Behavioral Avoidance Test Research Articles

Virtual Reality and Acrophobia: One-Year Follow-Up and Case Study

We present a study with 10 subjects being exposed to three sessions of simulated heights in a virtual reality (VR) system. Among the participants we highlight a 66-year-old man blind in his left eye. The participants show significant progress in anxiety, avoidance, and behavior measurements when confronted with real height circumstances. The results obtained 1 year later at follow-up are statistically significant in the Behavioral Avoidance Test (BAT) and the Attitudes Toward Heights Questionnaire (ATHQ), but not the Acrophobia Questionnaire (AQ).

Effectiveness of virtual reality exposure in the treatment of arachnophobia using 3D games

Buying or creating a virtual reality (VR) software is very costly. A less expensive alternative could be to modify already existing 3D computer games. The goal of this study is to assess the effectiveness of in virtuo exposure in the treatment of arachnophobia using modified 3D games. Participants were 10 women and 1 man. Virtual worlds were created using the game editor of a 3D computer game (Half-Life), modified to offer graduals hierarchies of fearful stimuli (spiders). Analyses revealed significant improvement between pre and post results on the behavioral avoidance test, the Spider Beliefs Questionnaire, and perceived self-efficacy. These promising results suggest that therapy using virtual reality exposure via a modified computer game is useful in the treatment of arachnophobia.

Documenting the Efficacy of Virtual RealityExposure with Psychophysiological andInformation Processing Measures

Many outcome studies have been conducted to assess the efficacy of virtual reality in the treatment of specific phobias. However, most studies used self-report data. The addition of objective measures of arousal and information processing mechanisms would be a valuable contribution in order to validate the usefulness of virtual reality in the treatment of anxiety disorders. The goal of this study was to document the impact of virtual reality exposure (VRE) on cardiac response and automatic processing of threatening stimuli. Twenty-eight adults suffering from arachnophobia were assessed and received an exposure-based treatment using virtual reality. General outcome and specific processes measures included a battery of standardized questionnaires, a pictorial emotional Stroop task, a behavioral avoidance test and a measure of participants' inter-beat intervals (IBI) while they were looking at a live tarantula. Assessment was conducted before and after treatment. Repeated measures ANOVAs revealed that therapy had a positive impact on questionnaire data, as well as on the behavioral avoidance test. Analyses made on the pictorial Stroop task showed that information processing of spider-related stimuli changed after treatment, which also indicates therapeutic success. Psychophysiological data also showed a positive change after treatment, suggesting a decrease in anxiety. In sum, VRE led to significant therapeutic improvements on objective measures as well as on self-report instruments.

Terrestrial avoidance behaviour tests as screening tool to assess soil contamination

To assess soil quality and risk assessment, bioassays can be useful tools to gauge the potential toxicity of contaminants focusing on their bioavailable fraction. A rapid and sublethal avoidance behaviour test was used as a screening tool with the earthworm Eisenia andrei and the isopod Porcellionides pruinosus, where organisms were exposed during 48 h to several chemicals (lindane, dimethoate and copper sulphate, for isopods and carbendazim, benomyl, dimethoate and copper sulphate for earthworms). Both species were also exposed to soils from an abandoned mine. For all bioassays a statistical approach was used to derive EC 50 values. Isopods and earthworms were able to perceive the presence of toxic compounds and escaping from contaminated to clean soil. Furthermore the behaviour parameter was equally or more sensitive then other sublethal parameters (e.g. reproduction or growth), expressing the advantages of Avoidance Behaviour Tests as screening tools in ERA.

Acrophobia and Pathological Height Vertigo: Indications for Vestibular Physical Therapy?

Acrophobia (fear of heights) may be related to a high degree of height vertigo caused by visual dependence in the maintenance of standing balance. The purpose of this case report is to describe the use of vestibular physical therapy intervention following behavioral therapy to reduce a patient's visual dependence and height vertigo. Mr N was a 37-year-old man with agoraphobia (fear of open spaces) that included symptoms of height phobia. Exposure to heights triggered symptoms of dizziness. Intervention. Mr N underwent 8 sessions of behavioral therapy that involved exposure to heights using a head-mounted virtual reality device. Subsequently, he underwent 8 weeks of physical therapy for an individualized vestibular physical therapy exercise program. After behavioral therapy, the patient demonstrated improvements on the behavioral avoidance test and the Illness Intrusiveness Rating Scale, but dizziness and body sway responses to moving visual scenes did not decrease. After physical therapy, his dizziness and sway responses decreased and his balance confidence increased. Symptoms of acrophobia and sway responses to full-field visual motion appeared to respond to vestibular physical therapy administered after completion of a course of behavioral therapy. Vestibular physical therapy may have a role in the management of height phobia related to excessive height vertigo.

Mixing Realities? An Application of Augmented Reality for the Treatment of Cockroach Phobia

Augmented reality (AR) refers to the introduction of virtual elements in the real world. That is, the person is seeing an image composed of a visualization of the real world, and a series of virtual elements that, at that same moment, are super-imposed on the real world. The most important aspect of AR is that the virtual elements supply to the person relevant and useful information that is not contained in the real world. AR has notable potential, and has already been used in diverse fields, such as medicine, the army, coaching, engineering, design, and robotics. Until now, AR has never been used in the scope of psychological treatment. Nevertheless, AR presents various advantages. Just like in the classical systems of virtual reality, it is possible to have total control over the virtual elements that are super-imposed on the real world, and how one interacts with those elements. AR could involve additional advantages; on one side it could be less expensive since it also uses the real world (this does not need to be modeled), and it could facilitate the feeling of presence (the sensation of being there), and reality judgment (the fact of judging the experience as real) of the person since the environment he or she is in, and what he or she is seeing is, in fact the "reality." In this paper, we present the data of the first case study in which AR has been used for the treatment of a specific phobia, cockroaches phobia. It addresses a system of AR that permits exposure to virtual cockroaches super-imposed on the real world. In order to carry out the exposure, the guidelines of Ost with respect to "one-session treatment" were followed. The results are promising. The participant demonstrated notable fear and avoidance in the behavioral avoidance test before the treatment, and not only was an important decrease in the scores of fear and avoidance observed after the treatment, but also the participant was capable of approaching, interacting, and killing live cockroaches immediately following the treatment. The results are maintained in a follow-up conducted 1 month after the termination of the treatment.

Disgust as a motivator of avoidance of spiders

Individuals with small animal phobias show elevated general disgust sensitivity, and spider phobics often endorse both fear and disgust in response to a spider. Some researchers have argued that the link between disgust and fear of small animals is spurious. On the other hand, disgust may play a functional role, as might any negative emotion that is strongly stimulus-bound, in which escape or avoidance is negatively reinforced. It is therefore important to clarify whether disgust has a functional or epiphenomenal role in avoidance of feared stimuli. The present study examined the degree to which disgust motivates avoidance of spider-related stimuli using a series of behavioral avoidance tests comparing a harmless tarantula, a pen that had come in contact with the spider, and a clean pen. Peak disgust was a stronger predictor than anxiety of avoidance of both the spider and the “contaminated” pen.

Interfaces That Heal: Coupling Real and Virtual Objects to Treat Spider Phobia

Tactile augmentation is a simple, safe, inexpensive interaction technique for adding physical texture and force feedback cues to virtual objects. This study explored whether virtual reality (VR) exposure therapy reduces fear of spiders and whether giving patients the illusion of physically touching the virtual spider increases treatment effectiveness. Eight clinically phobic students were randomly assigned to one of 3 groups-(a) no treatment, (b) VR with no tactile cues, or (c) VR with a physically "touchable" virtual spider-as were 28 nonclinically phobic students. Participants in the 2 VR treatment groups received three 1-hr exposure therapy sessions resulting in clinically significant drops in behavioral avoidance and subjective fear ratings. The tactile augmentation group showed the greatest progress on behavioral measures. On average, participants in this group, who only approached to 5.5 ft of a live spider on the pretreatment Behavioral Avoidance Test (Garcia-Palacios, 2002), were able to approach to 6 in. of the spider after VR exposure treatment and did so with much less anxiety (see www.vrpain.com for details). Practical implications are discussed.

