' s personal copy Treating cockroach phobia using a serious game on a mobile phone and augmented reality exposure : A single case study

In vivo exposure has proved its efficacy in the treatment of specific phobias; however, not all patients benefit from it. Communication and information technologies such as Virtual Reality (VR) and Augmented Reality (AR) have improved exposure treatment adherence and acceptance. Serious games (SG) could also be used in order to facilitate exposure treatment. A line of research on SG is emerging which focuses on health issues. We have developed a SG for the treatment of cockroach phobia that uses a mobile phone as the application device. This work examines results of an N = 1 study about whether the use of this mobile game can facilitate treatment of this specific phobia preparing her for the AR exposure. A 25-year-old woman with cockroach phobia participated in the study. Results showed that the use of the mobile game reduced her level of fear and avoidance before a ‘‘one-session” AR exposure treatment was applied, following the guidelines by Öst. The participant found very helpful the use of the SG before the AR exposure session and she was willing to use it after the AR exposure session as a homework assignment. Although the results of this study are preliminary, SG appears to be a line of research of high interest in clinical psychology for the treatment of specific phobias. 2010 Elsevier Ltd. All rights reserved.

[1]  A. Rizzo,et al.  Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis. , 2008, Journal of behavior therapy and experimental psychiatry.

[2]  L. Ost,et al.  One-session treatment for specific phobias. , 1989, Behaviour research and therapy.

[3]  Youngkyun Baek,et al.  Not just fun, but serious strategies: Using meta-cognitive strategies in game-based learning , 2009, Comput. Educ..

[4]  Rosa María Baños,et al.  Telepsychology and Self-Help: The Treatment of Phobias Using the Internet , 2008, Cyberpsychology Behav. Soc. Netw..

[5]  Rosemary Luckin,et al.  “Making it real”: exploring the potential of augmented reality for teaching primary school science , 2006, Virtual Reality.

[6]  S. Rachman,et al.  Emotional processing. , 1980, Behaviour research and therapy.

[7]  Clark C. Abt,et al.  Serious games , 2016, Springer International Publishing.

[8]  Paul Suetens,et al.  An augmented reality system for patient-specific guidance of cardiac catheter ablation procedures , 2005, IEEE Transactions on Medical Imaging.

[9]  R. Kessler,et al.  Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. , 1996, Archives of general psychiatry.

[10]  V E FRANKL,et al.  Paradoxical intention. A logotherapeutic technique. , 1960, American journal of psychotherapy.

[11]  Cristina Botella,et al.  Redefining Therapeutic Success with Virtual Reality Exposure Therapy , 2001, Cyberpsychology Behav. Soc. Netw..

[12]  Elizabeth A. Hembree,et al.  Myths regarding exposure therapy for PTSD , 2003 .

[13]  A. Fyer,et al.  Treatment of specific phobia in adults. , 2007, Clinical psychology review.

[14]  David A. Sylvester,et al.  The epidemiology of common fears and phobia. , 1969, Comprehensive psychiatry.

[15]  W. Silverman,et al.  Specific phobia. , 2005, Child and adolescent psychiatric clinics of North America.

[16]  David R. Michael,et al.  Serious Games: Games That Educate, Train, and Inform , 2005 .

[17]  A. Mathews,et al.  Brief standard self-rating for phobic patients. , 1979, Behaviour research and therapy.

[18]  H. Merckelbach,et al.  A comparison of two spider fear questionnaires. , 1996, Journal of behavior therapy and experimental psychiatry.

[19]  Rosa María Baños,et al.  Mixing Realities? An Application of Augmented Reality for the Treatment of Cockroach Phobia , 2005, Cyberpsychology Behav. Soc. Netw..

[20]  J. Prochaska,et al.  Systems of Psychotherapy: A Transtheoretical Analysis , 1979 .

[21]  D H Barlow,et al.  Reliability of DSM-III-R anxiety disorder categories. Using the Anxiety Disorders Interview Schedule-Revised (ADIS-R). , 1993, Archives of general psychiatry.

