Registration Number: NCT02085343
• Lead Sponsor: University of Texas at Austin

Brief Summary

This study tests whether a single session of exposure therapy may be enhanced by the addition of anti-phobic actions beyond the mere fading of safety behaviors. A total of 100 acrophobic participants will be randomly assigned to receive standard exposure therapy (EXP), exposure therapy with safety behavior fading (EXP + SBF), exposure with safety behavior fading and anti-phobic actions (EXP + SBF + AA), or to a wait-list control group (WL).

Detailed Description

This study tests whether a single session of exposure therapy may be enhanced by the addition of one of two augmentation strategies, including engagement in anti-phobic actions and fading of safety behaviors. Because utilization of safety behaviors is functionally precluded by anti-phobic action, the present study design will both replicate and extend prior research by addressing whether anti-phobic actions enhance exposure therapy beyond the mere fading of safety behaviors. A total of 100 individuals between the ages of 18 and 65 meeting DSM-IV criteria for acrophobia (fear of heights) will be randomly assigned to one of four conditions including (1) standard exposure therapy, (2) exposure therapy with safety behavior fading, (3) exposure therapy with safety behavior fading and anti-phobic actions, and (4) a wait-list control condition. All participants will complete an online prescreen and face-to-face screening assessment to determine eligibility and pre-treatment symptom severity. Participants will also complete assessments at post-treatment and 1-month follow-up assessments. Subjective fear during two behavioral approach tests (in the treatment and generalization context, respectively) conducted at pre-treatment, post-treatment, and 1-month follow-up assessments will serve as the primary measure of treatment outcome. Additionally, a battery of self-report questionnaires will be completed at pre-treatment, during treatment, at post-treatment, and at a 1-month follow-up assessment.

Study Timeline

• Study Start: 2013-02
• Study First Submitted: 2014-01-22
• Study First Submitted QC: 2014-03-10
• Study First Posted: 2014-03-12
• Status Verified: 2017-11
• Last Update Submitted: 2017-11-12
• Last Update Posted: 2017-11-14
• Primary Completion: 2018-03
• Study Completion: 2018-05

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 100

Inclusion Criteria

1. Age 18 to 65.
2. Fluent in English (written and spoken). This is required because assessment instruments are validated only in English.
3. Meet DSM-IV criteria for specific phobia, natural environment type, with acrophobic concerns, based on the Composite International Diagnostic Interview (CIDI-Auto; World Health Organization, 1997).
4. Report moderate fear or avoidance (i.e., a score of 30 or higher) on a modified version of the Acrophobia Questionnaire (AQ; Cohen, 1977).
5. Exhibit at least moderate fear (i.e., a fear score of 50 or higher, where 0 = no fear and 100 = extreme fear) during two behavioral approach tests (BATs) consisting of ascending two moderately challenging flights of stairs.

Exclusion Criteria

1. Medical condition(s) which may prevent safely climbing or descending stairs or walking for more than 15 minutes at a time (It will be necessary to walk to different sites for the behavioral approach tests).

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
EXP	EXP	Standard therapist-guided in vivo exposure therapy (EXP)
EXP + SBF + AA	EXP	Exposure therapy (EXP) with safety behavior fading (SBF) and anti-phobic action (AA)
EXP + SBF	EXP	Exposure therapy (EXP) with safety behavior fading (SBF)
EXP + SBF	EXP + SBF	Exposure therapy (EXP) with safety behavior fading (SBF)
EXP + SBF + AA	EXP + SBF + AA	Exposure therapy (EXP) with safety behavior fading (SBF) and anti-phobic action (AA)
EXP + SBF + AA	EXP + SBF	Exposure therapy (EXP) with safety behavior fading (SBF) and anti-phobic action (AA)

Primary Outcome Measures

Name	Time	Method
Peak subjective fear (0 - 100) upon exposure to heights in the generalization context.	Pre-treatment (1 week before treatment), treatment (1 week after pre-treatment), post-treatment (immediately following treatment), and follow-up (1 month after treatment).	Peak subjective fear ratings (0 - 100).

Secondary Outcome Measures

Name	Time	Method
Acrophobia Questionnaire - Modified (Cohen, 1977; Wolitzky & Telch, 2009)	Pre-treatment (1 week before treatment), treatment (1 week after pre-treatment), post-treatment (immediately following treatment), and follow-up (1 month after treatment).	20-item Likert-type scale assessing acrophobic symptoms
Height estimation task	Pre-treatment (1 week before treatment), treatment (1 week after pre-treatment), post-treatment (immediately following treatment), and follow-up (1 month after treatment).	Perceptual task requiring estimation of height from the top of a flight of stairs
Heart rate	Pre-treatment (1 week before treatment), treatment (1 week after pre-treatment), post-treatment (immediately following treatment), and follow-up (1 month after treatment).	Heart rate reactivity assessed using a Polar Heart Rate Monitor.
Treatment Process Questionnaire	Treatment (1 week following pre-treatment assessment)	Self-efficacy, anticipated anxiety, anticipated danger, and utilization of safety behaviors assessed via self-report.

Trial Locations

Locations (1)

The University of Texas at Austin; 🇺🇸 Austin, Texas, United States