Tips for Effective Implementation of Virtual Reality Exposure Therapy in Phobias—A Systematic Review

Background: The high incidence of phobias and the limited accessibility of psychotherapy are the reasons for the search for alternative treatments that increase the availability of effective treatment. The use of virtual reality (VR) technology is an option with the potential to overcome the barriers in obtaining an effective treatment. VR exposure therapy (VRET) is based on a very similar rationale for in vivo exposure therapy. The study aimed to answer the question of how to perform exposure therapy in a virtual reality environment so that it is effective.Methods: A systematic review of the literature, using PRISMA guidelines, was performed. After analysis of 362 records, 11 research papers on agoraphobia, 28 papers on social phobia and 10 about specific phobias were selected for this review.Results: VRET in agoraphobia and social phobia is effective when performed from 8 to 12 sessions, on average once a week for at least 15 min. In turn, the treatment of specific phobias is effective even in the form of one longer session, lasting 45–180 min. Head mounted displays are an effective technology for VRET. Increasing the frequency of sessions and adding drug therapy may shorten the overall treatment duration. The effectiveness of VRET in phobias is greater without concomitant psychiatric comorbidity and on the condition of inducing and maintaining in the patient an experience of immersion in the VR environment. Long-term studies show a sustained effect of VRET in the treatment of phobias.Conclusion: A large number of studies on in VR exposure therapy in phobias allows for the formulation of some recommendations on how to perform VRET, enabling the effective treatment. The review also indicates the directions of further VRET research in the treatment of phobias.

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The Simulation Game—Virtual Reality Therapy for the Treatment of Social Anxiety Disorder: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182413209 ◽

2021 ◽

Vol 18 (24) ◽

pp. 13209

Author(s):

Pasquale Caponnetto ◽

Sergio Triscari ◽

Marilena Maglia ◽

Maria C. Quattropani

Keyword(s):

Systematic Review ◽

Virtual Reality ◽

Anxiety Disorder ◽

Social Anxiety ◽

Social Anxiety Disorder ◽

Exposure Therapy ◽

Reality Therapy ◽

Virtual Reality Exposure Therapy ◽

Virtual Reality Exposure

(1) Background: With the term Virtual reality (VR) we refer to a three-dimensional environment generated by the computer, in which subjects interact with the environment as if they were really inside it. The most used VR tools are the so-called HMD (head-mounted display) which make it possible to achieve what theorists define “direct mediated action”. The aim of our systematic review is specifically to investigate the applications of virtual reality therapy for the treatment of social anxiety disorder, also known as social phobia. The most common treatment for social anxiety disorder is represented by “in vivo exposure therapy” (iVET). This method consists of exposing the participant, in a gradual and controlled way, to anxious stimuli, with the goal to change the subject’s response to the object or situation that is causing the fear. However, the main flaw of “in Vivo therapies” is represented by both the huge costs involved and the possible disturbance variables that can hinder the execution of the therapeutic treatment. Virtual reality exposure therapy could therefore, if confirmed in its effectiveness, constitute a solution to eliminate these two defects demonstrated by “in vivo exposure therapy”. The goal is to use VR as a means for the clinician to build a tailor-made path for the participant in order to make him acquire “in virtual” those skills necessary for a good adaptation in the “real” world. (2) Methods: From February 2021 until the date of submission of the article (September 2021), we conducted a systematic review aiming to verify the effectiveness of virtual reality exposure therapy (VRET) for the treatment of SAD. (3) Results: We identified a total of 205 unique articles. Among these, 20 full-text articles were assessed for eligibility and 5 of these met the eligibility criteria and were, therefore, included in the final systematic review. (4) Conclusions: Virtual reality therapies proved to be a valid alternative to the acquisition of social skills suitable for improving the symptoms of SAD. Although there has not been a significant difference between VRET and iVET, the low costs and flexibility of VRET open up new scenarios for achieving greater psychophysical well-being.

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Experiences of Gamified and Automated Virtual Reality Exposure Therapy for Spider Phobia: Qualitative Study

JMIR Serious Games ◽

10.2196/17807 ◽

2020 ◽

Vol 8 (2) ◽

pp. e17807 ◽

Cited By ~ 3

Author(s):

Philip Lindner ◽

Alexander Rozental ◽

Alice Jurell ◽

Lena Reuterskiöld ◽

Gerhard Andersson ◽

...

