Research On The Effect Of Virtual Reality Exposure Therapy On Fear Of Heights And Its Brain Mechanism

Objectives:1.The Chinese version of acrophobia questionnaire(AQ)and attitude attitudes high questionnaire(ATHQ)was revised to provide research tools for the following virtual reality exposure therapy(VRET).2.Comparing the differences in brain functional activities of resting phobias and healthy control(HC)subjects under resting conditions,exploring possible neural mechanisms of heightening phobia,and providing assistance for future research and diagnosis and treatment.3.To explore the efficacy,safety and possible mechanism of VRET in the treatment of acrophobia.Methods:Study 1: 786 people filled in AQ,756 valid questionnaires were recovered,460 people filled in ATHQ,448 valid questionnaires were recovered.AQ has two subscales: The Anxiety Scale(AQ-Anxiety)and the avoidance scale(AQ-Avoidance).The items of the questionnaire were analyzed by critical ratio method and correlation analysis method.The content validity was tested by expert consultation method,and the internal consistency reliability was used as the measurement index of the questionnaire reliability.Study 2: a case-control study was designed to compare the acrophobia group and the normal control group(HC).AQ,ATHQ,Behavior Avoidance Test(BAT)scores and f MRI data were collected from the acrophobia subjects recruited online(n = 23)and the HC subjects matched in gender,age and education years(n = 30).The voxel based degree centrality(DC)method was used to analyze the imaging data,and the differences of brain function network connection attributes between the two groups were compared by independent sample t-test.The correlation between DC value and AQ-Anxiety,AQ-Avoidance,ATHQ,BAT was analyzed.Study 3: 23 cases of acrophobia were treated with VRET for 3 weeks.AQ,ATHQ,BAT evaluation and resting f MRI were performed on the treated acrophobia.The changes of AQ,ATHQ and BAT before and after VRET treatment were compared by nonparametric test.The difference of DC value of whole brain before and after treatment was compared by paired sample t test.Results:1.In the AQ questionnaire,each question is significantly related to the total score,and the correlation coefficient is between 0.462 and 0.732;in the ATHQ questionnaire,each question is also significantly related to the total score,and the correlation coefficient is between 0.694 and 0.790.According to the subjects in the total scale score before and after 27% of the high and low groups,through independent sample t-test to compare the scores of each item high group and low group,all items have significant differences(p < 0.05).The internal consistency reliability of AQ total score and two subscales was between 0.905 and 0.938.2.Compared with HC group,acrophobia questionnaire anxiety(AQ-Anxiety)(t = 18.320,p = 0.000),acrophobia questionnaire avoidance(AQ-Avoidance)(t = 5.520,p = 0.000),ATHQ(t = 5.520,p = 0.000)and BAT(t = 5.520,p = 0.000)were significantly different in baseline.Compared with HC group,the DC values of the right dorsolateral prefrontal cortex(DLPFC)and the right ventrolateral prefrontal cortex(VLPFC)were significantly increased(p < 0.01,GRF correction)and the DC values of the left central posterior gyrus,bilateral fusiform gyrus,right lingual gyrus,left and right cerebellum were significantly reduced(p < 0.01),GRF correction).DLPFC on the right side was positively correlated with AQ-Anxiety(r = 0.449,p = 0.032),positively correlated with AQ-Avoidance(r = 0.610,p = 0.002);the cerebellum on the left side was negatively correlated with ATHQ(r =-0.506,p = 0.002),negatively correlated with AQ-Avoidance(r =-0.610,p = 0.002).3.After VRET for 6 times,the scores of AQ-Anxiety,AQ-Avoidance,ATHQ and BAT decreased and reached statistical significance(p < 0.01).In the abnormal brain area,the DC values of left posterior central gyrus,left and right fusiform gyrus,left and right cerebellar Ba6 areas increased,while the DC values of right VLPFC,right DLPFC,right lingual gyrus decreased,which reached statistical significance(p < 0.01,GRF correction).Compared with HC group,there was no significant difference in the whole brain DC value(p < 0.01,GRF correction),but AQ-Anxiety,AQ-Avoidance,ATHQ and BAT scores were still significantly different(p< 0.01).Conclusions:1.The Chinese revised versions of AQ and ATHQ are suitable for Chinese subjects and can be used in clinical research of acrophobia.2.In resting state,subjects with acrophobia have abnormal connections with other brain regions,such as cognitive control,emotion regulation and visual recognition loops,which may be the brain pathological mechanism of acrophobia.3.After VRET treatment,clinical symptoms and abnormal brain regions also recovered to normal levels.