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Title: Psychological Distress and Physiological Reactivity During In Vivo Exposure in People With Aviophobia
Author(s): Bert Busscher, Philip Spinhoven and Eco J.C. de Geus
Journal: Psychosomatic Medicine
Year: 2015
Volume: 77
Issue: 7
Pages: 762-774
DOI: 10.1097/PSY.0000000000000209
File URL: vuams-pubs/Busscher_2015.pdf
Abstract: Objectives: Exposure is regarded to be a crucial component of therapies for phobias. According to emotional processing theory, the success of exposure therapy is predicted by activation of subjective and physiological fear responses and their within-session habituation and between-session adaptation. This study tested this prediction for aviophobia. Methods: Seventy-nine participants following a highly standardized treatment program for aviophobia provided selfreported and physiological (heart rate, respiratory sinus arrhythmia) and pre-ejection period (heart rate, respiratory sinus arrhytmia and pre-ejection period) measurements of fear activation, within-session habituation, and between-session adaptation during exposure to flight-related stimuli, a flight simulator, and during two real flights. Multiple regression analyses were conducted to examine whether these measurements predicted therapy outcome up to 3 years after finishing therapy, including number of flights flown in this period. Results: Both subjective and physiological arousal measurements indicated strong fear activation and large within-session habituation and between-session adaptation during exposure. Flight anxiety measures showed large improvements up to 3 years after treatment (n2 between 0.72 and 0.91). Lower self-reported anxiety during flight exposure was associated with lower flight anxiety after exposure (R2 = 0.15) and more flights flown (R2 = 0.14). Within-flight habituation or betweensession adaptation of self-reported anxiety had no relationship with treatment outcome. Within-flight habituation of HR reactivity (R2 = 0.10) and respiratory sinus arrhythmia reactivity (R2 = 0.11) was associated with lower flight anxiety directly after the flight, but not on flight anxiety 3 years after finishing therapy or on long-term flying behavior. Conclusions: The results provide only weak support for emotional processing theory. Low self-reported anxiety during in vivo flight exposure was the best predictor of successful long-term therapy outcome. Key words: exposure therapy, emotional processing theory, fear of flying, autonomic nervous system, heart rate, exposure in vivo.

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