目的 探讨虚拟现实暴露治疗(virtual reality exposure therapy,VRET)对恐高症的长期疗效.方法 招募2018年10月至2021年1月南京医科大学附属脑科医院就诊的恐高症患者60例,按区组随机数字表法将患者分为VRET组(n=30)和想象暴露治疗(imaginal exposure therapy,IET)组(n=30).VRET组进行VRET治疗,IET组进行IET治疗,两组治疗均2次/周,持续3周.在基线期及治疗后,采用恐高症问卷(acrophobia questionnaire,AQ)及高度态度问卷(attitude towards high questionnaire,ATHQ)评估患者的恐高症状,采用行为回避测验(behavioral avoidance test,BAT)评估患者面对高度情景时的行为回避程度.治疗后2年随访,采用AQ和ATHQ评估患者的恐高症状.采用SPSS 27.0软件对数据进行重复测量方差分析和协方差分析.结果 (1)重复测量方差分析显示,两组治疗前后AQ-焦虑、AQ-回避、ATHQ评分均交互效应不显著(F=1.37,1.95,0.21,均P＞0.05),AQ-焦虑(F=43.29)和ATHQ评分(F=13.35)的时间主效应显著(均P＜0.05),AQ-回避评分的时间主效应和组别主效应均显著(F时间=62.84,F组别=5.65,均P＜0.05).VRET组在治疗后[(6.19±3.60)分]、随访期[(8.25±3.80)分]的AQ-回避评分显著低于IET组[治疗后(9.60±3.74)分,随访期(12.00±4.57)分](均P＜0.05).(2)在控制两组的BAT基线期初始值后,VRET组校正后BAT得分[(1.51±0.72)分]低于 IET 组[(4.39±0.75)分](F=55.81,P＜0.001),VRET 组疗效显著优于 IET组.结论 VRET对恐高症患者的恐高症状和行为回避程度均有一定改善作用,无论是即时疗效还是长期疗效,VRET对恐高症状的改善效果均优于IET.
The long-term efficacy of virtual reality exposure therapy for acrophobia
Objective To explore the long-term efficacy of virtual reality exposure therapy(VRET)for acrophobia.Method Sixty patients with acrophobia who visited the Nanjing Brain Hospital Affiliated to Nanjing Medical University from October 2018 to January 2021 were selected and randomly divided into VRET group(n=30)and imaginary exposure therapy(IET)group(n=30)using a block random number table method.The VRET group received VRET treatment,while the IET group received IET treatment.Both groups received treatment twice a week for 3 weeks.At baseline and after treatment,the acrophobia question-naire(AQ)and attitude towards high questionnaire(ATHQ)were used to assess the patients'acrophobia symptoms,and the behavioral avoidance test(BAT)was used to assess the patients'level of avoidance when facing high altitude situations.During the 2-year follow-up after treatment,AQ and ATHQ were used to eval-uate the patients'acrophobia symptoms.The repeated measures ANOVA and covariance analysis were used to analyze the data using SPSS 27.0 software.Result(1)Repeated measures ANOVA showed that there was no significant interaction effect of AQ-anxiety,AQ-avoidance,and ATHQ scores between the two groups before and after treatment(F=1.37,1.95,0.21,all P＞0.05),while the time main effect of AQ-anxiety(F=43.29)and ATHQ score(F=13.35)was significant(both P＜0.05),and the time main effect and group main effect of AQ-avoidance score were significant(Ftime=62.84,Fgroup=5.65,both P＜0.05).The AQ-avoidance scores of the VRET group(6.19±3.60,8.25±3.80)were significantly lower than those of the IET group(9.60±3.74,12.00±4.57)after treatment and during the follow-up period(both P＜0.05).(2)After controlling for the baseline initial values of BAT in the two groups,the VRET group had a lower correc-ted BAT score(1.51±0.72)than the IET group(4.39±0.75)(F=55.81,P＜0.001),indicating that the efficacy of the VRET group was significantly better than that of the IET group.Conclusion VRET sig-nificantly reduces acrophobia symptoms and behavioral avoidance level in patients with acrophobia,demon-strating superior efficacy compared to IET in both immediate and long-term effects.
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