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Does engagement with exposure yield better outcomes? Components of presence as a predictor of treatment response for virtual reality exposure therapy for social phobia
Open accessAbstract
Virtual reality exposure (VRE) has been shown to be effective for treating a variety of anxiety disorders, including social phobia. Presence, or the level of connection an individual feels with the virtual environment, is widely discussed as a critical construct both for the experience of anxiety within a virtual environment and for a successful response to VRE. Two published studies show that whereas generalized presence relates to fear ratings during VRE, it does not relate to treatment response. However, presence has been conceptualized as multidimensional, with three primary factors (spatial presence, involvement, and realness). These factors can be linked to other research on the facilitation of fear during exposure, inhibitors of treatment response (e.g., distraction), and more recent theoretical discussions of the mechanisms of exposure therapy, such as Bouton's description of expectancy violation. As such, one or more of these components of presence may be more strongly associated with the experience of fear during VRE and treatment response than the overarching construct. The current study (N=41) evaluated relations between three theorized components of presence, fear ratings during VRE, and treatment response for VRE for social phobia. Results suggest that total presence and realness subscale scores were related to in-session peak fear ratings. However, only scores on the involvement subscale significantly predicted treatment response. Implications of these findings are discussed.
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“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 et al., 2011
Experimental — accuracy not yet measuredIn the citing paper
“As several trials have demonstrated the potential of VRET for social anxiety disorder [27], [28], [75], one might conclude that the current subjective presence measures do not capture the essential sense of presence that is responsible for activating fear related to social anxiety in individuals.”
From A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders (2014) · cites this paper as [75]
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Zacarin, M. R. J., Borloti, E., & Haydu, V. B. (2019) · Temas em Psicologia · doi:10.9788/tp2019.2-14 · Cited by 26
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
Cortez-Vázquez, G., Adriaanse, M. C., Burchell, G. L., Ostelo, R., Panayiotou, G., & Vlemincx, E. (2024) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-023-09611-4 · Cited by 33
“Previous research has shown that greater involvement in a virtual environment exposure treatment is linked to improved treatment response for public speaking fear (Price et al., 2011).”
BackgroundVirtual Reality Therapy for Social Phobia: A Scoping Review
Elham, S., Mehrabi, M., Fatehi, F., & Salehi, A. (2020) · Studies in health technology and informatics · doi:10.3233/shti200253 · Cited by 25
“During the talk, their heart rate is monitored and the content of the presentation is recorded [10, 12, 14, 15, 20, 21].”
BackgroundMethodHawajri, O., Lindberg, J., & Suominen, S. (2023) · Issues in Mental Health Nursing · doi:10.1080/01612840.2023.2190051 · Cited by 28
“This shows that VRET has a sustained effect even after the end of treatment (Anderson et al., 2013; Price et al., 2011; Zainal et al., 2021).”
BackgroundA Comparison of Active and Passive Virtual Reality Exposure Scenarios to Elicit Social Anxiety
Sekhavat, Y. A., & Nomani, P. (2017) · International Journal of Serious Games · doi:10.17083/ijsg.v4i2.154 · Cited by 24
“According to [42], different aspects of presence are associated with the experience of fear.”
BackgroundOrru, K., Kask, S., & Nordlund, A. M. (2018) · Journal of Ecotourism · doi:10.1080/14724049.2018.1526290 · Cited by 24
“Existing research has shown the low feeling of authenticity and immersion in an experience to be the key impediment to emotional responses and feelings of presence while on a virtual tour (Guttentag, 2010; Price et al., 2011; Seth et al., 2012).”
BackgroundPresence and simulator sickness predict the usability of a virtual reality attention task
Voinescu, A., Petrini, K., & Fraser, D. S. (2023) · Virtual Reality · doi:10.1007/s10055-023-00782-3 · Cited by 28
“Some studies identified a positive relationship between presence and performance across various environments and tasks (Cooper et al. 2018; Price et al. 2011; Stevens and Kincaid 2015).”
BackgroundResultKerouš, B., Barteček, R., Román, R., Sojka, P., Bečev, O., & Liarokapis, F. (2020) · Journal of Ambient Intelligence and Humanized Computing · doi:10.1007/s12652-020-01858-7 · Cited by 23
Libera, C. D., Simon, J., Larøi, F., Quertemont, É., & Wagener, A. (2023) · Virtual Reality · doi:10.1007/s10055-023-00779-y · Cited by 27
“This study, as well as a few others (Felnhofer et al. 2019; Gamito et al. 2014; Price et al. 2011; Simon et al. 2020), is part of this approach.”
ResultMalihi, M., Nguyen, J. L., Cardy, R. E., Eldon, S., Petta, C., & Kushki, A. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00669 · Cited by 27
“Engagement re fl ects attention to the virtual stimuli and has been associated with enhanced intervention effectiveness (66).”
BackgroundSpagnolli, A., Bracken, C. C., & Orso, V. (2014) · Virtual Reality · doi:10.1007/s10055-013-0241-x · Cited by 23
“Price (2011) [61] Social phobia During the last 3 sessions of the treatment patients were exposed to three different virtual scenarios: a conference room, a classroom and a large auditorium.”
