Spider FearNCT05424250
Optimizing Exposure Using Occasional Aversive Imagery in Spider Fearful Individuals
A study testing occasional aversive imagination and Exposure in people with Spider Fear and Arachnophobia, run by Philipps University Marburg at 1 site in Germany.
Trial summary
The effectiveness of an optimized extinction training is investigated in spider-fearful individuals. Participants will undergo a one-session standardized extinction training, either with or without occasional metal imagination of most feared apprehension towards spiders. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Spider Fear, Arachnophobia
- What is being tested?
- occasional aversive imagination and Exposure
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 67 participants
- Where
- 1 siteGermany
- Study dates
- 15 Jun 2022to 30 Sep 2023
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Elevated score on Spider Phobia Questionnaire (SPQ) > 17
Who cannot join
- Severe allergies to bees/spiders/insects
- current psychotherapeutic/psychiatric treatment
- past psychotherapeutic/psychiatric treatment due to anxiety problems
- current or past psychotic symptoms
- current suicidal intent
- experience with exposure-based treatment
- current psychopharmacological medication
- severe cardiovascular, respiratory or neurological diseases
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Optimizing Exposure Therapy Via Occasional Aversive Imagery: A Randomized Controlled Trial With Spider Fearful Individuals
The effectiveness of an optimized extinction training is investigated in spider-fearful individuals. Participants will undergo a one-session standardized extinction training, either with or without occasional metal imagination of most feared apprehension towards spiders. The effectiveness of the training is measured by symptom improvement according to subjective ratings and behavioural avoidance tests one week later.
Read the detailed description
The present study aims to investigate the applicability of an optimized exposure training using imagination. Exposure training is an effective approach to the treatment of various anxiety disorders. However, there are a significant number of patients who do not benefit or who develop anxiety following successful treatment. The process of extinction underlying exposure is the focus of current research on optimizing exposure. In this regard, one promising approach for improving extinction learning involves the occasional presentation of fear-generating stimuli (unconditioned stimuli [US]; often an electrical stimulus in experimental studies) during extinction (occasional reinforced extinction, ORE). Previous experimental studies provide preliminary evidence for a less pronounced return of fear after extinction training with occasional presentation of the US. In clinical practice, this strategy is recommended to optimize extinction learning in the treatment of individuals with anxiety. However, the transfer of the procedure used (real presentation of an unconditioned stimulus) into clinical practice seems difficult to realize. One way to facilitate the transfer of the ORE approach into clinical practice could be the use of vivid imagination of a personally relevant fear-generating situation during extinction training/exposure (e.g., patients' central concerns). Therefore, the aim of the present study is to examine the applicability of ORE using imagination. In this context, a standardized extinction training either with or without mental imagination of a personally relevant fear situation (e.g., central concern of the consequences when confronted with spiders) will be performed in individuals with spider-fearful individuals. The approach used for individuals with spider fear is well established and has been successfully implemented in previous studies by instructed trainers (e.g., individuals with a bachelor's degree in psychology). The aim of this randomized controlled trial in healthy individuals with increased fear of spiders is to investigate whether optimized extinction training (extinction training + imagination) is more effective in reducing fear of spiders in the long term compared to standard extinction training.
- Conditions
- Spider Fear, Arachnophobia
- Being tested
- occasional aversive imagination, Exposure
- Medical subject headings
- Arachnophobia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
occasional aversive imaginationBehavioural
During six of the 27 exposure trials, participants in the experimental group are asked to imagine their most feared outcome towards spiders as vividly as possible while completing the specific trial.
ExposureBehavioural
- All participants complete an exposure training session (approx. 75 min) with seven exposure steps, which are repeated between one and five times (e.g. Step 4: directing the spider with a pen by touching its legs at least five times per repetition; this step must be repeated five times before continuing to the next step). One repetition per step is considered one trial, therefore each participant aims to complete 27 exposure trials.
| Study group | Role | What they receive |
|---|---|---|
| Exposure + occasional aversive imagination | Experimental | repeated imaginations of the participants' most feared apprehension during extinction training with seven standardized exposure steps Receives: Behavioral: occasional aversive imagination; Behavioral: Exposure |
| Exposure | Active comparator | Standard extinction training with seven standardized exposure steps Receives: Behavioral: Exposure |
What is being measured
The primary outcome is the main question the study is designed to answer.
