Automated app-based augmented reality cognitive behavioral therapy for spider phobia: Study protocol for a randomized controlled trial

Marieke B.J. Toffolo, Jamie R. Fehribach, Chris P.B.J. van Klaveren, Ilja Cornelisz, Annemieke van Straten, Jean Louis van Gelder, Tara Donker*

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Background Fear of spiders, or Arachnophobia, is one of the most common specific phobias. The gold standard treatment, in vivo exposure therapy, is effective, but comes with significant limitations, including restricted availability, high costs, and high refusal rates. Novel technologies, such as augmented reality, may help to overcome these limitations and make Exposure Therapy more accessible by using mobile devices. Objective This study will use a Randomized Controlled Trial design to investigate whether ZeroPhobia: Arachnophobia, a 6-week Augmented Reality Exposure Therapy smartphone self-help application, can effectively reduce spider phobia symptoms. Additionally, we will examine user-friendliness of the application and the effect of usage intensity and presence on treatment outcome. Methods This study is registered in the Netherlands Trial Registry under NL70238.029.19 (Trial NL9221). Ethical approval was received on October 11, 2019. One-hundred-twelve participants (age 18–64, score ≥ 59) on the Fear of Spiders Questionnaire [FSQ] will be recruited from the general Dutch population and randomly assigned to a treatment or waitlist control group. The ZeroPhobia application can be accessed on users’ smartphone. Baseline, post-test (i.e., at six weeks), 3- and 12-month follow-up assessments will be done, each including the Fear of Spiders Questionnaire as the main outcome measure as well as additional measures of anxiety, depression, user-friendliness, and presence as secondary measures and covariates. Results The study was funded on September 25, 2018. Data collection started in September 2021 and the study is expected to run until September 2022. Conclusions Our study will improve our understanding of the efficacy and feasibility of providing Exposure Therapy for spider phobia using an Augmented Reality self-help application, with the intention of making mental health care more accessible.

Original languageEnglish
Article numbere0271175
Pages (from-to)1-18
Number of pages18
JournalPLoS ONE
Issue number7
Publication statusPublished - 13 Jul 2022

Bibliographical note

Funding Information:
This study has been funded by the Dutch Research Council (NWO) Aspasia grant (015.014.072), NWO Creative Industrie-KIEM (KI.18.039), and an MIT R&D grant from Province of North Holland, the Netherlands. All funding was awarded to TD. The funders had and will not have a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2022 Toffolo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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