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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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Background
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Causal Inference in Generalizable Environments: Systematic Representative Design
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“…(i.e. fear of flying) (Wiederhold & Wiederhold, 2003), social phobia (Sekhavat & Nomani, 2017), Post Traumatic Stress Disorder (PTSD) (Gonçalves et al., 2012) and other stress-related disorders (Guillén et al., 2018) (also see a summary in (Maples-Keller et al., 2017; Parsons & Rizzo, 2008)).”
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“VR as a complementary intervention needs to be available outside of clinical settings and should have real world generalizability and relevance (81).”
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“In addition, virtual reality technology powered by AI has the capability to replicate real-world scenarios, so enabling patients to experience anxiety-provoking situations (4).”
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“In these contexts, VR has been useful given the possibility of constructing, manipulating, and individualizing therapeutic exposures that may be difficult to implement in vivo.(28) In the context of medical procedures, the efficacy of VR in managing and attenuating patient anxiety has been predominantly attributed to…”
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“VR also allows the player to have complete control, as the provider can control the exact aspects of the exposure environment [26].”
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“Over the past few years, more and more researchers have used Virtual Reality Exposure Therapy (VRET) for psychological or psychiatric disorders, including fear of flying [13], spider phobia [14], anxiety disorder [15], Post-Traumatic Stress Disorder (PTSD) [16], [17], etc.”
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Emotionally adaptive support: a narrative review of affective computing for mental health
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“In the medicine and treatment of mental disorders, VR can overcome fears during behavioral therapy in order for the patient to face challenges in a controlled environment (11, 12).”
BackgroundVirtual Reality and Correctional Rehabilitation: A Game Changer
Ticknor, B. (2019) · Criminal Justice and Behavior · doi:10.1177/0093854819842588 · Cited by 20
“Through extensive research, VRET has been shown to significantly reduce anxiety disorders in patients (Arroll, Wallace, Mount, Humm, & kingsford, 2017; Botella, FernandezAlvarez, Guillen, Garcia-Palacios, & Banos, 2017; Grillon, Riquier, Heberlin, & Thalmann, 2006; Maples-keller et al., 2017).”
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“Current research on mental health and the use of VR is related to social anxiety disorder or social phobia [19-23], psychosis [11,24], and high-functioning autism [25-27] and intellectual disabilities in young adults [28].”
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“For example, investment in formal training and dedicated staff may be necessary for providers to use VR with confidence (Maples-Keller et al., 2017; Boeldt et al., 2019).”
BackgroundSelf-citationVirtual Reality as a Moderator of Psychedelic-Assisted Psychotherapy
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“Virtual reality has been used as part of the treatment for psychiatric disorders, including anxiety, 57 being able to reduce anxiety symptoms, 58 and demonstrating similar effi-cacy compared with traditional exposure interventions, because it has a powerful real-life impact, and demonstrates good…”
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“Virtual reality (virtual reality technology, referred to as VR) [1-3] is a human-computer interaction technology developed in the United States in the late 1980s.”
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“Future studies are suggested to conduct power analysis and involve a larger sample size, to have adequate power to detect significant changes in health outcomes and reduce the possibility of publication bias [9, 74, 75].”
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“Such environments have been used for education [14], pain relief [15], and reducing fear [16].”
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“…disorder (ASD) and attention de fi cit hyperactivity disorder (ADHD), eating disorders, psychotic disorders, depressive disorders, and substance use disorders (Carl et al., 2019; Cie´slik et al., 2020; Clus et al., 2018; Freeman et al., 2017; Maples-Keller et al., 2017; Valmaggia et al., 2016).”
BackgroundViczko, J., Tarrant, J., & Jackson, R. (2021) · Frontiers in Virtual Reality · doi:10.3389/frvir.2021.618381 · Cited by 28
“While a substantial amount of research and design has focused on virtual reality (VR) systems with mental health applications (Malbos et al., 2013; Maples-Keller et al., 2017), comparatively less exists in the way of augmented reality (AR) applications (Pallavicini and Bouchard, 2019).”
