The Use of Virtual Reality in Acrophobia Research and Treatment

Coelho, Carlos M.; Waters, Allison M.; Hine, Trevor J.; Wallis, Guy

doi:10.1016/j.janxdis.2009.01.014

Cited by 127Virtual Reality Applications and ImpactsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesDigital Mental Health Interventions

The Use of Virtual Reality in Acrophobia Research and Treatment

Coelho, Carlos M., Waters, Allison M., Hine, Trevor J., Wallis, Guy·2009·Journal of Anxiety Disorders

DOI 10.1016/j.janxdis.2009.01.014

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Abstract

Acrophobia, or fear of heights, is a widespread and debilitating anxiety disorder affecting perhaps 1 in 20 adults. Virtual reality (VR) technology has been used in the psychological treatment of acrophobia since 1995, and has come to dominate the treatment of numerous anxiety disorders. It is now known that virtual reality exposure therapy (VRET) regimens are highly effective for acrophobia treatment. This paper reviews current theoretical understanding of acrophobia as well as the evolution of its common treatments from the traditional exposure therapies to the most recent virtually guided ones. In particular, the review focuses on recent innovations in the use of VR technology and discusses the benefits it may offer for examining the underlying causes of the disorder, allowing for the systematic assessment of interrelated factors such as the visual, vestibular and postural control systems.

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iVR has been extensively researched beyond specific phobias, and reports have validated a panoramic impact on both stress-related and chronic anxiety disorders.
“iVR has been extensively researched beyond specific phobias, and reports have validated a panoramic impact on both stress-related and chronic anxiety disorders [24,25].”
From SAFEvR MentalVeRse.app: Development of a Free Immersive Virtual Reality Exposure Therapy for Acrophobia and Claustrophobia (2024) · cites this paper as [25]

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Virtual Reality Therapy : An Innovative Paradigm
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Fears born and bred: non-associative fear acquisition?
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Short-Term Treatment of Acrophobia with Virtual Reality Therapy (VRT): A Case Report
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Fear of water in children and adults: Etiology and familial effects
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Virtual Reality Therapy for Anxiety Disorders: Advances in Evaluation and Treatment
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Avoidance of Heights on the Visual Cliff in Newly Walking Infants
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Practice as a psychotherapeutic variable: An experimental analysis within single cases
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Height phobia and biases in the interpretation of bodily sensations: Some links between acrophobia and agoraphobia
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Preliminary Results of a Clinical Trial Relative to the Use of Rifamycin SV in the Treatment of Herpes Zoster
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Origins of common fears: Effects on severity, anxiety responses and memories of onset
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Failure to overcome ‘innate’ fear: a developmental test of the non-associative model of fear acquisition
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Contrasting the Effectiveness and Efficiency of Virtual Reality and Real Environments in the Treatment of Acrophobia
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Cognitions and courage in the avoidance behavior of acrophobics
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The Role of Self-Motion in Acrophobia Treatment
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The origins of height fear: an evaluation of neoconditioning explanations
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Babies’ steps make giant strides toward a science of development
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Mosaics of Meaning: Enhancing the Intellectual Life of Young Adults Through Story
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Field Dependence and Body Balance
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Flagged first, then by citations

2 of the 161 references couldn’t be matched to a known paper.

