Beyond the screen – The potential of smartphone apps and immersive technologies in exposure-based interventions for phobias

Specific phobias are extremely common among adults. They are characterized by strong emotional reactions and avoidance behavior when exposed to the feared stimuli. Specifically fears concerning heights or animals such as spiders are highly prevalent, followed by fear of social situations such as fear of public speaking. The gold standard in treating specific phobias is exposure-based therapy. However, exposure-based therapy is limited in its practicability in clinical routine and poses a high hurdle for affected individuals. Virtual and augmented reality (VR/AR) smartphone apps offer attractive platforms to simulate exposure situations and by that increase the accessibility of mental health services in general. Thus, novel smartphone-based treatments hold the potential to facilitate the dissemination of exposure-based treatments for specific phobias. The studies presented as part of this thesis aimed at investigating three newly developed interventions for fear of heights, fear of public speaking and fear of spiders, using the currently available advanced technologies. In the first study (Bentz et al., 2021), a stand-alone, automated and gamified VR exposure app Easyheights was developed using 360° images. The app’s effectiveness to reduce fear of heights and avoidance behavior was investigated in a randomized controlled trial in an adult population with clinical and subclinical fear of heights. The repeated use of the app led to reduced fear and avoidance behavior in a real-life situation on a tower. For the second study (Müller, Fehlmann et al., 2022), the developed stand-alone, automated and gamified VR exposure app Fearless Speech aimed at reducing public speaking anxiety (PSA) and avoidance of eye contact. A virtual audience with 360° videos was used for the exposure and gaze control for the eye contact training. The app was investigated in a randomized controlled trial in healthy adults with subclinical PSA. After the repeated use of the app, participants showed reduced fear and improved eye contact in a real-life speech situation. The third study (Zimmer et al., 2021) examined the developed stand-alone, automated and gamified AR exposure app Phobys. In comparison to VR, AR has only recently been introduced to clinical research. The app was designed to reduce fear, disgust and avoidance behavior in adults with clinical and subclinical fear of spiders. The results of the randomized controlled trial showed that repeatedly using the app led to reduced fear, disgust and avoidance behavior in a real-life situation with a real spider. The results of these studies support the potential of stand-alone, automated VR and AR interventions delivered through smartphone apps. The developed apps allow for a high-quality user experience with a highly realistic environment, gaze control for an easy navigation as well as the possibility of interaction. In addition, gamification elements foster engagement with the apps. All three investigated apps offer low-threshold and low-cost treatment for individuals affected by specific phobias. Testing the effectiveness of these newly developed apps in real-life settings sets them apart from previous studies. Hence, this thesis highlights the potential of using smartphone apps with immersive technologies to advance and disseminate exposure-based treatments for specific phobias