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Updated: Mar 29, 2026

Human Fear Conditioning Conducted in Full Immersion 3-Dimensional Virtual Reality
Published on: August 9, 2010
Fear and physiological arousal during a virtual height challenge--effects in patients with acrophobia and healthy
Julia Diemer1, Nora Lohkamp2, Andreas Mühlberger3
1Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Universitätsstr. 31, 93053 Regensburg, Germany; Department of Psychiatry, University Hospital Münster, Albert-Schweitzer-Str. 11, 48149 Münster, Germany.
Abstract:
Virtual reality (VR) exposure therapy is becoming increasingly established, but the mode of action is not well understood. One potential efficacy factor might be physiological arousal. To investigate arousal during VR exposure, we exposed 40 patients with acrophobia and 40 matched healthy controls to a VR height challenge and assessed subjective (fear ratings) and physiological (heart rate, skin conductance level, salivary cortisol) fear reactions. Patients experienced a significant increase of subjective fear, heart rate and skin conductance level. Unexpectedly, controls, who reported no subjective fear, also showed an increase in heart rate and skin conductance. There was no increase in salivary cortisol levels in either group. Physiological arousal in acrophobic patients, in contrast to subjective fear, might not be stronger than that of controls confronted with height cues in VR, indicating marked discordance across symptom domains. The lack of a cortisol response in a clearly stressful paradigm warrants further study.
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Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes

