@article{scholten_baseline_2023,

title = {Baseline Severity as a Moderator of the Waiting List-Controlled Association of Cognitive Behavioral Therapy with Symptom Change in Social Anxiety Disorder: A Systematic Review and Individual Patient Data Meta-analysis},

author = {W. Scholten and A. Seldenrijk and A. Hoogendoorn and R. Bosman and A. Muntingh and E. Karyotaki and G. Andersson and T. Berger and P. Carlbring and T. Furmark and S. Bouchard and P. Goldin and I. Kampmann and N. Morina and N. Kocovski and E. Leibing and F. Leichsenring and T. Stolz and A. Van Balkom and N. Batelaan},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85166386036&doi=10.1001%2fjamapsychiatry.2023.1291&partnerID=40&md5=c279c8b0ff2d3b4558c6f8803cdda0af},

doi = {10.1001/jamapsychiatry.2023.1291},

issn = {2168622X (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {JAMA Psychiatry},

volume = {80},

number = {8},

pages = {822–831},

abstract = {Importance: Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD. Objective: To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD. Data Sources: For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial. Study Selection: Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD. Data Extraction and Synthesis: Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models. Main Outcomes and Measures: The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS. Results: A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list-controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = -20.3; 95% CI, -24.9 to -15.6; P <.001; Cohen d = -0.95; 95% CI, -1.16 to -0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = -0.22; 95% CI, -0.39 to -0.06; P =.009), indicating that individuals with severe symptoms had larger waiting list-controlled symptom reductions after CBT (Cohen d = -1.13 [95% CI, -1.39 to -0.88] for patients with very severe SAD; Cohen d = -0.54 [95% CI, -0.80 to -0.29] for patients with mild SAD). Conclusions and Relevance: In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.. © 2023 American Medical Association. All rights reserved.},

note = {Publisher: American Medical Association},

keywords = {adult, antidepressant agent, Anxiety disorder, article, avoidant personality disorder, clinical outcome, cognitive behavioral therapy, comorbidity, cycloserine, Depression, disease severity, female, hospital admission, human, Humans, Liebowitz Social Anxiety Scale, male, meta analysis, paroxetine, phobia, Preferred Reporting Items for Systematic Reviews and Meta-Analyses, procedures, psychotropic agent, randomized controlled trial (topic), Randomized Controlled Trials as Topic, semi structured interview, Social, social anxiety, social phobia, Structured Clinical Interview for DSM Disorders, symptom, systematic review, treatment response, Waiting Lists},

pubstate = {published},

tppubtype = {article}

}

@article{clemmensen_study_2020,

title = {Study protocol: Exposure in virtual reality for social anxiety disorder-a randomized controlled superiority trial comparing cognitive behavioral therapy with virtual reality based exposure to cognitive behavioral therapy with in vivo exposure},

author = {L. Clemmensen and S. Bouchard and J. Rasmussen and T. T. Holmberg and J. H. Nielsen and J. R. Mø. Jepsen and M. B. Lichtenstein},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85078711155&doi=10.1186%2fs12888-020-2453-4&partnerID=40&md5=28b076f10bf189f7c90b8bed4c719200},

doi = {10.1186/s12888-020-2453-4},

issn = {1471244X},

year  = {2020},

date = {2020-01-01},

journal = {BMC Psychiatry},

volume = {20},

number = {1},

abstract = {Background: Social Anxiety Disorder (SAD) is characterized by an intense fear of negative judgement by others. Cognitive Behavioral Therapy (CBT) is recommended for treatment, but a substantial part of individuals with SAD either do not seek treatment or drop-out. CBT with Virtual Reality (VR)-based exposure has several advantages compared to traditional exposure methods, mainly due to increased control of situational elements. The aim of the current study is to develop a CBT program containing VR-based exposure. The intervention is targeted to adult patients suffering from SAD and treatment effect will be assessed by changes in SAD symptoms. Methods: This article describes the study protocol of a Randomized Controlled Trial with three arms: 1) CBT with VR exposure based on 360° videos 2) CBT with in vivo exposure and 3) VR relaxation therapy. There will be 30 participants in each arm with a crossover at the end of the treatment period during which the participants in the third group will be randomly re-Allocated to one of the two former groups. The treatment program consists of 10 weekly individual sessions with a psychologist, and a six month follow-up consisting of a questionnaire. The primary outcome measure is reduction in SAD symptoms which will be assessed with the Social Interaction Anxiety Scale (SIAS). Discussion: There are currently no published studies on CBT with VR exposure based on 360° videos for SAD treatment. Furthermore, the current study will be the first Danish SAD treatment program that includes VR technology. Trial registration: clinicaltrials.gov (NCT03973541) June 3rd 2019. © 2020 The Author(s).},

