Smartglass-guided exposure for anxiety disorders: A proof-of-concept study

Exposure is a highly effective treatment for pathological fear and anxiety, but rarely usedin routine care. Issues of practicability and lack of therapists in rural areas are main barriers forthe dissemination of exposure. Smartglass devices may enable therapists to guide exposurefrom their own office via real-time feedback and may thereby increase practicability. The presentstudy explored the technological usability and clinical feasibility of Smartglass-guided exposurein a behavioral approach test in spider fearful individuals (N=40).Fearful individuals were asked to start the Smartglass themselves and established aconnection to a therapist, who guided the exposure test from afar. Clinical severity of spider fearwas assessed via questionnaire. Technological usability was assessed with establishedmeasures of usability, user experience, and user acceptance. Exploratory, individualcharacteristics of exposure were collected (e.g., within-session fear reduction, duration, safetybehavior).Overall, fearful individuals (94.9%) and therapists (100%) were able to establish aconnection. Usability of Smartglass-guided exposure was evaluated as positive. Within-sessionfear reduction was large (d=1.91). Adverse events were minimal. There were, however, someassociations between exposure characteristics and usability evaluation (e.g., lower userfriendlinessand longer exposure duration). Two case examples further highlight chances andrisks of Smartglass-guided exposure.These findings provide first evidence that Smartglass-guided exposure could be usefulin exposure therapy. Smartglass-guided exposure may ultimately help to increase practicabilityof exposure and increase dissemination, also in rural areas. These findings are promising forfuture research on the long-term outcome of evidence-based exposure in treatment seekingpatients.