title: Diaphragmatic breathing during virtual reality exposure therapy for aviophobia: functional coping strategy or avoidance behavior? a pilot study.
abstract: Although there is solid evidence for the efficacy of in vivo and virtual reality (VR) exposure therapy for a specific phobia, there is a significant debate over whether techniques promoting distraction or relaxation have impairing or enhancing effects on treatment outcome. In the present pilot study, we investigated the effect of diaphragmatic breathing (DB) as a relaxation technique during VR exposure treatment.
  
  
  
  Twenty-nine patients with aviophobia were randomly assigned to VR exposure treatment either with or without diaphragmatic breathing (six cycles per minute). Subjective fear ratings, heart rate and skin conductance were assessed as indicators of fear during both the exposure and the test session one week later.
  
  
  
  The group that experienced VR exposure combined with diaphragmatic breathing showed a higher tendency to effectively overcome the fear of flying. Psychophysiological measures of fear decreased and self-efficacy increased in both groups with no significant difference between the groups.
  
  
  
  Our findings indicate that diaphragmatic breathing during VR exposure does not interfere with the treatment outcome and may even enhance treatment effects of VR exposure therapy for aviophobic patients.
  
  
  
  Retrospectively registered. ClinicalTrials.gov NCT02990208 . Registered 07 December 2016.
authors.affiliation: Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Shiban
authors.affiliation: Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Diemer
authors.affiliation: Department of Psychology (Biological Psychology, Clinical Psychology and Psychotherapy), University of Würzburg, Marcusstraße 9-11, 97070, Würzburg, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Müller
authors.affiliation: Department of Psychology (Biological Psychology, Clinical Psychology and Psychotherapy), University of Würzburg, Marcusstraße 9-11, 97070, Würzburg, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Brütting-Schick
authors.affiliation: Department of Psychology (Biological Psychology, Clinical Psychology and Psychotherapy), University of Würzburg, Marcusstraße 9-11, 97070, Würzburg, Germany.
authors.forename: Paul
authors.initials: P
authors.lastname: Pauli
authors.affiliation: Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany. andreas.muehlberger@ur.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mühlberger
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology*; D000328:Adult; D000368:Aged; D001359:Aviation; D001362:Avoidance Learning / Q000502:physiology*; D001945:Breathing Exercises / Q000379:methods / Q000523:psychology*; D003131:Combined Modality Therapy; D003964:Diaphragm / Q000503:physiopathology; D005239:Fear; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010698:Phobic Disorders / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D010865:Pilot Projects; D016896:Treatment Outcome; D063367:Virtual Reality Exposure Therapy / Q000379:methods*; D055815:Young Adult
keywords: Aviophobia; Diaphragmatic breathing; Experimental study; Exposure therapy; Virtual reality