title: Fear of flying treatment methods: virtual reality exposure vs. cognitive behavioral therapy.
abstract: BACKGROUND
  Fear of flying (FOF) can be a serious problem for individuals who develop this condition and for military and civilian organizations that operate aircraft. The aim of this study was to compare the effectiveness of three treatments: bibliotherapy (BIB) without therapist contact; individualized virtual reality exposure therapy (VRE); and cognitive behavior therapy (CB). In addition, we evaluated the effect of following up VRE and CB with 2 d of group cognitive-behavioral training (GrCB).
  
  
  METHODS
  There were 86 subjects suffering from FOF who entered the study; 19 BIB, 29 VRE, and 16 CB subjects completed the treatment protocols. The BIB subjects were then treated with VRE (n = 7) or CB (n = 12). There were 59 subjects who were then trained with GrCB.
  
  
  RESULTS
  Treatment with VRE or CB was more effective than BIB. Both VRE and CB showed a decline in FOF on the two main outcome measures. There was no statistically significant difference between those two therapies. However, effect sizes were lower for VRE (small to moderate) than for CB (moderate) and the addition of GrCB had less effect for VRE than for CB.
  
  
  CONCLUSIONS
  VRE holds promise as treatment for FOF, but in this trial CB followed by GrCB showed the largest decrease in subjective anxiety. The results suggest that future research should focus on comparing the effectiveness of VRE vs. VRE plus cognitive techniques or measure the effectiveness of each component of treatment. Moreover, the effectiveness of the GrCB as stand-alone treatment should be investigated, which might even be superior in cost-effectiveness.
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands. mkrijn@chello.nl
authors.forename: Merel
authors.initials: M
authors.lastname: Krijn
authors.forename: Paul M G
authors.initials: PM
authors.lastname: Emmelkamp
authors.forename: Ragnar P
authors.initials: RP
authors.lastname: Olafsson
authors.forename: Manon
authors.initials: M
authors.lastname: Bouwman
authors.forename: Lucas J
authors.initials: LJ
authors.lastname: van Gerwen
authors.forename: Philip
authors.initials: P
authors.lastname: Spinhoven
authors.forename: Martijn J
authors.initials: MJ
authors.lastname: Schuemie
authors.forename: Charles A P G
authors.initials: CA
authors.lastname: van der Mast
mesh_terms: D000328:Adult; D000337:Aerospace Medicine; D000704:Analysis of Variance; D001008:Anxiety Disorders / Q000628:therapy*; D001638:Bibliotherapy; D015928:Cognitive Behavioral Therapy; D003198:Computer Simulation; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011615:Psychotherapy, Group; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014584:User-Computer Interface