Believing is seeing: Changes in visual perception following treatment for height fear

https://doi.org/10.1016/j.jbtep.2018.08.001Get rights and content

Highlights

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    Tested effects of height fear treatments on changes in perceptual bias of heights.

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    Height-fearful participants who underwent exposure had reductions in perceptual bias.

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    Other active treatments showed marginally significant perceptual bias decreases.

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    Participants in the control condition had no significant changes in perceptual bias.

Abstract

Background and objectives

People who are afraid of heights may have a perceptual bias, such that they see heights as higher than they truly are. The current study tested if there is a causal relationship between treatments for height fear and changes in perceptual bias.

Methods

Specifically, the effects on perceptual bias following three height fear interventions (exposure, cognitive bias modification for interpretations, and a combination of exposure and cognitive bias modification) and a control condition were examined in individuals with an extreme fear of heights (N = 107).

Results

Results provided preliminary evidence that some height fear interventions reduce perceptual bias. Specifically, participants that completed exposure had a significant decrease in perceptual bias, and participants in the cognitive bias modification and combination conditions had decreases in perceptual bias at the level of non-significant trends, while no reduction occurred for the control condition.

Limitations

Limitations of this study include that the hypothesis was largely informed by data from a parent study and that the effect sizes were small; thus, replicating these results is warranted.

Conclusions

These findings suggest that there may be a causal relationship between height fear treatments and altered perception of heights.

Section snippets

Participants

To be eligible, participants needed to have Acrophobia Questionnaire-Anxiety subscale scores of at least 45.45 (AQ-Anxiety; Cohen, 1972, 1977), and to score in the subthreshold or threshold range on the Specific Phobia section of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th ed., SCID; First, Spitzer, Gibbon, & Williams, 1994). See Steinman and Teachman (2014) for a CONSORT diagram for the parent study. Following treatment assignment

Materials1

Height fear. Participants completed the AQ-Anxiety (Cohen, 1977), a 20-item questionnaire measuring fear of various heights (e.g., “Riding a Ferris wheel”). Cronbach's alpha was .72 at pre-intervention and .89 at post-intervention.

Interpretation bias. Participants' interpretation of risks associated with heights was evaluated with the Heights Interpretation

Procedure

Potential participants completed the AQ-Anxiety and Specific Phobia section of the SCID. Participants were told that the purpose of the study was to investigate an experimental height fear intervention. Participants were sequentially assigned to the CBM-I, exposure, combined, or the control condition.2 Following consent, participants

Analytic plan

First, bivariate correlations were calculated. Second, unstandardized residual change scores were computed to capture change in the dependent variable (perceptual bias) and mediator (interpretation bias; see Hummel-Rossi & Weinberg, 1975). Third, a planned weighted contrasts Analysis of Variance (ANOVA) was conducted with condition (coded as control = +3; CBM = −1; exposure = −1; combined = −1) as the independent variable and change in perceptual bias as the dependent variable. Fourth,

Bivariate relations

To characterize the relations between pre- and post-intervention interpretation bias, height perception, and height fear, bivariate correlations were calculated (see Table 1). As expected, perceptual bias and interpretation bias were significantly correlated at both pre- and post-intervention assessments. Surprisingly, although height fear and perceptual bias were significantly correlated at the post-intervention assessment, they were not correlated at pre-intervention.

Discussion

The present study provided evidence that treatments for height fear may sometimes alter perceptual bias of heights. Results showed preliminary support, at the level of a nonsignificant trend, that participants in the active (CBM-I, exposure, and combined) vs. control condition experienced greater reductions in perceptual bias. Further, in follow-up t-tests, participants in the exposure condition demonstrated a statistically significant decrease in perceptual bias, and participants in the other

Acknowledgements

This work was supported in part by NIH grants RO1MH075781 and R01MH113752 to Bethany A. Teachman and an Association for Behavioral and Cognitive Therapies Dissertation Award to Shari A. Steinman. The authors declare no conflict of interest. We thank Jessica Beadel, Joanna Chango, Meghan Cody, David Fask, Jennifer Green, Erin Miga, and Meg Reuland for their assistance as therapists in this study. We also thank Katherine Bian, Celia Cressy, Alexander Cutler, Lauren Faulkner, Victoria Gravett,

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