note = {Publisher: BioMed Central},

keywords = {adult, Anxiety, article, clinical effectiveness, cognitive behavioral therapy, controlled study, exposure, follow up, health program, human, Humans, in vivo study, outcome assessment, phobia, psychologist, questionnaire, randomized controlled trial, relaxation training, Social, Social Interaction Anxiety Scale, social phobia, treatment outcome, virtual reality, virtual reality exposure therapy, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{tardif_re-examining_2019,

title = {Re-Examining Psychological Mechanisms Underlying Virtual Reality-Based Exposure for Spider Phobia},

author = {N. Tardif and C. -E. Therrien and S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85060171246&doi=10.1089%2fcyber.2017.0711&partnerID=40&md5=43737ac357efea6e35bd5668eb17e040},

doi = {10.1089/cyber.2017.0711},

issn = {21522715},

year  = {2019},

date = {2019-01-01},

journal = {Cyberpsychology, Behavior, and Social Networking},

volume = {22},

number = {1},

pages = {39–45},

abstract = {The proposed study aims at expanding results from a previous study on mechanisms of change after exposure in virtual reality (VR) and documenting the impact of adding tactile and haptic feedback. It was predicted that change in the severity of spider phobia according to the Fear of Spiders Questionnaire (FSQ) would be significantly predicted by change in dysfunctional beliefs toward spiders and self-efficacy, over and above the variance explained by a physiological measure of fear during exposure (heart rate) and presence during the immersion. Participants (N = 59) were randomly assigned to the presentation of visual stimuli only, visual plus tactile stimuli, or visual, tactile plus haptic feedback stimuli. A standard multiple regression was conducted to predict change on the FSQ using the following predictors: beliefs about spiders, beliefs about one's own behavior when facing spiders, perceived self-efficacy, disgust, presence, and heart rate. Only changes in beliefs about spiders and in perceived self-efficacy significantly predicted the reduction in fear of spiders. This result enhances our understanding of the mechanisms involved in exposure conducted in VR. Analyses of variance also show that participants reported statistically significant changes in their clinical condition, with little added value to the addition of tactile and haptic feedback. The advantages of tactile and haptic stimulation are questioned, at least in the context of only one brief exposure session and the equipment used. © 2019, Mary Ann Liebert, Inc.},

note = {Publisher: Mary Ann Liebert Inc.},

keywords = {animal, Animals, Fear, Heart Rate, human, Humans, phobia, Phobic Disorders, physiology, psychology, questionnaire, spider, Spiders, Surveys and Questionnaires, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{bouchard_authors_2018,

title = {Author’s reply:},

author = {S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85054728668&doi=10.1192%2fbjp.2018.192&partnerID=40&md5=11905e8a9bb8578e1df964a26b9930d4},

doi = {10.1192/bjp.2018.192},

issn = {00071250 (ISSN)},

year  = {2018},

date = {2018-01-01},

journal = {British Journal of Psychiatry},

volume = {213},

number = {4},

pages = {617},

note = {Publisher: Cambridge University Press},

keywords = {cost effectiveness analysis, gold standard, hospital admission, human, Humans, letter, Liebowitz Social Anxiety Scale, phobia, self report, Social, social phobia, speech, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{ikic_reduction_2017,

title = {Reduction in costs after treating comorbid panic disorder with agoraphobia and generalized anxiety disorder},

author = {V. Ikic and C. Bélanger and S. Bouchard and P. Gosselin and F. Langlois and J. Labrecque and M. J. Dugas and A. Marchand},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85018690998&partnerID=40&md5=0d0600e6dd4e2a381f733ac063d639dc},