Spider Phobia Questionnaire (SPQ)
31-item true/false questionnaire assessing symptoms of arachnophobia. Scores range from 0 to 31, with greater scores representing greater fear of spiders. Spider phobic individuals have obtained mean scores of 23.20 (SD = 2.90) and 23.76 (SD = 3.80) on the SPQ.
Measured: Change from baseline to post-treatment (i.e., 7-9 days)
Behavioral Approach Test (BAT)
Number of test steps fully completed (0-14 steps)
Measured: Change from baseline to post-treatment (i.e., 7-9 days)
Fear rating
Maximum fear rating on a scale from 0 (no fear) to 100 (severe fear) recorded once during BAT
Measured: Change from baseline to post-treatment (i.e., 7-9 days)
Secondary outcomes (4)
Fear of Spider Questionnaire (FSQ)
14-item questionnaire on a 7-point Likert scale (0 = 'I don't agree at all'; 6 = 'I completely agree') assessing symptoms of arachnophobia. Total score range: 0 to 84. Higher scores indicate worse severity of arachnophobia.
Measured: Change from baseline to post-treatment (i.e., 7-9 days)
Change in anxiety sensitivity (ASI-3)
The Anxiety Sensitivity Index (ASI-3) is a self-report measure of fear of anxiety-related body symptoms (i.e., anxiety sensitivity). Total score range: 0 to 72. Higher scores indicate worse anxiety sensitivity.
Measured: change from baseline to post-treatment (i.e. 7-9 days)
PROMIS Emotional Distress-Anxiety-Short Form
The DSM-5-TR Level 2-Anxiety-Adult measure is the 7-item PROMIS Anxiety Short Form that assesses the pure domain of anxiety in individuals age 18 and older. Each item on the measure is rated on a 5-point scale (1=never; 2=rarely; 3=sometimes; 4=often; and 5=always) with a range in score from 7 to 35 with higher scores indicating greater severity of anxiety.
Measured: change from baseline to post-treatment (i.e. 7-9 days)
US expectancy and fear ratings
Ratings of US expectancy and fear during exposure training on a scale from 0 (I don't expect my feared outcome/I am not scared at this moment) to 100 (I completely expect my feared outcome to happen/I am severely scared at this moment). Specifically, we asked participants to rate their US expectancy and fear before and during each of the 27 trials.
Measured: Baseline
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Jun 2022
- Study start15 Jun 2022
- Primary completion31 Jul 2023
- Study completion30 Sep 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (5)Papers the sponsor has linked to this study.
- Other trials for Spider FearStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind
- Who is masked
- Participant, Investigator, Outcomes assessor
- Enrolment
- 67 participants (actual)
Sponsor and investigators
- Lead sponsor
- Philipps University Marburg
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Christoph Benke, Philipps University Marburg
- Investigators
- Christoph Benke, PhD, Principal investigator, Philipps University MarburgChristiane Pané-Farré, PhD, Principal investigator, Philipps University MarburgDorothee Scheuermann, M.Sc., Principal investigator, Philipps University Marburg
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05424250
- Sponsor's protocol ID
- OPEX_SPIDER
- Status last verified
- Jan 2026
- First submitted
- 14 Jun 2022
- Last updated
- 9 Jan 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Craske MG, Treanor M, Conway CC, Zbozinek T, Vervliet B. Maximizing exposure therapy: an inhibitory learning approach. Behav Res Ther. 2014 Jul;58:10-23. doi: 10.1016/j.brat.2014.04.006. Epub 2014 May 9.
PubMed 24864005Culver NC, Stevens S, Fanselow MS, Craske MG. Building physiological toughness: Some aversive events during extinction may attenuate return of fear. J Behav Ther Exp Psychiatry. 2018 Mar;58:18-28. doi: 10.1016/j.jbtep.2017.07.003. Epub 2017 Jul 25.
