The full text of this article hosted at iucr.org is unavailable due to technical difficulties.

Research Article

Virtual reality exposure therapy in anxiety disorders: a quantitative meta‐analysis

David Opriş

Corresponding Author

E-mail address:david.opris@ubbcluj.ro

Department of Clinical Psychology and Psychotherapy, Babeş‐Bolyai University, Cluj‐Napoca

Correspondence to: David Opriş, Department of Clinical Psychology and Psychotherapy, Babeş‐Bolyai University, No. 37, Republicii Street 400015, Cluj‐Napoca, Romania
Search for more papers by this author
Sebastian Pintea

Department of Clinical Psychology and Psychotherapy, Babeş‐Bolyai University, Cluj‐Napoca

Search for more papers by this author
Azucena García‐Palacios

Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellón de la Plana

Search for more papers by this author
Cristina Botella

Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellón de la Plana

Search for more papers by this author
Ştefan Szamosközi

Department of Applied Psychology, Babeş‐Bolyai University, Cluj‐Napoca

Search for more papers by this author
Daniel David

Department of Clinical Psychology and Psychotherapy, Babeş‐Bolyai University, Cluj‐Napoca

Department of Oncological Sciences, Mount Sinai School of Medicine, New York

Search for more papers by this author
First published: 07 November 2011
Cited by: 110

The authors disclose the following financial relationships within the past 3 years: Contract grant sponsor: Ministerio de Ciencia e Innovacion, Spain; Contract grant number: PSI2010‐17563.

Authors contribution: David Opriş—design of the study, data interpretation and analysis, writing the manuscript; Sebastian Pintea—data interpretation and analysis; Azucena García‐Palacios—data interpretation and analysis; Cristina Botella—design of the study, data interpretation and analysis; Ştefan Szamosközi—data interpretation; Daniel David—design of the study, data interpretation.

Abstract

Virtual reality exposure therapy (VRET) is a promising intervention for the treatment of the anxiety disorders. The main objective of this meta‐analysis is to compare the efficacy of VRET, used in a behavioral or cognitive‐behavioral framework, with that of the classical evidence‐based treatments, in anxiety disorders. A comprehensive search of the literature identified 23 studies (n = 608) that were included in the final analysis. The results show that in the case of anxiety disorders, (1) VRET does far better than the waitlist control; (2) the post‐treatment results show similar efficacy between the behavioral and the cognitive behavioral interventions incorporating a virtual reality exposure component and the classical evidence‐based interventions, with no virtual reality exposure component; (3) VRET has a powerful real‐life impact, similar to that of the classical evidence‐based treatments; (4) VRET has a good stability of results over time, similar to that of the classical evidence‐based treatments; (5) there is a dose–response relationship for VRET; and (6) there is no difference in the dropout rate between the virtual reality exposure and the in vivo exposure. Implications are discussed. Depression and Anxiety 0:1–9, 2011.  © 2011 Wiley Periodicals, Inc.

