Efficacy of an internet-based exposure treatment for flying phobia (NO-FEAR Airlines) with and without therapist guidance: a randomized controlled trial

Daniel Campos, Juana Bretón-López, Cristina Botella, Adriana Mira, Diana Castilla, Sonia Mor, Rosa Baños, Soledad Quero, Daniel Campos, Juana Bretón-López, Cristina Botella, Adriana Mira, Diana Castilla, Sonia Mor, Rosa Baños, Soledad Quero

Abstract

Background: Internet-based treatments appear to be a promising way to enhance the in vivo exposure approach, specifically in terms of acceptability and access to treatment. However, the literature on specific phobias is scarce, and, as far as we know, there are no studies on Flying Phobia (FP). This study aims to investigate the effectiveness of an Internet-based exposure treatment for FP (NO-FEAR Airlines) that includes exposure scenarios composed of images and sounds, versus a waiting-list control group. A secondary aim is to explore two ways of delivering NO-FEAR Airlines, with and without therapist guidance.

Methods: A randomized controlled trial (RCT) was conducted in which 69 participants were allocated to: 1) NO-FEAR Airlines totally self-applied, 2) NO-FEAR Airlines with therapist guidance, 3) a waiting-list control group. Primary outcome measures were the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes included the Fear and Avoidance Scales, Clinician Severity Scale, and Patient's Improvement scale. Behavioral outcomes (post-treatment flights and safety behaviors) were also included. Mixed-model analyses with no ad hoc imputations were conducted for primary and secondary outcome measures.

Results: NO-FEAR Airlines (with and without therapist guidance) was significantly effective, compared to the waiting list control group, on all primary and secondary outcomes (all ps < .05), and no significant differences were found between the two ways of delivering the intervention. Significant improvements on diagnostic status and reliable change indexes were also found in both treatment groups at post-treatment. Regarding behavioral outcomes, significant differences in safety behaviors were found at post-treatment, compared to the waiting list. Treatment gains were maintained at 3- and 12-month follow-ups.

Conclusion: FP can be treated effectively via the Internet. NO-FEAR Airlines helps to enhance the exposure technique and provide access to evidence-based psychological treatment to more people in need. These data are congruent with previous studies highlighting the usefulness of computer-assisted exposure programs for FP, and they contribute to the literature on Internet-based interventions. To the best of our knowledge, this is the first RCT to investigate the effectiveness of an Internet-based treatment for FP and explore two ways of delivering the intervention (with and without therapist guidance).

Trial registration: Clinicaltrials.gov: NCT02298478 ( https://ichgcp.net/clinical-trials-registry/NCT02298478 ). Trial registration date 3 November 2014.

Keywords: Flying phobia; Internet-based exposure; Randomized controlled trial; Self-help; Therapist guidance.

Conflict of interest statement

Authors’ information

DC1 is a postdoctoral researcher at Universitat Jaume I in the Department of Basic and Clinical Psychology and Psychobiology, who currently holds a grant from the Generalitat Valenciana (VALi+d) (APOSTD/2018/055). DC1 is also a member of Labpsitec (Laboratory of psychology and technology). JB-L is a Professor of Clinical Psychology at Universitat Jaume I in the Department of Basic and Clinical Psychology and Psychobiology, and she is also a member of Labpsitec. CB is a full professor of Clinical Psychology at Universitat Jaume I in the Department of Basic and Clinical Psychology, and Psychobiology. She is also the Director of Labpsitec (http://www.labpsitec.com) and Head of a CIBER group (Centre for Network Biomedical Research) in the area of Biomedicine and Health Sciences (https://www.ciberobn.es/). CB is also director of the Doctoral Program in Psychology at Universitat Jaume I. AM holds a PhD in Psychology from Universitat Jaume I and is a researcher at Labpsitec. AM is also an assistant professor in the Department of Psychology and Sociology, Area of Psychobiology, University of Zaragoza, IIS Aragón (Teruel, Spain). DC2 holds a PhD in Psychology from Universitat Jaume I and is a senior researcher in Cognitive Ergonomics and Usability at Labpsitec. DC2 is also an assistant professor in the Department of Psychology and Sociology, Area of Psychobiology, University of Zaragoza, IIS Aragón (Teruel, Spain). SM is a PhD student at Universitat Jaume I in the Department of Basic and Clinical Psychology and Psychobiology, and currently holds a grant from the Generalitat Valenciana (VALi+d) (ACIF/2017/191). RB is a full professor at the Universitat de València, in the Department of Personality, Evaluation and Psychological Treatments, and she is a member of Labpsitec. SQ is a Professor of Clinical Psychology at Universitat Jaume I, in the Department of Basic and Clinical Psychology and Psychobiology. She is also co-director of the Master in General Health Psychology at Universitat Jaume I, and a member of Labpsitec.

Ethics approval and consent to participate

We confirm that any aspect of the work covered in this manuscript that involved human patients has been conducted with the ethical approval of all relevant bodies, and that such approvals are acknowledged within the manuscript. The study was approved by the Ethics Committee of Universitat Jaume I (Castellón, Spain) (20 December 2014). All participants interested in participating signed an informed consent form.

Consent for publication

“Not applicable” in this section.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart
Fig. 2
Fig. 2
NO-FEAR Airlines “screenshot”: Linear navigation design and Airline motif examples
Fig. 3
Fig. 3
Therapist guidance protocol
Fig. 4
Fig. 4
Reliable change. Percentage of the completer sample in each condition corresponding to recovered, improved, unimproved or deteriorated. FFQ-II. Fear of Flying Questionnaire. FFS. Fear of Flying Scale. NFA. NO-FEAR Airlines. NFA + TG. NO-FEAR Airlines with therapist guidance. WL. Waiting list

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