PubMed 28777975Lipp OV, Ryan KM, Luck CC, Craske MG, Waters AM. Presentation of unpaired unconditional stimuli during extinction reduces renewal of conditional fear and slows re-acquisition. Psychophysiology. 2021 Oct;58(10):e13899. doi: 10.1111/psyp.13899. Epub 2021 Jul 6.
PubMed 34231228Shiban Y, Wittmann J, Weissinger M, Muhlberger A. Gradual extinction reduces reinstatement. Front Behav Neurosci. 2015 Sep 15;9:254. doi: 10.3389/fnbeh.2015.00254. eCollection 2015.
PubMed 26441581Thompson A, McEvoy PM, Lipp OV. Enhancing extinction learning: Occasional presentations of the unconditioned stimulus during extinction eliminate spontaneous recovery, but not necessarily reacquisition of fear. Behav Res Ther. 2018 Sep;108:29-39. doi: 10.1016/j.brat.2018.07.001. Epub 2018 Jul 3.
PubMed 29981936
Study at a glance
From the registry record, last updated by the sponsor on 9 Jan 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Optimizing Exposure Therapy Via Occasional Aversive Imagery: A Randomized Controlled Trial With Spider Fearful Individuals
- ClinicalTrials.gov ID
- NCT05424250
- Acronym / sponsor ID
- OPEX_SPIDER
- Conditions
- Spider Fear, Arachnophobia
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 67 participants (actual)
- Lead sponsor
- Philipps University MarburgUniversity, hospital or other
- Study start
- 15 Jun 2022 (actual)
- Primary completion
- 31 Jul 2023 (actual)
- Study completion
- 30 Sep 2023 (actual)
- First posted
- 21 Jun 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The effectiveness of an optimized extinction training is investigated in spider-fearful individuals. Participants will undergo a one-session standardized extinction training, either with or without occasional metal imagination of most feared apprehension towards spiders. The effectiveness of the training is measured by symptom improvement according to subjective ratings and behavioural avoidance tests one week later.
Detailed description
The present study aims to investigate the applicability of an optimized exposure training using imagination. Exposure training is an effective approach to the treatment of various anxiety disorders. However, there are a significant number of patients who do not benefit or who develop anxiety following successful treatment. The process of extinction underlying exposure is the focus of current research on optimizing exposure. In this regard, one promising approach for improving extinction learning involves the occasional presentation of fear-generating stimuli (unconditioned stimuli [US]; often an electrical stimulus in experimental studies) during extinction (occasional reinforced extinction, ORE). Previous experimental studies provide preliminary evidence for a less pronounced return of fear after extinction training with occasional presentation of the US. In clinical practice, this strategy is recommended to optimize extinction learning in the treatment of individuals with anxiety. However, the transfer of the procedure used (real presentation of an unconditioned stimulus) into clinical practice seems difficult to realize. One way to facilitate the transfer of the ORE approach into clinical practice could be the use of vivid imagination of a personally relevant fear-generating situation during extinction training/exposure (e.g., patients' central concerns). Therefore, the aim of the present study is to examine the applicability of ORE using imagination. In this context, a standardized extinction training either with or without mental imagination of a personally relevant fear situation (e.g., central concern of the consequences when confronted with spiders) will be performed in individuals with spider-fearful individuals. The approach used for individuals with spider fear is well established and has been successfully implemented in previous studies by instructed trainers (e.g., individuals with a bachelor's degree in psychology). The aim of this randomized controlled trial in healthy individuals with increased fear of spiders is to investigate whether optimized extinction training (extinction training + imagination) is more effective in reducing fear of spiders in the long term compared to standard extinction training.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Triple blind (participant, investigator, outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Exposure + occasional aversive imagination | Experimental | Behavioral: occasional aversive imagination, Behavioral: Exposurerepeated imaginations of the participants' most feared apprehension during extinction training with seven standardized exposure steps |
| Exposure | Active comparator | Behavioral: ExposureStandard extinction training with seven standardized exposure steps |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (1 listed)
- Elevated score on Spider Phobia Questionnaire (SPQ) > 17
Key exclusion criteria (8 listed)
- Severe allergies to bees/spiders/insects
- current psychotherapeutic/psychiatric treatment
- past psychotherapeutic/psychiatric treatment due to anxiety problems
- current or past psychotic symptoms
- current suicidal intent
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| occasional aversive imaginationDuring six of the 27 exposure trials, participants in the experimental group are asked to imagine their most feared outcome towards spiders as vividly as possible while completing the specific trial. | Behavioural | Exposure + occasional aversive imagination |
| Exposure• All participants complete an exposure training session (approx. 75 min) with seven exposure steps, which are repeated between one and five times (e.g. Step 4: directing the spider with a pen by touching its legs at least five times per repetition; this step must be repeated five times before continuing to the next step). One repetition per step is considered one trial, therefore each participant aims to complete 27 exposure trials. | Behavioural | Exposure, Exposure + occasional aversive imagination |
Primary outcome
Spider Phobia Questionnaire (SPQ)
Time frame: Change from baseline to post-treatment (i.e., 7-9 days)
31-item true/false questionnaire assessing symptoms of arachnophobia. Scores range from 0 to 31, with greater scores representing greater fear of spiders. Spider phobic individuals have obtained mean scores of 23.20 (SD = 2.90) and 23.76 (SD = 3.80) on the SPQ.
