Augmented Reality Exposure Therapy Research Articles

The efficacy of augmented reality exposure therapy in the treatment of spider phobia-a randomized controlled trial.

The evidence for the use of Augmented Reality (AR) in treating specific phobias has been growing. However, issues of accessibility persist, especially in developing countries. The current study examined a novel, but relatively simple therapist guided smartphone-based AR Exposure Treatment (ARET) of spider phobia. Participants who reported symptoms of Arachnophobia were randomized into one of three comparison groups: ARET (n = 20), traditional in vivo exposure therapy (IVET; n = 18) and a waitlist control group (n = 17). Behavioral approach, subjective symptom measures, and galvanic skin response were assessed pre- and post-treatment. The study was concluded with a one-month follow up assessment. Results indicated that both treatment groups showed statistically significant and clinically meaningful improvements in behavioral approach at post-test that were maintained at 1 month follow- up, compared to the wait-listed group. Moreover, the treatment groups demonstrated significant improvements in subjective symptom report at 1-month follow up. Given its utility and potential accessibility, our findings suggest that future AR evaluation research could be conducted in therapy settings with minimal resources.

The Efficacy and Therapeutic Alliance of Augmented Reality Exposure Therapy in Treating Adults With Phobic Disorders: Systematic Review.

Phobic disorders are characterized by excessive fear of a stimulus that can affect the quality of a patient's life. The lifetime prevalence in adults is 7.7% to 12.5%. The current literature provides evidence-based inferences about the effectiveness of in-vivo exposure therapy (IVET) in treating phobia. However, this method can put the therapist and the client in danger, with high drop out and refusal rates. A newer approach for exposure therapy using augmented reality technology is under assessment. This systematic review investigated the novel technology's efficacy, cost-efficacy, and therapeutic alliance in treating adults with phobia. An extensive search was conducted using 4 major databases (MEDLINE, PsycINFO, Embase, and Scopus) using a comprehensive list of synonyms for augmented reality exposure therapy (ARET) and phobic disorders. The search targeted any randomized control trial testing ARET in adults with phobic disorders up to August 8, 2022. A total of 6 studies were included, with 208 participants providing results. Studies investigating the efficacy of ARET compared to no intervention showed significant results (P<.05) in the ARET group improvement. Head-to-head comparative studies comparing ARET to IVET showed no significant difference (P>.05) in the effectiveness and therapeutic alliance between both therapies. Further, the results demonstrated that the ARET group had a better long-term effect than IVET, with the ability to put the patients in more situations to face the feared object. The current data suggest clinically significant efficacy and a promising therapeutic alliance of ARET. However, no data are available investigating the cost-effectiveness of ARET. Further research is warranted to ascertain ARET's cost-effectiveness and examine its efficacy in other populations and anxiety conditions.

Effects of Augmented Reality Exposure Therapy Combined with Cognitive Intervention on Cat Phobia

Effects of Augmented Reality Exposure Therapy Combined with Cognitive Intervention on Cat Phobia

The Medical Metaverse, Part 1: Introduction, Definitions, and New Horizons for Neuropsychiatry.

