Skip to main content
OpenTrials
Completed

NCT Number: NCT05424250

Optimizing Exposure Using Occasional Aversive Imagery in 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.

Completed

Looking for future studies?

Notify Me

Key information

Conditions

Spider Fear Arachnophobia

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Philipps-University Marburg

Marburg, Hesse, 35037, Germany

About this study

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.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

occasional aversive imagination

Behavioral

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.

Exposure

Behavioral
  • 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.

Primary outcomes

  1. 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.

  2. 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)

  3. 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

Secondary outcomes

  1. 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.

  2. 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.

  3. 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.

  4. 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.

Sponsors and collaborators

Lead sponsor

Philipps University Marburg

Other

Registry information

Official study title

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

Important dates

Study start
2022
Primary completion
2023
Study completion
2023
First posted
Jun 21, 2022
Registry last updated
Jan 9, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

Related clinical trials

Published trials that share one or more normalized conditions with this study.