BackgroundSong, Y., Jordan, J. I., Shaffer, K. A., Wing, E. K., McRae, K., & Waugh, C. E. (2018) · Cognition & Emotion · doi:10.1080/02699931.2018.1541789 · Cited by 27
Clemmensen, L., Bouchard, S., Rasmussen, J., Holmberg, T. T., Nielsen, J. H., Jepsen, J. R. M., & Lichtenstein, M. B. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-2453-4 · Cited by 26
Virtual reality exposure therapy for reducing school anxiety in adolescents: Pilot study
Beele, G., Liesong, P., Bojanowski, S., Hildebrand, K., Weingart, M., Asbrand, J., Correll, C. U., Morina, N., & Uhlhaas, P. J. (2024) · JMIR Mental Health · doi:10.2196/56235 · Cited by 20
“It may therefore also be relevant for therapeutic efficacy [55].”
BackgroundResultInfluentialVugts, M. A. P., Zedlitz, A. M. E. E., Joosen, M. C. W., & Vrijhoef, H. J. (2019) · Journal of Medical Internet Research · doi:10.2196/14766 · Cited by 21
Lobbestael, J., & Cima, M. (2021) · Brain Sciences · doi:10.3390/brainsci11121653 · Cited by 19
“environment and avatars and telepresence were rated between 17 and 47/100 and, thus, comparable to the results of some other studies [81,82], but lower than observed in other studies [79,80,83–85].”
ResultLee, J., Kang, D.-Y., & Kim, J. (2023) · Cyberpsychology, Behavior, and Social Networking · doi:10.1089/cyber.2022.0243 · Cited by 17
Bloch, F., Rigaud, A., & Kemoun, G. (2013) · European Geriatric Medicine · doi:10.1016/j.eurger.2013.10.005 · Cited by 16
“Several experiments have also been conducted with VRET to treat various psychological disorders [14] such as agoraphobia [15], body image disorders [16] and fear of flying [17].”
BackgroundArnfred, B. T., Svendsen, J. K., Adjorlu, A., & Horthøj, C. (2023) · Frontiers in Virtual Reality · doi:10.3389/frvir.2023.952741 · Cited by 16
“21 studies examining SAD were included.”
BackgroundInfluentialScheveneels, S., Engelhard, I. M., & Meyerbröker, K. (2024) · Clinical Psychological Science · doi:10.1177/21677026241267945 · Cited by 18
“In a follow-up study considering the different components of presence, overall presence also did not predict VRET outcome (Price et al., 2011).”
Effects of system- and media-driven immersive capabilities on presence and affective experience
Standen, B., Anderson, J., Sumich, A. L., & Heym, N. (2021) · Virtual Reality · doi:10.1007/s10055-021-00579-2 · Cited by 14
“Indeed, presence has been associated with elicitation of greater levels of fear (Price et al. 2011) and anxiety (Ling et al. 2014), which are essential for exposure therapy to be successful (Benito and Walther 2015).”
BackgroundVR for Studying the Neuroscience of Emotional Responses
Andreatta, M., Winkler, M. H., Collins, P., Gromer, D., Gall, D., Pauli, P., & Gamer, M. (2023) · Current topics in behavioral neurosciences · doi:10.1007/7854_2022_405 · Cited by 14
Chard, I., Zalk, N. V., & Picinali, L. (2023) · Frontiers in Virtual Reality · doi:10.3389/frvir.2023.1159549 · Cited by 12
Predictors of Engagement in Virtual Reality Storytelling Environments about Migration
Avila, C., Bacca-Acosta, J., & Chaves-Rodríguez, J. (2023) · Applied Sciences · doi:10.3390/app131910915 · Cited by 12
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 16
Johnson, S. B., & Anderson, P. L. (2016) · Anxiety Stress & Coping · doi:10.1080/10615806.2016.1138289 · Cited by 14
Heart Rate Prediction from Head Movement during Virtual Reality Treatment for Social Anxiety
Noori, F. M., Kahlon, S., Lindner, P., Nordgreen, T., Torresen, J., & Riegler, M. (2019) · 2019 International Conference on Content-Based Multimedia Indexing (CBMI) · doi:10.1109/cbmi.2019.8877454 · Cited by 11
Steinhaeusser, S. C., Eckstein, B., & Lugrin, B. (2022) · Entertainment Computing · doi:10.1016/j.entcom.2022.100539 · Cited by 11
Chang, Y.-C., & Yang, C. (2024) · Behavioral Sciences · doi:10.3390/bs14090781 · Cited by 13
“McLean et al. found that increasing immersion and sensory awareness during VR experiences can help improve VR presence [18], thereby stimulating emotions [22–26].”
Background
Metadata
- Authors
- Price, M., Mehta, N., Tone, E. B., & Anderson, P. L.
- Affiliations
- Medical University of South Carolina (US)
- Georgia State University (US)
- Corresponding author
- Anderson, Page L.
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2011-08
- Volume
- 25
- Issue
- 6
- Pages
- 763-770
- ISSN
- 0887-6185 (ISSN-L)
- PMC
- PMC3401534
- OpenAlex
- W2006180230
- Cited by
- 187
- References
- 38
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 19 · 2023: 23 · 2022: 13 · 2021: 8 · 2020: 19 · 2019: 19 · 2018: 19 · 2017: 10 · 2016: 7 · 2015: 13 · 2014: 8 · 2013: 9 · 2012: 1
- FWCI
- 10.17
- 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)
- Digital Archive @ GSU (submittedVersion)
- Funders
- National Institute of Mental Health (R42MH060506)
- 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, social anxiety disorder, presence, spatial presence, involvement, realness, treatment response, expectancy violation, distraction, anxiety disorders
- MeSH terms
- Adult, Amygdala, Anxiety, Fear, Female, Humans, Implosive Therapy, Male, Phobic Disorders, Surveys and Questionnaires, User-Computer Interface, Treatment Outcome
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