Back to table of contents Next article Windows to the BrainFull AccessThe Medical Metaverse, Part 1: Introduction, Definitions, and New Horizons for NeuropsychiatryWilfredo López-Ojeda, M.S., Ph.D., and Robin A. Hurley, M.D.Wilfredo López-OjedaSearch for more papers by this author, M.S., Ph.D., and Robin A. HurleySearch for more papers by this author, M.D.Published Online:12 Jan 2023https://doi.org/10.1176/appi.neuropsych.20220187AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Editor’s note: This report is the first of a two-part series introducing the concepts of the medical metaverse. Part 1 covers the basic definitions and its current utility in mental health care. Part 2 will address the metaverse as it relates to clinical neurosciences and will appear in a subsequent issue of The Journal of Neuropsychiatry and Clinical Neurosciences.The “metaverse” was initially used in literature by the science fiction writer Neal Stephenson in his 1992 dystopian novel Snow Crash (8, 9). The metaverse denotes a digital platform as a new and alternative environment manifested through digital content delivered via advanced technological devices employing artificial intelligence (AI) (2). This platform encompasses highly immersive and collaborative environments based on three-dimensional and real-time digital worlds in which multiple users can engage in activities (e.g., social, economic, and cultural). The users interact via avatars in versatile settings without physical limitations (10, 11). A metaverse research organization, the Acceleration Studies Foundation (ASF), proposed thinking about the metaverse as a link or connection point between the real and virtual worlds (2, 12). In the metaverse, however, users are not limited by the typical rules of nature (e.g., age, gender, appearance, and species). Freedom from other restrictions, such as time and space, is also enabled by virtual reality (VR) technologies (both hardware and software). Thus, individuals can engage in a wide array of activities that are impossible in real life (2).Metaverse TechnologiesThe cybernetic progression continues to advance with support from major technology companies. According to the literature, within the next 5 years tens of billions of dollars will be invested to expand currently available platforms (13). This rapid progression of core technologies, including AI, “big data,” the Internet of things (IoT), edge computing, blockchain, digital twins (DT), extended reality (XR), and high-speed 5G Internet networks, underpins the metaverse’s existence, advancement, and sustainability (14–18). The coronavirus disease 2019 (COVID-19) pandemic stimulated additional advances (2). Therefore, it is necessary to understand the concept of the metaverse, its nuances, and its applications for medical education and health care delivery (19).According to the ASF, the metaverse roadmap distinguishes technologies along two separate dimensions, augmentation versus simulation and intimate versus external, to characterize four general types of metaverse technologies: augmented reality (AR), lifelogging, mirror worlds, and virtual worlds (1). In the metaverse, augmentation and simulation are defined by whether the information is presented in physical reality (via AR) or in VR (via simulation) (Figures 1 and 2) (1, 2). Conversely, intimate (identity-focused) technologies are centered on the actions of the individual or object; for example, the user or object (i.e., semi-intelligent object) engages by using an avatar or digital profile. In contrast, the external (world-focused) technologies are centered on the outside world, and they typically focus on the control of aspects of the surrounding world, such as the ability to provide information about the conditions of the external environment and how the user can control these conditions (Figures 1 and 2) (1, 2).FIGURE 1. Quadrant-based metaverse diagram.The horizontal axis includes metaverse technologies that facilitate the empirical relationship between technology and user. The left side reflects the external environment, and the personalized experience of the user is intensified toward the right, intimate side (1, 2). In the external milieu, the surrounding world is emphasized, and this outward perspective is user centered and provides guidance to the user on how to engage with these environmental features. The intimate element of the metaverse provides an inward perspective and focuses on individualized behaviors guided by customized data. The vertical axis includes technologies that exemplify the relationship between reality and innovation. Augmentation increases the human sensory experience by incorporating new functions into the real-world environment via visual, auditory, and other sensory stimuli. Conversely, simulation duplicates the real world by modeling reality in a virtual world (1, 2).FIGURE 2. Four categories of metaverse technology.A. Augmented reality (AR). AR uses virtual imaging and fetching technologies to integrate digital information into the real-world environment (3). B. Lifelogging. This technology obtains digital records of the user’s personal data (e.g., heart rate, breathing, and sleep patterns) by capturing, storing, and sharing information by using multimodal digital sensors integrated in high-tech devices, such as smart watches, smart phones, and wearables (2, 4). C. Mirror worlds. In this type of technology, the real world is depicted (i.e., simulated) with digital innovations (e.g., satellites and interactive software) to reflect the characteristics of the external world in the cybernetic world. These simulations replicate an accurate version of the real-world structures and human environments (i.e., mirror duplicates). Google Earth, Foldit, and Microsoft Teams are examples of digital applications simulating mirror worlds (2, 5, 6). D. Virtual worlds. The virtual world incorporates virtual reality (VR) technology. In VR, the user is fully immersed and is completely blinded to the real environment; this immersion is facilitated by a head-mounted display (digital lenses) in which the user receives visual, auditory, and other sensory inputs (1, 2, 7).COVER. Artistic depiction of the medical metaverse. On the right, various technologies of the digital biomedical world. On the left, the head-mounted display lenses and the brain symbolize the