Facing fear through play: A smartphone-based proof-of-concept intervention using inverted augmented reality

Despite the well-documented efficacy of exposure therapy for phobic disorders, its real-world implementation remains limited due to barriers in accessibility, acceptability, and generalization.

This proof-of-concept study examined the feasibility and preliminary effects of a novel gamified augmented reality (AR) intervention designed to support in vivo exposure by embedding playful, non-threatening virtual stimuli into real-world anxiety-provoking contexts.

Twenty individuals with various phobic disorders participated in a multiple-baseline design. At a randomly assigned time point, participants used a smartphone-based AR application, or in some cases, a VR headset version, to interact with virtual game elements within individualized fear-relevant environments. The task involved physically navigating individualized fear-relevant environments while collecting color-coded virtual objects presented via augmented reality within the real-world setting.

Linear mixed-effects analyses indicated a significant reduction in self-reported situational fear following the intervention, with a large within-subject effect size estimate (Cohen's d = 2.21). Secondary outcomes related to anxiety sensitivity, agoraphobic cognitions, and depressive symptoms also showed pre-post improvements with small to moderate effect sizes. No significant differences were observed across device types or treatment settings.

The findings provide preliminary support for a low-threshold, smartphone-based AR approach that may complement exposure-based interventions in naturalistic settings. However, given the small and heterogeneous sample and the absence of a control group, these results should be interpreted cautiously. Future randomized controlled studies with larger and more homogeneous samples, validated behavioral outcome measures, and follow-up assessments are needed to clarify efficacy, mechanisms of change, and long-term effects.