Long-term effects of delayed motherhood in mice on postnatal development and behavioural traits of offspring.

Some epidemiological evidence tentatively suggests that children born to older parents may have lower intellectual development and maturity than children whose parents are younger. This study aims to analyse the long-term effects of delayed motherhood in mice on postnatal development and behavioural traits later in life. Hybrid females, either at the age of 10 weeks or 51 weeks, were individually housed with a randomly selected 12-14 week old hybrid male. After a postweaning resting period of 1 week, dams were caged again with a new randomly selected 12-14 week old male. This sequence of events was repeated until old females reached the end of their reproductive life. Delayed motherhood in mice not only had negative effects on reproductive potential but also on preweaning development of offspring as evidenced by higher mortality, retarded sensorimotor integration and lower body weights as well as on behavioural traits of young adult offspring including decreased spontaneous motor activity, lower step-through latencies in the retention trial of a passive avoidance behaviour test, and no changes in escape latencies throughout five daily sessions in a Morris water maze test. Advanced maternal age at conception may influence preweaning development and learning capacity of offspring in the mouse model.

Behavioral avoidance tests and disgust in contamination fears: distinctions from trait anxiety

Much of the existing literature examining the role of disgust is limited to specific phobia. Recent research has begun to examine the role of disgust in contamination fear, a subtype of obsessive–compulsive symptoms. Through the use of behavioral avoidance tasks (BATs), the current study was designed to examine the role of disgust in people with contamination fears, with attention to distinguishing high and low trait anxiety. From a large screening of undergraduate students, three groups were formed based on their level of contamination fear and level of trait anxiety: contamination fearful ( n=12), high-trait anxiety ( n=11), and low trait anxiety ( n=15). Subjects were asked to engage in six different BATs corresponding to six domains of disgust (food, animals, body products, body envelope violations, death, and sympathetic magic). One-way analysis of variance (ANOVA) showed significant differences between the contamination fearful group and the high trait anxiety group on the animal and sympathetic magic BATs. Significant differences on the food, animal, body envelope violations, and death BATs were also found between the contamination fearful group and the low-trait anxious group. The findings modestly support the importance of disgust in contamination fears. Implications for the study of disgust in contamination fear are provided.

Virtual reality exposure in the treatment of social anxiety

Virtual reality as a medium for exposure therapy in the treatment of social anxiety was utilized in a private-practice setting for two different courses of individual treatment: weekly psychotherapy and a 3-day intensive course of therapy. Participants met diagnostic criteria for social phobia with prominent public speaking fears, and completed self-report questionnaires at pretreatment and posttreatment. During exposure therapy, participants were presented with a virtual audience, consisting of video of actual people embedded within a virtual classroom environment. Results indicated that treatment was successful as measured by completion of a behavioral avoidance test at the end of treatment, decreases in self-reported measures of public speaking anxiety comparable to controlled clinical outcome trials for social phobia, and qualitative feedback. Follow-up data, obtained from 1 participant, showed continued improvement after therapy was completed. These preliminary findings suggest that virtual reality may be a useful tool for exposure therapy within a comprehensive treatment of social anxiety.

Genetic Mapping of Variation in Spatial Learning in the Mouse

Inbred strains of mice are known to differ in their performance in the Morris water maze task, a test of spatial discrimination and place navigation in rodents, but the genetic basis of individual variation in spatial learning is unknown. We have mapped genetic effects that contribute to the difference between two strains, DBA/2 and C57BL6/J, using an F2 intercross and methods to detect quantitative trait loci (QTL). We found two QTL, one on chromosome 4 and one on chromosome 12, that influence behavior in the probe trial of the water maze (genome-wide significance p = 0.017 and 0.015, respectively). By including tests of avoidance conditioning and behavior in a novel environment, we show that the QTL on chromosomes 4 and 12 specifically influence variation in spatial learning. QTL that influence differences in fearful behavior (on chromosomes 1, 3, 7, 15, and 19) operate while mice are trained in the water maze apparatus.

