Gamification in the Treatment of Spider Phobia

• 7-day exposure therapy via self-developed app according to (Haberkamp et al., submitted) (Behavioral), also known as Spider Gamification App: Confrontation with spiders via gamified app
• Therapist-guided one-session online exposure therapy according to (Öst, 1989) (Behavioral), also known as Online exposure: Massed exposure therapy over the course of one single session, applied in a remote-online context

Primary outcomes

• Change in avoidance behavior (Behavioral Approach Task; BAT) [Baseline; (after one-session exposure if applied); Post-treatment (1-week after baseline); 3-week follow-up (4-weeks after baseline)]: Scores range from 0 ("participant refuses to enter the room with spider") to 12 ("participant holds the spider at least for 20 sec").
• Change in spider fear (Spider Phobia Questionnaire; SPQ) [Baseline; Post-treatment (1-week after baseline); 3-week follow-up (4-weeks after baseline)]: The scale ranges from 0-31. High scores reflect high subjective levels and low scores low subjective levels of spider fear.
• Change in spider fear: Spider-Anxiety Questionnaire (FAS) [Baseline; Post-treatment (1-week after baseline); 3-week follow-up (4-weeks after baseline)]: The scale ranges from 0-108. High scores reflect high subjective levels and low scores low subjective levels of spider fear.

Secondary outcomes

• Change in disgust before and after playing the app [Before starting and immediately after completing the game]: Seven-point rating scale scoring from 0 to 6: high scores reflect high levels and low scores low levels of experienced disgust; participants play twice a day (between 8 - 11 am and 4 - 7 pm); ratings are part of the app
• Change in arousal before and after playing the app [Before starting and immediately after completing the game]: Seven-point rating scale scoring from 0 to 6: high scores reflect high levels and low scores low levels of experienced arousal; participants play twice a day (between 8 - 11 am and 4 - 7 pm); ratings are part of the app
• Change in anxiety before and after playing the app [Before starting and immediately after completing the game]: Seven-point rating scale scoring from 0 to 6: high scores reflect high levels and low scores low levels of experienced anxiety; participants play twice a day (between 8 - 11 am and 4 - 7 pm); ratings are part of the app

Other outcomes

• Beck Depression Inventory II (BDI-II) [Baseline, Post-treatment (1-week after baseline); 3-week follow-up (4-weeks after baseline)]: Measures severity of depression; The scale ranges from 0-63: 0-13 minimal depressive symptoms; 14-19 mild symptoms; 20-28 moderate symptoms; 29-63 severe symptoms.
• Brief Symptom Inventory (BSI) [Baseline, Post-treatment (1-week after baseline); 3-week follow-up (4-weeks after baseline)]: Measures clinically relevant psychological symptoms.
• German version of the Client Satisfaction Questionnaire (CSQ-8) [(after one-session exposure if applied), Post-treatment (1-week after baseline); 3-week follow-up (4-weeks after baseline)]: Standardised satisfaction measurement
• Mobile Application Rating Scale (MARS) [Post-treatment (1-week after baseline)]: Questionnaire assessing the quality of new user-oriented health applications

Sex: All, ages: 18 Years to 65 Years

Inclusion Criteria:

Participants must

* be 18 years or older,
* SPQ score ≥ 14
* BDI-II score ≤ 18

Exclusion Criteria:

Participants will be deemed ineligible if they do not meet the above inclusion criteria or

* are allergic to spiders or bee stings,
* are currently undergoing psychotherapeutic and/or psychopharmacological treatments,
* are experiencing current psychosis, mania, or substance abuse, or
* successfully complete 8 or more of 12 possible BAT steps at baseline (to ensure that participants are indeed spider fearful)
* are at higher risk from Covid-19 or
* participated in a pilot study in 2019.

• Anke Haberkamp, PhD, Principal investigator, Philipps University Marburg