Effects of exposure in virtual reality and in vivo on subjective symptom burden and physiological parameters of height-anxious healthy participants - A pilot study

Exposure in vivo is a highly effective treatment for anxiety disorders and acrophobia in particular. Nevertheless, it is rarely implemented in outpatient treatment. Exposure in virtual reality (VR) might be an alternative but its effect on subjective symptom burden and physiological parameters is questionable. Therefore, in this study, N = 33 participants with fear of heights received both in vivo and VR exposure in a randomized order. Subjective symptom burden before and after each exposure as well as heart rate and heart rate variability (SDNN, LF/HF ratio) during exposure sessions were assessed. Linear mixed models were calculated with the effect of condition (VR vs. in vivo) and scenario on HR, SDNN and LF/HF ratio. Subjective symptom burden was significantly reduced after both exposure sessions (p = .002; p < .001). Heart rate was significantly higher during exposure scenarios than baseline (p < .001). SDNN and LF/HF ratio reflected a significantly higher general power of HRV and a significantly higher activation of the sympathetic nervous system during exposure sessions compared to baseline and during VR exposure compared to in vivo. All in all, VR exposure shows comparable or superior effects compared to in vivo exposure regarding acrophobic fears and physiological parameters.