Virtual reality exposure therapy in anxiety disorders: a systematic review of process-and-outcome studies
Open accessAbstract
In recent years, virtual reality exposure therapy (VRET) has become an interesting alternative for the treatment of anxiety disorders. Research has focused on the efficacy of VRET in treating anxiety disorders: phobias, panic disorder, and posttraumatic stress disorder. In this systematic review, strict methodological criteria are used to give an overview of the controlled trials regarding the efficacy of VRET in patients with anxiety disorders. Furthermore, research into process variables such as the therapeutic alliance and cognitions and enhancement of therapy effects through cognitive enhancers is discussed. The implications for implementation into clinical practice are considered.
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VRET specifically does not impair the therapeutic alliance.
“and VRET specifically (Horigome et al., 2020; Meyerbroker and Emmelkamp, 2010).”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Meyerbroker and Emmelkamp, 2010
The Therapeutic Alliance and Expectancy of Therapeutic Gains section reports that alliance quality was positively related to VRET outcomes for fear of flying, but not for acrophobia; it does not establish that VRET leaves the alliance unimpaired. The Concluding Remarks say there were no indications of interference with the therapeutic process, but that observation draws on internet-based treatment, not VRET specifically. Page numbers are unavailable in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe outcomes from the IM-VRCBT group are concordant to other investigations indicating that exposure and relaxation VR scenarios are similarly effective to the classical, face-to-face version of these strategies in reducing GAD symptoms.
“Consequently, the outcomes from the IM-VRCBT group are concordant to other investigations indicating that exposure and relaxation VR scenarios are similarly effective to the classical, face-to-face version of these strategies in reducing GAD symptoms (Gorini and Riva, 2008; Meyerbröker and Emmelkamp, 2010; Guitard et al., 2019).”
From Standard CBT versus integrative and multimodal CBT assisted by virtual-reality for generalized anxiety disorder (2022) · cites this paper as Meyerbröker and Emmelkamp, 2010
The Panic Disorder section reports comparable outcomes for VR-assisted CBT and CBT with in-vivo exposure, which supports the broad comparison of VR and conventional exposure. It concerns panic disorder, not GAD, and does not establish that VR relaxation scenarios are as effective as face-to-face relaxation for reducing GAD symptoms. The Efficacy of VRET section lists generalized anxiety disorder as a search term but reports no such comparison. (LLM, conf=0.88)
Experimental — accuracy not yet measuredVRET has been shown to be effective for flying phobia treatment in several meta-analyses and systematic reviews.
“VRET has been shown to be effective for FP treatment in several meta-analyses and systematic reviews [28–31].”
From An Internet-based treatment for flying phobia (NO-FEAR Airlines): Study protocol for a randomized controlled trial (2016) · cites this paper as [30]
Immersive virtual reality exposure therapy may be effective for anxiety disorders.
“A growing body of research indicates that immersive virtual reality exposure therapy may be effective for anxiety disorders (53), as well as pediatric disorders such as attention deficit disorder (54, 55).”
From Behavioral Intervention Technologies: Evidence review and recommendations for future research in mental health (2013) · cites this paper as [53]
The effects of VR interventions on treatment attrition remained unclear, with some speculation of possible superiority, but no assessment in a meta-analysis.
“The effects of VR interventions on treatment attrition remained unclear, with some speculation of possible superiority1,5,8, but no assessment in a meta-analysis.”
From The effectiveness of virtual reality based interventions for symptoms of anxiety and depression: A meta-analysis (2018) · cites this paper as [5]
These findings contradict previous speculation of possible comparative benefit of VR-enhanced interventions.
“These findings contradict previous speculation of possible comparative benefit1,5,8.”
From The effectiveness of virtual reality based interventions for symptoms of anxiety and depression: A meta-analysis (2018) · cites this paper as [5]
A study of fear of flying, but not an acrophobia study, found a significant correlation between alliance and outcome.
“In a systematic review of VRET process and outcome research, only two studies were identified that captured alliance information [15]: a study of fear of flying, but not an acrophobia study, found a significant correlation with outcome.”
In a systematic review of VRET process and outcome research, only two studies were identified that captured alliance information.
“In a systematic review of VRET process and outcome research, only two studies were identified that captured alliance information [15]: a study of fear of flying, but not an acrophobia study, found a significant correlation with outcome.”
Few studies have assessed alliance during VRET treatments.
“Few studies, however, have assessed alliance during VRET treatments, perhaps due to an expectation that alliance will be poor in treatments that prevent face-to-face contact with a therapist [9].”
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- Authors
- Meyerbröker, K., & Emmelkamp, P. M. G.
- Affiliations
- University of Amsterdam (NL)
- Corresponding author
- Meyerbröker, Katharina
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2010-08-23
- Volume
- 27
- Issue
- 10
- Pages
- 933-944
- ISSN
- 1091-4269 (ISSN-L)
- OpenAlex
- W1982861985
- Cited by
- 290
- References
- 59
- Citations by year
- 2026: 13 · 2025: 15 · 2024: 10 · 2023: 9 · 2022: 19 · 2021: 17 · 2020: 27 · 2019: 19 · 2018: 30 · 2017: 22 · 2016: 18 · 2015: 25 · 2014: 21 · 2013: 27 · 2012: 8
- FWCI
- 3.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (publishedVersion)
- UvA-DARE (University of Amsterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Koninklijke Nederlandse Akademie van Wetenschappen
- Topics
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- virtual reality exposure therapy, anxiety disorders, phobia, panic disorder, post-traumatic stress disorder, treatment efficacy, therapeutic relationship, nootropic drugs, process parameters, clinical implementation
- MeSH terms
- Anxiety Disorders, Computer Simulation, Humans, Implosive Therapy, Reality Therapy, Therapy, Computer-Assisted, User-Computer Interface, Randomized Controlled Trials as Topic, Treatment Outcome
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