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The role of presence in virtual reality exposure therapy
Open accessAbstract
A growing body of literature suggests that virtual reality is a successful tool for exposure therapy in the treatment of anxiety disorders. Virtual reality (VR) researchers posit the construct of presence, defined as the interpretation of an artificial stimulus as if it were real, to be a presumed factor that enables anxiety to be felt during virtual reality exposure therapy (VRE). However, a handful of empirical studies on the relation between presence and anxiety in VRE have yielded mixed findings. The current study tested the following hypotheses about the relation between presence and anxiety in VRE with a clinical sample of fearful flyers: (1) presence is related to in-session anxiety; (2) presence mediates the extent that pre-existing (pre-treatment) anxiety is experienced during exposure with VR; (3) presence is positively related to the amount of phobic elements included within the virtual environment; (4) presence is related to treatment outcome. Results supported presence as a factor that contributes to the experience of anxiety in the virtual environment as well as a relation between presence and the phobic elements, but did not support a relation between presence and treatment outcome. The study suggests that presence may be a necessary but insufficient requirement for successful VRE.
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“Research on the sense of presence and reality judgments has been conducted in VRET (Gromer et al., 2019; Cummings and Bailenson, 2016, Price and Anderson, 2007; Baños et al., 2000), but no studies have been found in the literature on these topics in ICBTs.”
From An internet-based treatment for flying phobia using 360° images: A feasibility pilot study (2022) · cites this paper as Price and Anderson, 2007
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“In terms of treatment efficacy, research has also suggested that, although presence is linked to the anxiety experienced during the exposure, there is no direct relationship between sense of presence and treatment outcomes (Price et al., 2011; Price and Anderson, 2007; Tardif et al., 2019).”
From An Internet-based treatment for Flying Phobia using 360° images: Study protocol for a feasibility pilot study (2021) · cites this paper as Price and Anderson, 2007
In the citing paper
“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].”
From Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review (2017) · cites this paper as [56]
In the citing paper
“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.”
From Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review (2017) · cites this paper as [56]
In the citing paper
“suggesting that presence is a necessary but insufficient requirement for symptom reduction (Price and Anderson 2007), congruent with the 2004 study.”
From Better, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy (2021) · cites this paper as Price and Anderson 2007
In the citing paper
“presence did not moderate outcomes”
From Better, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy (2021) · cites this paper as Price and Anderson 2007
In the citing paper
“A 2007 study on VR exposure for aviophobia found that while presence partially mediated the association between pre-existing anxiety and distress during exposure”
From Better, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy (2021) · cites this paper as Price and Anderson 2007
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Choe, M.-J., & Noh, G.-Y. (2019) · Journal of Digital Contents Society · doi:10.9728/dcs.2019.20.6.1125
Nieminen, M. P., & Kirjonen, M. (2020) · Lecture notes in computer science · doi:10.1007/978-3-030-58465-8_4
Innovation in Shared Virtual Spaces for Mental Health Therapy
Chagnon, C. J., Backer, J., & Djamasbi, S. (2022) · Communications in computer and information science · doi:10.1007/978-3-031-06394-7_49
An evaluation from presence perspective of customer experiences in virtual environments
Lee, C., Chou, C., & Sun, T. L. (2012) · CRC Press eBooks · doi:10.1201/b11932-4
Metadata
- Authors
- Price, M., & Anderson, P.
- Affiliations
- Georgia State University (US)
- Corresponding author
- Anderson, Page
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2007
- Volume
- 21
- Issue
- 5
- Pages
- 742-751
- ISSN
- 0887-6185 (ISSN-L)
- PMC
- PMC3670421
- OpenAlex
- W2033913146
- Cited by
- 223
- References
- 25
- Citations by year
- 2026: 10 · 2025: 15 · 2024: 18 · 2023: 17 · 2022: 23 · 2021: 15 · 2020: 19 · 2019: 14 · 2018: 18 · 2017: 7 · 2016: 8 · 2015: 8 · 2014: 13 · 2013: 7 · 2012: 10
- FWCI
- 4.27
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Anxiety Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R41MH58493-01, R41MH058493)
- 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, presence, anxiety, fear of flying, aviophobia, phobic stimuli, treatment outcomes, anxiety disorders, virtual worlds
- MeSH terms
- Adaptation, Psychological, Adult, Agoraphobia, Aircraft, Desensitization, Psychologic, Fear, Female, Humans, Male, Phobic Disorders, User-Computer Interface, Panic Disorder, Outcome Assessment, Health Care
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