TY - JOUR T1 - Symbolic online exposure for spider fear: habituation of fear, disgust and physiological arousal and predictors of symptom improvement. AU - Matthews,Allison, AU - Naran,Nishma, AU - Kirkby,Kenneth C, Y1 - 2015/01/03/ PY - 2014/08/07/received PY - 2014/11/25/revised PY - 2014/12/17/accepted PY - 2015/1/12/entrez PY - 2015/1/13/pubmed PY - 2015/7/29/medline KW - Emotional processing theory KW - Habituation KW - Heart rate KW - Online exposure KW - Skin conductance KW - Spider phobia SP - 129 EP - 37 JF - Journal of behavior therapy and experimental psychiatry JO - J Behav Ther Exp Psychiatry VL - 47 N2 - BACKGROUND AND OBJECTIVES: This research compared the effects of real versus hyper-real images on anxiety, disgust, and physiological arousal during internet-delivered exposure in high spider-fearfuls. Hyper-real images were digitally altered to highlight fearful aspects. A further aim was to examine self-reported and behavioural therapeutic outcomes and exposure-related predictors of these outcomes. METHODS: Twenty-eight females were randomised to real (n = 14) or hyper-real (n = 14) treatment groups and nine participants were subsequently allocated to a wait-list control group. Treatment groups viewed an 8-stage exposure hierarchy of real or hyper-real spider images. Subjective anxiety and disgust ratings were taken during each stage (0, 60, 120, 180 s) with heart rate and skin conductance recorded throughout. RESULTS: Anxiety, disgust and physiological arousal habituated within each exposure stage, with no differential effect of real compared to hyper-real images. Both treatment groups but not controls demonstrated significant reductions in behavioural avoidance and self-reported phobic symptoms from pre-treatment to post-treatment with large effect sizes noted. The change in within-stage habituation of anxiety, disgust and heart rate, between the first and last stage, predicted improvement in behavioural avoidance at post-treatment. This suggests that generalisation of habituation to multiple images is an important predictor of improvement. LIMITATIONS: While findings in relation to therapeutic outcome should be considered preliminary, clear relationships were found between exposure-related variables and outcome among those who undertook treatment. CONCLUSIONS: Findings provide evidence in support of the efficacy of online image-based exposure and have implications for informing further research into the underlying mechanisms of image-based exposure treatment. SN - 1873-7943 UR - https://www.unboundmedicine.com/medline/citation/25577731/Symbolic_online_exposure_for_spider_fear:_habituation_of_fear_disgust_and_physiological_arousal_and_predictors_of_symptom_improvement_ DB - PRIME DP - Unbound Medicine ER -