Number of times cited: 110

  • , The future of interpersonal skills development: Immersive virtual reality training with virtual humans, Human Resource Development Quarterly, 29, 2, (125-141), (2018).
  • , The efficacy of smartphone‐based mental health interventions for depressive symptoms: a meta‐analysis of randomized controlled trials, World Psychiatry, 16, 3, (287-298), (2017).
  • , Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review, Current Psychiatry Reports, 19, 7, (2017).
  • , Using Virtual Interactive Training Agents (ViTA) with Adults with Autism and Other Developmental Disabilities, Journal of Autism and Developmental Disorders, (2017).
  • , Three-dimensional head-mounted gaming task procedure maximizes effects of vestibular rehabilitation in unilateral vestibular hypofunction, International Journal of Rehabilitation Research, 40, 4, (325), (2017).
  • , Virtual reality in the assessment, understanding, and treatment of mental health disorders, Psychological Medicine, 47, 14, (2393), (2017).
  • , Review of Virtual Reality Treatment in Psychiatry: Evidence Versus Current Diffusion and Use, Current Psychiatry Reports, 19, 11, (2017).
  • , Angststörungen, Psychiatrie, Psychosomatik, Psychotherapie, 10.1007/978-3-662-49295-6_69, (1857-1932), (2018).
  • , Virtual Reality Objectifies the Diagnosis of Psychiatric Disorders: A Literature Review, Frontiers in Psychiatry, 8, (2017).
  • , DJINNI: A Novel Technology Supported Exposure Therapy Paradigm for SAD Combining Virtual Reality and Augmented Reality, Frontiers in Psychiatry, 8, (2017).
  • , Virtual reality exposure therapy in flight anxiety: A quantitative meta-analysis, Computers in Human Behavior, 72, (371), (2017).
  • , Serious Games for Mental Health: Are They Accessible, Feasible, and Effective? A Systematic Review and Meta-analysis, Frontiers in Psychiatry, 7, (2017).
  • , Virtual Reality Applications for the Assessment and Treatment of PTSD, Handbook of Military Psychology, 10.1007/978-3-319-66192-6_27, (453-471), (2017).
  • , Efficacy of an adaptation of the Best Possible Self intervention implemented through positive technology: a randomized control trial, Applied Research in Quality of Life, (2017).
  • , The Use of Virtual Reality Technology in the Treatment of Anxiety and Other Psychiatric Disorders, Harvard Review of Psychiatry, 25, 3, (103), (2017).
  • , Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials, Journal of Affective Disorders, 218, (15), (2017).
  • , Potential of virtual reality as a diagnostic tool for social anxiety: A pilot study, Computers in Human Behavior, 76, (128), (2017).
  • , Virtual Reality Training for Public Speaking—A QUEST-VR Framework Validation, Frontiers in ICT, 4, (2017).
  • , Virtual Reality-Enhanced Extinction of Phobias and Post-Traumatic Stress, Neurotherapeutics, 10.1007/s13311-017-0534-y, 14, 3, (554-563), (2017).
  • , Skin Conductance Reactivity to Standardized Virtual Reality Combat Scenes in Veterans with PTSD, Applied Psychophysiology and Biofeedback, 10.1007/s10484-017-9366-0, 42, 3, (209-221), (2017).
  • , Computational Psychometrics for Modeling System Dynamics during Stressful Disasters, Frontiers in Psychology, 8, (2017).
  • , Creating state of the art, next-generation Virtual Reality exposure therapies for anxiety disorders using consumer hardware platforms: design considerations and future directions, Cognitive Behaviour Therapy, 46, 5, (404), (2017).
  • , Mass imagineering: Combining human imagination and automated engineering from early education to digital afterlife, Technology in Society, 51, (163), (2017).
  • , La sémiologie motrice dans les troubles anxieux et obsessionnels, Annales Médico-psychologiques, revue psychiatrique, 175, 5, (469), (2017).
  • , Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD, European Journal of Psychotraumatology, 8, sup5, (1414560), (2017).
  • , Internet and mobile interventions for depression: Opportunities and challenges, Depression and Anxiety, 34, 7, (596-602), (2017).
  • , StreetWise: developing a serious game to support forensic mental health service users' preparation for discharge: a feasibility study, Journal of Psychiatric and Mental Health Nursing, 24, 4, (185-193), (2016).
  • , Perception of Peripersonal and Interpersonal Space in Patients with Restrictive‐type Anorexia, European Eating Disorders Review, 25, 3, (179-187), (2017).
  • , The virtues of virtual reality in exposure therapy, British Journal of Psychiatry, 210, 04, (245), (2017).
