Fear of flying treatment methods: virtual reality exposure vs. cognitive behavioral therapy.

INTRODUCTION: Fear of flying (FOF) can be a serious problem for individuals who develop this condition and for military and civilian organizations that operate aircraft. The aim of this study was to compare the effectiveness of three treatments: bibliotherapy (BIB) without therapist contact; individualized virtual reality exposure therapy (VRE); and cognitive behavior therapy (CB). In addition, we evaluated the effect of following up VRE and CB with 2 d of group cognitive-behavioral training (GrCB). METHODS: There were 86 subjects suffering from FOF who entered the study; 19 BIB, 29 VRE, and 16 CB subjects completed the treatment protocols. The BIB subjects were then treated with VRE (n = 7) or CB (n = 12). There were 59 subjects who were then trained with GrCB. RESULTS: Treatment with VRE or CB was more effective than BIB. Both VRE and CB showed a decline in FOF on the two main outcome measures. There was no statistically significant difference between those two therapies. However, effect sizes were lower for VRE (small to moderate) than for CB (moderate) and the addition of GrCB had less effect for VRE than for CB. DISCUSSION: VRE holds promise as treatment for FOF, but in this trial CB followed by GrCB showed the largest decrease in subjective anxiety. The results suggest that future research should focus on comparing the effectiveness of VRE vs. VRE plus cognitive techniques or measure the effectiveness of each component of treatment. Moreover, the effectiveness of the GrCB as stand-alone treatment should be investigated, which might even be superior in cost-effectiveness.

E-mailed standardized cognitive behavioural treatment of work-related stress: a randomized controlled trial.

The aim of this study was to assess the effects of a 7-week standardized cognitive behavioural treatment of work-related stress conducted via e-mail. A total of 342 people applied for treatment in reaction to a newspaper article. Initial screening reduced the sample to a heterogeneous (sub)clinical group of 239 participants. Participants were assigned randomly to a waiting list condition (n = 62), or to immediate treatment (n = 177). A follow-up was conducted 3 years after inception of the treatment. The outcome measures used were the Depression Anxiety Stress Scales (DASS-42) and the Emotional Exhaustion scale of the Maslach Burnout Inventory - General Survey (MBI-GS). Fifty participants (21%) dropped out. Both groups showed statistically significant improvements. Intention-to-treat analysis of covariance (ANCOVAs) revealed that participants in the treatment condition improved significantly more than those in the waiting control condition (0.001

or = d > or = 0.5 (anxiety)). The between-group effects ranged from d = 0.6 (stress) to d = 0.1 (anxiety). At follow-up, the effects were more pronounced, but this result requires replication in view of high attrition at follow-up. The results warrant further research on Internet-driven standardized cognitive behavioural therapy for work-related stress. Such research should include the direct comparison of this treatment with face-to-face treatment, and should address the optimal level of therapist contact in Internet-driven treatment.