Optimizing Exposure Using Occasional Aversive Imagery in Spider Fearful Individuals

January 7, 2026 updated by: Christoph Benke, Philipps University Marburg

Optimizing Exposure Therapy Via Occasional Aversive Imagery: A Randomized Controlled Trial With Spider Fearful Individuals

The effectiveness of an optimized extinction training is investigated in spider-fearful individuals. Participants will undergo a one-session standardized extinction training, either with or without occasional metal imagination of most feared apprehension towards spiders. The effectiveness of the training is measured by symptom improvement according to subjective ratings and behavioural avoidance tests one week later.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

The present study aims to investigate the applicability of an optimized exposure training using imagination. Exposure training is an effective approach to the treatment of various anxiety disorders. However, there are a significant number of patients who do not benefit or who develop anxiety following successful treatment. The process of extinction underlying exposure is the focus of current research on optimizing exposure. In this regard, one promising approach for improving extinction learning involves the occasional presentation of fear-generating stimuli (unconditioned stimuli [US]; often an electrical stimulus in experimental studies) during extinction (occasional reinforced extinction, ORE). Previous experimental studies provide preliminary evidence for a less pronounced return of fear after extinction training with occasional presentation of the US. In clinical practice, this strategy is recommended to optimize extinction learning in the treatment of individuals with anxiety. However, the transfer of the procedure used (real presentation of an unconditioned stimulus) into clinical practice seems difficult to realize. One way to facilitate the transfer of the ORE approach into clinical practice could be the use of vivid imagination of a personally relevant fear-generating situation during extinction training/exposure (e.g., patients' central concerns). Therefore, the aim of the present study is to examine the applicability of ORE using imagination. In this context, a standardized extinction training either with or without mental imagination of a personally relevant fear situation (e.g., central concern of the consequences when confronted with spiders) will be performed in individuals with spider-fearful individuals. The approach used for individuals with spider fear is well established and has been successfully implemented in previous studies by instructed trainers (e.g., individuals with a bachelor's degree in psychology). The aim of this randomized controlled trial in healthy individuals with increased fear of spiders is to investigate whether optimized extinction training (extinction training + imagination) is more effective in reducing fear of spiders in the long term compared to standard extinction training.

Study Type

Interventional

Enrollment (Actual)

67

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Germany
    • Hesse
      • Marburg, Hesse, Germany, 35037
        • Philipps-University Marburg

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Elevated score on Spider Phobia Questionnaire (SPQ) > 17

Exclusion Criteria:

  • Severe allergies to bees/spiders/insects
  • current psychotherapeutic/psychiatric treatment
  • past psychotherapeutic/psychiatric treatment due to anxiety problems
  • current or past psychotic symptoms
  • current suicidal intent
  • experience with exposure-based treatment
  • current psychopharmacological medication
  • severe cardiovascular, respiratory or neurological diseases

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Exposure + occasional aversive imagination
repeated imaginations of the participants' most feared apprehension during extinction training with seven standardized exposure steps
Behavioral: occasional aversive imagination
During six of the 27 exposure trials, participants in the experimental group are asked to imagine their most feared outcome towards spiders as vividly as possible while completing the specific trial.
Behavioral: Exposure
• All participants complete an exposure training session (approx. 75 min) with seven exposure steps, which are repeated between one and five times (e.g. Step 4: directing the spider with a pen by touching its legs at least five times per repetition; this step must be repeated five times before continuing to the next step). One repetition per step is considered one trial, therefore each participant aims to complete 27 exposure trials.
Active Comparator: Exposure
Standard extinction training with seven standardized exposure steps
Behavioral: Exposure
• All participants complete an exposure training session (approx. 75 min) with seven exposure steps, which are repeated between one and five times (e.g. Step 4: directing the spider with a pen by touching its legs at least five times per repetition; this step must be repeated five times before continuing to the next step). One repetition per step is considered one trial, therefore each participant aims to complete 27 exposure trials.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Spider Phobia Questionnaire (SPQ)
Time Frame: Change from baseline to post-treatment (i.e., 7-9 days)
31-item true/false questionnaire assessing symptoms of arachnophobia. Scores range from 0 to 31, with greater scores representing greater fear of spiders. Spider phobic individuals have obtained mean scores of 23.20 (SD = 2.90) and 23.76 (SD = 3.80) on the SPQ.
Change from baseline to post-treatment (i.e., 7-9 days)
Behavioral Approach Test (BAT)
Time Frame: Change from baseline to post-treatment (i.e., 7-9 days)
Number of test steps fully completed (0-14 steps)
Change from baseline to post-treatment (i.e., 7-9 days)
Fear rating
Time Frame: Change from baseline to post-treatment (i.e., 7-9 days)
Maximum fear rating on a scale from 0 (no fear) to 100 (severe fear) recorded once during BAT
Change from baseline to post-treatment (i.e., 7-9 days)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Fear of Spider Questionnaire (FSQ)
Time Frame: Change from baseline to post-treatment (i.e., 7-9 days)
14-item questionnaire on a 7-point Likert scale (0 = 'I don't agree at all'; 6 = 'I completely agree') assessing symptoms of arachnophobia. Total score range: 0 to 84. Higher scores indicate worse severity of arachnophobia.
Change from baseline to post-treatment (i.e., 7-9 days)
Change in anxiety sensitivity (ASI-3)
Time Frame: change from baseline to post-treatment (i.e. 7-9 days)
The Anxiety Sensitivity Index (ASI-3) is a self-report measure of fear of anxiety-related body symptoms (i.e., anxiety sensitivity). Total score range: 0 to 72. Higher scores indicate worse anxiety sensitivity.
change from baseline to post-treatment (i.e. 7-9 days)
PROMIS Emotional Distress-Anxiety-Short Form
Time Frame: change from baseline to post-treatment (i.e. 7-9 days)
The DSM-5-TR Level 2-Anxiety-Adult measure is the 7-item PROMIS Anxiety Short Form that assesses the pure domain of anxiety in individuals age 18 and older. Each item on the measure is rated on a 5-point scale (1=never; 2=rarely; 3=sometimes; 4=often; and 5=always) with a range in score from 7 to 35 with higher scores indicating greater severity of anxiety.
change from baseline to post-treatment (i.e. 7-9 days)
US expectancy and fear ratings
Time Frame: Baseline
Ratings of US expectancy and fear during exposure training on a scale from 0 (I don't expect my feared outcome/I am not scared at this moment) to 100 (I completely expect my feared outcome to happen/I am severely scared at this moment). Specifically, we asked participants to rate their US expectancy and fear before and during each of the 27 trials.
Baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Philipps University Marburg

Investigators

  • Principal Investigator: Christoph Benke, PhD, Philipps University Marburg
  • Principal Investigator: Christiane Pané-Farré, PhD, Philipps University Marburg
  • Principal Investigator: Dorothee Scheuermann, M.Sc., Philipps University Marburg

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 15, 2022

Primary Completion (Actual)

July 31, 2023

Study Completion (Actual)

September 30, 2023

Study Registration Dates

First Submitted

June 14, 2022

First Submitted That Met QC Criteria

June 14, 2022

First Posted (Actual)

June 21, 2022

Study Record Updates

Last Update Posted (Actual)

January 9, 2026

Last Update Submitted That Met QC Criteria

January 7, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • OPEX_SPIDER

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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