title: Effect of multiple context exposure on renewal in spider phobia.
abstract: BACKGROUND
  Renewal of fear is one form of relapse that occurs after successful exposure therapy as a result of an encounter with a feared object in a context different from the exposure context. The current study is the first to examine whether virtual reality (VR) exposure conducted in multiple contexts reduces the likelihood of renewal.
  
  
  METHODS
  Thirty spider-phobic patients were randomly allocated to one of two groups that were exposed to a virtual spider four times either in a single context or in multiple contexts. All participants completed a renewal test in a novel virtual context, and an in-vivo behavior avoidance test with a real spider before and after exposure.
  
  
  RESULTS
  As reflected in the ratings, skin conductance level, and behavioral measures, the fear of spiders decreased significantly in both groups within and between the exposure trials and from pre to post exposure. Importantly, extinction in multiple contexts was able to significantly reduce renewal compared to extinction in a single context.
  
  
  CONCLUSIONS
  Based on highly controlled context manipulations using VR, this study was able to successfully transfer animal work to phobic patients. These findings strongly suggest that exposure in multiple contexts improves the generalizability of exposure to a new context. Consequently, we recommend the application of multiple context exposures in a clinical setting to reduce the likelihood of renewal. In addition, virtual reality was demonstrated to be a helpful tool for inducing contextual shifts during the exposures.
authors.affiliation: Department of Psychology, University of Würzburg, Germany.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Shiban
authors.forename: Paul
authors.initials: P
authors.lastname: Pauli
authors.forename: Andreas
authors.initials: A
authors.lastname: Mühlberger
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000818:Animals; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010698:Phobic Disorders / Q000523:psychology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D013112:Spiders; D063367:Virtual Reality Exposure Therapy / Q000379:methods*; D055815:Young Adult