immersive experience of extended reality and its role in the metaverse.All images created under the terms of the Creative Commons Attribution License. Created with VH Dissector, Canva, and BioRender.com.Medical MetaverseMetaverse technologies have opened new horizons for innovations in medicine. Medical education and health care practices are embracing technological advancements to improve patient care (2, 20–22). A wide range of subspecialties, such as cardiology, emergency medicine, gastroenterology, gynecology, oncology, ophthalmology, and radiology, are employing metaverse technologies (4, 22–26). Mental health disciplines are also benefiting from metaverse innovations, specifically XR technologies (VR, AR, and mixed reality) (27). VR technologies are among the most widely used advances in mental health interventions. VR exposure therapy (VRET) and AR exposure therapy have proven effective in treating specific phobias, posttraumatic stress disorder (PTSD), anxiety, attention-deficit hyperactivity disorder, substance-related disorders, depression, and eating disorders (20, 28–31).VRET employs psychotherapeutic immersive paradigms that provide multisensory VR experiences to amplify the patient’s experiential engagement during treatment sessions (27). VRET interventions are effective in reducing PTSD symptoms of active-duty and combat soldiers after military trauma (32, 33). XR therapeutic benefits are based partly on its immersive capabilities that allow experiences at a digital multisensorial level and integrate a seamless human-computer interface (27). Deepak Chopra indicated that “the metaverse guides us past the notion that mind, body, and spirit are separate” because the metaverse incorporates technologies (e.g., AR and VR) to rectify one’s dysfunctional reality by using virtual (functional) reality (34). VR innovations allow for the reproduction of transcendental experiences (e.g., delivering joy, distraction, and positive affect in a soothing environment) (34–36). Higher-level cognitive functions (e.g., decision making and problem solving) may vary based on the body’s characteristics that the individual perceives as self-owned. A study performed by Banakou et al. used superintelligent (“Albert Einstein”) and average-intelligence virtual body avatars to illustrate this concept (37). Participants who embodied the Einstein avatar performed cognitively better than those who embodied an average-intelligence avatar of an age similar to their own (37). A similar influence of the owned body has been shown in social behavior studies. These experiments investigated whether acting through certain types of avatars (i.e., as players in video games) and the avatars’ actions could influence pro- or antisocial behaviors (194 subjects). Players choosing more heroic avatars were encouraged to behave in a more prosocial manner. The authors reported that after acting as a villain or superhero within the virtual world, participants modeled the behaviors of their chosen avatars when interacting with their fellow players in the real world. In addition, the investigators highlighted that role-taking activities supported behaviors consistent with the priming actions (i.e., activities of the heroic or villainous avatar) (38). The introduction of avatars may support treatment engagement during psychotherapy (39). Thus, the virtual world can serve as a vehicle for observation, simulation, and modeling, and avatars power these processes (38). Additional benefits of avatar-integrated therapies include increases in treatment seeking via anonymity, reductions in communication barriers, facilitation of expression and exploration of client identity, and improvements in interventional settings by allowing therapists to control and manipulate the treatment conditions within the virtual environment (39).Metaverse technologies may establish an ideal scenario for mental health research (e.g., sense of body ownership) and the development of new therapies. The fact that real-life situations are difficult to replicate in the real world (i.e., during psychotherapy sessions) but can be safely recreated in cyberspace opens many possibilities for new therapeutic interventions (28). For example, VRET has proven effective in replicating human reactions (e.g., fear-inducing situations generating social anxiety) in real social environments (40, 41). Furthermore, VRET has been successfully used to reduce social anxiety associated with stuttering when speaking to those with authority or during public speaking (42).The COVID-19 pandemic has resulted in significant lifestyle changes worldwide. By extension, health care systems have transformed traditional health education and clinical care settings in an effort to decrease face-to-face interactions. Metaverse technologies are an effective alternative for remote care of certain chronic conditions and biometrically enhance care models involving mental health treatment. These treatments include mindfulness and cognitive-behavioral therapy, either guided by a therapist or as a self-help program (43, 44). In addition, medical metaverse XR innovations may supplement current therapeutic approaches and expand mental health care access (31).ConclusionsIn conclusion, the world is experiencing a digital health care transformation with the development of core technologies (e.g., AI, IoT, DT, and XR). The metaverse is driving these innovations synergistically to increase access to health care services among multiple disciplines, supplement medical education and training, and optimize the experience of delivering and receiving medical care to meet the clinical needs of patients. Part 2 of this series will further explore the rapidly changing influence that the metaverse has on clinical neurosciences.Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC) and the Research and Academic Affairs Service Line, W. G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (López-Ojeda, Hurley); Departments of Psychiatry and Behavioral Medicine (López-Ojeda, Hurley) and Department of Radiology (Hurley), Wake Forest School of Medicine, Winston-Salem, N.C.; Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Hurley).Send correspondence to Dr. Hurley ([email protected]).Supported by Veterans Integrated Services Network 6 MIRECC.The authors report no financial relationships with commercial interests.

