title: Fear and physiological arousal during a virtual height challenge--effects in patients with acrophobia and healthy controls.
abstract: Virtual reality (VR) exposure therapy is becoming increasingly established, but the mode of action is not well understood. One potential efficacy factor might be physiological arousal. To investigate arousal during VR exposure, we exposed 40 patients with acrophobia and 40 matched healthy controls to a VR height challenge and assessed subjective (fear ratings) and physiological (heart rate, skin conductance level, salivary cortisol) fear reactions. Patients experienced a significant increase of subjective fear, heart rate and skin conductance level. Unexpectedly, controls, who reported no subjective fear, also showed an increase in heart rate and skin conductance. There was no increase in salivary cortisol levels in either group. Physiological arousal in acrophobic patients, in contrast to subjective fear, might not be stronger than that of controls confronted with height cues in VR, indicating marked discordance across symptom domains. The lack of a cortisol response in a clearly stressful paradigm warrants further study.
authors.affiliation: Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Universitätsstr. 31, 93053 Regensburg, Germany; Department of Psychiatry, University Hospital Münster, Albert-Schweitzer-Str. 11, 48149 Münster, Germany. Electronic address: julia.diemer@psychologie.uni-regensburg.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Diemer
authors.affiliation: Department of Psychiatry, University Hospital Münster, Albert-Schweitzer-Str. 11, 48149 Münster, Germany.
authors.forename: Nora
authors.initials: N
authors.lastname: Lohkamp
authors.affiliation: Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Universitätsstr. 31, 93053 Regensburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mühlberger
authors.affiliation: Department of Psychiatry, University Hospital Münster, Albert-Schweitzer-Str. 11, 48149 Münster, Germany; Inn-Salzach-Hospital, Gabersee 7, 83512 Wasserburg am Inn, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University of Munich, Nussbaumstr. 7, 80336 Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Zwanzger
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001143:Arousal / Q000502:physiology*; D016022:Case-Control Studies; D005239:Fear / Q000523:psychology*; D005260:Female; D005712:Galvanic Skin Response / Q000502:physiology; D064368:Healthy Volunteers; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010698:Phobic Disorders / Q000523:psychology*; D012463:Saliva / Q000737:chemistry; D011795:Surveys and Questionnaires; D063367:Virtual Reality Exposure Therapy / Q000379:methods*
chemical_list: D006854:Hydrocortisone
keywords: Anxiety disorders; Challenge; Exposure therapy; Psychophysiology; Specific phobia; Virtual reality