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Specific phobias are one of the most common anxiety disorders with prevalence of up to 14.1% for adults (Eaton et al., 2018). Specific phobia is characterized by an excessive fear of an object or situation and its avoidance (Bandelow et al., 2014). In research, avoidance behavior is often assessed via the Behavioral Avoidance Test (BAT) that employs real fear-eliciting stimuli (e.g., spiders; Bernstein & Nietzel, 1974; Schwarzmeier et al., 2020). Though different versions of the BAT are available (e.g., sliding the spider towards oneself vs. moving towards the spider; (Hoffman et al., 2003; Schwarzmeier et al., 2020), feasibility and standardization could be improved by implementing the BAT virtual reality (VR; Mühlberger et al., 2008). While previous research has validated VR-BATs based on self-report measures, to date no studies have compared avoidance behavior and psychophysiological measures of fear between traditional and VR-BATs, as well as compared different versions of the BAT. This study aims to validate a VR-BAT regarding multiple measures of fear and avoidance and to compare different approaching behaviors, utilized in BATs. We also aim to explore the effect of haptic and immersion and presence in VR-BATs. Towards these aims, patients with spider phobia (aged 18 to 65) will complete four randomized BATs, two in VR and two in vivo. BATs will involve either approaching a (virtual) spider on foot or sliding a (virtual) spider towards oneself. The final distance between the patient and the spider in each BAT will indicate avoidance behavior. Fear ratings will be given at multiple time points: before testing, when first seeing the spider, at the beginning of the BAT (3 meters distance between spider and participant), after bridging 25%, 50%, and 75% of the distance between the spider and the participants, at the final distance and after the spider or the participant left the testing room. Psychophysiological measures (heart rate, intervals between the heartbeats, skin conductance level, skin temperature, and velocity) will be assessed during the entire testing. To link these measures to final distance and fear ratings, anchor points will be used (see time points). Psychometric measures of anxiety (State-Trait Anxiety Inventory (STAI)) and state affectivity (Positive and negative Affect Schedule (PANAS-State)) will be assessed after each BAT, as well as questionnaires on their (VR-)experience (e.g., haptic, usability and immersion). As this study is part of a larger project, this preregistration will mainly focus on comparing multiple versions of the BAT.

Additional file 1. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents*.

Additional file 1. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents*.