Efficacy and acceptability of different interventions for acrophobia: a network meta-analysis of randomised controlled trials

Abstract Background Currently, different psychological interventions have shown significant efficacy in the treatment of acrophobia. However, the superiority of these individual treatments remains unclear. This network meta-analysis (NMA) aimed to investigate the efficacy, acceptability, and superiority of different existing interventions for acrophobia. Methods We conducted a NMA of randomised controlled trials (RCTs) and compared the efficacy, acceptability, and superiority of different existing interventions for acrophobia. Results In total, 17 RCTs (946 participants) were included in this study. The NMA demonstrated that virtual reality (VR) coach-delivered psychotherapy (standardised mean difference [SMD]=-2.08, 95% confidence interval [CI]: -3.22 to -0.93), in vivo exposure augmented with oppositional action (SMD=-1.66, 95% CI: -2.81 to -0.51), VR exposure therapy with 20 mg cortisol administration (SMD=-1.61, 95% CI: -3.14 to -0.09), VR based cognitive behavioural therapy (VRbasedCBT; SMD=-1.14, 95% CI: -2.22 to -0.05), and in vivo exposure (SMD=-1.02, 95% CI: -1.81 to -0.23) were significantly superior than the placebo/control interventions in improving the symptoms of patients with acrophobia. The NMA further indicated that VR coach-delivered psychotherapy was associated with the best improvement among all the 19 treatments for acrophobia. Furthermore, only VRbasedCBT (odds ratio=2.55, 95% CI: 1.09 to 5.96) was associated with higher dropout rate than the control/placebo. Limitations Sample heterogeneity, non-standardised assessment tools, and limited RCTs in some of the treatment arms. Conclusions VR coach-delivered psychotherapy could be considered as a first-line intervention for treating acrophobia. However, because of the study limitations, the overall evidence was not sufficiently strong, which warrants future studies.