Most people with a specific phobia never receive treatment. Virtual reality exposure therapy is one promising option, but most studies have used high-end equipment found only in research settings, and most have looked at a single phobia. A randomised controlled trial in The Australian and New Zealand Journal of Psychiatry tested something different: a smartphone app called oVRcome.
The app combines self-guided virtual reality exposure with cognitive behaviour therapy over six weeks. Its six modules cover psychoeducation, relaxation, mindfulness, cognitive techniques, exposure and relapse prevention. Adults aged 18 to 64 living in New Zealand took part if they feared flying, heights, spiders, dogs or needles.
In all, 126 people were randomised to the app or to a waitlist, and 109 completed the six-week follow-up, a retention rate of 86.5%. Phobia severity fell by 20.53 points in the app group and by 12.31 in the waitlist group (p < 0.001). The effect size for the difference was 0.86. The gap favoured the app.
The authors concluded that self-guided use of the app was effective at reducing phobia symptoms in this sample. The fears were self-reported, not formally diagnosed, so the result applies to people who recognise a fear rather than to a clinical group.
If a fear is affecting your daily life, your GP or a psychologist can talk through the options with you.
What the study set out to do
Mobile health applications for mental health are widely accessible, but most have had limited research evaluation. Virtual reality exposure therapy is an emerging treatment for specific phobias, yet most studies have used high-end virtual reality devices that are typically available only in research and limited clinical settings, and most have addressed a single phobia. This study evaluated oVRcome, a mobile health application that combines self-guided virtual reality exposure with cognitive behaviour therapy, across five specific phobias.
How it was done
The design was a two-arm, six-week randomised controlled trial with a waitlist control group and a follow-up at week 12. Participants had to live in New Zealand, be aged 18 to 64, have access to a smartphone and the internet, and have a fear of flying, heights, spiders, dogs or needles. They also had to score above 4 on the Brief Standard Self-rating scale for phobic patients.
The app consists of six modules delivered over six weeks: psychoeducation, relaxation, mindfulness, cognitive techniques, exposure through virtual reality, and relapse prevention. The primary outcome was the change from baseline to week 6 on the Severity Measures for Specific Phobia - Adults. All analyses were performed on the intention-to-treat set, which means everyone who was randomised was counted in the group they were assigned to.
Some of the terms are worth unpacking. Self-guided means that no therapist leads the sessions; the person works through the modules on their own. Psychoeducation explains how fear and avoidance work, relaxation and mindfulness build skills for managing the body's response, and cognitive techniques examine the thoughts that keep a fear going. Relapse prevention plans for setbacks. A waitlist group receives the app later, so the comparison shows what happens over the same six weeks without it.
What it found
A total of 126 participants were randomised, and 109 completed the follow-up at week 6, giving a retention rate of 86.5%. The mean change in severity score from baseline to week 6 was greater in the active group than in the waitlist group. The active group changed by -20.53 (standard deviation 8.24) and the waitlist group by -12.31 (standard deviation 10.66), with p < 0.001. The effect size for the difference was 0.86.
The authors concluded that self-guided use of the oVRcome app was effective at reducing the severity of specific phobia symptoms in a sample of people with a self-reported fear of flying, heights, spiders, dogs or needles.
What it means, and what to keep in mind
The study points to a way of reaching people who would not otherwise attend a clinic, using a device many already own. The comparison was with a waitlist, which shows that the app did better than waiting but does not show how it compares with face-to-face therapy. The abstract also reports results at week 6 only, so it does not tell us how long the change lasted.
The phobias were self-reported. That makes the findings relevant to people who recognise a fear that bothers them, though it is a different group from patients assessed and diagnosed in a clinic.
If a fear is limiting what you do, a psychologist or your GP can help you decide on the right level of support.