Handheld or head-mounted? An experimental comparison of the potential of augmented reality for animal phobia treatment using smartphone and HoloLens 2

Exposure therapy is an effective treatment for specific phobia that could be further enhanced through Augmented Reality, a novel technology that can facilitate implementation of gradual exposure and promote treatment acceptability. Effective exposure interventions require stimuli evoking high levels of anxiety. Therefore, it is important to ascertain whether animals can induce anxiety in distinct Augmented Reality modalities, such as Head-Mounted Displays and smartphones, which can differ in user experience and technological embodiment. This study compared the anxiety inducing potential and experienced realism of a spider within the HoloLens 2 Augmented Reality headset and an Augmented Reality smartphone application. Sixty-five participants were exposed to a virtual spider in a 5-step Behavioral Approach Task through both the HoloLens 2 head-mounted display and the PHOBOS Augmented Reality smartphone application. Participants reported Subjective Units of Distress at each step and physiological arousal was measured using heart rate and Skin Conductance. Results show that both technological modalities induced self-reported anxiety for spiders in a Behavioral Approach Task task in a non-clinical sample. The Hololens 2 modality was also related to an skin conductance (SC) increase. Perceived realism did not differ between modalities but was associated with increased anxiety in the HoloLens 2 modality. Findings demonstrate that both implemented modalities have potential for enabling Augmented Reality Exposure Therapy, although the role of experienced realism merits additional investigation. Future research should assess the effectiveness of Augmented Reality Exposure Therapy in clinical samples and assess whether new extended reality modalities, such as passthrough virtual reality, could accommodate observed limitations and improve Augmented Reality Exposure Therapy experiences and outcomes.

Coronavirus: introduction of the application of augmented reality to help children with disorders to overcome the phobia of contamination facing an indefinite end of the pandemic

Augmented reality has been increasingly used as a therapeutic tool in psychiatry. In particular, augmented reality exposure therapy (ARET) has been developed from and proposed as an alternative to standard cognitive behavioral therapy (CBT) for the treatment of phobic disorders. Using real-time 3D model and visual displays, the child is immersed in different computer-generated virtual environments designed for different types of phobia. As imaginative or in vivo exposure therapy, ARET consists in a gradual presentation of phobic stimuli. The desensitization through ARET has been found to be efficient in different types of anxiety disorder, and in particular in phobic disorders. The endeavor of this work is to examine researches done in the field of AR applied to children With Disorders. Thus, we will try to verify whether the use of these techniques makes useful or not an intervention in the case of children with disorder. The work presented aims at a reflection on the introduction of the use of AR in the treatment of these children by means of current researches. We will also observe, throughout this work, the involvement of NICTs such as augmented reality in changing the activities made with these tools on the didactic and methodological level.

