TY - JOUR
T1 - Efficacy and acceptability of different interventions for acrophobia
T2 - A network meta-analysis of randomised controlled trials
AU - Chou, Po Han
AU - Tseng, Ping Tao
AU - Wu, Yi Cheng
AU - Chang, Jane Pei Chen
AU - Tu, Yu Kang
AU - Stubbs, Brendon
AU - Carvalho, Andre F.
AU - Lin, Pao Yen
AU - Chen, Yen Wen
AU - Su, Kuan Pin
N1 - Funding Information:
The authors of this work were supported by the following grants: MOST 109-2320-B-038-057-MY3, 109-2320-B-039-066, 108-2320-B-039-048, 108-2813-C-039-133-B and 108-2314-B-039-016 from the Ministry of Science and Technology, Taiwan; CMRC-CMA-3 from Higher Education Sprout Project by the Ministry of Education (MOE), Taiwan; ANHRF109-31 from An Nan Hospital, China Medical University, Tainan, Taiwan; CMU108-SR-106 from the China Medical University, Taichung, Taiwan; and CMU104-S-16-01, CMU103-BC-4-1, CRS-108-048, DMR-108-216, DMR-109-102-, DMR-109-244, DMR-HHC-109-11 and DMR-HCC-109-12 from the China Medical University Hospital, Taichung, Taiwan. The authors had contacted Drs. Michael Davis, Bruce L. Baker, Ross G. Menzies, Paul Bourque, Robert Ladouceur, and Ariel J. Lang for further original data and very thanks to their great help.
Funding Information:
The authors of this work were supported by the following grants: MOST 109-2320-B-038-057-MY3, 109-2320-B-039-066, 108-2320-B-039-048, 108-2813-C-039-133-B and 108-2314-B-039-016 from the Ministry of Science and Technology, Taiwan; CMRC-CMA-3 from Higher Education Sprout Project by the Ministry of Education (MOE), Taiwan; ANHRF109-31 from An Nan Hospital, China Medical University, Tainan, Taiwan; CMU108-SR-106 from the China Medical University, Taichung, Taiwan; and CMU104-S-16-01, CMU103-BC-4-1, CRS-108-048, DMR-108-216, DMR-109-102-, DMR-109-244, DMR-HHC-109-11 and DMR-HCC-109-12 from the China Medical University Hospital, Taichung, Taiwan.
Publisher Copyright:
© 2020
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Background: Currently, different psychological interventions have shown significant efficacy in the treatment of acrophobia. However, the superiority of these individual treatments remains unclear. This network meta-analysis (NMA) aimed to investigate the efficacy, acceptability, and superiority of different existing interventions for acrophobia. Methods: We conducted a NMA of randomised controlled trials (RCTs) and compared the efficacy, acceptability, and superiority of different existing interventions for acrophobia. Results: In total, 17 RCTs (946 participants) were included in this study. The NMA demonstrated that virtual reality (VR) coach-delivered psychotherapy (standardised mean difference [SMD]=-2.08, 95% confidence interval [CI]: -3.22 to -0.93), in vivo exposure augmented with oppositional action (SMD=-1.66, 95% CI: -2.81 to -0.51), VR exposure therapy with 20 mg cortisol administration (SMD=-1.61, 95% CI: -3.14 to -0.09), VR based cognitive behavioural therapy (VRbasedCBT; SMD=-1.14, 95% CI: -2.22 to -0.05), and in vivo exposure (SMD=-1.02, 95% CI: -1.81 to -0.23) were significantly superior than the placebo/control interventions in improving the symptoms of patients with acrophobia. The NMA further indicated that VR coach-delivered psychotherapy was associated with the best improvement among all the 19 treatments for acrophobia. Furthermore, only VRbasedCBT (odds ratio=2.55, 95% CI: 1.09 to 5.96) was associated with higher dropout rate than the control/placebo. Limitations: Sample heterogeneity, non-standardised assessment tools, and limited RCTs in some of the treatment arms. Conclusions: VR coach-delivered psychotherapy could be considered as a first-line intervention for treating acrophobia. However, because of the study limitations, the overall evidence was not sufficiently strong, which warrants future studies.
AB - Background: Currently, different psychological interventions have shown significant efficacy in the treatment of acrophobia. However, the superiority of these individual treatments remains unclear. This network meta-analysis (NMA) aimed to investigate the efficacy, acceptability, and superiority of different existing interventions for acrophobia. Methods: We conducted a NMA of randomised controlled trials (RCTs) and compared the efficacy, acceptability, and superiority of different existing interventions for acrophobia. Results: In total, 17 RCTs (946 participants) were included in this study. The NMA demonstrated that virtual reality (VR) coach-delivered psychotherapy (standardised mean difference [SMD]=-2.08, 95% confidence interval [CI]: -3.22 to -0.93), in vivo exposure augmented with oppositional action (SMD=-1.66, 95% CI: -2.81 to -0.51), VR exposure therapy with 20 mg cortisol administration (SMD=-1.61, 95% CI: -3.14 to -0.09), VR based cognitive behavioural therapy (VRbasedCBT; SMD=-1.14, 95% CI: -2.22 to -0.05), and in vivo exposure (SMD=-1.02, 95% CI: -1.81 to -0.23) were significantly superior than the placebo/control interventions in improving the symptoms of patients with acrophobia. The NMA further indicated that VR coach-delivered psychotherapy was associated with the best improvement among all the 19 treatments for acrophobia. Furthermore, only VRbasedCBT (odds ratio=2.55, 95% CI: 1.09 to 5.96) was associated with higher dropout rate than the control/placebo. Limitations: Sample heterogeneity, non-standardised assessment tools, and limited RCTs in some of the treatment arms. Conclusions: VR coach-delivered psychotherapy could be considered as a first-line intervention for treating acrophobia. However, because of the study limitations, the overall evidence was not sufficiently strong, which warrants future studies.
KW - Acrophobia
KW - Fear of height
KW - Network meta-analysis
KW - Psychotherapy
KW - Virtual reality
UR - http://www.scopus.com/inward/record.url?scp=85099264974&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2020.12.172
DO - 10.1016/j.jad.2020.12.172
M3 - Article
AN - SCOPUS:85099264974
SN - 0165-0327
VL - 282
SP - 786
EP - 794
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -
