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Cited by 460Virtual Reality Applications and ImpactsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesDigital Mental Health Interventions

Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review

Open access
Botella, Cristina, Fernández-Álvarez, Javier, Guillén, Verónica, García-Palacios, Azucena, Baños, Rosa·2017·Current Psychiatry Reports
DOI 10.1007/s11920-017-0788-4
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Abstract

This review is designed to systematically examine the available evidence about virtual reality exposure therapy's (VRET) efficacy for phobias, critically describe some of the most important challenges in the field and discuss possible directions. Evidence reveals that virtual reality (VR) is an effective treatment for phobias and useful for studying specific issues, such as pharmacological compounds and behavioral manipulations, that can enhance treatment outcomes. In addition, some variables, such as sense of presence in virtual environments, have a significant influence on outcomes, but further research is needed to better understand their role in therapeutic outcomes. We conclude that VR is a useful tool to improve exposure therapy and it can be a good option to analyze the processes and mechanisms involved in exposure therapy and the ways this strategy can be enhanced. In the coming years, there will be a significant expansion of VR in routine practice in clinical contexts.

AI snapshot

Written from the paper’s full text.

TL;DR

This PRISMA systematic review identified 11 RCTs published from 2012 to January 2017 on virtual reality exposure therapy (VRET) for phobias and found VRET generally superior to waitlist and broadly comparable to active evidence-based treatments, with some exceptions. It also reviews presence, cognitive enhancers, and behavioral manipulations as mechanisms or enhancements, while noting small samples and limited clinical-setting evidence.

Key findings

  • The search yielded 124 citations; 27 articles were selected after abstract review, and 11 RCTs met inclusion criteria. Ten studies used VR and one used augmented reality; disorders included three social anxiety disorder, five agoraphobia (with or without panic disorder), one small animal phobia, one mixed phobia study, and one fear of flying. No sub-sample exceeded 35 participants.
  • VRET was significantly more efficacious than non-active control conditions (waitlist) for all disorders and studies except one panic disorder study [32], which found no significant differences between conditions. Against active conditions, VRET generally showed no significant differences, with few exceptions: Bouchard et al. [20] was the only study favoring VRET; Kampmann et al. [22•] showed follow-up favoring in vivo; Botella et al. [18•] was equally efficacious at follow-up; Meyerbröker et al. [29] favored in vivo in one of four measures.
  • A meta-analysis on presence and anxiety during VRET identified 33 papers with 1,196 participants and confirmed a positive relationship, moderated by factors such as large effects for fear of animals and flying, moderate for acrophobia, and small for social anxiety disorder; correlations were stronger for clinical than non-clinical populations. Another meta-analysis aggregating 83 studies found technological immersion had a medium-sized effect on presence.
  • Enhancement studies indicated cognitive enhancers (DCS, YHCL, G-CORT, BDNF) can improve exposure outcomes; multiple VR contexts enhanced exposure generalizability in spider phobia; perceptual cues produced higher fear activation and greater fear habituation; fear reactivation prior to exposure had no effect on outcomes; and size-estimation bias in spider phobia was corrected with exposure therapy.

Methods

  • PRISMA systematic review. Databases included PsycNet, PubMed, Scopus, and Web of Science, searching publications from 2012 to January 2017. RCT inclusion criteria were: diagnosis of a phobia, VRET applied to clinical symptoms, at least ten participants per experimental condition, English or Spanish publication, and peer-reviewed journal.
  • Titles and abstracts were screened, then full texts were independently reviewed by two researchers; discrepancies were resolved through discussion and final agreement. Reviews, meta-analyses, protocols, case studies, and process/mechanism studies were retrieved but excluded from the principal RCT analysis.
  • Main analysis was a descriptive/qualitative synthesis of the 11 included RCTs, with Table 1 presenting specific CONSORT checklist items for each RCT; the authors note that quantitative meta-analytical studies should test the descriptive assumptions.

