Potential Predictors of Virtual Reality Exposure Therapy for Fear of Flying: Anxiety Sensitivity, Self-efficacy and the Therapeutic Alliance

The efficacy of virtual reality exposure therapy (VRET) for fear of flying has been well established. Yet, little is known about the extent to which anxiety sensitivity and self-efficacy predict the efficacy of VRET. We aimed at investigating these cognitive predictors as well as the contribution of the therapeutic alliance to treatment outcome. In a within-subjects design with 67 patients with fear of flying, four sessions of an exposure-based treatment using VRET were given. Sessions were held every week, each consisting of two virtual flights of 25 min. Results showed that pre-treatment levels of anxiety sensitivity, initial improvement in self-efficacy (and not pre-treatment levels of self-efficacy), and the quality of the therapeutic alliance significantly predicted treatment outcome. The findings provide evidence that initial changes in self-efficacy, pre-treatment anxiety sensitivity, and therapeutic alliance are significant predictors of response to VRET for specific phobia.