Cited by 120Virtual Reality Applications and ImpactsDigital Mental Health InterventionsPsychotherapy Techniques and Applications

The DOI matches its Crossref record; 136 of the 136 references it cites were found in a registry or an index; 2 of the 88 sources its claims cite were checked for support.

Better, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy

Open access
Lindner, Philip·2021·International Journal of Cognitive Therapy

Abstract

Virtual reality (VR) is an immersive technology capable of creating a powerful, perceptual illusion of being present in a virtual environment. VR technology has been used in cognitive behavior therapy since the 1990s and accumulated an impressive evidence base, yet with the recent release of consumer VR platforms came a true paradigm shift in the capabilities and scalability of VR for mental health. This narrative review summarizes the past, present, and future of the field, including milestone studies and discussions on the clinical potential of alternative embodiment, gamification, avatar therapists, virtual gatherings, immersive storytelling, and more. Although the future is hard to predict, clinical VR has and will continue to be inherently intertwined with what are now rapid developments in technology, presenting both challenges and exciting opportunities to do what is not possible in the real world.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review summarizes the past, present, and future of virtual reality cognitive behavior therapy (VR-CBT), focusing mainly on anxiety disorders. It argues that consumer VR has created a paradigm shift, with automated VR treatments showing strong symptom reductions and growing potential for scalable mental health interventions.

Key findings

  • By 2012, k = 21 randomized controlled trials of VR exposure therapy for anxiety disorders were available for meta-analysis, showing that VR exposure outperformed waitlist controls, had similar outcomes to other evidence-based interventions, and had stable long-term effects (Opriş et al. 2012).
  • A 2015 meta-analysis found that previously reported within- and between-group effect sizes remained when only trials with in vivo behavioral outcomes were considered, indicating that fear reductions in VR translate to reduced fear in vivo (Morina et al. 2015).
  • A 2014 meta-analysis reported an overall significant correlation of r = .28 (95% CI: 0.18–0.38) between self-reported distress and presence during exposure, with significant differences across sample clinical characteristics and VR equipment type (Ling et al. 2014).
  • Recent automated VR exposure trials for acrophobia and spider phobia report impressive symptom reductions; one spider phobia trial examined non-inferiority against gold-standard in vivo exposure (Miloff et al. 2019). Adoption remains limited: Steam data in spring 2020 showed around 2% of active users had VR access, roughly 2 million users; Sony reported more than five million PlayStation VR units sold by end of 2019; at least twenty million VR units were distributed worldwide, possibly twice that.

Methods

  • Narrative review, not a systematic review or meta-analysis, providing a historical overview and context for VR-CBT and how technology developments have fueled clinical progress.
  • Focuses on VR-CBT treatments for anxiety disorders because this application dominates the literature, while also discussing other clinical applications.
  • Covers the past (roughly 1968–2013), present (2014–2020), and future, synthesizing milestone studies, meta-analyses, randomized trials, surveys, and technology developments rather than collecting primary data.

Limitations

  • The author states the aim is not to provide a systematic review or meta-analysis, the focus is on anxiety disorders, and coverage of VR as an experimental platform for psychopathology and treatment mechanisms is beyond scope.
  • The text makes evident that the review is non-exhaustive and selective, and that future-oriented sections are predictions based on gaps, trends, and recent advances rather than demonstrated outcomes.
  • The author reports involvement in academia-industry collaborations related to the work, including direct financial reimbursement for consulting for Mimerse, though holds no financial stake in any such company.

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

Integrity signals

Registry

Crossref · 10.1007/s41811-020-00090-7

Cites

136 of 136 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Fig. 1 VR research published up until release of consumer VR technology
Fig. 1 VR research published up until release of consumer VR technologyCC-BY · From the PDF

Verification

Claims the paper makes

66 Not checked yet · 24 Own interpretation · 6 No basis given · 1 Supported so far

Verify all 86 references — free account

Show all 53 claims

  • Probably not a substantial claim. 21
  • It may state two separate claims as one. 27
44 of 44
  • The paper relies on this without support.

    VR exposure is always safer than in vivo equivalent exposure.

    “Further, VR exposure will always be safer than in vivo equivalent exposure”
  • The paper relies on this without support.

    Consumer VR will achieve mass adoption.

    “VR and other mixed reality technologies are still awaiting mass adoption, but when this does happen, there will already be a firm evidence base to inform the next generation of VR interventions for mental health.”
  • The paper relies on this without support.

    VR technology will continue to develop rapidly.

    “The future of VR-CBT will continue to be inherently intertwined with the development of VR technology, yet the latter now develops at a pace so rapid that clinical researchers are struggling to keep up”
  • The paper relies on this without support.

    The expected effect sizes in VR exposure studies were large.

    “since the expected effect sizes in these studies were large (as with in vivo exposure therapy), even smaller trials may nonetheless have been well powered”
  • The paper relies on this without support.

    Patients have markedly fewer preconceptions of what constitutes a VR psychological treatment.

    “Patients, in turn, are also likely to have markedly fewer preconceptions of what constitutes a VR psychological treatment, offering good grounds for (double) blinding.”
5 of 5

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?

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.

1 of 1

Citations

Cites

Research works printed but not linked: 2

  1. Alsem, S. (2019). Using interactive virtual reality to treat aggressive behavior problems in children. in 9th World Congress of Behavioural and Cognitive Therapies.
  2. Carl, E., Stein, A. T., Levihn-Coon, A., Pogue, J. R., Rothbaum, B., Emmelkamp, P., et al. (2019). Virtual reality exposure therapy for anxiety and related disorders: a meta-analysis of randomized controlled trials. Journal of Anxiety Disorders, 61, 27–36. https://doi.org/10.1016/j.janxdis.2018.08.003. · DOI · Paper page

Cited by

Sorted by citations

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Metadata

Authors
Lindner, P.
Affiliations
Region Stockholm (SE)
Corresponding author
Lindner, Philip
Venue
International Journal of Cognitive Therapy
Published
2020-10-20
Volume
14
Issue
1
Pages
23-46
ISSN
  • 1937-1209 (ISSN-L)
  • 1937-1217
OpenAlex
W3093847664
Cited by
120
References
136
Citations by year
2026: 19 · 2025: 28 · 2024: 30 · 2023: 24 · 2022: 7 · 2021: 11 · 2020: 1
FWCI
7.83
Type
journal article
Language
en
Open access
Locations
International Journal of Cognitive Therapy (publishedVersion, cc-by)
Funders
Karolinska Institutet
Topics
  • Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
virtual reality, cognitive behavioral therapy, immersive technologies, embodiment, gamification, immersive storytelling, psychotherapy

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