Limitations

  • The paper states that no protocol was published for this systematic review; authors of primary studies were not contacted for unpublished/ongoing studies or missing data; and quality assessment was not reported study-by-study, only as an overall CONSORT table.
  • The paper states methodological limitations of included RCTs: small sample sizes; all studies conducted in controlled research contexts rather than clinical settings; lack of statistical procedures for mechanisms of change; CONSORT adherence issues (only four studies provided a registration number and only one described sample size determination); need to report dropouts and side effects; and samples were mostly women and adults, requiring more studies with children and elderly populations.
  • Evident from the text: this is an uncorrected proof with missing/duplicated references and incomplete table/caption details, so some bibliographic and table information is unavailable; the review is also restricted to 2012–January 2017 and English/Spanish peer-reviewed RCTs.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s11920-017-0788-4

Cites

100 of 100 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 44 cited sources checked · 0 supported · 0 flagged

  • Findingreasoning

    Overall comparison of VRET conditions to active conditions shows no significant differences between conditions across diverse active conditions and mental disorders, with few exceptions.

    “With respect to the overall comparison of VRET conditions to active conditions, there is a pattern that shows no significant differences between the conditions taking into consideration diverse active conditions and a number of mental disorders, with just few exceptions.”
    Quote in the paperSubstantial claim
  • Findingcitation

    Meyerbröker's study presents results favoring the in vivo condition above the VRET condition in one out of four measures.

    “Meyerbröker's study [29] only presents results favoring in vivo condition above VRET condition in one out of four measures.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Meyerbroeker K, Morina N, Kerkhof GA, Emmelkamp PMG. Virtual reality exposure therapy does not provide any additional value in agoraphobic patients: a randomized controlled trial. Psychother Psychosom. 2013;82:170–6. source

      Not checked in the free run.

  • Findingcitation

    Fear reactivation prior to exposure had no effect on treatment outcomes.

    “These studies found no effect of fear reactivation prior to exposure on treatment outcomes”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [76] Shiban Y, Brütting J, Pauli P, Mühlberger A. Fear reactivation prior to exposure therapy: does it facilitate the effects of VR exposure in a randomized clinical sample? J Behav Ther Exp Psychiatry. 2015;46:133–40. source

      Not checked in the free run.

  • Findingcitation

    Botella's study was equally efficacious in the follow-up measurements.

    “Botella's study [18•] shows to be equally efficacious in the follow-up measurements”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18•]

      Not checked in the free run.

  • Findingown data

    Eleven studies were identified that fulfilled the selection criteria and contained potentially useful information about the efficacy of VRET for the treatment of phobias.

    “Eleven studies were identified that fulfilled the selection criteria and contained potentially useful information about the efficacy of VRET for the treatment of phobias.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 17
  • May combine two claims. 22
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Ling et al.'s meta-analysis identified 33 papers with a total of 1,196 participants.

    “Ling et al.'s meta-analysis [12] examined the relationship between presence and anxiety during VRET, identifying 33 papers with a total of 1.196 participants.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] •• Ling Y, Nefs HT, Morina N, Heynderickx I, Brinkman WP. A meta-analysis on the relationship between self-reported presence and anxiety in virtual reality exposure therapy for anxiety disorders. PLoS One. 2014;6:9. This meta-analysis demonstrates the positive relationship between sense of presence and anxiety. Moreover, it shows that this relationship is moderated by different factors

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingreasoning

    It is not clear whether users' pre-existing anxiety increases their likelihood of feeling present or whether an anxiety-inducing virtual environment enhances presence.

    “It is not clear whether users' pre-existing anxiety increases their likelihood of feeling present or if an anxietyinducing virtual environment enhances presence.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The sample size was small in all included studies, and no sub-sample exceeded 35 participants.

    “The sample size was small in all studies, and no sub-sample exceeded 35 participants.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Not all meta-analyses and reviews achieve high-quality standards.