Real-life contextualization of exposure therapy using augmented reality: A pilot clinical trial of a novel treatment method.

Phobias, including arachnophobia, are common and can be treated with exposure therapy, a method that is limited by a lack of feared objects/situations in clinical settings. In a pilot parallel randomized controlled trial (RCT) to test the feasibility and efficacy of augmented reality exposure therapy (ARET), 25 men and women ages 18 to 45 with arachnophobia were designated (ABAB block allocation) to ARET for arachnophobia (n = 13) or waitlist control (n = 12). Data were collected at baseline, 1-week, and 1-month follow-up, and single-session ARET occurred immediately following baseline collection for the intervention group. All ARET participants were able to touch a live tarantula or the tank containing it after single-session exposure; the control group remained >1 meter away from the tank. Effects persisted or improved at 1-month followup. The Fear of Spiders Questionnaire (FSQ) and Behavioral Approach Test (BAT) showed large, significant beneficial effects of ARET compared with a waitlist control group (BAT: P < .001, partial eta squared = .542; FSQ: P < .001, partial eta squared = .720). We found ARET can feasibly be delivered using a wearable device running novel software with rapid responses and sustained effects. Replication and expansion of this pilot RCT will further support use of ARET for this and other specific phobias.

Augmenting Exposure Therapy: Mobile Augmented Reality for Specific Phobia

New technologies, such as virtual reality (VR) and augmented reality (AR), can be used as an add-on to exposure therapy for common anxiety disorders. While the benefits of VR for exposure therapy have already been demonstrated extensively in research, AR applications are only just becoming widely available. Evidence for the added value and effectiveness of augmented reality exposure therapy (ARET) is still scarce. The current study aimed to explore whether a first markerless AR iOS app for specific phobia could induce fear for multiple animal species in a general population sample. In two experiments participants made use of the Phobos AR app in a behavioral approach task (BAT), using animals for which they were anxious, but not phobic. Self-report data and physiological measures were recorded. In Experiment 1, 108 participants chose one of the seven available animal species and were either allocated to a smartphone or tablet condition. Results showed increasing levels of self-reported anxiety with increasing levels of BAT difficulty. However, this increase was smaller in individuals reporting low levels of perceived realism. No effects on heart rate (HR) could be established. In Experiment 2, 52 participants were exposed to virtual spiders. For both self-reported anxiety and the interaction with perceived realism, results were similar to Experiment 1. Skin conductance did increase significantly from baseline to the highest level of difficulty of the BAT and the severity of fear of spiders also appeared to be related to the fear response in the BAT. In conclusion, the study shows that animals presented in AR through a mobile device can evoke anxiety, which is a prerequisite for the implementation of ARET. However, further research should establish the effects of ARET in a clinical sample of people with specific phobias.

On-line anxiety level detection from biosignals: Machine learning based on a randomized controlled trial with spider-fearful individuals.

We present performance results concerning the validation for anxiety level detection based on trained mathematical models using supervised machine learning techniques. The model training is based on biosignals acquired in a randomized controlled trial. Wearable sensors were used to collect electrocardiogram, electrodermal activity, and respiration from spider-fearful individuals. We designed and applied ten approaches for data labeling considering individual biosignals as well as subjective ratings. Performance results revealed a selection of trained models adapted for two-level (low and high) and three-level (low, medium and high) classification of anxiety using a minimal set of six features. We obtained a remarkable accuracy of 89.8% for the two-level classification and of 74.4% for the three-level classification using a short time window length of ten seconds when applying the approach that uses subjective ratings for data labeling. Bagged Trees proved to be the most suitable classifier type among the classification models studied. The trained models will have a practical impact on the feasibility study of an augmented reality exposure therapy based on a therapeutic game for the treatment of arachnophobia.