issn = {10914358},

year  = {2017},

date = {2017-01-01},

journal = {Journal of Mental Health Policy and Economics},

volume = {20},

number = {1},

pages = {11–20},

abstract = {Background: Panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) are impairing and costly disorders that are often misdiagnosed and left untreated despite multiple consultations. These disorders frequently co-occur, but little is known about the costs associated with their comorbidity and the impact of cognitive-behavioral therapy (CBT) on cost reduction. Aims of the Study: The first objective of this study was to assess the mental health-related costs associated with the specific concomitance of PDA and GAD. The second aim was to determine whether there is a reduction in direct and indirect mental healthrelated costs following conventional CBT for the primary disorder only (PDA or GAD) or combined CBT adapted to the comorbidity (PDA and GAD). Methods: A total of 123 participants with a double diagnosis of PDA and GAD participated in this study. Direct and indirect mental health-related costs were assessed and calculated from a societal perspective at the pre-Test, the post-Test, and the three-month, sixmonth and one-year follow-ups. Results: At the pre-Test, PDA-GAD comorbidity was found to generate a mean total cost of CAD2,000.48 (SD = 2,069.62) per participant over a three-month period. The indirect costs were much higher than the direct costs. Both treatment modalities led to significant and similar decreases in all cost categories from the pretest to the post-Test. This reduction was maintained until the oneyear follow-up. Discussion: Methodological choices may have underestimated cost evaluations. Nonetheless, this study supports the cost offset effects of both conventional CBT for primary PDA or GAD and combined CBT for PDA-GAD comorbidity. Implications for Healthcare Provision and Use: Treatment of comorbid and costly disorders with evidence-based treatments such as CBT may lead to considerable economic benefits for society. Implications for Health Policies: Considering the limited resources of healthcare systems, it is important to make choices that will lead to better accessibility of quality services. The application of CBT for PDA, GAD or both disorders and training mental health professionals in this therapeutic approach should be encouraged. Additionally, it would be favorable for insurance plans to reimburse employees for expenses associated with psychological treatment for anxiety disorders. Implications for Further Research: In addition to symptom reduction, it would be of great pertinence to explore which factors can contribute to reducing direct and indirect mental health-related costs. © 2017 ICMPE.},

note = {Publisher: ICMPE},

keywords = {adult, agoraphobia, Anxiety disorder, Anxiety Disorders, article, cognitive behavioral therapy, cognitive therapy, comorbidity, controlled study, dysthymia, economics, female, follow up, generalized anxiety disorder, health care cost, Health Care Costs, human, Humans, major clinical study, major depression, male, Mental health, obsessive compulsive disorder, panic, Panic Disorder, phobia, posttraumatic stress disorder, procedures, Quebec, social phobia, statistics and numerical data},

pubstate = {published},

tppubtype = {article}

}

@article{bouchard_virtual_2017,

title = {Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial},

author = {S. Bouchard and S. Dumoulin and G. Robillard and T. Guitard and E. Klinger and H. Forget and C. Loranger and F. X. Roucaut},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85018214603&doi=10.1192%2fbjp.bp.116.184234&partnerID=40&md5=245751bf4ef3f8ae014a9c5816a585c3},

doi = {10.1192/bjp.bp.116.184234},

issn = {00071250},

year  = {2017},

date = {2017-01-01},

journal = {British Journal of Psychiatry},

volume = {210},

number = {4},

pages = {276–283},

abstract = {Background: People with social anxiety disorder (SAD) fear social interactions and may be reluctant to seek treatments involving exposure to social situations. Social exposure conducted in virtual reality (VR), embedded in individual cognitive-behavioural therapy (CBT), could be an answer. Aims: To show that conducting VR exposure in CBT for SAD is effective and is more practical for therapists than conducting exposure in vivo. Method: Participants were randomly assigned to either VR exposure (n =17), in vivo exposure (n=22) or waiting list (n= 20). Participants in the active arms received individual CBT for 14 weekly sessions and outcome was assessed with questionnaires and a behaviour avoidance test. (Trial registration number ISRCTN99747069.) Results: Improvements were found on the primary (Liebowitz Social Anxiety Scale) and all five secondary outcome measures in both CBT groups compared with the waiting list. Conducting exposure in VR was more effective at post-treatment than in vivo on the primary outcome measure and on one secondary measure. Improvements were maintained at the 6-month follow-up. VR was significantly more practical for therapists than in vivo exposure. Conclusions: Using VR can be advantageous over standard CBT as a potential solution for treatment avoidance and as an efficient, cost-effective and practical medium of exposure. Declaration of interest S.B. and G.R. are consultants to and own equity in Cliniques et Développement In Virtuo, which develops virtual environments; however, Cliniques et Développement In Virtuo did not create the virtual environments used in this study. The terms of these arrangements were reviewed and approved by Universitédu Québec en Outaouais, in accordance with its policy on conflicts of interest. © The Royal College of Psychiatrists 2017.},

note = {Publisher: Royal College of Psychiatrists},

keywords = {adult, article, avoidance behavior, clinical outcome, cognitive therapy, comparative effectiveness, comparative study, computer interface, controlled study, cost, devices, female, hospital admission, human, Humans, Implosive Therapy, in vivo study, major clinical study, male, Middle Aged, outcome assessment, Outcome Assessment (Health Care), phobia, procedures, randomized controlled trial, Social, social phobia, User-Computer Interface, virtual reality, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{baus_moving_2014,

