An interventional study of Visual Feedback and Self-efficacy enhancement: in Fear of Heights and Specific Phobia, Situational, sponsored by Ruhr University of Bochum. Completed at 1 site in Germany. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2026-05-07.
Sponsored by Ruhr University of Bochum · Not applicable, Interventional, and Treatment
Self-efficacy (SE) enhancement after virtual reality exposure (VRET) for heights can promote treatment-induced effects (Raeder et al. 2019). Raeder et al (2019) employed an intervention to enhance SE by introducing specific questions about autobiographical events of success and mastery experiences in the course of VRET. Building on these previous findings, the present study aims to examine whether SE-enhancement DURING and/or AFTER a brief VR-based exposure for fear of heights (in the following referred to as VR-height-exposure) is suitable to promote exposure-induced reductions in height-related fear and avoidance. To this end, repeated visual feedback DURING a brief VR-height-exposure will be used to selectively promote SE and mastery experiences. In a similar vein, SE-enhancement AFTER VR-height-exposure will be administered. The effects of these interventions will be assessed on different treatment outcome levels. It will be further examined whether the combined SE enhancement (DURING and AFTER exposure) is more effective that 1.) SE enhancement performed DURING VR-height-exposure only or 2.) SE enhancement performed AFTER VR-height-exposure only.
The investigators hypothesize that SE enhancement (either administered DURING or AFTER VR-height-exposure) will be more effective (as indicated by more pronounced reductions in height-related fear and avoidance) than VR-height-exposure alone. It is further expected that the combined SE enhancement DURING and AFTER VR-height-exposure will be more effective compared to SE enhancement DURING VR-height-exposure alone and/or SE enhancement DURING VR-height-exposure alone.
The aim of this study is to evaluate whether visual feedback DURING VR-height-exposure and SE-enhancement strategies that are designed to promote mastery experience AFTER exposure are suitable to benefit exposure-induced reductions in height-related fear and avoidance.
Participants will be randomly assigned to one of the following conditions: a) visual feedback DURING VR-height-exposure and SE-enhancement targeting mastery experience AFTER VR-height-exposure b) no visual feedback DURING VR-height-exposure but SE-enhancement targeting mastery experience AFTER VR-height-exposure, c) visual feedback DURING VR-height-exposure but a control intervention AFTER VR-height-exposure d) no visual feedback and control intervention after VR-height- exposure. The SE-enhancement as well as the control intervention involve memory reactivation either with or without emphasis on a mastery experience attained during the VR-height-exposure. The visual feedback is presented in form of a progress-update combined with positive affirmation.
The VR-height-exposure concludes different exercises in a virtual environment that simulate situations, that can be challenging to height-fearful individuals in real life, such as glass-elevators, a glass-bridge, a tall ladder and lattice stairs. During VR-height-exposure, self-reported fear is measured in Subjective Units of Distress (SUDS). The VR-environment is presented via head-mounted displays and the participants can use touch-controllers to navigate through the exercises guided by the experimenter.
As outcome measures, subjective fear and height-related avoidance will be assessed at three time points: pre-exposure, post-exposure and at 3 months-follow-up.
Subjective fear is measured using the Acrophobia Questionnaire (AQ; Cohen, 1977). To measure height-related avoidance behavior, a Behavioural Approach Test (BAT) will be performed in a nearby church tower, that includes 13 steps of varying difficulty and requires active behavioral approach towards height-situations.
Furthermore, danger expectancies and fear expectancies (DES, AES) will be measured at pre- and post-exposure as well as at 3-months-follow-up. During all BATs and the VR-height-exposure, heart-rate variability (HRV) will be assessed as a psychophysiological indicator for fear response.
Moreover, participants are asked to rate their general self-efficacy via Questionnaire (GSE) and their perceived self-efficacy via Visual Analogue Scales (VAS) at pre- and post-exposure as well as 3-months follow-up. Furthermore, the VAS measures mood, excitement, and distraction.
Additionally, several control variables are assessed pre-exposure, including Beck's Depression Inventory II (BDI-II), The State-and-Trait-Anxiety Inventory (STAI-T; STAI-S), the Self-Efficacy Scale (SES) and the CSSES.
Implicit Approach-Avoidance biases towards height-related stimuli will also be assessed pre- and post VR-height-training utilizing the Approach-Avoidance-Task (AAT). The participants are instructed to push away (simulating avoidance) vs. pull towards (simulating approach) neutral vs. height-related pictures according to the way they are tilted (tilted-right vs. tilted left) using the computer mouse. Reaction time delays in the pull towards height-related pictures condition can be an indicator for implicit avoidance tendencies.
Exclusion Criteria:
positive visual feedback during VR-height-exposure combined with SE-enhancement after exposure.
Behavioral: Visual Feedback · Behavioral: Self-efficacy enhancement:
positive visual feedback during VR-height-exposure, and a placebo intervention after exposure.
Behavioral: Visual Feedback · Behavioral: placebo intervention
no visual feedback during exposure but SE-enhancement after exposure.
Behavioral: Self-efficacy enhancement: · Behavioral: No visual feedback
no visual feedback during exposure and placebo intervention after exposure.
Behavioral: placebo intervention · Behavioral: No visual feedback
Visual progress feedback and words of positive affirmation will be presented triggered by checkpoints set in the VR-height-exposure.
specific instructions regarding the retrieval of mastery experiences during exposure will be given (modified version of the procedure used in Raeder et al. 2019).
specific instructions regarding the retrieval of the exposure session will be given without an emphasis on personal mastery experience (modified version of the procedure used in Raeder et al. 2019).
Participants can not trigger any checkpoints during VR and therefore not receive any progress feedback or positive affirmation.
Change in the Behavioural Approach Test (BAT)
Time frame: from baseline to 24 hours after exposure and 3-months-follow-up
Change in Acrophobia Questionnaire (AQ)
Time frame: from baseline to 24 hours after exposure and 3-months-follow-up
Change in subjective fear during the BAT
Subjective fear during the BATs will be measured using the Subjective Units of Distress Scale (SUDS)
Time frame: from baseline to 24 hours after exposure and 3-months-follow-up
Changes in Heart Rate Variability (HRV) during the BAT
Time frame: at baseline, 24 hours after exposure and at 3-months-follow-up
Change in Danger Expectancy Scale (DES)
Time frame: from baseline to 24 hours after exposure and 3-months-follow-up
Change in Anxiety Expectancy Scale (AES)
Time frame: from baseline to 24 hours after exposure and 3-months-follow-up
Differences in GSE between the respective groups
ANOVA with mean GSE-scores
Time frame: at pre-exposure, immediately after exposure and 3-months-follow-up
Differences in AQ between the respective groups
ANOVA with mean AQ-scores
Time frame: at baseline, 24 hours after exposure and 3-months-follow-up
Change in perceived SE from pre to post VR-height-exposure
Changes in perceived SE will be measures with visual analogue scales (VAS)
Time frame: from baseline to 24 hours after exposure and 3-months-follow-up
Becks Depression Inventory II (BDI)
Time frame: assessed at baseline
State-Trait Anxiety Inventory (STAI-T/STAI-S)
Time frame: assessed at baseline
Self-Efficacy Scale (SES)
Time frame: assessed at baseline
Chronic Stress Self-Efficacy Scale (CSSES)
Time frame: assessed at baseline
Avoidance Bias in height-fearful individuals
An Avoidance Bias will be assessed utilizing the AAT
Time frame: assessed at baseline
Changes in Avoidance Bias
Time frame: from baseline to 24 hours after exposure
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Acrophobia
Ruhr University of Bochum