PONE-D-21-38295Automated app-based augmented reality cognitive behavioural therapy for spider phobia: Study protocol for a randomized controlled trialPLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Partly

Reviewer #2: Yes

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dear Authors, this protocol is very interesting and has a novel idea that might address an important public health concern. Please find some comments, below. I would love to read the revised protocol, and am also enthusiastic to read the finding of this study.

1. Abstract part, I suggest avoiding using abbreviations in the abstract part.

2. Introduction part, it will be good if the authors, clearly state what merits ARET will have over VRET?

3. Exclusion part, it is stated as to “when they are starting, adjusting, or planning to start or adjust their psychotropic medication within three months prior to the time of recruitment until the planned end of the study”. How the participants know like adjusting psychotropic medication because this is the role of the physician.

4. Sample size part, it is stated that a small study on ARET reveals that as it has 0.8 effect size, while, authors prefer to use effect size of 0.6 to calculate the sample size. But, if the authors want to have a conservative effect size, why not another effect size that yields a more conservative effect size? Or if the authors are interested to increase sample size, why not other ways of escalating the number of participants?

5. I think it will be good if the author does power analysis and add this to the protocol?

6. Procedure part, in the protocol, it is stated as “Potential participants will receive two email reminders to fill in this screener. If there is no response or a participant indicates they are no longer interested, these individuals will not be contacted again”. So, what is the time interval between two email reminders?

7. It is stated as “participants can repeat the module if they want to”. However, if some participants repeat the module, while if the others do not repeat the module, then, I think it will affect the outcomes and makes it difficult to reach conclusion. So, how do the authors deal with issues?

8. For the waiting list group, there is no placebo given for 6 weeks. How did the author see these issues?

9. Participants in the waiting list group might have exposure to spiders through other means like on the internet by themselves during 6 weeks period of study. So, how do researchers handle this?

10. I suggest adding validity, reliability, sensitivity, and specificity for FSQ?

11. Why does the author describe the outcomes that are measured by SPQ as secondary outcomes? Since the study deals with the reduction of phobia.

12. In protocol stated, “In case participants experience negative side effects, such as overwhelming fear or anxiety, the research team (including an experienced clinician) is available to offer the necessary support”. I suggest adding some information on how the participant’s help sought will be handled in the protocol?

13. I could not find the details of Module 1 to 6. So, if possible, I suggest to add this module.

Reviewer #2: The protocol seemed to have sound methodology and procedures were described in details. Furthermore, opinion from a better expert in this field would be better.

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Reviewer #1: No

Reviewer #2: Yes: Dr. Panchanan Acharjee

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Automated app-based augmented reality cognitive behavioral therapy for spider phobia: Study protocol for a randomized controlled trial

PONE-D-21-38295R1

Dear Dr. Donker,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Walid Kamal Abdelbasset, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Yes

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dear Authors, thank you for the response to my comments and all my comments and concerns are well addressed.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

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