    “Despite all these efforts, not all meta-analyses and reviews achieve high-quality standards [6].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Botella C, Baños RR, García-Palacios A, Quero S. Virtual reality and other realities. In: Hofmann S, Asmundson G, editors. The science of cognitive behavioral therapy. New York: Academic; 2017.

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Studies show unclear relationships between presence and emotions; some found significant positive correlations, some did not, and some found negative correlations.

    “However, studies show unclear relationships between presence and emotions. Some studies found significant positive correlations, [56,57], some did not [54,58,59], and some even found negative correlations [60,61].”
    Quote in the paperSubstantial claim0 of 7 sources checked
    • cites [56] Price M, Anderson P. The role of presence in virtual reality exposure therapy. J Anxiety Disord. 2007;21:742–51. source

      Not checked in the free run.

    • cites [57] Schuemie MJ, Bruynzeel M, Drost L, Brinckman M, De Haan G, et al. Treatment of acrophobia in virtual reality: a pilot study. In: Broeckx, F, Pauwels L. (Eds.) Conference Proceedings Euromedia 2000 May 8–10; Antwerp, Belgium. Ostend, Belgium: EUROSIS – ETI Publications. p. 271–275.

      Not checked in the free run.

    • cites [54] Krijn M, Emmelkamp PM, Biemond R, de Wilde de Ligny C, Schuemie MJ, van der Mast CAP. Treatment of acrophobia in virtual reality: the role of immersion and presence. Behav Res Ther. 2004;42:229–39. source

      Not checked in the free run.

    • cites [58] Walshe D, Lewis E, O’Sullivan K, Kim SI. Virtually driving: are the driving environments “real enough” for exposure therapy with accident victims? An explorative study. Cyberpsychol Behav. 2005;8:532–7. source

      Not checked in the free run.

    • cites [59] Kim K, Kim C-H, Cha KR, Park J, Han K, Kim YK, et al. Anxiety provocation and measurement using virtual reality in patients with obsessive-compulsive disorder. CyberPsychology Behav. 2008;11:637–41. source

      Not checked in the free run.

    • cites [60] Ling Y, Brinkman W-P, Nefs HT, Qu C, Heynderickx I. Effects of stereoscopic viewing on presence, anxiety, and cybersickness in a virtual reality environment for public speaking. Presence Teleoper Virtual Environ. 2012;21:254–67. source

      Not checked in the free run.

    • cites [61] Villani D, Repetto C, Cipresso P, Riva G. May I experience more presence in doing the same thing in virtual reality than in reality? An answer from a simulated job interview. Interact Comput Oxford University Press. 2012;24:265–72. source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    All these studies showed a clear superiority of VRET versus non-active control groups, and equal or even slightly greater efficacy than other active control groups.

    “All these studies showed a clear superiority of VRET versus non-active control groups, and equal or even slightly greater efficacy than other active control groups (mainly in vivo exposure within a CBT protocol).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    The meta-analysis confirmed a positive relationship between presence and anxiety, influenced by moderating factors, with a large relationship for fear of animals and fear of flying, moderate for acrophobia, and small for social anxiety disorder.

    “This meta-analysis confirmed the positive relationship between presence and anxiety, and that this relationship is influenced by several moderating factors (with a large relationship for fear of animals and fear of flying, moderate for acrophobia, and small for social anxiety disorder).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] •• Ling Y, Nefs HT, Morina N, Heynderickx I, Brinkman WP. A meta-analysis on the relationship between self-reported presence and anxiety in virtual reality exposure therapy for anxiety disorders. PLoS One. 2014;6:9. This meta-analysis demonstrates the positive relationship between sense of presence and anxiety. Moreover, it shows that this relationship is moderated by different factors

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    In all included studies, the experimental conditions for comparison were evidence-based treatments and were compared to active conditions or a waiting list.

    “In all of them, the experimental conditions for comparison were evidencebased treatments and were compared to active conditions or a waiting list (WL).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    VRET was significantly more efficacious than waiting list for all disorders and all studies, except for panic disorder.