Behavioral avoidance test for childhood obsessive-compulsive disorder: a home-based observation.

Obsessive-compulsive disorder (OCD) is one of the most debilitating of the anxiety disorders. As our knowledge about this childhood condition continues to grow, there is a need for controlled treatment-outcome trials with precise assessments that are sensitive to treatment change, to guide the development of effective interventions. To evaluate the efficacy of a treatment protocol, it is necessary to have reliable and sensitive measures of OCD symptoms, including measures of obsessions, compulsions, and related levels of distress and avoidance. Whilst structured diagnostic interviews, semistructured clinical interviews, and self-report measures have been widely used in the assessment of childhood OCD, related levels of behavioral distress and avoidance have not been measured in treatment-outcome trials. This study investigated the sensitivity of a behavioral avoidance test (BAT), conducted in the home environment, in assessing treatment-outcome effects for children and adolescents with OCD following a 14-week cognitive-behavioral therapy (CBT) family intervention, in comparison to children in an 8-week "waitlist" control group. The results of the current study strongly support the sensitivity of a standardized BAT in assessing treatment-related changes in children and adolescents with OCD. Implications and future directions for research are discussed.

Identification of the gene and the mutation responsible for the mouse nob phenotype.

The available evidence indicates that the naturally occurring mouse mutant nob (no b-wave) provides an animal model for the complete form of human X-linked congenital stationary night blindness (CSNB1). The goals of the present study were to identify the nob gene defect, to characterize the expression pattern of the involved gene, and to assess visual sensitivity in nob mice. Positional cloning, screening of candidate genes, and sequencing were used to identify the nob gene. The expression pattern of the nyx gene was examined with Northern blot analysis and in situ hybridization. Visual sensitivity was measured with an active avoidance behavioral test. The nob phenotype is caused by an 85-bp deletion in the mouse nyx gene, which encodes the nyctalopin protein. Expression of nyx was most abundant in the retina and, in particular, in the inner nuclear layer. The nyctalopin protein contains 11 leucine-rich repeats and is flanked by cysteine rich regions, which identifies it as a member of the small leucine rich proteoglycan family. Behavioral testing shows that nob mice have a significant decrease in visual sensitivity. The nob mouse is a model for human CSNB1. This model will be useful in defining the role of nyctalopin in signal transmission between photoreceptors and retinal bipolar cells.

Danger Expectancies, Self-efficacy and Subjective Anxiety as Mediators of Avoidance Behaviour in Spider Phobia

AbstractForty-five participants diagnosed with specific phobia (spiders) gave ratings of subjective anxiety, self-efficacy and the probability of being bitten or injured by a spider while completing a behavioural avoidance test involving exposure to a live spider. Testing was performed before and after treatment and at a 3-month follow-up. Results indicated that subjective anxiety was a more useful predictor of avoidance behaviour than self-efficacy. Danger expectancies in relation to being bitten and/or injured by a spider were not found to be a significant cognitive symptom in the majority of spider phobia sufferers during the behavioural avoidance test with a live spider. Methodological factors that may account for the low reporting of danger-related cognitions in the present study are discussed.

Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia

The aim of the present study was to evaluate the effectiveness of low-budget virtual reality (VR) exposure versus exposure in vivo in a between-group design in 33 patients suffering from acrophobia. The virtual environments used in treatment were exactly copied from the real environments used in the exposure in vivo program. VR exposure was found to be as effective as exposure in vivo on anxiety and avoidance as measured with the Acrophobia Questionnaire (AQ), the Attitude Towards Heights Questionnaire (ATHQ) and the Behavioral Avoidance Test (BAT). Results were maintained up to six months follow-up. The present study shows that VR exposure can be effective with relatively cheap hardware and software on stand-alone computers currently on the market. Further studies into the effectiveness of VR exposure are recommended in other clinical groups as agoraphobics and social phobics and studies in which VR exposure is compared with more emerging virtual worlds as presented in CAVE-type systems.