  • 2017 17th International Conference on Control, Automation and Systems (ICCAS) Jeju 2017 17th International Conference on Control, Automation and Systems (ICCAS) IEEE , (2017). 978-89-93215-14-4 Preliminary test of affective virtual reality scenes with head mount display for emotion elicitation experiment , (2017). 325 329 8204459 , 10.23919/ICCAS.2017.8204459 http://ieeexplore.ieee.org/document/8204459/
  • , Diaphragmatic breathing during virtual reality exposure therapy for aviophobia: functional coping strategy or avoidance behavior? a pilot study, BMC Psychiatry, 17, 1, (2017).
  • , Overcoming Public Speaking Anxiety of Software Engineers Using Virtual Reality Exposure Therapy, Systems, Software and Services Process Improvement, 10.1007/978-3-319-64218-5_15, (191-202), (2017).
  • , Virtual Reality and Other Realities, The Science of Cognitive Behavioral Therapy, 10.1016/B978-0-12-803457-6.00022-2, (551-590), (2017).
  • , A methodological review of meta-analyses of the effectiveness of clinical psychology treatments, Behavior Research Methods, (2017).
  • , Does a Combination of Virtual Reality, Neuromodulation and Neuroimaging Provide a Comprehensive Platform for Neurorehabilitation? – A Narrative Review of the Literature, Frontiers in Human Neuroscience, 10, (2016).
  • , A Meta-Analysis on the Efficacy of Technology Mediated CBT for Anxious Children and Adolescents, Journal of Rational-Emotive & Cognitive-Behavior Therapy, 10.1007/s10942-015-0228-5, 34, 1, (31-50), (2015).
  • , Angststörungen, Psychiatrie, Psychosomatik, Psychotherapie, 10.1007/978-3-642-45028-0_69-1, (1-77), (2016).
  • , Exposure to virtual social interactions in the treatment of social anxiety disorder: A randomized controlled trial, Behaviour Research and Therapy, 77, (147), (2016).
  • , Virtual reality measures in neuropsychological assessment: a meta-analytic review, The Clinical Neuropsychologist, 30, 2, (165), (2016).
  • , Capitalizing upon the Attractive and Addictive Properties of Massively Multiplayer Online Role-Playing Games to Promote Wellbeing, Frontiers in Psychiatry, 7, (2016).
  • , Meta-analysis of technology-assisted interventions for social anxiety disorder, Journal of Anxiety Disorders, 42, (71), (2016).
  • , Virtual Reality Exposure Therapy for Anxiety Disorders: Small Samples and No Controls?, Frontiers in Psychology, 7, (2016).
  • , Childhood trauma, psychosis liability and social stress reactivity: a virtual reality study, Psychological Medicine, 46, 16, (3339), (2016).
  • , Salivary cortisol and cardiovascular reactivity to a public speaking task in a virtual and real-life environment, Computers in Human Behavior, 62, (124), (2016).
  • , Virtual reality in the psychological treatment for mental health problems: An systematic review of recent evidence, Psychiatry Research, 236, (189), (2016).
  • , Emotional Mental Imagery as Simulation of Reality: Fear and Beyond—A Tribute to Peter Lang, Behavior Therapy, 47, 5, (702), (2016).
  • , Olfactory Stimuli Increase Presence During Simulated Exposure, Virtual, Augmented and Mixed Reality, 10.1007/978-3-319-39907-2_16, (164-172), (2016).
  • , Virtual reality and anxiety in primiparous women during episiotomy repair, Iranian Journal of Nursing and Midwifery Research, 21, 5, (521), (2016).
  • , Transforming Experience: The Potential of Augmented Reality and Virtual Reality for Enhancing Personal and Clinical Change, Frontiers in Psychiatry, 7, (2016).
  • , Tomorrow's world: current developments in the therapeutic use of technology for psychosis, BJPsych Advances, 22, 05, (301), (2016).
  • , Psychological countermeasures in manned space missions: “EARTH” system for the Mars-500 project, Computers in Human Behavior, 55, (898), (2016).
  • 2016 22nd International Conference on Virtual System & Multimedia (VSMM) Kuala Lumpur, Malaysia 2016 22nd International Conference on Virtual System & Multimedia (VSMM) IEEE , (2016). 978-1-4673-8993-8 Virtual environments design assessment for the treatment of claustrophobia , (2016). 1 8 7863215 , 10.1109/VSMM.2016.7863215 http://ieeexplore.ieee.org/document/7863215/
  • , Fear and physiological arousal during a virtual height challenge—effects in patients with acrophobia and healthy controls, Journal of Anxiety Disorders, 37, (30), (2016).
  • , Feasibility of Virtual Reality Environments for Adolescent Social Anxiety Disorder, Research on Social Work Practice, 26, 7, (825), (2016).
  • , Utility of virtual reality environments to examine physiological reactivity and subjective distress in adults who stutter, Journal of Fluency Disorders, 50, (85), (2016).
  • , Occupational e-Mental Health: Current Approaches and Promising Perspectives for Promoting Mental Health in Workers, Healthy at Work, 10.1007/978-3-319-32331-2_19, (257-281), (2016).