Sorted by citations

mHealth: A Mechanism to Deliver More Accessible, More Effective Mental Health Care
Price, M., Yuen, E. K., Goetter, E. M., Herbert, J. D., Forman, E. M., Acierno, R., & Ruggiero, K. J. (2014) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1855 · Cited by 488 · see citing works
Virtual reality exposure therapy in anxiety disorders: a systematic review of process-and-outcome studies
Meyerbröker, K., & Emmelkamp, P. M. G. (2010) · Depression and Anxiety · doi:10.1002/da.20734 · Cited by 290 · see citing works
“In a review of the triggers of acrophobic behavior it was concluded that motion combined with height rather than height on its own triggers phobic responses.([59]) In this sense VRET can help in the future understanding treatment processes but also processes related to fear itself.”
Background
The Origins of Specific Phobias: Influential Theories and Current Perspectives
Coelho, C. M., & Purkis, H. M. (2009) · Review of General Psychology · doi:10.1037/a0017759 · Cited by 113 · see citing works
Induction and Profiling of Strong Multi-Componential Emotions in Virtual Reality
Meuleman, B., & Rudrauf, D. (2018) · IEEE Transactions on Affective Computing · doi:10.1109/taffc.2018.2864730 · Cited by 89 · see citing works
“, public speaking) with the aim of reducing phobic responses or anxiety by repeated exposure [43], [44], [45], [46], [47], [48],”
Background
An Investigation of Various Machine and Deep Learning Techniques Applied in Automatic Fear Level Detection and Acrophobia Virtual Therapy
Balan, O. C., Moise, G., Moldoveanu, A. D. B., Leordeanu, M., & Moldoveanu, F. (2020) · Sensors · doi:10.3390/s20020496 · Cited by 82 · see citing works
“VRET is equally as efficient as the classical evidence-based interventions (CBT and in vivo exposure), provides real-life impact, has good stability of results in time and engages the patients in the therapy as much as in vivo exposure does [8,16].”
Background
Adaptation of emotional state and standing balance parameters following repeated exposure to height-induced postural threat
Zaback, M., Adkin, A. L., & Carpenter, M. G. (2019) · Scientific Reports · doi:10.1038/s41598-019-48722-z · Cited by 73 · see citing works
Toward Trustworthy Metaverse: Advancements and Challenges
Jim, J. R., Hosain, M. T., Mridha, M. F., Kabir, M. M., & Shin, J. (2023) · IEEE Access · doi:10.1109/access.2023.3326258 · Cited by 69 · see citing works
“Coelho et al. discussed the use of VR technology as a superior methodology in achieving improvements in both the research and treatment of the causes of acrophobia [63].”
Method
Visuo-vestibular contributions to anxiety and fear
Coelho, C. M., & Balaban, C. D. (2015) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2014.10.023 · Cited by 67 · see citing works
Self-citation
Stress research during the COVID-19 pandemic and beyond
Pfeifer, L. S., Heyers, K., Ocklenburg, S., & Wolf, O. T. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.09.045 · Cited by 67 · see citing works
Neuroticism modulates brain visuo-vestibular and anxiety systems during a virtual rollercoaster task
Riccelli, R., Indovina, I., Staab, J. P., Nigro, S. L., Augimeri, A., Lacquaniti, F., & Passamonti, L. (2016) · Human Brain Mapping · doi:10.1002/hbm.23411 · Cited by 65 · see citing works
“The realistic and immersive virtual reality environment implemented in the rollercoaster task enabled us to investigate visually induced balance threat in a similar way to previously developed paradigms [Coelho et al., 2009; Diemer et al., 2015; Peperkorn and Muhlberger, 2013].”
Method
Feasibility of Virtual Reality Environments for Adolescent Social Anxiety Disorder
Parrish, D., Oxhandler, H. K., Duron, J.-B., Swank, P., & Bordnick, P. (2016) · Research on Social Work Practice · doi:10.1177/1049731514568897 · Cited by 63 · see citing works
Ethical challenges of using virtual environments in the assessment and treatment of psychopathological disorders
Parsons, T. D. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10030378 · Cited by 61 · see citing works
“On the one hand, clinicians have effectively treated various phobias with VRET in general [68–73] and with acrophobia (fear of heights) [74,75] in particular.”
Background
The Feasibility and Acceptability of Virtual Environments in the Treatment of Childhood Social Anxiety Disorder
Wong Sarver, N., Beidel, D. C., & Spitalnick, J. S. (2014) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2013.843461 · Cited by 59 · see citing works
Killing for the greater good: Action aversion and the emotional inhibition of harm in moral dilemmas
McDonald, M. M., Defever, A. M., & Navarrete, C. D. (2017) · Evolution and Human Behavior · doi:10.1016/j.evolhumbehav.2017.06.001 · Cited by 54 · see citing works
Deconstructing acrophobia: physiological and psychological precursors to developing a fear of heights
Coelho, C. M., & Wallis, G. M. (2010) · Depression and Anxiety · doi:10.1002/da.20698 · Cited by 52 · see citing works
“The unique contribution of this article is to explore the role of the abovementioned factors,([19]) which have been studied before in disconnected articles concerning heights and fear of heights.”
Background
Acrophobia impairs visual exploration and balance during standing and walking
Brandt, T., Kugler, G., Schniepp, R., Wuehr, M., & Huppert, D. (2015) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.12692 · Cited by 49 · see citing works
Virtual Reality One-Session Treatment of Child-Specific Phobia of Dogs: A Controlled, Multiple Baseline Case Series
Farrell, L. J., Miyamoto, T., Donovan, C. L., Waters, A. M., Krisch, K. A., & Ollendick, T. H. (2020) · Behavior Therapy · doi:10.1016/j.beth.2020.06.003 · Cited by 49 · see citing works
Fear of heights and visual height intolerance
Brandt, T., & Huppert, D. (2013) · Current Opinion in Neurology · doi:10.1097/wco.0000000000000057 · Cited by 44 · see citing works
Fear of heights in virtual reality saturates 20 to 40 m above ground
Wuehr, M., Breitkopf, K., Decker, J., Ibarra, G., Huppert, D., & Brandt, T. (2019) · Journal of Neurology · doi:10.1007/s00415-019-09370-5 · Cited by 39 · see citing works
Virtual Reality in Consumer Product Design
Rebelo, F., Duarte, E., Noriega, P., & Soares, M. M. (2011) · Ergonomics design and management · doi:10.1201/b10950-28 · Cited by 38 · see citing works
“VR has also been used to develop therapeutic tools (Riva, Wiederhold, and Molinari 1998; Rothbaum et al. 1995; Vincelli 1999), such as the treatment of fear of heights (Coelho et al. 2006, 2009) and fear of flying (Rothbaum et al. 2000).”
Method
Applications of the metaverse in medicine and healthcare
Hulsen, T. (2023) · Advances in Laboratory Medicine / Avances en Medicina de Laboratorio · doi:10.1515/almed-2023-0124 · Cited by 36 · see citing works
“Patients su ﬀ ering from certain phobias (e.g., agoraphobia [48], acrophobia [49], fear of ﬂ ying [50]) or disorders such as posttraumatic stress disorder (PTSD) can be helped by applying ‘ exposure therapy ’ [51], in which they are exposed to situations that gives them an anxiety attack.”
Background
Virtual reality in context of Industry 4.0 proposed projects at Brno University of Technology
Kovář, J., Mouralová, K., Kšica, F., Kroupa, J., Andrš, O., & Hadaš, Z. (2016) · International Conference on Mechatronics - Mechatronika · Cited by 36 · see citing works
