Intervention: VR-CBT app
anxiety
ROAR
The treatment was delivered through a VR-CBT app that participants could download on their own smartphone in combination with a $5 VR viewer. The VR-CBT app was launched as a beta test in both the Google Play store (Android) and the App store (IOS), meaning that the app could only be accessed through an URL and a unique pin code for each participant that was provided by the research team. Technical questions from participants were answered by e-mail by a research team member.The VR-CBT app consisted of six CBT-based animated modules that included a virtual therapist (modeled on the first author). The modules took between 5 and 40 min each to complete. The app also included severalgamified immersive VR environments and interactions such as checking in at an airport, the boarding process, finding one's seat, taking off, flying with turbulence, and landing (see online Supplementary Fig. SF1 and a video SV1 in the online supplement). The scenarios covered the entire exposure spectrum of flight anxiety and was developed based on input from a user-test among 15 participants suffering from flight anxiety. Examples of (gamified) interactions included locating objects that passengers brought onto the airplane (scavenger hunt) and comforting another nervous passenger. In addition, the app included sounds typical of airplane travel (e.g. engine roar, announcements from the cabin crew, chattering voices). Participants were able to progress to subsequent exposure levels if they rated their anxiety as ⩽3 on a ten-point scale after finishing a level. Participants who rated the VR level with a score of >3 received a message explaining that they should practice the same level again before moving on to the next level. Virtual environment navigation occurred via gaze control. See Fehribach et al. (The VR-CBT app is available in Google Play (for Android devices) and the App Store (for Apple smartphones) for about $10. The app runs on nearly all smartphones from 2016 or newer (as long as they are equipped with a gyroscope). In terms of hardware, only a rudimentary VR viewer is required (cost approx. $5–10).