Behavioral Approach Test (BAT)
Time frame: Change from baseline to post-treatment (i.e., 7-9 days)
Number of test steps fully completed (0-14 steps)
Fear rating
Time frame: Change from baseline to post-treatment (i.e., 7-9 days)
Maximum fear rating on a scale from 0 (no fear) to 100 (severe fear) recorded once during BAT
4 secondary outcomes
Fear of Spider Questionnaire (FSQ)
Time frame: Change from baseline to post-treatment (i.e., 7-9 days)
Change in anxiety sensitivity (ASI-3)
Time frame: change from baseline to post-treatment (i.e. 7-9 days)
PROMIS Emotional Distress-Anxiety-Short Form
Time frame: change from baseline to post-treatment (i.e. 7-9 days)
US expectancy and fear ratings
Time frame: Baseline
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 9 Jan 2026.
- Background: PubMed 24864005Craske MG, Treanor M, Conway CC, Zbozinek T, Vervliet B. Maximizing exposure therapy: an inhibitory learning approach. Behav Res Ther. 2014 Jul;58:10-23. doi: 10.1016/j.brat.2014.04.006. Epub 2014 May 9.
- Background: PubMed 28777975Culver NC, Stevens S, Fanselow MS, Craske MG. Building physiological toughness: Some aversive events during extinction may attenuate return of fear. J Behav Ther Exp Psychiatry. 2018 Mar;58:18-28. doi: 10.1016/j.jbtep.2017.07.003. Epub 2017 Jul 25.
- Background: PubMed 34231228Lipp OV, Ryan KM, Luck CC, Craske MG, Waters AM. Presentation of unpaired unconditional stimuli during extinction reduces renewal of conditional fear and slows re-acquisition. Psychophysiology. 2021 Oct;58(10):e13899. doi: 10.1111/psyp.13899. Epub 2021 Jul 6.
- Background: PubMed 26441581Shiban Y, Wittmann J, Weissinger M, Muhlberger A. Gradual extinction reduces reinstatement. Front Behav Neurosci. 2015 Sep 15;9:254. doi: 10.3389/fnbeh.2015.00254. eCollection 2015.
- Background: PubMed 29981936Thompson A, McEvoy PM, Lipp OV. Enhancing extinction learning: Occasional presentations of the unconditioned stimulus during extinction eliminate spontaneous recovery, but not necessarily reacquisition of fear. Behav Res Ther. 2018 Sep;108:29-39. doi: 10.1016/j.brat.2018.07.001. Epub 2018 Jul 3.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Christoph Benke, PhD principal investigator
Philipps University Marburg
Christiane Pané-Farré, PhD principal investigator
Philipps University Marburg
Dorothee Scheuermann, M.Sc. principal investigator
Philipps University Marburg
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing occasional aversive imagination and Exposure in people with Spider Fear and Arachnophobia, run by Philipps University Marburg at 1 site in Germany.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 9 Jan 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Germany. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Spider Phobia Questionnaire (SPQ) (time frame: Change from baseline to post-treatment (i.e., 7-9 days)). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05424250, which also lists 5 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 Jan 2026.