Efficacy of an internet-based exposure treatment for flying phobia (NO-FEAR Airlines) with and without therapist guidance: a randomized controlled trial

Daniel Campos,Soledad Quero,Cristina Botella,Juana Bretón-López,Sonia Mor,Adriana Mira,Rosa Baños,Diana Castilla

doi:10.1186/s12888-019-2060-4

Abstract

BackgroundInternet-based treatments appear to be a promising way to enhance the in vivo exposure approach, specifically in terms of acceptability and access to treatment. However, the literature on specific phobias is scarce, and, as far as we know, there are no studies on Flying Phobia (FP). This study aims to investigate the effectiveness of an Internet-based exposure treatment for FP (NO-FEAR Airlines) that includes exposure scenarios composed of images and sounds, versus a waiting-list control group. A secondary aim is to explore two ways of delivering NO-FEAR Airlines, with and without therapist guidance.MethodsA randomized controlled trial (RCT) was conducted in which 69 participants were allocated to: 1) NO-FEAR Airlines totally self-applied, 2) NO-FEAR Airlines with therapist guidance, 3) a waiting-list control group. Primary outcome measures were the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes included the Fear and Avoidance Scales, Clinician Severity Scale, and Patient’s Improvement scale. Behavioral outcomes (post-treatment flights and safety behaviors) were also included. Mixed-model analyses with no ad hoc imputations were conducted for primary and secondary outcome measures.ResultsNO-FEAR Airlines (with and without therapist guidance) was significantly effective, compared to the waiting list control group, on all primary and secondary outcomes (all ps < .05), and no significant differences were found between the two ways of delivering the intervention. Significant improvements on diagnostic status and reliable change indexes were also found in both treatment groups at post-treatment. Regarding behavioral outcomes, significant differences in safety behaviors were found at post-treatment, compared to the waiting list. Treatment gains were maintained at 3- and 12-month follow-ups.ConclusionFP can be treated effectively via the Internet. NO-FEAR Airlines helps to enhance the exposure technique and provide access to evidence-based psychological treatment to more people in need. These data are congruent with previous studies highlighting the usefulness of computer-assisted exposure programs for FP, and they contribute to the literature on Internet-based interventions. To the best of our knowledge, this is the first RCT to investigate the effectiveness of an Internet-based treatment for FP and explore two ways of delivering the intervention (with and without therapist guidance).Trial registrationClinicaltrials.gov: NCT02298478 (https://clinicaltrials.gov/ct2/show/NCT02298478). Trial registration date 3 November 2014.

Highlights

Internet-based treatments appear to be a promising way to enhance the in vivo exposure approach, in terms of acceptability and access to treatment
The aim of this study is to investigate the effectiveness of an Internet-based exposure treatment for Flying Phobia (FP) (NO-FEAR Airlines) that includes exposure scenarios composed of images and real sounds, versus a waiting list control group, in a randomized controlled trial (RCT)
Study design This study was a randomized controlled trial (RCT), in which participants were randomly allocated to three groups: 1) Internet-based exposure treatment for FP without therapist guidance (NO-FEAR Airlines totally self-applied, NFA); 2) Internet-based exposure treatment for FP with therapist guidance (NO-FEAR Airlines with therapist guidance, NFA + Therapist guidance (TG)); and 3) a waiting list (WL) control group

Summary

Introduction

Internet-based treatments appear to be a promising way to enhance the in vivo exposure approach, in terms of acceptability and access to treatment. For FP, evidence indicates that more than 90% of participants whose treatment included in vivo exposure continued to fly at one- to four-year follow-up [8]. Despite this evidence, the in vivo exposure technique is linked to several limitations in its implementation, such as low acceptance among therapists and patients and difficulties in accessing the treatment. Two issues that are important in FP treatment are the economic cost of in vivo exposure and the additional difficulty of applying the exposure technique in an appropriate way (controlling important variables such as the duration of the exposure or the number of sessions) - due to the limited access to the feared stimulus (i.e., airport or airplane) [15]

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