    “This is the case for all disorders and all studies, except from panic disorder in which only one study was conducted [32] showing no significant differences between conditions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] Pelissolo A, Zaoui M, Aguayo G, Yao SN, Roche S, Ecochard R, et al. Virtual reality exposure therapy versus cognitive behavior therapy for panic disorder with agoraphobia: a randomized comparison study. J CyberTherapy Rehabil. 2012;5:35–43.

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Findingcitation

    Perceptual cues produced higher fear activation and greater fear habituation than conceptual cues in claustrophobia and spider phobia.

    “Results showed that perceptual cues produced higher fear activation and greater fear habituation.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] Shiban Y, Peperkorn H, Alpers GW, Pauli P, Mühlberger A. Influence of perceptual cues and conceptual information on the activation and reduction of claustrophobic fear. J Behav Ther Exp Psychiatry. 2016;51:19–26. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    It remains unclear why presence and anxiety are related.

    “Although significant correlations between presence and anxiety have been reported, it remains unclear why they are related [62].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [62] Peperkorn HM, Diemer J, Mühlberger A. Temporal dynamics in the relation between presence and fear in virtual reality. Comput Hum Behav. 2015;48:542–7. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Size estimation is biased in spider phobia, but this bias is corrected with exposure therapy.

    “and they showed that size estimation is biased in spider phobia, but this bias is corrected with exposure therapy.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [77] Shiban Y, Fruth MB, Pauli P, Kinateder M, Reichenberger J, Mühlberger A. Treatment effect on biases in size estimation in spider phobia. Biol Psychol. 2016;121:146–52. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Kampmann et al. [22•], Botella et al. [18•], and Meyerbröker et al. [29] present results in favor of the in vivo condition.

    “On the contrary, just Kampmann et al. [22•], Botella et al. [18•], and Meyerbröker et al. [29] present results in favor of the in vivo condition.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [22•]

      Not checked in the free run.

    • cites [18•]

      Not checked in the free run.

    • cites [29] Meyerbroeker K, Morina N, Kerkhof GA, Emmelkamp PMG. Virtual reality exposure therapy does not provide any additional value in agoraphobic patients: a randomized controlled trial. Psychother Psychosom. 2013;82:170–6. source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    The majority of participants were women and adult populations.

    “Regarding the sociodemographic characteristics of participants, the majority were women and adult populations”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Discrepancies between the researchers were resolved through discussion and final agreement.

    “Any discrepancies between the researchers were resolved through discussion and final agreement.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    VRET is a technological adjunct that can help the clinician apply treatments more ecologically and effectively.

    “VRET is not considered a new form of therapy, but rather a technological adjunct [5] that can help the clinician to apply treatments more ecologically and effectively [6].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [5] Newman MG, Szkodny LE, Llera SJ, Przeworski A. A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: is human contact necessary for therapeutic efficacy? Clin Psychol Rev. 2011;31:89–103. source

      Not checked in the free run.

    • cites [6] Botella C, Baños RR, García-Palacios A, Quero S. Virtual reality and other realities. In: Hofmann S, Asmundson G, editors. The science of cognitive behavioral therapy. New York: Academic; 2017.

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Full texts of studies that appeared to meet the inclusion criteria were independently reviewed and screened by two researchers.

    “The full texts of studies that appeared to meet the inclusion criteria were then independently reviewed and screened by two researchers to establish their relevance, in addition to studies with insufficient information in the title and abstract.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    VRET can overcome or mitigate exposure therapy's aversiveness by producing greater user acceptance and providing control and access to situations where exposure therapy would be uncontrollable.

    “VR exposure therapy (VRET) can overcome or mitigate this problem by producing greater user acceptance and providing control and access to situations where exposure therapy would be uncontrollable”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Exposure therapy is the gold standard evidence-based technique for phobias.
    • Rests on an assumption: Exposure therapy may be difficult to accept and is sometimes rejected by patients because they consider it too aversive.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    VR is considered an effective tool for the treatment of many psychological problems.