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 exposure therapy methods in the treatment of flight anxiety: a randomized trial
Faraci, P., Triscari, M. T., Catalisano, D., D’Angelo, V., & Urso, V. (2015) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s93401 · Cited by 35 · see citing works
Putting the Gaming Experience at the Center of the Therapy—The Video Game Therapy® Approach
Bocci, F., Ferrari, A., & Sarini, M. (2023) · Healthcare · doi:10.3390/healthcare11121767 · Cited by 36 · see citing works
“In addition, VR exposure has shown positive results relating to the treatment of arachnophobia [91], the phobia of driving [92], and acrophobia [93].”
Background
Authentic Fear Responses in Virtual Reality: A Mobile EEG Study on Affective, Behavioral and Electrophysiological Correlates of Fear
Kisker, J., Lange, L., Flinkenflügel, K., Kaup, M., Labersweiler, N., Tetenborg, F., Ott, P., Gundler, C., Gruber, T., Osinsky, R., et al. (2021) · Frontiers in Virtual Reality · doi:10.3389/frvir.2021.716318 · Cited by 35 · see citing works
“In a similar vein, VR exposure therapies effectively trigger fear responses and modify phobia-related reactions permanently, e.g., concerning acrophobia (e.g., Coelho et al., 2009), arachnophobia (e.g., Bouchard et al., 2006), agoraphobia, and social phobia (e.g., Wechsler et al., 2019).”
Background
Virtual reality in assessment and treatment of schizophrenia: a systematic review
Macedo, M., Marques, A. J., & Queirós, C. M. L. (2015) · Jornal Brasileiro de Psiquiatria · doi:10.1590/0047-2085000000059 · Cited by 33 · see citing works
Anxiety detection from Electrodermal Activity Sensor with movement & interaction during Virtual Reality Simulation
Kritikos, I., Tzannetos, G., Zoitaki, C., Poulopoulou, S., & Koutsouris, D. (2019) · International IEEE/EMBS Conference on Neural Engineering · doi:10.1109/ner.2019.8717170 · Cited by 34 · see citing works
“Figure 7: Virtual Reality environment of the acrophobic simulation, out on the balcony typically avoid height-related situations such as stairs, terraces, apartments, being in high buildings, elevators, on bridges or even go on plane trips [4], [28], [29].”
Background
WoaH: A Virtual Reality Work-at-Height Simulator
Loreto, C. D., Chardonnet, J.-R., Ryard, J., & Rousseau, A. (2018) · IEEE Conference on Virtual Reality and 3D User Interfaces (VR) · doi:10.1109/vr.2018.8448292 · Cited by 32 · see citing works
“emphasize the role of lateral displacements during an acrophobia therapy, involving the role of parallax in the visuo-vestibular conflict which occurs in the distance vertigo [12].”
Background
Reactivation and Evaluation of Mastery Experiences Promotes Exposure Benefit in Height Phobia
Raeder, F., Woud, M. L., Schneider, S., Totzeck, C., Adolph, D., Margraf, J., & Zlomuzica, A. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-019-10018-x · Cited by 32 · see citing works
Fuzzy Mapping on Psychological Disorders in Construction Management
Chen, W., Mohd-Rahim, F. A., Chan, Y. Y., & Abdul‐Rahman, H. (2016) · Journal of Construction Engineering and Management · doi:10.1061/(asce)co.1943-7862.0001217 · Cited by 31 · see citing works
Experimental Psychopathology and Clinical Psychology: An Integrative Model to Guide Clinical Science and Practice
Waters, A. M., LeBeau, R. T., & Craske, M. G. (2017) · Psychopathology Review · doi:10.5127/pr.038015 · Cited by 32 · see citing works
Comparison between Full Body Motion Recognition Camera Interaction and Hand Controllers Interaction used in Virtual Reality Exposure Therapy for Acrophobia
Kritikos, I., Zoitaki, C., Tzannetos, G., Mehmeti, A., Douloudi, M., Nikolaou, G., Alevizopoulos, G., & Koutsouris, D. (2020) · Sensors · doi:10.3390/s20051244 · Cited by 27 · see citing works
“Studies suggest that one in 20 people reach diagnostic criteria for acrophobia [6,7].”
Background
New Directions in Virtual Reality-Based Therapy for Anxiety Disorders
David, D., Matu, S.-A., & David, O. A. (2013) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2013.6.2.114 · Cited by 25 · see citing works
Susceptibility to Fear of Heights in Bilateral Vestibulopathy and Other Disorders of Vertigo and Balance
Brandt, T., Grill, E., Strupp, M. L., & Huppert, D. (2018) · Frontiers in Neurology · doi:10.3389/fneur.2018.00406 · Cited by 24 · see citing works
“Several experiments have supported this, showing that susceptible subjects walk in a cautious way, both when visually exposed to heights as well as when only aware of heights but not visually exposed (17, 43) or during virtual reality stimulation [used in acrophobia research and treatment; (44)].”
Background
Walk This Beam: Impact of Different Balance Assistance Strategies and Height Exposure on Performance and Physiological Arousal in VR
Dietz, D., Oechsner, C., Ou, C., Chiossi, F., Sarto, F., Mayer, S., & Butz, A. M. (2022) · ACM Symposium on Virtual Reality Software and Technology (VRST) · doi:10.1145/3562939.3567818 · Cited by 24 · see citing works
“In their work on treatment possibilities of Acrophobia (fear of heights) in VR, Coelho et al. [17] state that about 1 in 20 adults suffer from named anxiety disorder.”
Background
Brain metabolism and related connectivity in patients with acrophobia treated by virtual reality therapy: an 18F-FDG PET pilot study sensitized by virtual exposure
Verger, A., Malbos, É., Reynaud, E., Mallet, P., Mestre, D., Pergandi, J.-M., Khalfa, S., & Guedj, É. (2018) · EJNMMI Research · doi:10.1186/s13550-018-0446-9 · Cited by 24 · see citing works
Using a virtual environment to assess cognition in the elderly
Lesk, V. E., Shamsuddin, S. N. W., Walters, E. R., & Ugail, H. (2014) · Virtual Reality · doi:10.1007/s10055-014-0252-2 · Cited by 23 · see citing works
“Virtual reality (VR) is a technology used in many applications, from the arts to health care such as arachnophobia (Garcia-Palacios et al. 2002), fear of flying (Banos et al. 2002), acrophobia (Coelho et al. 2009), fear of public speaking (Slater et al. 2006) and motor rehabilitation (Holden 2005).”
Background
The time course of location-avoidance learning in fear of spiders
Rinck, M., Koene, M., Telli, S., van den Brink, W. G. M. –., Verhoeven, B., & Becker, E. S. (2015) · Cognition & Emotion · doi:10.1080/02699931.2015.1009873 · Cited by 22 · see citing works
Designing Virtual Reality Assisted Psychotherapy for Anxiety in Older Adults Living with Parkinson’s Disease: Integrating Literature for Scoping
Thangavelu, K., Hayward, J. A., Pachana, N. A., Byrne, G. J., Mitchell, L. K., Wallis, G. M., Au, T. R., & Dissanayaka, N. N. (2020) · Clinical Gerontologist · doi:10.1080/07317115.2019.1709597 · Cited by 22 · see citing works
User Experience and Immersion of Interactive Omnidirectional Videos in CAVE Systems and Head-Mounted Displays
Kallioniemi, P., Mäkelä, V., Saarinen, S., Turunen, M., Winter, Y., & Istudor, A. (2017) · Lecture notes in computer science · doi:10.1007/978-3-319-68059-0_20 · Cited by 21 · see citing works
“This interesting finding and its connection to acrophobia could be an interesting topic of research, and has also been looked into by Coelho et. al [6].”
A Machine Learning Approach to Automatic Phobia Therapy with Virtual Reality
Balan, O. C., Moldoveanu, A. D. B., & Leordeanu, M. (2021) · Contemporary clinical neuroscience · doi:10.1007/978-3-030-54564-2_27 · Cited by 20 · see citing works
Are you afraid of heights and suitable for working at height?