Comparisons of Different Measures for Cognitions in Agoraphobic Patients

According to the cognitive models of panic disorder with and without agoraphobia, patients engage in catastrophic cognitions when anxious. An important question to address is the relationship between measures used in previous research. The present study compares different measures of cognitive material from the same sample of 70 patients with panic disorder with agrophobia. Cognitions were assessed through questionnaires, interview and self-monitoring during a behavioural avoidance test. No congruence between the different measures of cognitive material was found. Furthermore, cognitions collected through interview were more in line with the assumptions derived from the cognitive model, than were cognitions reported through self-monitoring. To answer the question whether this is due to methodological inadequacy or whether it reflects the state of affairs requires future research.

Phobia of self-injecting and self-testing in insulin-treated diabetes patients: opportunities for screening.

To define clinically relevant cut-off points for severe fear of self-injecting (FSI) and self-testing (FST) (phobia) in insulin-treated patients with diabetes, and to estimate the magnitude of these phobias in our research population. FSI and FST were assessed in a cross-sectional survey using the Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ). A sample of 24 insulin-treated adult diabetic patients was selected from the high-scorers on FSI and/or FST (> or = 95th percentile). FSI and FST were re-assessed, after which patients participated in a behavioural avoidance test (BAT), thereby determining the current level of avoidance of either self-injecting or self-testing. FSI and FST scores were linked to the outcome of the BATs. Cut-off scores for severe FSI/FST were determined and extrapolated to the total study population (n = 1275). Seven patients participated in the self-injecting BAT: two patients refused to perform an extra injection. In the self-testing BAT (n = 17) four patients declined to perform the extra blood glucose self-test. Extrapolation of FSI and FST cut-off scores to the total research population showed that 0.2-1.3% of the population scored in the severe FSI range. In FST, 0.6-0.8% of the total study population obtained scores in the cut-off range. Severe FSI and FST, characterized by emotional distress and avoidance behaviour, seems to occur in a small group of insulin-treated patients with diabetes. The D-FISQ can be of use to health care professionals (physicians, nurse specialists) in quickly providing valuable information on levels of FSI and FST in diabetes patients.

Sertraline in Children and Adolescents With Social Anxiety Disorder: An Open Trial

The aim of this open-label study was to assess the therapeutic benefits, response pattern, and safety of sertraline in children with social anxiety disorder. Fourteen outpatient subjects with a primary Axis I diagnosis of social anxiety disorder were treated in an 8-week open trial of sertraline. Diagnostic and primary outcome measures included the Anxiety Disorders Interview Schedule for Children, Clinical Global Impressions scale (CGI), Social Phobia and Anxiety Inventory for Children, and a standardized behavioral avoidance test. As measured by the CGI (Improvement subscale), 36% (5/14) of subjects were classified as treatment responders and 29% (4/14) as partial responders by the end of the 8-week trial. A significant clinical response appeared by week 6. Self-report and behavioral measures showed significant clinical improvement into normal range across all domains measured. The mean dose of sertraline was 123.21+/-37.29 mg per day. Sertraline was generally well tolerated. In open treatment, sertraline resulted in significant improvement in symptoms of childhood social anxiety disorder. Absolute response rates varied depending on rating scales used. Findings from this study are sufficiently strong to warrant a future multisite, randomized, double-blind, placebo-controlled trial of sertraline for treatment of childhood social anxiety disorder.

Comparisons of Different Measures for Cognitions in Agoraphobic Patients

According to the cognitive models of panic disorder with and without agoraphobia, patients engage in catastrophic cognitions when anxious. An important question to address is the relationship between measures used in previous research. The present study compares different measures of cognitive material from the same sample of 70 patients with panic disorder with agrophobia. Cognitions were assessed through questionnaires, interview and self-monitoring during a behavioural avoidance test. No congruence between the different measures of cognitive material was found. Furthermore, cognitions collected through interview were more in line with the assumptions derived from the cognitive model, than were cognitions reported through self-monitoring. To answer the question whether this is due to methodological inadequacy or whether it reflects the state of affairs requires future research.