    “Currently, VR is considered an effective tool for the treatment of many psychological problems [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Riva G, Botella C, Baños R, Mantovani F, García-Palacios A, Quero S, et al. Presence-inducing media for mental health applications. In: Immersed in media. Cham: Springer International Publishing; 2015. p. 283–332. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Premisenone given

    VR's efficacy has been most striking in the area of phobias, especially in carrying out exposure therapy.

    “In particular, VR's efficacy has been most striking in the area of phobias, especially in carrying out exposure therapy.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The PRISMA guidelines for systematic reviews and meta-analyses were employed to conduct the literature search.

    “The PRISMA guidelines for systematic reviews and metaanalyses were employed to conduct a literature search [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    VR is a good way to conduct exposure therapy and to study specific issues such as pharmacological compounds and behavioral manipulations that can enhance treatment outcomes.

    “In summary, VR is a good way to conduct exposure therapy, but also to study specific issues, such as pharmacological compounds and behavioral manipulations, that can enhance treatment outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Presence seems to be an important factor in inducing anxiety and fear and in achieving a successful treatment outcome.

    “In conclusion, although presence seems to be an important factor in inducing anxiety and fear and achieving a successful treatment outcome, more research is needed to better understand how these factors interact and clarify the causal relationship between presence and fear in VRET.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation

    Cognitive enhancers can be a safe and easy option to increase the effects of exposure therapy.

    “In summary, cognitive enhancers can be a safe and easy option to increase the effects of exposure therapy (for more information, see [67, 68, 69•].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [67, 68, 69•]

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationreasoning

    Using VR can be a good option in studies where it is important to explore the processes and mechanisms involved in exposure therapy.

    “Using VR can be a good option in studies where it is important to explore the processes and mechanisms involved in exposure therapy.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: VR provides complete control over the cues presented and related parameters such as time, distance, and size.

  • May combine two claims.

    Premisecitation

    Participants who dropped out early experienced less presence and did not feel anxiety in the virtual environment compared to completer patients.

    “In fact, the authors found that participants who dropped out early experienced less presence and did not feel anxiety in the virtual environment, compared to completer patients.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Krijn M, Emmelkamp PM, Biemond R, de Wilde de Ligny C, Schuemie MJ, van der Mast CAP. Treatment of acrophobia in virtual reality: the role of immersion and presence. Behav Res Ther. 2004;42:229–39. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Ling et al. presented the first meta-analysis on the relationship between sense of presence and anxiety during VRET, confirming a positive relationship between them.

    “Finally, Ling, Nefs, Morina, Heynderickx, and Brinkman [12••] presented the first meta-analysis on the relationship between sense of presence and anxiety during VRET, confirming a positive relationship between them.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12••]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Price and Anderson found that presence contributed to the experience of anxiety and was associated with peak fear ratings during the first VRET session, but they did not find a relationship between presence and treatment response.

    “Price and Anderson [56] reported similar results for fear of flying: presence contributed to the experience of anxiety, and it was associated with peak fear ratings during the first VRET session, but they did not find a relationship between presence and treatment response.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [56] Price M, Anderson P. The role of presence in virtual reality exposure therapy. J Anxiety Disord. 2007;21:742–51. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This review followed the structured PRISMA guidelines.

    “This review followed the structured PRISMA guidelines.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The authors of the studies were not contacted to obtain further information about ongoing, unpublished studies/manuscripts, and to complete some missing data from the primary studies that were not provided in the available articles.

    “Second, the authors of the studies were not contacted to obtain further information about ongoing, unpublished studies/manuscripts, and to complete some missing data from the primary studies that were not provided in the available articles.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Children and the elderly are populations for which VR may be particularly useful because of the total control and protection VR provides.