Design of smart objects of fear with a taxonomy of factors affecting the user experience of exposure therapy systems for small-animal phobias

In vivo exposure therapy (IVET) is the treatment of choice for specific phobias, including animal phobia. Recently virtual reality exposure therapy (VRET) and Augmented reality exposure therapy (ARET) have been presented and validated as suitable tools, however, to the best of our knowledge, no other work has identified nor provided an explicit classification or taxonomy to classify, compare and even inform the design of these kind of systems. In this work we propose a taxonomy of feedback factors that affect the experience of use of mixed reality systems for small-animal phobias. The taxonomy comprises feedback factors in three categories, namely realism, interaction, and intensity; while considering: auditory, haptic and visual dimensions for each. To illustrate this taxonomy in use, we conducted a survey to compare mixed reality applications for small-animal phobias, analysing their features according to the factors proposed in the taxonomy. In addition, we developed the concept of smart objects of fear by means of a design fiction world. In this world, in addition to IVET, VRET and ARET, where the objects of fear are either real (in the former) or virtual (in the two later), we envision a new kind of mixed reality therapy, where the objects of fear are represented using context-aware smart objects, capable of inferring the emotional state of the patient, and of adapting their behavior to improve the system’s response during the therapy; which in turn, may enrich the patient’s therapy experience. We validated the perceived usability of this design fiction world with an expert in exposure therapy for small-animal phobias, whom perceived it as useful and correct. Finally, we show how the use of the taxonomy allowed us to discuss the features of the proposed future technologies in terms of how they furnish each of the factors of the taxonomy.

[Virtual reality exposure therapy for anxiety disorders].

Anxiety disorders are among the most prevalent mental disorders in Germany. Exposure therapy has proven effective in treating anxiety disorders. During exposure therapy, patients are systematically confronted with the feared stimulus or situation. Exposure therapy can be conducted in vivo or in sensu. Recently, aconsiderable amount of research on virtual reality exposure therapy (VRET) in the treatment of anxiety disorders-especially phobias-has been published. During virtual reality exposure therapy, patients are confronted with avirtual representation of the feared stimulus or situation. There are many studies showing that virtual reality exposure therapy is effective-especially in treating specific phobias. One major advantage of virtual reality exposure therapy is that therapists can easily control the feared object or situation. Furthermore, virtual reality exposure therapy requires less organizational effort and is less time-consuming than exposure therapy in vivo. The principal disadvantage of virtual reality exposure therapy is the danger of cyber sickness. With the development of affordable user-friendly systems, therapists may increasingly use virtual reality exposure therapy to treat patients suffering from anxiety disorders. With respect to the future development of virtual reality exposure therapy, augmented reality seems to be apromising treatment alternative. Future studies need to confirm the efficacy of augmented reality exposure therapy in treating anxiety disorders.

DJINNI: A Novel Technology Supported Exposure Therapy Paradigm for SAD Combining Virtual Reality and Augmented Reality.

The present paper explores the benefits and the capabilities of various emerging state-of-the-art interactive 3D and Internet of Things technologies and investigates how these technologies can be exploited to develop a more effective technology supported exposure therapy solution for social anxiety disorder. “DJINNI” is a conceptual design of an in vivo augmented reality (AR) exposure therapy mobile support system that exploits several capturing technologies and integrates the patient’s state and situation by vision-based, audio-based, and physiology-based analysis as well as by indoor/outdoor localization techniques. DJINNI also comprises an innovative virtual reality exposure therapy system that is adaptive and customizable to the demands of the in vivo experience and therapeutic progress. DJINNI follows a gamification approach where rewards and achievements are utilized to motivate the patient to progress in her/his treatment. The current paper reviews the state of the art of technologies needed for such a solution and recommends how these technologies could be integrated in the development of an individually tailored and yet feasible and effective AR/virtual reality-based exposure therapy. Finally, the paper outlines how DJINNI could be part of classical cognitive behavioral treatment and how to validate such a setup.

