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Open Paper

Anxiety Disorders

Anxiety Disorders: Digital Delivery, Virtual Reality, and Novel Interventions

2 - (OP7) Functional Segregation Within Visual Network in Acrophobia Using Virtual Reality Exposure Therapy and Imaginal Exposure Therapy: A Randomized Controlled Trial

Thursday, June 25, 2026
2:22 PM - 2:39 PM PDT
Location: Golden Gate C1, B2 Level
Keywords: Anxiety, Phobias, Exposure
Recommended Readings: The study investigates efficacy of virtual reality exposure therapy (VRET) and imaginal exposure therapy (IET) on symptoms and visual network using independent component analysis (ICA),   A significant main effect of time was also identified within visual network, with patients presenting increased rsFCs in occipital areas and decreased intrinsic rsFCs in frontal areas within visual network.,   This study underscores the importance of visual network processing segregation in the development and intervention mechanisms of acrophobia.,   ,  

    Author(s)

  • Yongjun Chen, M.S.

    psychotherapist
    Nanjing Brain Hospital Affiliated to Nanjing Medical University
    nanjing, Jiangsu, China (People's Republic)

    Handouts

    • Co-Author(s)

  • SW

    Sichu Wu, Ph.D.

    nanjing
    Nanjing Brain Hospital Affiliated to Nanjing Medical University
    nanjing, Jiangsu, China (People's Republic)

  • ZC

    Zixin Chen, M.A.

    nanjing
    Nanjing Brain Hospital Affiliated to Nanjing Medical University
    nanjing, Jiangsu, China (People's Republic)

  • Zz

    Zehui zhang, M.A.

    nanjing
    Nanjing Brain Hospital Affiliated to Nanjing Medical University
    nanjing, Jiangsu, China (People's Republic)

  • ZX

    Ziyue Xu, M.A.

    nanjing
    Nanjing Brain Hospital Affiliated to Nanjing Medical University
    nanjing, Jiangsu, China (People's Republic)

  • JW

    Jifan Wang, M.A.

    nanjing
    Nanjing Brain Hospital Affiliated to Nanjing Medical University
    nanjing, Jiangsu, China (People's Republic)

  • MG

    Meilin Guo, M.A.

    nanjing
    Nanjing Brain Hospital Affiliated to Nanjing Medical University
    nanjing, Jiangsu, China (People's Republic)

  • SH

    Shujun Hou, M.A.

    nanjing
    Nanjing Brain Hospital Affiliated to Nanjing Medical University
    nanjing, Jiangsu, China (People's Republic)

  • XH

    Xuan Huang, M.A.

    nanjing
    Nanjing Brain Hospital Affiliated to Nanjing Medical University
    nanjing, Jiangsu, China (People's Republic)

    • Author(s)

  • Ning Zhang, M.D., Ph.D. (he/him/his)

    Psychiatrist/Psychotherapist/Clinical Psychologist
    The Affiliated Brain Hospital of Nanjing Medical University
    Nanjing, Jiangsu, China (People's Republic)

  • CW

    Chun Wang, Ph.D.

    Psychiatrist/Psychotherapist/Clinical Psychologist
    The Affiliated Brain Hospital of Nanjing Medical University
    Nanjing, Jiangsu, China (People's Republic)



Background: Acrophobia has been the focus of recent research studies. Previous studies have identified abnormal brain function in acrophobia, with some of these abnormalities located in visual network. This network is involved in the processing of emotional visual stimuli and mental imagery, both of which are commonly abnormal in acrophobia. However, model-free characterization of the resting-state functional connectivity (rsFC) in this network is less explored in acrophobia. The present study investigates the efficacy of virtual reality exposure therapy (VRET) and imaginal exposure therapy (IET) on symptoms and visual network in acrophobia using independent component analysis (ICA).

Methods: Participants (N = 50) were randomly assigned to either the VRET or the IET using a block randomization method at a 1:1 ratio. The intervention sessions were conducted twice a week for a period of three weeks, and the study groups were evaluated pre- and post-intervention using resting-state functional magnetic resonance imaging (rs-fMRI) scans and symptoms of acrophobia. A mixed-design repeated measures analysis of variance (ANOVA) was performed in visual network using ICA pre- and post-intervention. Pearson correlation analysis was conducted between visual network intrinsic FC and Acrophobia Questionnaire (AQ), Attitude Towards Heights Questionnaire (ATHQ), Behavior Avoidance Test (BAT) and 7-item Generalized Anxiety Disorder Scale (GAD-7) pre- and post-intervention.

Results: In acrophobia, no group × time interaction effect was identified within the visual network. However, Increase intrinsic FC was observed among the intervention groups in right lingual within visual network, which exhibited a significant negative correlation with the reduction of AQ, specifically in the VRET group. A significant main effect of time was also identified within visual network, with patients presenting increased rsFCs in occipital areas and decreased intrinsic rsFCs in frontal areas within visual network. After intervention, a negative correlation was identified between the reduction of BAT and ATHQ-anxiety scores and increased intrinsic rsFCs in the occipital regions in the VRET group. Conversely, a positive correlation was observed between the reduction of BAT and ATHQ-anxiety scores and decreased intrinsic rsFCs in the frontal regions in the IET group.

Conclusion: VRET and IET could effectively influence intrinsic rsFCs of occipital and frontal regions within visual network. After intervention, acrophobia patients showed increased intrinsic rsFCs in occipital regions and decreased intrinsic rsFCs in frontal regions within visual network, which are consistent with improvement of acrophobia symptoms. This study underscores the importance of visual network processing segregation in the development and intervention mechanisms of acrophobia.

Learning Objectives:

  • explains their mechanism within a visual network，aiming to the VRET help more acrophobia in the remote districts