    “However, paradoxically, children and the elderly are populations for which VR may be particularly useful because of the total control (and protection for participants) VR provide.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The quality assessment of primary studies was not reported study by study, but rather an overall table for CONSORT criteria is presented.

    “Finally, the quality assessment of primary studies was not reported study by study, but rather an overall table for CONSORT criteria is presented.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some recent work stresses the importance of using VR to enhance children's lives by creating compelling experiences.

    “Fortunately, some recent work [84•] stresses the importance of using VR to enhance children's lives by creating compelling experiences [84•, 85].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [84•]

      Not checked in the free run.

    • cites [85] Riva G, Baños RM, Botella C, Mantovani F, Gaggioli A. Transforming experience: the potential of augmented reality and virtual reality for enhancing personal and clinical change. Front Psychiatry. 2016;7:1–14. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    No protocol was published to conduct this systematic review.

    “First, no protocol was published to conduct this systematic review.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    VR applications can be very useful for the treatment of phobias.

    “VR applications can be very useful for the treatment of phobias.”
    Quote in the paperSubstantial claim
35 of 35

  • The paper relies on this without support.

    Exposure therapy is the gold standard evidence-based technique for phobias.

    “Exposure therapy is considered the “gold standard” evidence-based technique for these disorders”

  • The paper relies on this without support.

    Exposure therapy may be difficult to accept and is sometimes rejected by patients because they consider it too aversive.

    “but it may be difficult to accept and is sometimes rejected by patients because they consider it too aversive.”

  • The paper relies on this without support.

    Experiencing anxiety is a key requisite for effective exposure therapy.

    “Because experiencing anxiety is considered a key requisite for effective exposure therapy”

  • The paper relies on this without support.

    VR provides complete control over the cues presented and related parameters such as time, distance, and size.

    “VR can be an excellent choice (provides complete control over the cues presented and related parameters such as time, distance, size, etc.).”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Exposure therapy operates on the principle of gradually exposing individuals to feared situations, enabling them to confront and tolerate their fears, ultimately leading to a reduction in anxiety and avoidance behaviors.

    “Exposure therapy, a cognitive-behavioral intervention widely recognized as the “gold standard” for treating anxiety disorders, operates on the principle of gradually exposing individuals to feared situations, enabling them to confront and tolerate their fears, ultimately leading to a reduction in anxiety and avoidance behaviors (27, 33).”

    From A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression (2023) · cites this paper as [33]

    The Introduction (page unavailable) describes exposure therapy as a gold-standard treatment for phobias and says VR can provide access to feared situations. The VR-based Exposure Therapy Enhancement section (page unavailable) discusses fear habituation, fear extinction, and reductions in symptom severity. These passages support the general account of exposure and reduced fear, but do not establish that exposure is necessarily gradual or specifically reduces avoidance behaviors. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Exposure therapy is widely recognized as the gold standard for treating anxiety disorders.

    “Exposure therapy, a cognitive-behavioral intervention widely recognized as the “gold standard” for treating anxiety disorders, operates on the principle of gradually exposing individuals to feared situations, enabling them to confront and tolerate their fears, ultimately leading to a reduction in anxiety and avoidance behaviors (27, 33).”

    From A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression (2023) · cites this paper as [33]

    The Introduction calls exposure therapy the “gold standard” evidence-based technique for phobias. The VR-based Exposure Therapy Enhancement section says it is efficacious for anxiety disorders, but does not extend the “gold standard” designation to anxiety disorders generally. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • VRET offers a technological approach to deliver exposure therapy, allowing individuals to engage with situations that may be otherwise difficult to access or control.

    “VRET offers a technological approach to deliver exposure therapy, allowing individuals to engage with situations that may be otherwise difficult to access or control (33).”

    From A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression (2023) · cites this paper as [33]

  • VRET has shown efficacy for treating specific phobias, including FP, in several studies.