Wang, H., Wang, Q., & Hu, F. (2019) · Biomedical Signal Processing and Control · doi:10.1016/j.bspc.2019.03.011 · Cited by 20 · see citing works
Cognitive-Behavioral Treatment of an 11-Year-Old Male Presenting With Emetophobia: A Case Study
Graziano, P., Callueng, C. M., & Geffken, G. (2010) · Clinical Case Studies · doi:10.1177/1534650110384436 · Cited by 24 · see citing works
“Recently, there has been clinical work using virtual technology to simulate exposures that are otherwise difficult to duplicate in the therapy session (Coelho et al., 2009; Rothbaum et al., 2006).”
Background
Playful User-Generated Treatment
Alexandrovsky, D., Volkmar, G., Spliethöver, M., Finke, S., Herrlich, M., Döring, T., Smeddinck, J. D., & Malaka, R. (2020) · Annual Symposium on Computer-Human Interaction in Play · doi:10.1145/3410404.3414222 · Cited by 20 · see citing works
“showed that exposure to heights in VR can achieve the same effect as in-vivo therapy [42]; a result that has been reproduced multiple times [28, 66, 83, 86].”
BackgroundResult
Predicting the Efficacy of Simulator-based Training Using a Perceptual Judgment Task Versus Questionnaire-based Measures of Presence
Wallis, G. M., & Tichon, J. (2013) · PRESENCE Virtual and Augmented Reality · doi:10.1162/pres_a_00135 · Cited by 18 · see citing works
“Such responses may well be crucial in desensitization work or stress inoculation (Meehan, Insko, Whitton, & Brooks, 2002; Coelho, Waters, Hine, & Wallis, 2009), but may prove too coarse to measure all aspects of simulator quality.”
Background
Efficacy and acceptability of different interventions for acrophobia: A network meta-analysis of randomised controlled trials
Chou, P., Tseng, P., Wu, Y., Chang, J. P., Tu, Y., Stubbs, B., Carvalho, A. F., Lin, P.-Y., Chen, Y.-W., & Su, K. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.12.172 · Cited by 20 · see citing works
Physiological acrophobia evaluation through in vivo exposure in a VR CAVE
Costa, J. P., Robb, J., & Nacke, L. E. (2014) · IEEE Games, Entertainment, Media Conference (GEM) · doi:10.1109/gem.2014.7047969 · Cited by 17 · see citing works
“Coelho et al. [12, 13] found that having the patient move in an acrophobia-inducing setting causes more anxiety than therapy sessions that do not involve movement.”
Background
Using convolutional neural networks to decode EEG-based functional brain network with different severity of acrophobia
Wang, Q., Wang, H., Hu, F., Hua, C., & Wang, D. (2020) · Journal of Neural Engineering · doi:10.1088/1741-2552/abcdbd · Cited by 16 · see citing works
“Therefore, people with acrophobia will have excessive self-protection and abnormal fear [39, 47, 48].”
Background
The combination of cognitive-behavioural therapy with virtual reality for the treatment of postnatal depression in a brief intervention context: A single-case study trial
Stamou, G., Garcia-Palacios, A., Woodford, B. J., Suso-Ribera, C., & Botella, C. (2021) · Journal of Healthcare Engineering · doi:10.1155/2021/5514770 · Cited by 15 · see citing works
Visual feedback-dependent modulation of arousal, postural control, and muscle stretch reflexes assessed in real and virtual environments
Hodgson, D. D., King, J. A., Darici, O., Dalton, B. H., Cleworth, T. W., Cluff, T., & Peters, R. M. (2023) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2023.1128548 · Cited by 13 · see citing works
“, 2016), and clinically in people with acrophobia (Coelho et al., 2009; Rimer et al., 2021), or anxiety disorders (Meyerbröker and Emmelkamp, 2011).”
Background
Altered spontaneous neural activity in frontal and visual regions in patients with acrophobia
Hang, Y., Zhong, Y., Zhang, G., Wu, Z., Kong, J., Wang, Q., Ding, H., Wu, H., Yuan, S., Wang, C., et al. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.02.022 · Cited by 13 · see citing works
eTher – An Assistive Virtual Agent for Acrophobia Therapy in Virtual Reality
Balan, O. C., Cristea, Ș., Moise, G., Petrescu, L., Ivașcu, S., Moldoveanu, A. D. B., Moldoveanu, F., & Leordeanu, M. (2020) · Lecture notes in computer science · doi:10.1007/978-3-030-59990-4_2 · Cited by 13 · see citing works
Visual Respiratory Feedback in Virtual Reality Exposure Therapy: A Pilot Study
Mevlevioğlu, D., Murphy, D., & Tabirca, S. (2021) · ACM International Conference on Interactive Media Experiences · doi:10.1145/3452918.3458799 · Cited by 12 · see citing works
“A phobia is an anxiety disorder characterised by the illogical fear of an object or a situation that interferes with the person’s daily life [5].”
Background
The presence of fear: How subjective fear, not physiological changes, shapes the experience of presence.
Maymon, C., Crawford, M. T., Blackburne, K., Botes, A., Carnegie, K., Mehr, S. A., Meier, J., Murphy, J., Miles, N. L., Robinson, K., et al. (2024) · Journal of Experimental Psychology General · doi:10.1037/xge0001576 · Cited by 15 · see citing works
Self-Efficacy Beliefs Are Associated with Visual Height Intolerance: A Cross-Sectional Survey
Grill, E., Schäffler, F., Huppert, D., Müller, M., Kapfhammer, H., & Brandt, T. (2014) · PLoS ONE · doi:10.1371/journal.pone.0116220 · Cited by 12 · see citing works
“learning models can be useful for therapy [22].”
Background
Effects of Virtual Reality–Based Multimodal Audio-Tactile Cueing in Patients With Spatial Attention Deficits: Pilot Usability Study
Knobel, S. E. J., Kaufmann, B. C., Geiser, N., Gerber, S. M., Müri, R. M., Nef, T., Nyffeler, T., & Cazzoli, D. (2022) · JMIR Serious Games · doi:10.2196/34884 · Cited by 11 · see citing works
“Virtual reality (VR) devices are being increasingly used, and can be found in industries [1,2] and areas of entertainment, military [3,4], and medicine [5-11].”
Background
Novel VR-Based Biofeedback Systems: A Comparison Between Heart Rate Variability- and Electrodermal Activity-Driven Approaches
Baldini, A., Patron, E., Gentili, C., Scilingo, E. P., & Greco, A. (2024) · IEEE Transactions on Affective Computing · doi:10.1109/taffc.2024.3352424 · Cited by 13 · see citing works
Effect of gender on immersion in collaborative iODV applications
Kallioniemi, P., Keskinen, T., Hakulinen, J., Turunen, M., Karhu, J., & Ronkainen, K. (2017) · International Conference on Mobile and Ubiquitous Multimedia (MUM) · doi:10.1145/3152832.3152869 · Cited by 11 · see citing works
“For this reason, VR applications are offering a new domain for entertainment and even treating different kind of phobias [11, 25].”
Background
Height intolerance between physiological mechanisms and psychological distress: a review of literature and our experience
Teggi, R., Comacchio, F., Fornasari, F., & Mira, E. (2019) · Acta Otorhinolaryngologica Italica · doi:10.14639/0392-100x-2190 · Cited by 10 · see citing works
Impact of VR Settings on Immersiveness in VR-Based Construction Skills Training: Case Study of Scaffolding Work
Kim, J., Ahn, S., & Han, S. (2020) · ASCE Construction Research Congress (CRC) · doi:10.1061/9780784482865.036 · Cited by 10 · see citing works
Virtual Reality System for the Treatment of Acrophobia
de Oliveira, R. E. M., & Oliveira, J. C. D. (2017) · Symposium on Virtual and Augmented Reality (SVR) · doi:10.1109/svr.2017.18 · Cited by 9 · see citing works
“Diversos estudos descrevem a utilização da RV em diferentes fobias, tais como: aracnofobia [11] [1], acrofobia [14] [6], fobia social [13] [17], fobia de dirigir e fobia de viajar de avião [5] [4].”
