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The Use of Virtual Reality Technology in the Treatment of Anxiety and Other Psychiatric Disorders
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LEARNING OBJECTIVES: After participating in this activity, learners should be better able to:• Evaluate the literature regarding the effectiveness of incorporating virtual reality (VR) in the treatment of psychiatric disorders• Assess the use of exposure-based intervention for anxiety disorders ABSTRACT: Virtual reality (VR) allows users to experience a sense of presence in a computer-generated, three-dimensional environment. Sensory information is delivered through a head-mounted display and specialized interface devices. These devices track head movements so that the movements and images change in a natural way with head motion, allowing for a sense of immersion. VR, which allows for controlled delivery of sensory stimulation via the therapist, is a convenient and cost-effective treatment. This review focuses on the available literature regarding the effectiveness of incorporating VR within the treatment of various psychiatric disorders, with particular attention to exposure-based intervention for anxiety disorders. A systematic literature search was conducted in order to identify studies implementing VR-based treatment for anxiety or other psychiatric disorders. This article reviews the history of the development of VR-based technology and its use within psychiatric treatment, the empirical evidence for VR-based treatment, and the benefits for using VR for psychiatric research and treatment. It also presents recommendations for how to incorporate VR into psychiatric care and discusses future directions for VR-based treatment and clinical research.
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“Experiencing presence when immersed in VR has been reported to be an important factor for the implementation of effective interventions in VR (Maples-Keller et al., 2017).”
From iSenseVR: bringing VR exposure therapy outside the laboratory (2019) · cites this paper as Maples-Keller et al., 2017
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“VR exposure therapy allows the controlled delivery of sensory stimulation (Maples-Keller et al., 2017).”
From iSenseVR: bringing VR exposure therapy outside the laboratory (2019) · cites this paper as Maples-Keller et al., 2017
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“For instance, virtual reality (VR) technology, accessed through head-mounted displays, provides an immersive experience similar to real-life situations and has been used in controlled environments [7].”
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“However, when traditional graded exposure becomes complex to set up due to difficulties to control specific environment cues, VR offers opportunities for highly controllable settings empowering sensory exposure with the presence of the therapist, which would not be possible otherwise (Maples-Keller et al., 2017).”
From iSenseVR: bringing VR exposure therapy outside the laboratory (2019) · cites this paper as Maples-Keller et al., 2017
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THE ROLE OF TECHNOLOGY IN ENHANCING MENTAL HEALTH ADVOCACY: A SYSTEMATIC REVIEW
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“Presence is the participant’s psychological response to a virtual environment (45) in terms of their sense of immersion and emotions, such as anxiety (51, 52).”
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“While the recognized intervention for phobia in the general population is manualized CBT, there is growing evidence that using a VRE to facilitate graded exposure has a place in treatment.(21,22) Our data indicate that the adaptations we have implemented by using the VRE technique may confer a number of benefits for s…”
BackgroundSchroeder, A., Bogie, B. J. M., Rahman, T. T., Thérond, A., Matheson, H., & Guimond, S. (2021) · JMIR Mental Health · doi:10.2196/28502 · Cited by 58
“With VR, patients can practice functioning in familiar settings, which may allow them to develop skills that are more generalizable to real-world situations [27,28].”
BackgroundMo, J., Vickerstaff, V., Minton, O., Tavabie, S., Taubert, M., Stone, P. C., & White, N. (2022) · Palliative Medicine · doi:10.1177/02692163221099584 · Cited by 60
“32 USA 2020 Hospice None 12 Cancer heart failure, bronchiectasis, Pneumonia 8 (67), 2 (17), 1 (8), 1 (8) 4 (33) 8 (67) 72 (16)”
Stress Reduction Using Bilateral Stimulation in Virtual Reality
Kamińska, D., Smółka, K., Zwoliński, G., Wiak, S., Merecz‐Kot, D., & Anbarjafari, G. (2020) · IEEE Access · doi:10.1109/access.2020.3035540 · Cited by 58
Virtual Reality Applications in Medicine During the COVID-19 Pandemic: Systematic Review
Pallavicini, F., Pepe, A., Clerici, M., & Mantovani, F. (2022) · JMIR Serious Games · doi:10.2196/35000 · Cited by 64
Restout, J., Bernache‐Assollant, I., Morizio, C., Boujut, A., Angelini, L., Tchalla, A. E., & Perrochon, A. (2023) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2022.12.026 · Cited by 57
Chung, O. S., Robinson, T., Johnson, A. M., Dowling, N. L., Ng, C. H., Yücel, M., & Segrave, R. A. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.791123 · Cited by 53
“Virtual reality (VR) has emerged as an efficacious tool for treating a wide range of mental illnesses, and a highly promising method for assessing them (1, 2).”