Keyword(s):

Virtual Reality ◽

Anxiety Disorders ◽

Exposure Therapy ◽

Real Life ◽

Spider Phobia ◽

Semistructured Interview ◽

User Experiences ◽

Virtual Reality Exposure Therapy ◽

Virtual Reality Exposure

Background Virtual reality exposure therapy is an efficacious treatment of anxiety disorders, and recent research suggests that such treatments can be automated, relying on gamification elements instead of a real-life therapist directing treatment. Such automated, gamified treatments could be disseminated without restrictions, helping to close the treatment gap for anxiety disorders. Despite initial findings suggesting high efficacy, very is little is known about how users experience this type of intervention. Objective The aim of this study was to examine user experiences of automated, gamified virtual reality exposure therapy using in-depth qualitative methods. Methods Seven participants were recruited from a parallel clinical trial comparing automated, gamified virtual reality exposure therapy for spider phobia against an in vivo exposure equivalent. Participants received the same virtual reality treatment as in the trial and completed a semistructured interview afterward. The transcribed material was analyzed using thematic analysis. Results Many of the uncovered themes pertained directly or indirectly to a sense of presence in the virtual environment, both positive and negative. The automated format was perceived as natural and the gamification elements appear to have been successful in framing the experience not as psychotherapy devoid of a therapist but rather as a serious game with a psychotherapeutic goal. Conclusions Automated, gamified virtual reality exposure therapy appears to be an appealing treatment modality and to work by the intended mechanisms. Findings from the current study may guide the next generation of interventions and inform dissemination efforts and future qualitative research into user experiences.

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Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: A meta-analysis

Journal of Behavior Therapy and Experimental Psychiatry ◽

10.1016/j.jbtep.2007.07.007 ◽

2008 ◽

Vol 39 (3) ◽

pp. 250-261 ◽

Cited By ~ 456

Author(s):

Thomas D. Parsons ◽

Albert A. Rizzo

Keyword(s):

Virtual Reality ◽

Exposure Therapy ◽

Meta Analysis ◽

Affective Outcomes ◽

Virtual Reality Exposure Therapy ◽

Specific Phobias ◽

Virtual Reality Exposure

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Virtual reality exposure therapy in the treatment of driving phobia

Psicologia Teoria e Pesquisa ◽

10.1590/s0102-37722010000100015 ◽

2010 ◽

Vol 26 (1) ◽

pp. 131-137 ◽

Cited By ~ 8

Author(s):

Rafael Thomaz da Costa ◽

Marcele Regine de Carvalho ◽

Antonio Egidio Nardi

Keyword(s):

Clinical Trials ◽

Virtual Reality ◽

Web Of Science ◽

Exposure Therapy ◽

Controlled Clinical Trials ◽

Virtual Reality Exposure Therapy ◽

Randomized Controlled Clinical Trials ◽

Randomized Controlled ◽

Virtual Reality Exposure

A growing number of researches has appeared on virtual reality exposure therapy (VRET) to treat anxiety disorders. The purpose of this article was to review some evidences that support the VRET efficacy to treat driving phobia. The studies were identified through computerized search (PubMed/Medline, Web of Science, and Scielo databases) from 1984 to 2007. Some findings are promising. Anxiety/avoidance ratings declined from pre to post-treatment. VRET may be used as a first step in the treatment of driving phobia, as long as it may facilitate the in vivo exposure, thus reducing risks and high costs of such exposure. Notwithstanding, more randomized/controlled clinical trials are required to prove its efficacy.

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Using Virtual Reality Exposure Therapy in Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Value in Health ◽

10.1016/j.jval.2021.04.1285 ◽

2021 ◽

Author(s):

Qiangru Huang ◽

Junqing Lin ◽

Rui Han ◽

Cheng Peng ◽

Aji Huang

Keyword(s):

Systematic Review ◽

Virtual Reality ◽

Pain Management ◽

Randomized Controlled Trials ◽

Exposure Therapy ◽

Meta Analysis ◽

Controlled Trials ◽

Virtual Reality Exposure Therapy ◽

Randomized Controlled ◽

Virtual Reality Exposure

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Meta-Analysis of the Efficacy of Virtual Reality Exposure Therapy for Social Anxiety

Behaviour Change ◽

10.1017/bec.2018.15 ◽

2018 ◽

Vol 35 (3) ◽

pp. 152-166 ◽

Cited By ~ 23

Author(s):

Rachel K. Chesham ◽

John M. Malouff ◽

Nicola S. Schutte

Keyword(s):

Virtual Reality ◽

Social Anxiety ◽

Exposure Therapy ◽

Meta Analysis ◽

Psychological Problem ◽

Imaginal Exposure ◽

Virtual Reality Exposure Therapy ◽

Meta Analyses ◽

Virtual Reality Exposure

AbstractSocial anxiety is a common, debilitating psychological problem. In the present study, two meta-analyses examined the efficacy of virtual reality exposure therapy for social anxiety. The first meta-analysis tested whether virtual reality exposure therapy reduces social anxiety more than a waitlist control condition. The results of the first meta-analysis, consisting of six studies and 233 participants, showed a significant overall effect size, indicating that virtual reality exposure therapy was effective in reducing social anxiety. The second meta-analysis tested whether the standard treatment for social anxiety, which includes in vivo or imaginal exposure, leads to greater effects than virtual reality exposure therapy. The second meta-analysis, consisting of seven studies and 340 total participants, showed essentially no difference in effect sizes between virtual reality exposure and in vivo or imaginal exposure. The results of the two meta-analyses support the use of virtual reality in the treatment of social anxiety.

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