A comparison of virtual reality vs. imaginal exposure for aviophobia on measures of anxiety and presence

Abstract

Aviophobia affects an individual's personal life, business opportunities, and overall quality oflife. It may prevent individuals from visiting distant family or friends, traveling for enjoyment, and obtaining jobs that require travel. Previous literature estimates that 10 to 50% ofthe population is affected by Aviophobia, or fear offlying (Agras, Sylvester, & Oliveau, 1969; Magee, Eaton, Wittchen, McGonagle, & Kessler, 1996; Van Gerwen & Diekstra, 2000). Both past and current literature strongly supports exposure-based methods for treating flying phobia. Due to cost, time, and security measures in airports, conducting in-vivo exposure therapy is not always possible or accessible. Imaginai exposure therapy can be implemented, but has several limitations. For instance, some patients are unable, due to poor imagination, inability to suspend disbelief or poor concentration abilities, or unwilling, to go through the imaginai procedure. Furthermore, therapists require training to become skilled at conducting the imagery scenes. As an alternative to imaginai exposure therapy, researchers have developed simulated computer flight experiences, incorporating the use of virtual reality technology. Advanced computer technology provides a new medium to conduct exposure therapy. The Virtual Reality (VR) head-mounted display and other high tech equipment allow patients to experience a virtual airport and airport-related scenes using as many as five human senses. VR exposure attempts to create a sense of presence within a three dimensional computer-generated world thus having "the subjective experience of being in one place or environment, even when one is physically situated in another" (Witmer & Singer, 1998, p. 225). While the concept ofpresence is suggested to be an important part ofthe VR experience, it has been inconsistently measured, resulting in conflicting findings. This is particularly applicable to the extent to which the concept of presence is similar to, or different from, anxiety during a VR session. The purpose ofthe current study was to compare VR exposure versus imaginai exposure on measures offlight related anxiety. Additionally, the current researcher explored whether sitting in an actual airplane chair had an effect on the level of anxiety reported by participants compared to sitting in a regular office chair. Finally, the extent to which anxiety was correlated with presence was examined. Sixty undergraduate students were recruited from Hofstra University. Qualification requirements were a total score of 56 or higher on the Flight Anxiety Situations Questionnaire, and answering "yes" to the experimenter's question, "Are you afraid offlying" (Nousi, Van Gerwen, & Spinoven, 2009). The study was a 2x2 randomized between subjects' design, with the independent variables being type of exposure (Virtual Reality or Imaginai) and type of chair (airplane or regular). The dependent variables were defined as the average level of anxiety as measured by a Subjective Units of Distress Scale (Wolpe, 1969; SUDs) taken during multiple points throughout the exposure sessions, and number of objective behavioral observations obtained through a behavioral coding system (Hoffman, 2009). The relationship between anxiety and presence was assessed through a correlation. Results suggest that imaginai exposure therapy led participants to rate a higher average subjective level of anxiety, and to engage in more observed fidgeting behavior than did those in the VR exposure condition. No significant differences were found for other observed anxiety behaviors. Furthermore, significant differences were not identified between groups for type of chair on either average SUDs or observed anxiety behaviors. Anxiety, as measured by average SUDs, was correlated with Spatial Presence, Engagement, and Ecological/ Naturalness Presence. A relationship between Ecological/Naturalness Presence and observed fidgeting was found. Furthermore, verbalized anxiety was correlated with Spatial Presence. Implications for the treatment of aviophobia are discussed