    “it has shown its efficacy for treating specific phobias (including FP) in several studies (Botella et al., 2017; Parsons and Rizzo, 2008)”

    From An Internet-based treatment for Flying Phobia using 360° images: Study protocol for a feasibility pilot study (2021) · cites this paper as Botella et al., 2017

  • Virtual reality has demonstrated utility in the treatment of mental health problems such as phobias and anxiety symptoms.

    “For example, it has demonstrated its utility in the treatment of mental health problems, such as phobias and anxiety symptoms, among others [15]”

    From Innovative Technology–Based Interventions to Reduce Stigma Toward People With Mental Illness: Systematic Review and Meta-analysis (2022) · cites this paper as [15]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • A second study shows no advantage over a waiting list

    Major

    The text says only the panic-disorder study [32] failed to show a significant difference from a non-active control. But the table also reports equal post-treatment results for VRCBT and a waiting list in study [31].

  • Anderson trial total does not match its group sizes

    Minor

    The three reported groups contain 25 participants each, totaling 75, while the table lists 97 participants for the study. The table does not account for the remaining 22.

    Reported 97 · recomputed 75

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Craske MG, Barlow DH. Mastery of anxiety and panic. 4th ed. Oxford: Oxford University Press; 2007.
  2. Triscari MT, Faraci P, Catalisano D, D’Angelo V, Urso V. Effectiveness of cognitive behavioral therapy integrated with systematic desensitization, cognitive behavioral therapy combined with eye movement desensitization and reprocessing therapy, and cognitive behavioral therapy combined with virtual reality expo. Neuropsychiatr Dis Treat. 2015;11:2591–8.
  3. Schuemie MJ, Bruynzeel M, Drost L, Brinckman M, De Haan G, et al. Treatment of acrophobia in virtual reality: a pilot study. In: Broeckx, F, Pauwels L. (Eds.) Conference Proceedings Euromedia 2000 May 8–10; Antwerp, Belgium. Ostend, Belgium: EUROSIS – ETI Publications. p. 271–275.
  4. Cárdenas G, Botella C, Quero S, Baños R, Durán X, De Rosa A, et al. Efectividad del programa de tratamiento virtual flight con población mexicana effectiveness of the treatment program virtual flight with mexican population. Rev Argen Clin Psic. 2016;25:145–56.
  5. Bailenson JN. Doppelgangers—a new form of self? Psychologist. 2012;25:36–8.

Cited by

Sorted by citations

Related

Authors
Botella, C., Fernández-Álvarez, J., Guillén, V., García-Palacios, A., & Baños, R.
Affiliations
  • Universitat Jaume I (ES)
  • Universitat de València (ES)
Corresponding author
Botella, Cristina
ORCID
Venue
Current Psychiatry Reports
Publisher
Springer Science and Business Media LLC
Published
2017-05-24
Volume
19
Issue
7
Pages
42-42
ISSN
  • 1523-3812 (ISSN-L)
  • 1535-1645
DOI
10.1007/s11920-017-0788-4
OpenAlex
W2618420032
Semantic Scholar
c12ccf82713595a3224675d18e8dd3e7264eaf3f
Cited by
460
References
100
Citations by year
2026: 34 · 2025: 64 · 2024: 58 · 2023: 50 · 2022: 66 · 2021: 70 · 2020: 57 · 2019: 39 · 2018: 20 · 2017: 1
FWCI
3.09
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (unspecified)
Locations
  • Current Psychiatry Reports (publishedVersion)
  • PubMed (publishedVersion)
  • Repositori UJI (Universitat Jaume I) (acceptedVersion)
  • Repository of Digital Objects for Teaching Research and Culture (University of Valencia) (submittedVersion, cc-by-nc)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, public-domain)
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, phobia, exposure therapy, treatment efficacy, presence, drug augmentation, behavioral interventions, anxiety disorders, clinical implementation
MeSH terms
Virtual Reality, Humans, Phobic Disorders, Treatment Outcome, Behavior Control, Virtual Reality Exposure Therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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