MethodParticipatory Design of VR Scenarios for Exposure Therapy
Flobak, E., Wake, J. D., Vindenes, J., Kahlon, S., Nordgreen, T., & Guribye, F. (2019) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3290605.3300799 · Cited by 53
“Systematic reviews of VR for exposure therapy show that the efcacy of these interventions is similar to that of in vivo interventions [23, 29, 30].”
BackgroundWang, H.-Y., & Sun, J. C. (2021) · Interactive Learning Environments · doi:10.1080/10494820.2021.1928711 · Cited by 61
“, 2017); mental health (Maples-Keller et al., 2017; Valmaggia et al., 2016); and education (Moro et al.”
BackgroundPallavicini, F., Pepe, A., Ferrari, A., Garcea, G., Zanacchi, A., & Mantovani, F. (2018) · PRESENCE Virtual and Augmented Reality · doi:10.1162/pres_a_00325 · Cited by 56
Sharifpour, S., Manshaee, G., & Sajjadian, I. (2020) · Counselling and Psychotherapy Research · doi:10.1002/capr.12311 · Cited by 60
Extended Reality for Enhanced Telehealth During and Beyond COVID-19: Viewpoint
Ong, T., Wilczewski, H., Paige, S. R., Soni, H., Welch, B. M., & Bunnell, B. E. (2021) · JMIR Serious Games · doi:10.2196/26520 · Cited by 58
“These VR, AR, and MR technologies—collectively referred to as extended reality (XR)—have been demonstrated for inpatient and outpatient psychiatric, medical, and rehabilitative applications with equal or greater effectiveness than their non-XR standard treatments [13,15-17].”
BackgroundSelf-citationProvider experiences of virtual reality in clinical treatment
Vincent, C., Eberts, M., Naik, T. U., Gulick, V., & O’Hayer, C. V. (2021) · PLoS ONE · doi:10.1371/journal.pone.0259364 · Cited by 52
“These subjective findings corroborate previous studies that have shown the effectiveness of VR in treatment of phobias [4, 11, 12, 26–28], anxiety [5, 6, 10, 13, 20, 29], PTSD [2, 7, 14], addictions [8, 30, 31], and pain management [2, 3, 15, 16, 18, 32].”
ResultChen, Y., Zhou, Z., Cao, M., Liu, M., Lin, Z., Yang, W., Yang, X., Dhaidhai, D. T., & Xiong, P. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104683 · Cited by 57
Ghiţă, A., Teixidor, L., Monràs, M., Ortega, L., Mondón, S., Gual, A., Paredes, S. M., Urgell, L. V., Porras-García, B., Ferrer‐García, M., et al. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00074 · Cited by 51
Effectiveness and User Experience of Virtual Reality for Social Anxiety Disorder: Systematic Review
Shahid, S., Kelson, J. N., & Saliba, A. J. (2023) · JMIR Mental Health · doi:10.2196/48916 · Cited by 49
“VR can also improve accessibility to exposure therapy for individuals who find it logistically challenging or emotionally overwhelming to engage in real-world scenarios [17].”
BackgroundUsing biomechanics to investigate the effect of VR on eye vergence system
Iskander, J., Hossny, M., & Nahavandi, S. (2019) · Applied Ergonomics · doi:10.1016/j.apergo.2019.102883 · Cited by 58
The clinical potential of augmented reality.
Vinci, C., Brandon, K. O., Kleinjan, M., & Brandon, T. H. (2020) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12357 · Cited by 51
Virtual Reality for Pain Management in Cancer: A Comprehensive Review
Pittara, M., Matsangidou, M., Stylianides, K., Petkov, N., & Pattichis, C. S. (2020) · IEEE Access · doi:10.1109/access.2020.3044233 · Cited by 51
“VOLUME XX, 2017 2 training interventions and VR-assisted therapies, eating disorders, autism, and smoking addiction [12], [13], [14], [15], [16], [17].”
