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January 16, 2001

Rothbaum looks to 'virtually'
cure fear of flying

By Heather Szafranski

Virtual reality exposure therapy (VRE) is a potentially efficient and cost-effective treatment for fear of flying, according to a study published in the December issue of the Journal of Consulting and Clinical Psychology.

“Fear of flying is a significant problem, affecting about 25 million adults in the United States,” said Barbara Rothbaum, principal investigator of the study and associate professor of psychiatry and behavioral sciences. “Avoidance of flying causes sufferers serious vocational and social consequences.”

Virtual reality offers a new human-computer interaction paradigm in which users are no longer simply external observers of images on a computer screen, but are active participants within a computer-generated, three-dimensional virtual world.

“The most effective treatment for fears and phobias is to expose the sufferer to the feared object in a therapeutic manner,” Rothbaum said. “Exposure most often occurs when patients imagine the feared situation—imaginal exposure—and/or put themselves in the actual situation—in vivo exposure—until the fear subsides.

“The obvious drawbacks of these two methods,” she continued, “are lack of realism [with imaginal exposure] and higher cost, greater impracticality and reluctance with in vivo exposure. Virtual reality technology offers the potential to make exposure more realistic than imaginal exposure and more practical than in vivo exposure.”

For their research, Rothbaum’s team studied 49 patients, ages 24 to 69, with fear of flying and assigned them to one of three groups: VRE, standard exposure (SE) or wait list (WL). Forty-five patients completed the study, and, in addition to standard pre- and post-treatment methods and follow-ups at six and 12 months post-treatment, a post-treatment test flight was conducted to assess participants’ anxiety and avoidance for an actual airplane flight.

After it was determined that participants met certain criteria to participate in the study, they were treated for eight individual sessions over six weeks. VRE treatments comprised simulations of sitting in an airplane, airplane take-offs and landings, and flying in both calm and stormy weather, and they were provided twice weekly for two weeks according to a treatment manual designed by the researchers. The treatments included recorded sounds of flight attendants, takeoffs, landings and weather effects outside the airplane.

Participants sat in a specially designed seat with an embedded 100-watt subwoofer and an attached airplane seatbelt. VR-generated scenes placed participants in a passenger seat by the window on a commercial airplane. As they moved their heads to the left, they were able to see out the left-hand window. As they moved their heads to the right, the empty seats to the right side of the airplane and the right-side window came into view.

At six months after treatment, 11 of 14 VRE participants and nine of 13 SE parti-cipants had flown since the graduation flight of the study. Overall, by the six-month followup, 14 of the 15 remaining VRE and SE participants had flown since the termination of treatment, either on the graduation flight or otherwise.

Results of this study indicated that VRE and SE treatments were equally effective both in decreases in symptoms, as measured by standardized questionnaires, and by the number of participants able to fly on a real airplane following treatment.

In addition, anxiety ratings during the actual flight indicated that VRE-treated patients were as comfortable as SE-treated patients. When WL participants were asked to choose which treatment they would receive, an overwhelming majority of participants chose VRE, indicating a clear



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