Background
VREAD: A Virtual Simulation to Investigate Cognitive Function in the Elderly
Shamsuddin, S. N. W., Ugail, H., Lesk, V. E., & Walters, E. R. (2012) · International Conference on Cyberworlds (CW) · doi:10.1109/cw.2012.37 · Cited by 9 · see citing works
“In the latter area it has been used in fields such as phobias with regard to spiders [16], fear of flying [17], acrophobia [18], fear of public speaking [19] and motor rehabilitation [20].”
Method
SAFEvR MentalVeRse.app: Development of a Free Immersive Virtual Reality Exposure Therapy for Acrophobia and Claustrophobia
Gaina, M.-A., Sbarcea, S.-V., Popa, B.-S., Stefanescu, B.-V., Gaina, A.-M., Szalontay, A.-S., Bolos, A., & Stefanescu, C. (2024) · Brain Sciences · doi:10.3390/brainsci14070651 · Cited by 8 · see citing works
“…and achieving clinically relevant results [22], with evidence showing substantial improvements in therapeutic outcomes [23]. iVR has been extensively researched beyond specific phobias, and reports have validated a panoramic impact on both stress-related and chronic anxiety disorders [24,25].”
Background
Immersive virtual plus-maze to examine behavior and psychophysiological-related variables in young people with problematic alcohol and cannabis consumption
Moreno‐Fernández, R. D., García-León, D., Rodríguez, G. P., Martín-Romero, R., Buades-Sitjar, F., & Sampedro‐Piquero, P. (2023) · Neurobiology of Stress · doi:10.1016/j.ynstr.2023.100564 · Cited by 8 · see citing works
“Nevertheless, although the trait anxiety showed by our participants was low (20-30 points), it was not close to zero, which could be related to certain discomfort experienced by them when they were exposed to a height situation with a risk of death by falling (Coelho et al., 2009; Öhman and Mineka, 2001).”
Virtual reality exposure effect in acrophobia: psychological and physiological evidence from a single experimental session
Varšová, K. K., Szitás, D., Janoušek, O., Jurkovičová, L., Kateřina, B., & Juřík, V. (2024) · Virtual Reality · doi:10.1007/s10055-024-01037-5 · Cited by 9 · see citing works
“At the same time, however, many studies have demonstrated the utility of VR as a potential therapeutic tool (Coelho et al. 2009; Ose et al. 2019; Maples-Keller et al. 2017).”
Manipulating situational risk in human-automation research – Validation of a new experimental paradigm in virtual reality
Hoesterey, S., & Onnasch, L. (2021) · Proceedings of the Human Factors and Ergonomics Society Annual Meeting · doi:10.1177/1071181321651161 · Cited by 8 · see citing works
“Emotional and physical responses to height exposure are so similar in VR compared to real life that it can and has been used as a tool for exposure therapy for treatment of acrophobia (e.g., Coelho et al., 2009).”
Method
Using Virtual Reality to Examine the Neural and Physiological Responses to Height and Perturbations in Quiet Standing
Kaur, R., Sun, R., Ziegelman, L., Sowers, R. B., & Hernandez, M. E. (2019) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc.2019.8857647 · Cited by 8 · see citing works
“As Virtual Reality (VR) can safely and feasibly provide pertinent and realistic visual scenarios, it has been used in a spectrum of studies examining acrophobia [4], [5].”
Background
EEG microstate in people with different degrees of fear of heights during virtual high-altitude exposure
Teng, C., Cong, L., Tian, Q., Liu, K., Cheng, S., Zhang, T., Dang, W., Hou, Y., Ma, J., Hui, D., et al. (2024) · Brain Research Bulletin · doi:10.1016/j.brainresbull.2024.111112 · Cited by 7 · see citing works
“As a subtype of specific phobias (SP), fear of heights (FoH), also termed as acrophobia, is a psychiatric disorder characterized by un-reasonable or extreme fear during high-altitude exposure (Coelho et al., 2009).”
Background
Digital Therapeutics in the Management of Chronic Pain
Rogozinski, B., Greenleaf, W., Sackman, J., & Cahana, A. (2018) · Springer eBooks · doi:10.1007/978-3-319-95369-4_30 · Cited by 7 · see citing works
Virtual Reality, Visual Cliffs, and Movement Disorders
Kaur, R., Lin, X., Layton, A., Hernandez, M. E., & Sowers, R. B. (2018) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc.2018.8512246 · Cited by 6 · see citing works
“Virtual reality (VR) technologies can provide realistic visual feedback of cliff scenarios, allowing for a range of studies of acrophobic responses [11], [12], [13], [14], [15], [16], [17], [18], particularly those which are ocular [19], [20], [21], [22], [23], [24].”
Background
Altered brain function in patients with acrophobia: A voxel-wise degree centrality analysis
Guo, M., Zhong, Y., Xu, J., Zhang, G., Xu, A., Kong, J., Wang, Q., Hang, Y., Xie, Y., Wu, Z., et al. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.05.058 · Cited by 6 · see citing works
Virtual Reality in Evidence-Based Psychotherapy
Szentgotai, A., Opri, D., & Davi, D. (2010) · InTech eBooks · doi:10.5772/13130 · Cited by 6 · see citing works
“…pointed out that motion combined with simulated height, rather that height per se, lead to the phobic response (Coelho et al., 2006; Coelho et al., 2008), suggesting the need to also explore visuo-vestibular and motion mechanisms as possible diathesis factors in this disorder (Coelho et al., 2009).”
Background
Emotion in motion: perceiving fear in the behaviour of individuals from minimal motion capture displays
Crawford, M. T., Maymon, C. N., Miles, N. L., Blackburne, K., Tooley, M., & Grimshaw, G. M. (2024) · Cognition & Emotion · doi:10.1080/02699931.2023.2300748 · Cited by 5 · see citing works
“The evidence that participants were experiencing realistic fear is further supported by studies that use similar height-based VR simulations (Cle-worth et al., 2012; Coelho et al., 2009; El Basbasse et al., 2023; Gromer et al., 2019; Kisker et al., 2019; Nielsen et al., 2022).”
Result
Participant Modeling: The Use of a Guided Master in the Modern World of Virtual Reality Exposure Therapy Targeting Fear of Heights
Caravas, P., Kritikos, I., Alevizopoulos, G., & Koutsouris, D. (2021) · Lecture notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering · doi:10.1007/978-3-030-76066-3_13 · Cited by 5 · see citing works
HRV-Based Detection of Fear of Heights in a VR Environment
Arpaïa, P., Barbato, S., D’Errico, G., Mastrati, G., Moccaldi, N., Robbio, R., & Wriessnegger, S. C. (2023) · Lecture notes in computer science · doi:10.1007/978-3-031-43401-3_33 · Cited by 5 · see citing works
Healing anxiety disorders with glucocorticoids
Sandi, C. (2011) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1103410108 · Cited by 5 · see citing works
“These observations support the popularity, since its outset in 1995, of virtual reality exposure over other behavioral therapies for the treatment of height phobia (10).”
Background
The Walls Are Closing In: Postural Responses to a Virtual Reality Claustrophobic Simulation
Chander, H., Freeman, H. R., Hill, C. M., Hudson, C. R., Arachchige, S. N. K. K., Turner, A. J., Jones, J. A., & Knight, A. C. (2022) · Clinical and Translational Neuroscience · doi:10.3390/ctn6020015 · Cited by 5 · see citing works
“VR has also been used successfully as a rehabilitation and intervention tool for Acrophobia through the virtual reality exposure therapy (VERT) [34].”
Method
A New Experimental Paradigm to Manipulate Risk in Human-Automation Research
