title: Fear reactivation prior to exposure therapy: does it facilitate  the effects of VR exposure in a randomized clinical sample?
abstract: OBJECTIVE
  The current study is the first to examine whether reactivation of fear memory prior to exposure therapy reduces relapse in a randomized clinical sample.
  
  
  METHODS
  In a standardized treatment protocol combining virtual reality and in-vivo exposure, patients underwent a fear reactivation procedure using a virtual spider 10 min prior to a virtual reality (VR) exposure (reactivation group: RG, n = 15). A control group (CG, n = 17) was exposed to a virtual plant 10 min prior to the VR exposure. Outcome measures were a VR spontaneous recovery test (SRT) and in-vivo a behavioral avoidance test assessed 24 h after VR exposure. One week later an in-vivo exposure session followed. Additionally, a follow-up using psychometric assessment was conducted six months after the first session.
  
  
  RESULTS
  Both groups benefitted significantly and equally from the combined treatment, and importantly, the SRT revealed no return of fear in both groups. Furthermore, follow-up tests showed long-term treatment effects with no group differences.
  
  
  CONCLUSIONS
  Due to different study components (VR treatment and in-vivo), we were not able to determine which treatment module was mainly responsible for the long-term treatment effect. Furthermore, no direct measure of memory destabilization was possible in this study.
  
  
  CONCLUSIONS
  Our treatment package was highly effective in reducing phobic fear up to 6 months following treatment. Explicit fear reactivation prior to exposure was not beneficial in VR exposure treatment, possibly due to a failure to induce a memory destabilization or due to an implicit fear reactivation prior to treatment in both groups.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Shiban
authors.forename: Johanna
authors.initials: J
authors.lastname: Brütting
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 / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D005712:Galvanic Skin Response; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010698:Phobic Disorders / Q000523:psychology* / Q000534:rehabilitation*; D011594:Psychometrics; D013112:Spiders; D011795:Surveys and Questionnaires; D063367:Virtual Reality Exposure Therapy / Q000379:methods*; D055815:Young Adult