BackgroundTherapeutic virtual reality in prison: Participatory design with incarcerated women
Teng, M. Q., & Gordon, E. (2021) · New Media & Society · doi:10.1177/1461444821993131 · Cited by 23
“The key aspect of VR that maps well onto exposure methods is the potential immersion of patients in vivid, life-like, and three-dimensional virtual environments, delivered through head-mounted displays (HMDs), that are tailored to the specifics of their “fear structures” (Birckhead et al., 2019; Maples-Keller et al.,…”
BackgroundInfluentialA Systematic Review of Virtual Reality Interventions for Children with Social Skills Deficits
Wang, X., Young, G. W., Guckin, C. M., & Smolić, A. (2021) · IEEE International Conference on Teaching, Assessment, and Learning for Engineering · doi:10.1109/tale52509.2021.9678808 · Cited by 31
“978-1-6654-3687-8/21/$31.00 ©2021 IEEE Virtual reality (VR) technology is currently experiencing a reemergence [8] and is increasingly being used in mental health treatment and clinical research [9].”
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“Furthermore, confidentiality risks for patients, accessibility and controllability of the stimuli, privacy, and ethical concerns may also exist (Ma et al., 2021; Maples-Keller et al., 2017).”
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Fischer, C. S., Heider, J., Schröder, A., & Taylor, J. E. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-019-10054-7 · Cited by 25
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“To date, intervention studies that employed VR have been successful in treating posttraumatic stress syndrome, anxiety syndrome, and smoking [19,20].”
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VR Panoramic Technology in Urban Rail Transit Vehicle Engineering Simulation System
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A systematic review of technology-assisted interventions for co-morbid depression and substance use
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“Emerging and affordable technologies, such as mobile virtual reality headsets, present further opportunity to develop new interventions.(90) Further research is needed to effectively translate the current findings into clinical practice.”
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Emotional self-regulation, virtual reality and neurofeedback
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“The range of the total score is 0 to 40 (subclinical [0–7], small [8–15], medium [16–23] severe [24-31], and extreme [32–40]) [42].”
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“However, most studies on VR based relaxation lack this personalised and adaptive approach [26].”
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“Future work may consider more immersive approaches such as virtual reality [54] and approaches such as SMS text messages [55] or chatbots [56] that foster a sense of social connection and may encourage stronger engagement with the intervention content.”
Urban Landscape Design Based on Data Fusion and Computer Virtual Reality Technology
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Virtual reality and music's impact on psychological well-being
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“Both VR (8) and music (9) have been used in the past to improve people’s well-being.”
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Combining frontal gamma asymmetry neurofeedback with virtual reality: A proof of concept case study
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Matsangidou, M., Schiza, E. C., Hadjiaros, M., Neokleous, K. C., Avraamides, M. N., Papayianni, E., Frangoudes, F., & Pattichis, C. S. (2020) · Lecture notes in computer science · doi:10.1007/978-3-030-49282-3_26 · Cited by 20
A Visuo-Haptic Attention Training Game With Dynamic Adjustment of Difficulty
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“Training should be congruent with the role trainees are expected to fulfill on the field, covering new delivery modalities such as remote CBT and self-guided treatments [69,71,74,81,82,92,98] and the specifics of managing in vivo or virtual reality exposure in a clinical setting [43,89,125].”
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“Moreover, the range of virtual reality (VR) treatments is expanding [8].”
BackgroundSánchez-Nieto, D., Castaño-Castaño, S., Martos, R. N., Obrero‐Gaitán, E., Cortés‐Pérez, I., & Nieto-Escámez, F. A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032727 · Cited by 21
PublicVR: a virtual reality exposure therapy intervention for adults with speech anxiety
Spyridonis, F., Daylamani-Zad, D., & Nightingale, J. (2024) · Virtual Reality · doi:10.1007/s10055-024-00998-x · Cited by 19
“In fact, Maples-Keller et al. (2017) identified that the use of artificial settings and virtually generated environments eliminates many constraints of the real world and therefore acts as a valuable method of treating SADs.”
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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