Investigating Sudden Gains during Virtual Reality Exposure Therapy for a Patient with Anxiety Disorders: A Single-Subject Research Design with an Evidence-Based Practice Approach

Abstract

Introduction. The present study was designed to assess the efficacy of an intervention (i.e., initially VRET) on the clinical symptomatology of patients suffering from anxiety disorders. Unfortunately, the patient only carried out a single VRET exercise, which did not cause her anxiety. Therefore, the intervention was modified to fit the patient’s prevailing needs. Moreover, we aimed to explore the presence of SGs. This research also had the specific intention to implement an EBP approach in the care of the patient. Methods. This case study consisted of a multiple baseline design. Our sample consisted of one patient with GAD and agoraphobia. The present study incorporates the data collected during the first eight sessions of the therapeutic intervention. In each session, we investigated the evolution of several anxiety-related variables such as the intensity of the anxiety, anxiety-related physical symptoms, the frequency of the avoidance, the anticipation of the feared stimuli, and the sense of self-efficacy in regard to facing the feared stimuli. The effect size of the treatment was measured by the method of Percentage of Nonoverlapping Data (PND). Moreover, the presence of SGs was determined in accordance with the criteria established by Tang and DeRubeis (1999). Hypotheses. We hypothesized that there would be a decrease in participants’ anxiety during the psychological intervention compared to their pre-treatment anxiety. More specifically, the intensity of the anxiety, the anxiety-related physical symptoms, the frequency of the avoidance, and the anticipation of the feared stimuli would lessen and the sense of self-efficacy in regard to facing the feared stimuli would increase. Furthermore, we expected to detect SGs in the evolution of clinical symptomatology. Results. The intervention led to a decrease in the patient’s avoidance behaviors and the anxiety-related physical symptom dizziness intensity. Moreover, there was an SG between sessions four and five in the intensity of dizziness felt by the patient. Conclusion. These results suggest that the first sessions of therapeutic intervention can lead to an amelioration of the patient’s symptomatology, in this case, a decrease in avoidance behaviors and dizziness intensity. It also confirmed the presence of SGs in psychological intervention for anxiety disorders. It would be interesting to analyze the data again once the intervention is completed, with the hope to find further amelioration of the clinical symptomatology and/or other SGs. More research on VRET, SGs, and the implementation of EBP in clinical practice is necessary.