title = {Moving from virtual reality exposure-based therapy to augmented reality exposure-based therapy: A review},

author = {O. Baus and S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84897016348&doi=10.3389%2ffnhum.2014.00112&partnerID=40&md5=daae74386678a753194f5b127b852140},

doi = {10.3389/fnhum.2014.00112},

issn = {16625161},

year  = {2014},

date = {2014-01-01},

journal = {Frontiers in Human Neuroscience},

volume = {8},

number = {MAR},

abstract = {This paper reviews the move from virtual reality exposure-based therapy to augmented reality exposure-based therapy (ARET). Unlike virtual reality (VR), which entails a complete virtual environment (VE), augmented reality (AR) limits itself to producing certain virtual elements to then merge them into the view of the physical world. Although, the general public may only have become aware of AR in the last few years, AR type applications have been around since beginning of the twentieth century. Since, then, technological developments have enabled an ever increasing level of seamless integration of virtual and physical elements into one view. Like VR, AR allows the exposure to stimuli which, due to various reasons, may not be suitable for real-life scenarios. As such, AR has proven itself to be a medium through which individuals suffering from specific phobia can be exposed safely to the object(s) of their fear, without the costs associated with programing complete VEs. Thus, ARET can offer an efficacious alternative to some less advantageous exposure-based therapies. Above and beyond presenting what has been accomplished in ARET, this paper covers some less well-known aspects of the history of AR, raises some ARET related issues, and proposes potential avenues to be followed. These include the type of measures to be used to qualify the user's experience in an augmented reality environment, the exclusion of certain AR-type functionalities from the definition of AR, as well as the potential use of ARET to treat non-small animal phobias, such as social phobia. © 2014 Baus and Bouchard.},

note = {Publisher: Frontiers Media S. A.},

keywords = {augmented reality exposure based therapy, behavior therapy, clinical effectiveness, Fear, history of medicine, human, intermethod comparison, phobia, review, safety, social phobia, virtual reality, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{yuen_acceptance_2013,

title = {Acceptance based behavior therapy for social anxiety disorder through videoconferencing},

author = {E. K. Yuen and J. D. Herbert and E. M. Forman and E. M. Goetter and A. S. Juarascio and S. Rabin and C. Goodwin and S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84879799248&doi=10.1016%2fj.janxdis.2013.03.002&partnerID=40&md5=a280b967176db691df32f37d15cb52a1},

doi = {10.1016/j.janxdis.2013.03.002},

issn = {18737897 (ISSN)},

year  = {2013},

date = {2013-01-01},

journal = {Journal of Anxiety Disorders},

volume = {27},

number = {4},

pages = {389–397},

abstract = {Most individuals with social anxiety disorder (SAD) do not receive any type of treatment. Reasons include logistical barriers (e.g., geographic location, travel time), fear of stigmatization, and fear of the social interactions associated with seeking treatment. Videoconferencing technology holds great promise in the widespread delivery of evidence-based treatments to those who would otherwise not receive treatment. This pilot study assessed the feasibility, acceptability, and initial efficacy of an acceptance-based behavioral intervention using Skype videoconferencing to treat adults with generalized SAD. Twenty-four participants received 12 sessions of weekly therapy and were assessed at pre-treatment, mid-treatment, post-treatment, and 3-month follow-up. Participants and therapists rated the intervention as acceptable and feasible. Analyses revealed significant pre-treatment to follow-up improvements in social anxiety, depression, disability, quality of life, and experiential avoidance, with effect sizes comparable to or larger than previously published results of studies delivering in-person CBT for SAD. Implications and future directions are discussed. © 2013 Elsevier Ltd.},

keywords = {acceptance based behavior therapy, adult, agoraphobia, alcoholism, article, avoidance behavior, Beck Depression Inventory, behavior therapy, Behavioral Assessment Test, Brief Version of the Fear of Negative Evaluation Scale, clinical article, clinical trial, comorbidity, disability, effect size, Feasibility Studies, feasibility study, female, follow up, Follow-Up Studies, generalized anxiety disorder, human, Humans, interview, Liebowitz Social Anxiety Scale, major depression, male, named inventories, panic, patient attitude, Patient Satisfaction, phobia, Phobic Disorders, Pilot Projects, pilot study, procedures, Psychiatric Status Rating Scales, psychologic test, Psychological, psychological rating scale, psychotherapist attitude, quality of life, questionnaires and rating scales, Skype, social anxiety, social phobia, Social Phobia and Anxiety Inventory, Structured Clinical Interview for DSM Disorders, telehealth, Telemedicine, Telemental health, Telepsychology, treatment outcome, videoconferencing},