Hoesterey, S., & Onnasch, L. (2022) · Human Factors The Journal of the Human Factors and Ergonomics Society · doi:10.1177/00187208221133878 · Cited by 4 · see citing works
“The emotional and physical responses to altitude exposure in VR are similar enough to real life that it has been used as a tool for exposure therapy for the treatment of acro-phobia (e.g., Coelho et al., 2009).”
Method
Virtual Reality Exposure Therapy
Turman, M. L., Olden, M., Emrich, M., & Difede, J. (2024) · CBT: science into practice · doi:10.1007/978-3-031-72720-7_4 · Cited by 5 · see citing works
Implementation of the MOTEK CAREN system in behavioural therapy for patients with anxiety disorders.
Krysta, K., Wilczyński, K. M., Paliga, J., Szczęsna, A., Wojciechowska, M., Martyniak, E., & Krzystanek, M. (2016) · PubMed · Cited by 4 · see citing works
The role of different sensory stimuli in an at height simulation
Shah, D., & Lawson, G. (2025) · Applied Ergonomics · doi:10.1016/j.apergo.2025.104559 · Cited by 3 · see citing works
Short Paper: A Video Self-avatar Influences the Perception of Heights in an Augmented Reality Oculus Rift
Gutekunst, M., Geuss, M. N., Rauhoeft, G., Stefanucci, J. K., Kloos, U., & Mohler, B. J. (2014) · Reutlingen University Academic Bibliography (Reutlingen University) · doi:10.2312/ve.20141358 · Cited by 3 · see citing works
Is a Combination of Pharmacotherapy and Psychotherapy Superior to Each Alone?
Choi, K., & Kim, Y. (2017) · Springer eBooks · doi:10.1007/978-981-10-6577-4_21 · Cited by 4 · see citing works
Hyperion : A Simulation of High Places in the Form of Virtual Reality for Acrophobia Sufferers
Lengkong, O. H., & Bororing, J. (2020) · International Conference on Cybernetics and Intelligent System (ICORIS) · doi:10.1109/icoris50180.2020.9320824 · Cited by 3 · see citing works
“…by trauma, parenting styles as well as one's mindset with symptoms in the form of great anxiety when anticipating heights, immediate reactions when at a height such as kneeling, hiking, or looking for something to hold on to, include stair, elevator, plane travel, also can lead to vertigo[1][2][3].”
Background
Applications of the Metaverse in Medicine and Healthcare
Mittal, V., Upadhyay, P., & Sharma, A. (2024) · Information systems engineering and management · doi:10.1007/978-3-031-72418-3_7 · Cited by 3 · see citing works
Exposure Based Therapy pada Fobia Ketinggian
Bahanan, F., & Yulianti, E. (2020) · Jurnal Psikiatri Surabaya · doi:10.20473/jps.v8i1.15865 · Cited by 3 · see citing works
A RANDOMIZED CONTROLLED STUDY OF THE EFFECTIVENESS OF CASUAL VIDEO GAMES IN REDUCING SYMPTOMS OF ANXIETY
Fish, M. T. (2011) · The Scholarship East Carolina University's Institutional Repository (East Carolina University) · Cited by 3 · see citing works
Attitudes towards virtual reality usage in exposure treatment: Data from German practitioners and how a demonstration changes them.
Badeja, D., Schier, F., McGinity, M., & Hoyer, J. (2026) · Psychotherapy Research · doi:10.1080/10503307.2025.2534978 · Cited by 2 · see citing works
“While VR has been demonstrated to be effective in inducing and treating fear of heights (Coelho et al., 2009), MR’s validity and practicability in this particular context has not yet been explored.”
VR for Specific Phobias: a Perspective on Adaptive and Physiological Feedback-Based Exposure Therapy
Ciurlia, M., Paiano, M., Rubino, M., D’Errico, G., Pellegrino, G., Barba, M. C., & Paolis, L. T. D. (2025) · Lecture notes in computer science · doi:10.1007/978-3-031-97763-3_20 · Cited by 2 · see citing works
Playful User-Generated Treatment
Volkmar, G., Alexandrovsky, D., Smeddinck, J. D., Herrlich, M., & Malaka, R. (2020) · Annual Symposium on Computer-Human Interaction in Play · doi:10.1145/3383668.3419893 · Cited by 2 · see citing works
“The immersive characteristics of reality-altering technologies such as virtual reality ( VR ) open avenues for novel modes of treatment and facilitate the democratization of therapy [6, 18, 22, 28].”
Background
Cognitive Behavior Therapy of Urinary Incontinence Phobia: A Case Report
Tan, T., & Lim, L. E. C. (2015) · Open Journal of Psychiatry · doi:10.4236/ojpsych.2015.51009 · Cited by 2 · see citing works
“Although treatment has been adapted to target a wide variety of phobic conditions [11]-[14], the literature is sparse on treatment success with the phobia of urinary incontinence.”
Background
Towards Early Diagnosis of Dementia Using a Virtual Environment
Shamsuddin, S. N. W., Ugail, H., Lesk, V. E., & Walters, E. R. (2013) · Lecture notes in computer science · doi:10.1007/978-3-642-38803-3_13 · Cited by 2 · see citing works
La Video Game Therapy® Un approccio innovativo integrato
Bocci, F., & Girelli, A. (2024) · RIVISTA SPERIMENTALE DI FRENIATRIA · doi:10.3280/rsf2024-003006 · Cited by 1 · see citing works
VRSPi: towards a neuroadaptive VR exposure therapy system for spider phobia
Wriessnegger, S. C., Kiatthaveephong, S., Leitner, M., & Kostoglou, K. (2026) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2026.1717588 · Cited by 1 · see citing works
“…have shown significant reductions in subjective fear and physiological arousal after repeated sessions (Francová et al., 2025), with VR sessions often achieving similar therapeutic gains in less time than real-world exposures (Coelho et al., 2009; Balan et al., 2019; Azimisefat et al., 2022).”
RELACIÓN ENTRE LOS TRASTORNOS POR ANSIEDAD Y ALTERACIONES DEL OÍDO INTERNO
Urzola, C., & Chica-Urzola, H. L. (2010) · Cited by 1 · see citing works
Virtual reality can help to develop a new reality
Brakoulias, V. (2013) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867412455852 · Cited by 1 · see citing works
“In a study where VRET was used to treat acrophobia, it was found that anxiety arose not only in the context of height, but as a result of the combined effect of height with motion (Coelho et al., 2009).”
Background
Exploring Virtual Reality for Neural Rehabilitation and Phobia Treatment
Vargas-Herrera, D., Oropeza-Ramos, L. A., Cabrera, O., Caldelas, I., Brambila-Paz, F., & Montúfar‐Chaveznava, R. (2019) · Communications in computer and information science · doi:10.1007/978-3-030-16785-1_4 · Cited by 1 · see citing works
“About 5% of the general population suffer from acro-phobia [19].”
Background
Virtual Reality in the Treatment of Acrophobia
Maravalhas, V., Marques, A. J., de Sousa, S., Monteiro, P. R. R., & de Almeida, R. S. (2021) · Advances in intelligent systems and computing · doi:10.1007/978-3-030-72657-7_53 · Cited by 1 · see citing works
MRI examination teaching system by using virtual reality (VR)
Lu, T.-C., Li, W., You, M.-R., Chen, C. C., Chai, J., & Wu, Y.-Y. (2021) · International Journal of Applied Science and Engineering · doi:10.6703/ijase.202109_18(5).011 · Cited by 1 · see citing works
“In the past research, it has been confirmed that virtual reality can cause acrophobia of patients in high-rise situations (Coelho et al., 1995).”
BackgroundInfluential
When Fear Overshadows Perceived Plausibility: The Influence of Incongruencies on Acrophobia in VR
Brübach, L., Celikhan, D., Rüffert, L., Westermeier, F., Latoschik, M. E., & Wienrich, C. (2025) · IEEE Conference on Virtual Reality and 3D User Interfaces (VR) · doi:10.1109/vr59515.2025.00089 · Cited by 1 · see citing works
“Acrophobia, affecting about 1 in 20 adults [8], was chosen to evoke fear even in a non-clinical sample [12, 18].”

