Reaching New Heights: Comparing Interpretation Bias Modification to Exposure Therapy for Extreme Height Fear

Cognitive models of anxiety posit that biases in interpretation maintain, and potentially cause, anxiety disorders. This study tested whether it is possible to decrease height fear symptoms through cognitive bias modification for interpretations (CBM-I). Additionally, the clinical utility of CBM-I was tested by comparing it to an already established treatment: exposure therapy. Extremely height fearful (N=110) individuals participated in the study. Acrophobic symptoms were measured before and after two sessions of CBM-I, and compared to the standard treatment for acrophobia (exposure therapy), a combination of CBM-I and exposure therapy, and a Control condition. As a secondary goal, the current study examined the attenuation of perceptual bias following height fear reduction.

In line with hypotheses, participants in all three active conditions (but not the Control condition) experienced a decrease in height-relevant interpretation bias, symptoms, and behavioral avoidance. Of note, symptom change was mediated by change in interpretation bias. Additionally, as expected, changes in outcome measures tended to correlate with each other. Further, symptom reduction for all active conditions was maintained or further reduced at one-month follow-up. Surprisingly, results only provided very minimal evidence for the attenuation of perceptual bias following fear reduction. Overall, findings suggest that different pathways of fear reduction (exposure vs. shifting interpretations) can lead to similar reductions in height fear. This study provides the first evidence that directly shifting cognitive processing, even with no therapist involvement, can reduce symptoms as effectively as the gold standard, therapist-directed exposure therapy.