  • , The Use of Virtual Reality to Facilitate Mindfulness Skills Training in Dialectical Behavioral Therapy for Borderline Personality Disorder: A Case Study, Frontiers in Psychology, 7, (2016).
  • the Fourth International Conference TEEM '16 Salamanca, Spain Proceedings of the Fourth International Conference on Technological Ecosystems for Enhancing Multiculturality - TEEM '16 Technological Ecosystems for Enhancing Multiculturality ACM Press New York, New York, USA , (2016). 9781450347471 , 10.1145/3012430 20161207025650 http://dl.acm.org/citation.cfm?doid=3012430 Virtual reality and its uses a systematic literature review , (2016). 435 439 , 10.1145/3012430.3012553 20161207025654 http://dl.acm.org/citation.cfm?doid=3012430.3012553
  • , Comprehensive Treatment, Clinical Case Studies, 15, 5, (343), (2016).
  • 2016 3rd International Conference on Computer and Information Sciences (ICCOINS) Kuala Lumpur, Malaysia 2016 3rd International Conference on Computer and Information Sciences (ICCOINS) IEEE , (2016). 978-1-5090-2549-7 Expert review of the multimodal interaction model for Foot Reflexology VRST application , (2016). 530 535 7783271 , 10.1109/ICCOINS.2016.7783271 http://ieeexplore.ieee.org/document/7783271/
  • , E-virtual reality exposure therapy in acrophobia: A pilot study, Journal of Telemedicine and Telecare, 22, 4, (215), (2016).
  • , Effect of virtual reality exposure therapy on social participation in people with a psychotic disorder (VRETp): study protocol for a randomized controlled trial, Trials, 17, 1, (2016).
  • , Virtual Reality Exposure for PTSD Due to Military Combat and Terrorist Attacks, Journal of Contemporary Psychotherapy, 45, 4, (255), (2015).
  • , Konfrontationstherapie im Fokus, InFo Neurologie & Psychiatrie, 17, 11, (36), (2015).
  • , Virtual Reality in Psychotherapy, International Encyclopedia of the Social & Behavioral Sciences, 10.1016/B978-0-08-097086-8.21070-2, (138-146), (2015).
  • , Temporal dynamics in the relation between presence and fear in virtual reality, Computers in Human Behavior, 48, (542), (2015).
  • , The hybrid doctor–patient relationship in the age of technology – Telepsychiatry consultations and the use of virtual space, International Review of Psychiatry, 27, 6, (476), (2015).
  • , Illusory ownership of an invisible body reduces autonomic and subjective social anxiety responses, Scientific Reports, 5, 1, (2015).
  • , Virtuelle Welten für die psychiatrische Anwendung, NeuroTransmitter, 26, 10, (45), (2015).
  • , The impact of perception and presence on emotional reactions: a review of research in virtual reality, Frontiers in Psychology, 6, (2015).
  • , Using virtual reality to improve the efficacy of cognitive-behavioral therapy (CBT) in the treatment of late-life anxiety: preliminary recommendations for future research, International Psychogeriatrics, 27, 07, (1217), (2015).
  • , The Art of Exposure: Putting Science Into Practice, Cognitive and Behavioral Practice, 22, 3, (379), (2015).
  • , Real-time modulation of visual feedback on human full-body movements in a virtual mirror: development and proof-of-concept, Journal of NeuroEngineering and Rehabilitation, 12, 1, (2), (2015).
  • , Virtual Reality Exposure Therapy for Anxiety and Specific Phobias, Encyclopedia of Information Science and Technology, Third Edition, 10.4018/978-1-4666-5888-2.ch636, (6475-6483), (2015).
  • the 2015 Virtual Reality International Conference VRIC '15 Laval, France Proceedings of the 2015 Virtual Reality International Conference on ZZZ - VRIC '15 ZZZ ACM Press New York, New York, USA , (2015). 9781450333139 , 10.1145/2806173 20160808090321 http://dl.acm.org/citation.cfm?doid=2806173 Virtual reality environments as auxiliaries in the treatment of obesity , (2015). 1 6 , 10.1145/2806173.2806175 20160808090321 http://dl.acm.org/citation.cfm?doid=2806173.2806175
  • , Internet-based treatment of depression, Current Opinion in Psychology, 4, (131), (2015).
  • , Treating small animal phobias using a projective-augmented reality system: A single-case study, Computers in Human Behavior, 49, (343), (2015).
  • , Effect of combined multiple contexts and multiple stimuli exposure in spider phobia: A randomized clinical trial in virtual reality, Behaviour Research and Therapy, 71, (45), (2015).
  • 2015 IEEE 13th International Scientific Conference on Informatics Poprad, Slovakia 2015 IEEE 13th International Scientific Conference on Informatics IEEE , (2015). 978-1-4673-9867-1 978-1-4673-9868-8 Phobia treatment with the help of virtual reality , (2015). 114 119 7377818 , 10.1109/Informatics.2015.7377818 http://ieeexplore.ieee.org/document/7377818/
  • , Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments, Behaviour Research and Therapy, 74, (18), (2015).
  • , Integrating Virtual Reality With Activity Management for the Treatment of Fibromyalgia, The Clinical Journal of Pain, 31, 6, (564), (2015).
  • , Comparison of Virtual Reality Based Therapy With Customized Vestibular Physical Therapy for the Treatment of Vestibular Disorders, IEEE Transactions on Neural Systems and Rehabilitation Engineering, 22, 2, (389), (2014).
  • , Clinical Virtual Reality, Handbook of Virtual Environments, 10.1201/b17360-53, (1159-1203), (2014).
  • , Anwendung virtueller Realitäten in der forensischen Psychiatrie, Der Nervenarzt, 85, 3, (298), (2014).
  • , Virtual Reality Exposure Therapy for Combat-Related Posttraumatic Stress Disorder, Computer, 47, 7, (31), (2014).
  • , Virtual Reality Exposure Therapy, The Wiley Handbook of Anxiety Disorders, (1310-1324), (2014).
  • , A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders, PLoS ONE, 9, 5, (e96144), (2014).
  • , Virtual reality exposure therapy for the treatment of anxiety disorders: An evaluation of research quality, Journal of Anxiety Disorders, 28, 6, (625), (2014).
  • , Emotional Wellbeing, International Journal of Human-Computer Studies, 72, 8-9, (627), (2014).
  • , Robot-Based Psychotherapy: Concepts Development, State of the Art, and New Directions, International Journal of Cognitive Therapy, 7, 2, (192), (2014).
  • , Conversations with a virtual human: Synthetic emotions and human responses, Computers in Human Behavior, 34, (58), (2014).
  • , A Pilot Study of the VirtuSphere as a Virtual Reality Enhancement, International Journal of Human-Computer Interaction, 30, 1, (24), (2014).
  • , Terapia behawioralna zaburzeń lękowych, Postępy Psychiatrii i Neurologii, 23, 1, (3), (2014).
  • , Acceptability of virtual reality interoceptive exposure for the treatment of panic disorder with agoraphobia, British Journal of Guidance & Counselling, 42, 2, (123), (2014).
  • , The Use of Electronic Games in Therapy: a Review with Clinical Implications, Current Psychiatry Reports, 16, 12, (2014).
  • , Virtual reality exposure in anxiety disorders: Impact on psychophysiological reactivity, The World Journal of Biological Psychiatry, 15, 6, (427), (2014).
  • , Virtual Reality for the Induction of Positive Emotions in the Treatment of Fibromyalgia: A Pilot Study over Acceptability, Satisfaction, and the Effect of Virtual Reality on Mood, Cyberpsychology, Behavior, and Social Networking, 17, 6, (379), (2014).
  • , Outcomes associated with virtual reality in psychological interventions: where are we now?, Clinical Psychology Review, 34, 8, (634), (2014).
  • , Brave New Worlds--Review and Update on Virtual Reality Assessment and Treatment in Psychosis, Schizophrenia Bulletin, 40, 6, (1194), (2014).
  • , Innovation in Technology-Aided Psychotherapy Through Human Factors/Ergonomics: Toward a Collaborative Approach, Journal of Contemporary Psychotherapy, 43, 4, (253), (2013).
  • , Virtual Reality Applications to Address the Wounds of War, Psychiatric Annals, 43, 3, (123), (2013).
  • , New Directions in Virtual Reality-Based Therapy for Anxiety Disorders, International Journal of Cognitive Therapy, 6, 2, (114), (2013).
  • , Is virtual reality always an effective stressors for exposure treatments? some insights from a controlled trial, BMC Psychiatry, 13, 1, (2013).
  • , Human perception of a conversational virtual human: an empirical study on the effect of emotion and culture, Virtual Reality, 17, 4, (307), (2013).
  • , Functional Analysis With Typically Developing Children: Best Practice or Too Early to Tell?: In Response to Hanley (2012), Behavior Analysis in Practice, 6, 2, (62), (2013).
  • , A Commentary on the Current and Future Status of Educational and Developmental Psychology in Australia, The Australian Educational and Developmental Psychologist, 30, 01, (1), (2013).
  • , Do conversations with virtual avatars increase feelings of social anxiety?, Journal of Anxiety Disorders, 27, 4, (398), (2013).
  • , Efficacy of Virtual Reality Exposure Therapy in the Treatment of PTSD: A Systematic Review, PLoS ONE, 7, 12, (e48469), (2012).
  • , In Vivo versus Augmented Reality Exposure in the Treatment of Small Animal Phobia: A Randomized Controlled Trial, PLOS ONE, 10.1371/journal.pone.0148237, 11, 2, (e0148237), (2016).
  • , Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments, JMIR Mental Health, 10.2196/mental.4984, 3, 1, (e7), (2016).