Treating small animal phobias using a projective-augmented reality system: A single-case study

In vivo exposure is the evidence based treatment for small animal phobias. However, this type of treatment still present a low treatment seek rate and a high drop-out rate, due to its aversive character for the patients. New technologies such as Virtual Reality (VR) and augmented reality (AR) have started to show their potential in anxiety disorders, including small animal phobia treatment and have demonstrated their efficacy. However, these systems still present limitations regarding the possibility to offer an optimal therapy to the phobia sufferers. This study evaluates the clinical efficacy of new AR exposure therapy – a projection-based system (P-ARET) for small animal phobias in the short (post-treatment), and long term (3- and 12-month follow-up). Four patients diagnosed with cockroach phobia participated in this pilot treatment study. The results show that all patients improved significantly in main outcome measures after the treatment. The study also follows a strategy of benchmarking, in which the results obtained from the evaluation of the P-ARET system in clinical setting are compared with two other clinically validated phobia therapies (traditional, in vivo exposure therapy (IVET); virtual reality exposure therapy (VRET); and AR exposure therapy with the use of a head-mounted display (HMD-ARET). The results indicate that the clinical effectiveness of new projection-based AR system for small animal phobia treatment was comparable to those achieved by the therapeutic conditions in other studies. However, the P-ARET system brings some advantages in terms of patient-therapist communication and more natural interaction with the system.

How Technology Influences the Therapeutic Process: Evaluation of the Patient-Therapist Relationship in Augmented Reality Exposure Therapy and In Vivo Exposure Therapy

New technologies have slowly become a part of psychologists' therapeutic office. However, many therapists still have doubts about the possibility of creating a good therapeutic relationship with patients in the presence of technology. This study evaluates the development of the therapeutic alliance in individuals with small animal phobia disorder who were treated with Augmented Reality Exposure Therapy or In Vivo Exposure Therapy. Twenty-two participants received an intensive session of cognitive behavioural therapy in either a technology-mediated therapeutic context or in a traditional therapeutic context. The results show no significant difference for the therapeutic alliance between two conditions. The results seem to show that technologies such as Augmented Reality do not represent a danger to negatively influence the therapeutic alliance.

Evaluation of the quality of collaboration between the client and the therapist in phobia treatments

A growing number of empirical studies evaluate the influence of Mental Health (MH) technology on the clinical effectiveness, the therapeutic relationship (i.e., therapeutic alliance), and usability issues. However, to the authors’ knowledge, no studies have yet been performed regarding the influence of technology on the therapeutic process in terms of collaboration. This study evaluates the quality of collaboration between the client and therapist in Augmented Reality Exposure Therapy (ARET) context and the traditional, In Vivo Exposure Therapy (IVET) context with the Therapeutic Collaborative Scale (TCS). Twenty participants received an intensive session of cognitive behavioral therapy in either a technology-mediated therapeutic context or in a traditional therapeutic context. The results indicate that both therapeutic conditions show high collaboration scores. However, the asymmetry of roles between the therapist and the client under both conditions were detected. Also, a greater level of distraction was observed for therapists in ARET, which affected the quality of the therapists’ involvement in the therapeutic session. The implications of these results are discussed.

Treating Cockroach Phobia With Augmented Reality

In vivo exposure is the recommended treatment of choice for specific phobias; however, it demonstrates a high attrition rate and is not effective in all instances. The use of virtual reality (VR) has improved the acceptance of exposure treatments to some individuals. Augmented reality (AR) is a variation of VR wherein the user sees the real world augmented by virtual elements. The present study tests an AR system in the short (posttreatment) and long term (3, 6, and 12 months) for the treatment of cockroach phobia using a multiple baseline design across individuals (with 6 participants). The AR exposure therapy was applied using the “one-session treatment” guidelines developed by Öst, Salkovskis, and Hellström (1991). Results showed that AR was effective at treating cockroach phobia. All participants improved significantly in all outcome measures after treatment; furthermore, the treatment gains were maintained at 3, 6, and 12-month follow-up periods. This study discusses the advantages of AR as well as its potential applications.