A Systematic Literature Review: Acrophobia Treatment with Virtual Reality
Giraldy, D. J., & Novaldo, W. (2022) · Engineering MAthematics and Computer Science (EMACS) Journal · doi:10.21512/emacsjournal.v4i1.8077 · Cited by 8 · see citing works
Virtual Reality Exposure Therapy For Acrophobia:A Systematic Review Of Clinical Evidence
Joy, S. S., Ghosh, A., Uddin, M. S., Hasan, K. J., & Cruze, C. F. (2026) · Daffodil International University Journal of Science and Technology · doi:10.36481/diujst.v21i1.7fs0k172
A Review of VR Application in Acrophobia TreatmentPreprint
Sanghavi, P., & Mehendale, N. D. (2025) · SSRN Electronic Journal · doi:10.2139/ssrn.5042199
Innovations in Virtual Reality for Treating Acrophobia: Design and Implementation
Leong, W. Y., Leong, Y. Z., & Kumar, R. (2025) · International Conference on Cognitive Computing in Engineering, Communications, Sciences and Biomedical Health Informatics (IC3ECSBHI) · doi:10.1109/ic3ecsbhi63591.2025.10990951 · Cited by 8 · see citing works
VR-Based Exposure Therapy for Acrophobia: Effects of Visual Realism and Interactivity
Pan, G., & Leong, W. Y. (2025) · INTI JOURNAL. · doi:10.61453/intij.202517

