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Clinical Trial
. 2017 Jan 18;17(1):29.
doi: 10.1186/s12888-016-1181-2.

Diaphragmatic breathing during virtual reality exposure therapy for aviophobia: functional coping strategy or avoidance behavior? a pilot study

Youssef Shiban  1 , Julia Diemer  1 , Jana Müller  2 , Johanna Brütting-Schick  2 , Paul Pauli  2 , Andreas Mühlberger  3
Affiliations
Clinical Trial

Diaphragmatic breathing during virtual reality exposure therapy for aviophobia: functional coping strategy or avoidance behavior? a pilot study

Youssef Shiban et al. BMC Psychiatry. .

Abstract

Background: Although there is solid evidence for the efficacy of in vivo and virtual reality (VR) exposure therapy for a specific phobia, there is a significant debate over whether techniques promoting distraction or relaxation have impairing or enhancing effects on treatment outcome. In the present pilot study, we investigated the effect of diaphragmatic breathing (DB) as a relaxation technique during VR exposure treatment.

Method: Twenty-nine patients with aviophobia were randomly assigned to VR exposure treatment either with or without diaphragmatic breathing (six cycles per minute). Subjective fear ratings, heart rate and skin conductance were assessed as indicators of fear during both the exposure and the test session one week later.

Results: The group that experienced VR exposure combined with diaphragmatic breathing showed a higher tendency to effectively overcome the fear of flying. Psychophysiological measures of fear decreased and self-efficacy increased in both groups with no significant difference between the groups.

Conclusions: Our findings indicate that diaphragmatic breathing during VR exposure does not interfere with the treatment outcome and may even enhance treatment effects of VR exposure therapy for aviophobic patients.

Trial registration: Retrospectively registered. ClinicalTrials.gov NCT02990208 . Registered 07 December 2016.

Keywords: Aviophobia; Diaphragmatic breathing; Experimental study; Exposure therapy; Virtual reality.

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Figures

Fig. 1
Fig. 1
Questionnaire ratings of the Fear of Flying Scale (FFS). Note. VRET = Virtual reality exposure therapy, DB = diaphragmatic breathing. Graphs represent the mean of the questionnaire ratings of the FFS for the five measurements for both groups (VRET + DB: N = 15, VRET: N = 14): pre exposure, post exposure, pre test (one week after exposure session), post test and follow up (after one year, VRET + DB: N = 12, VRET: N = 13). Standard errors are represented as error bars
Fig. 2
Fig. 2
Self-efficacy scores. Note. VRET = Virtual reality exposure therapy, DB = diaphragmatic breathing. Graphs represent the mean of the self-efficacy scores for the five measurements for both groups (VRET + DB: N = 15, VRET: N = 14): pre exposure, post exposure, pre test (one week after exposure session), post test and follow up (after one year, VRET + DB: N = 12, VRET: N = 14). Standard errors are represented as error bars
Fig. 3
Fig. 3
Fear ratings during the exposure (3a) and test session (3b). Note. VRET = Virtual reality exposure therapy, DB = diaphragmatic breathing, c1/c2 = calm, t1/t2 = turbulence. Graphs represent the mean of the fear ratings during the exposures (1–3) and the test sessions (1–2) for both groups. Standard errors are represented as error bars
Fig. 4
Fig. 4
Heart rate (HR) during the exposure (4a) and test session (4b). Note. VRET = Virtual reality exposure therapy, DB = diaphragmatic breathing, c1/c2 = calm, t1/t2 = turbulence. Graphs represent the mean of the heart rate during the exposures (1–3) and the test sessions (1–2) for both groups. Standard errors are represented as error bars
Fig. 5
Fig. 5
Skin conductance level (SCL) during the exposure (5a) and test sessions (5b). Note. VRET = Virtual reality exposure therapy, DB = diaphragmatic breathing, c1/c2 = calm, t1/t2 = turbulence. Graphs represent the mean of the SCL during the exposures (1–3) and the test sessions (1–2) for both groups. Standard errors are represented as error bars
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References

    1. Ekeberg Ø, Fauske B, Berg‐Hansen B. Norwegian airline passengers are not more afraid of flying after the terror act of September 11. The flight anxiety, however, is significantly attributed to acts of terrorism. Scand J Psychol. 2014;55:464–468. doi: 10.1111/sjop.12137. - DOI - PMC - PubMed
    1. Mühlberger A, Weik A, Pauli P, Wiedemann G. One-session virtual reality exposure treatment for fear of flying: 1-Year follow-up and graduation flight accompaniment effects. Psychother Res. 2006;16:26–40. doi: 10.1080/10503300500090944. - DOI
    1. Corbin WR, Farmer NM, Nolen-Hoekesma S. Relations among stress, coping strategies, coping motives, alcohol consumption and related problems: A mediated moderation model. Addict Behav. 2013;38:1912–1919. doi: 10.1016/j.addbeh.2012.12.005. - DOI - PubMed
    1. Parrish CL, Radomsky AS, Dugas MJ. Anxiety-control strategies: is there room for neutralization in successful exposure treatment? Clin Psychol Rev. 2008;28:1400–1412. doi: 10.1016/j.cpr.2008.07.007. - DOI - PubMed
    1. Rougemont-Bücking A, Grivel J. Risk perception and emotional coping: a pathway for behavioural addiction? Eur Addict Res. 2014;20:49–58. doi: 10.1159/000353589. - DOI - PubMed

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