Primary and secondary outcome measures
SECONDARY
In order to weight our study results according to their clinical importance, we have defined primary and secondary outcome measures. Primary outcome measures included changes in Behavioral Approach Tests (BATs), subjective fear levels and heart rate measurements in response to both spiders and heights from before to after exposure. These measures are considered to be more important for the translation into a clinical context (since they indicate a change in avoidance behavior), than mere changes in spider- and height-fear related questionnaires, which were therefore regarded as secondary outcome measures.However, technical difficulties during data collection limited the availability of heart rate data to a restricted number of participants, compromising statistical power and data reliability. Additionally, the physically demanding nature of the height BAT, requiring participants to climb the church tower’s stairs, turned out to be a confounding factor that compromised the heart rate measurement as a physiological indicator of fear. Due to these confounds we decided not to report heart rate data.