Fear reactivation prior to exposure therapy: does it facilitate the effects of VR exposure in a randomized clinical sample?

Background and Objectives: The current study is the first to examine whether reactivation of fear memory prior to exposure therapy reduces relapse in a randomized clinical sample.
Methods: In a standardized treatment protocol combining virtual reality and in-vivo exposure, patients underwent a fear reactivation procedure using a virtual spider 10 min prior to a virtual reality (VR) exposure (reactivation group: RG, n = 15). A control group (CG, n = 17) was exposed to a virtual plant 10 min prior to the VR exposure. Outcome measures were a VR spontaneous recovery test (SRT) and in-vivo a behavioral avoidance test assessed 24 h after VR exposure. One week later an in-vivo exposure session followed. Additionally, a follow-up using psychometric assessment was conducted six months after the first session.
Results: Both groups benefitted significantly and equally from the combined treatment, and importantly, the SRT revealed no return of fear in both groups. Furthermore, follow-up tests showed long-term treatment effects with no group differences.
Limitations: Due to different study components (VR treatment and in-vivo), we were not able to determine which treatment module was mainly responsible for the long-term treatment effect. Furthermore, no direct measure of memory destabilization was possible in this study.
Conclusions: Our treatment package was highly effective in reducing phobic fear up to 6 months following treatment. Explicit fear reactivation prior to exposure was not beneficial in VR exposure treatment, possibly due to a failure to induce a memory destabilization or due to an implicit fear reactivation prior to treatment in both groups.