pubstate = {published},

tppubtype = {article}

}

@article{bouchard_could_2011,

title = {Could virtual reality be effective in treating children with phobias?},

author = {S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-79951655992&doi=10.1586%2fern.10.196&partnerID=40&md5=a941040ff9b2edf8439f26b36edc7163},

doi = {10.1586/ern.10.196},

issn = {17448360 (ISSN)},

year  = {2011},

date = {2011-01-01},

journal = {Expert Review of Neurotherapeutics},

volume = {11},

number = {2},

pages = {207–213},

abstract = {The use of virtual reality to treat anxiety disorders in adults is gaining popularity and its efficacy is supported by numerous outcome studies. Similar research for children is lagging behind. The outcome studies on the use of virtual reality to treat anxiety disorders in children currently address only specific phobias, and all of the available trials are reviewed in this article. Despite the limited number of studies, results are very encouraging for the treatment of school and spider phobias. A study with adolescents suggests that, at least for social anxiety, exposure stimuli would be more effective if they were developed specifically for younger populations. Virtual reality may not increase children's motivation towards therapy unless their fearful apprehension is addressed before initiating the treatment. © 2011 Expert Reviews Ltd.},

keywords = {Adolescent, Anxiety, Anxiety Disorders, arachnophobia, article, audiovisual equipment, Child, child psychiatry, Children, cognitive therapy, Cognitive-behavior therapy, Computer Simulation, Computer-Assisted, controlled clinical trial (topic), environmental factor, Exposure therapy, groups by age, human, Humans, image display, motivation, phobia, Phobic Disorders, social phobia, spider, Therapy, treatment outcome, User-Computer Interface, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{st-jacques_is_2010,

title = {Is virtual reality effective to motivate and raise interest in phobic children toward therapy? A clinical trial study of in vivo with in virtuo versus in vivo only treatment exposure},

author = {J. St-Jacques and S. Bouchard and C. Bélanger},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-77955295979&doi=10.4088%2fJCP.08m04822blu&partnerID=40&md5=d542122407b00dcaecc8c51dcaf40610},

doi = {10.4088/JCP.08m04822blu},

issn = {01606689},

year  = {2010},

date = {2010-01-01},

journal = {Journal of Clinical Psychiatry},

volume = {71},

number = {7},

pages = {924–931},

abstract = {Objective: The first objective of this study was to assess if a combined treatment with mostly virtual reality-based (in virtuo) exposure increases phobic children's motivation toward therapy compared to children who only receive in vivo exposure. Another objective was the assessment of motivation as a predictor of treatment outcome. Method: Thirty-one DSM-IV-diagnosed arachnophobic participants aged from 8 to 15 years were randomly assigned to 1 of 2 treatment conditions: in vivo exposure alone or in virtuo plus in vivo exposure. Measures of motivation were taken at pretest and at the end of each part of the treatment; some other measures were taken at each session. The "Why Are You in Therapy?" questionnaire for children was the target measure of motivation and the main variable in the study. Outcome measures were taken at pretest, at the end of each part of the treatment, and at the 6-month follow-up. This study was conducted between September 2006 and March 2007. Results: The results showed that children who received in virtuo exposure did not show a higher level of motivation toward their treatment than those who received in vivo exposure, but statistically significant interactions were found for both parts of the treatment. Multiple regression analysis confirmed that motivation was a significant predictor of outcome (P < .01), especially extrinsic integrated motivation. Participants in the combined treatment were significantly more phobic before beginning treatment, but both treatments appeared successful (P < .001). Conclusions: In this study, the use of virtual reality did not increase motivation toward psychotherapy. At the end of the second part of therapy, all participants were comparably efficient in facing a live tarantula. These results bear important clinical implications concerning how to use virtual reality with children and concerning motivation of children toward therapy in general. They are discussed in the light of how to present in virtuo therapy to children. Trial Registration: controlled-trials.com Identifier: ISRCTN87716831. © Copyright 2010 Physicians Postgraduate Press, Inc.},

keywords = {Adolescent, Animals, article, Child, clinical article, clinical trial, cognitive therapy, Combined Modality Therapy, Computer-Assisted, controlled clinical trial, controlled study, exposure, female, follow up, human, Humans, Implosive Therapy, Internal-External Control, male, motivation, outcome assessment, phobia, Phobic Disorders, predictor variable, priority journal, psychotherapy, randomized controlled trial, school child, Spiders, Therapy, treatment outcome, User-Computer Interface, virtual reality},

pubstate = {published},

tppubtype = {article}

}