Authors: Coelho, C. M., Waters, A. M., Hine, T. J., & Wallis, G.
Affiliations: The University of Queensland (AU)
Griffith University (AU)
Corresponding author: Coelho, Carlos M.
ORCID: Coelho, Carlos M.
Waters, Allison M.
Hine, Trevor J.
Wallis, Guy
Venue: Journal of Anxiety Disorders
Publisher: Elsevier BV
Published: 2009-06
Volume: 23
Issue: 5
Pages: 563-574
ISSN: 0887-6185 (ISSN-L)
DOI: 10.1016/j.janxdis.2009.01.014
OpenAlex: W2148405318
Cited by: 127
References: 161
Citations by year: 2026: 5 · 2025: 6 · 2024: 12 · 2023: 9 · 2022: 5 · 2021: 12 · 2020: 17 · 2019: 9 · 2018: 9 · 2017: 6 · 2016: 6 · 2015: 6 · 2014: 5 · 2013: 9 · 2012: 2
FWCI: 0.36
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Journal of Anxiety Disorders (publishedVersion)
PubMed (publishedVersion)
Griffith Research Online (submittedVersion)
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: acrophobia, virtual reality exposure therapy, fear of heights, anxiety disorders, exposure therapy, virtual reality, vestibular system, postural control, visual perception, treatment efficacy
MeSH terms: Fear, Humans, Locomotion, Motion Perception, Phobic Disorders, Photic Stimulation, Posture, User-Computer Interface, Vestibule, Labyrinth, Visual Perception, Cognitive Behavioral Therapy, Self Efficacy

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The Use of Virtual Reality in Acrophobia Research and Treatment

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