[22]  Peter J. Lang,et al.  A Bio‐Informational Theory of Emotional Imagery , 1979 .

[23]  J. Talbott,et al.  Individual and Societal Effects of Mental Disorders on Earnings in the United States: Results from the National Comorbidity Survey Replication , 2009 .

[24]  Cristina Botella,et al.  Comparing Acceptance and Refusal Rates of Virtual Reality Exposure vs. In Vivo Exposure by Patients with Specific Phobias , 2007, Cyberpsychology Behav. Soc. Netw..

[25]  B. Rothbaum,et al.  Virtual reality exposure therapy and standard (in vivo) exposure therapy in the treatment of fear of flying. , 2006, Behavior therapy.

[26]  M. Kozak,et al.  Emotional processing of fear: exposure to corrective information. , 1986, Psychological bulletin.

[27]  Kenneth C. Kirkby,et al.  Computer-Delivered Behavioural Avoidance Tests for Spider Phobia , 2004, Behaviour Change.

[28]  P. Milgram,et al.  A Taxonomy of Mixed Reality Visual Displays , 1994 .

[29]  Theodoros N. Arvanitis,et al.  Human factors and qualitative pedagogical evaluation of a mobile augmented reality system for science education used by learners with physical disabilities , 2009, Personal and Ubiquitous Computing.

[30]  Mark B. Powers,et al.  Virtual reality exposure therapy for anxiety disorders: A meta-analysis. , 2008, Journal of anxiety disorders.

[31]  C. Botella,et al.  Virtual reality in the treatment of spider phobia: a controlled study. , 2002, Behaviour research and therapy.

[32]  Ronald Azuma,et al.  A Survey of Augmented Reality , 1997, Presence: Teleoperators & Virtual Environments.

[33]  J Szymanski,et al.  Fear of Spiders Questionnaire. , 1995, Journal of behavior therapy and experimental psychiatry.

[34]  Bunmi O. Olatunji,et al.  The Cruelest Cure? Ethical Issues in the Implementation of Exposure-Based Treatments , 2009 .

[35]  J. Teasdale.  Self-efficacy: Toward a unifying theory of behavioural change? , 1978 .

[36]  Ludger Hovestadt,et al.  Serious Games Can Support Psychotherapy of Children and Adolescents , 2007, USAB.

[37]  R. Baños,et al.  Treating cockroach phobia with augmented reality. , 2010, Behavior therapy.

[38]  A. Arntz,et al.  Negative beliefs of spider phobics: A psychometric evaluation of the spider phobia beliefs questionnaire , 1993 .

[39]  Cristina Botella,et al.  Virtual reality in the treatment of claustrophobic fear: A controlled, multiple-baseline design , 2000 .

[40]  R. Kessler,et al.  67 THE ECONOMIC BURDEN OF ANXIETY AND STRESS DISORDERS , 2001 .

[41]  L G Ost.  [One-session treatment of specific phobias--a rapid and effective method]. , 1988, Lakartidningen.

[42]  J. W. Thompson,et al.  Phobia: prevalence and risk factors , 1990, Social Psychiatry and Psychiatric Epidemiology.

[43]  Michael Zyda,et al.  From visual simulation to virtual reality to games , 2005, Computer.

[44]  Matthew W Lewis.  Analysis of the Roles of “Serious Games” in Helping Teach Health-Related Knowledge and Skills and in Changing Behavior , 2007, Journal of diabetes science and technology.

[45]  Lars-Göran Öst,et al.  One-session therapist-directed exposure vs. self-exposure in the treatment of spider phobia * , 1991 .

[46]  D. C. Richard,et al.  Chapter 1 8 – Exposure therapy has a public relations problem: A dearth of litigation amid a wealth of concern , 2007 .

[47]  S. Mineka,et al.  The effects of changing contexts on return of fear following exposure therapy for spider fear. , 1999, Journal of consulting and clinical psychology.

[48]  C. Enrique Ortiz,et al.  Mobile information device profile for Java 2 MicroEdition , 2001 .

[49]  Joseph Wolpe,et al.  The practice of behavior therapy , 1969 .