Weibel, R. P., Kerr, J. I., Naegelin, M., Ferrario, A., Schinazi, V. R., Marca, R. L., Hölscher, C., Nater, U. M., & von Wangenheim, F. (2022) · Computers in Human Behavior · doi:10.1016/j.chb.2022.107607 · Cited by 63
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 54
Bender, S. M., & Sung, B. (2021) · Psychology and Marketing · doi:10.1002/mar.21444 · Cited by 49
İnözü, M., Çelikcan, U., Akın-Sarı, B., & Çıçek, N. M. (2020) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2020.100518 · Cited by 52
Ma, L., Mor, S., Anderson, P. L., Baños, R., Botella, C., Bouchard, S., Cárdenas‐López, G., Donker, T., Fernández‐Álvarez, J., Lindner, P., et al. (2021) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2021.1939410 · Cited by 49
“…vivo exposures can be addressed or minimised by the use of VR technology, notably the need for logistic planning (i.e. time and location), accessibility and controllability of the environment/stimuli, and anonymity/confidentiality of the patient (Maples-Keller et al., 2017; Neudeck & Einsle, 2012).”
BackgroundSelf-citationKim, S.-N., & Lee, H. (2021) · Landscape and Urban Planning · doi:10.1016/j.landurbplan.2021.104290 · Cited by 45
Self-citationThe effect of virtual reality on anxiety, stress, and hemodynamic parameters during cesarean section
Almedhesh, S. A., Elgzar, W. T., Ibrahim, H. A., & Osman, H. A. (2022) · Saudi Medical Journal · doi:10.15537/smj.2022.43.4.20210921 · Cited by 46
The use of virtual reality in the rehabilitation of aphasia: a systematic review
Devane, N., Behn, N., Marshall, J., Ramachandran, A., Wilson, S., & Hilari, K. (2022) · Disability and Rehabilitation · doi:10.1080/09638288.2022.2138573 · Cited by 50
“For example, in virtual reality exposure therapy, it is proposed that the treat-ment works because the virtual representation is real enough to elicit the anxiety [114].”
BackgroundRamón, L. A. S. D., Martínez, A. F. F., Carricondo, A. R. G., Gálvez, F. E., & Alarcón, R. (2023) · The Journal of the American Dental Association · doi:10.1016/j.adaj.2022.11.008 · Cited by 45
Fan, L., Wang, J., Li, Q., Song, Z., Dong, J., Bao, F., & Wang, X. (2023) · Frontiers in Neuroscience · doi:10.3389/fnins.2023.1173127 · Cited by 45
“, 2014), education (Ruan, 2022), and healthcare (Mirelman et al., 2011; Maples-Keller et al., 2017).”
Virtual reality modulating dynamics of neuroplasticity: Innovations in neuro-motor rehabilitation
Wankhede, N. L., Koppula, S., Ballal, S., Doshi, H., Kumawat, R., Raju, S., Arora, I., Sammeta, S. S., Khalid, M., Zafar, A., et al. (2024) · Neuroscience · doi:10.1016/j.neuroscience.2024.12.040 · Cited by 52
Virtual medicine: how virtual reality is easing pain, calming nerves and improving health
Spiegel, B. M. R. (2018) · The Medical Journal of Australia · doi:10.5694/mja17.00540 · Cited by 45
Virtual Reality–Based Biofeedback and Guided Meditation in Rheumatology: A Pilot Study
Venuturupalli, S., Chu, T., Vicari, M., Kumar, A., Fortune, N., & Spielberg, B. (2019) · ACR Open Rheumatology · doi:10.1002/acr2.11092 · Cited by 45
“VR has shown to be useful in psychiatric settings, especially for those with anxiety-related disorders (48), such as social anxiety disorder.”
Background
Metadata
- Authors
- Maples-Keller, J. L., Bunnell, B. E., Kim, S.-J., & Rothbaum, B. O.
- Affiliations
- Emory University (US)
- Venue
- Harvard Review of Psychiatry
- Published
- 2017-05
- Volume
- 25
- Issue
- 3
- Pages
- 103-113
- ISSN
- 1067-3229 (ISSN-L)
- 1465-7309
- PMC
- PMC5421394
- OpenAlex
- W2611287876
- Cited by
- 862
- References
- 108
- Citations by year
- 2026: 111 · 2025: 147 · 2024: 115 · 2023: 93 · 2022: 113 · 2021: 117 · 2020: 85 · 2019: 51 · 2018: 24 · 2017: 5
- FWCI
- 4.40
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Harvard Review of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Genentech
- National Institute of Mental Health (R01MH094757, R01MH070880)
- 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 › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- virtual reality, anxiety disorders, mental illness, exposure therapy, virtual reality exposure therapy, immersive virtual reality, head-mounted displays, treatment effectiveness, psychiatric treatment
- MeSH terms
- Anxiety Disorders, Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Virtual Reality Exposure Therapy
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