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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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ResultVirtual reality exposure therapy for anxiety disorders: A meta-analysis
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“14 There is evidence that treatment gains made in VRE generalize to real life, as meta-analytic results suggest that VRE patients, compared to wait-list patients, perform significantly better on behavioral assessments post-treatment, and found no significant differences between VRE and in-vivo…”
BackgroundSutherland, I. E. (1965) · Cited by 754
What's real about virtual reality?
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“In particular, VR is effective in treating acrophobia based on both within-group,(38) and controlled between-group, data.(10,39,40) Similar effects have been observed in RCTs for treating arachnophobia (fear of spiders) and, in one multiple-baseline study, fear of driving.”
BackgroundSelf-citationVirtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis
Opriş, D., Pintea, S., García-Palacios, A., Botella, C., Szamosközi, Ş., & David, D. (2012) · Depression and Anxiety · doi:10.1002/da.20910 · Cited by 636 · cited 1×
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“control of sensory cues, particularly for auditory, tactile, and olfactory systems, increases the sense of realism and memory of the virtual environment.(1,4,5)”
BackgroundEfficacy of treatments for anxiety disorders: a meta-analysis
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“Anxiety Disorders Awide body of research has suggested large treatment effects for exposure-based therapy for anxiety disorders.(11) Modern exposure therapy is based on emotion-processing theory, which posits that fearmemories are structures that contain information regarding fear stimuli, responses, and meaning.”
BackgroundVirtual Reality Exposure Therapy for Vietnam Veterans With Posttraumatic Stress Disorder
Rothbaum, B. O., Hodges, L. F., Ready, D. J., Graap, K. M., & Alarcón, R. D. (2001) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v62n0808 · Cited by 531
Self-citationA controlled study of virtual reality exposure therapy for the fear of flying.
Rothbaum, B. O., Hodges, L., Smith, S., Lee, J. H., & Price, L. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.6.1020 · Cited by 501 · cited 1×
“rates VR exposure to a virtual airport and airplane in the last four sessions.(23) Specific equipment and training are needed to integrate VR into psychiatric practice effectively.”
BackgroundSelf-citationVirtual reality in the treatment of spider phobia: a controlled study
Garcia-Palacios, A., Hoffman, H., Carlin, A., Furness, T. A., & Botella, C. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00068-7 · Cited by 490
Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia
Emmelkamp, P. M. G., Krijn, M., Hulsbosch, A. M., de Vries, S., Schuemie, M. J., & van der Mast, C. A. P. G. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00023-7 · Cited by 475 · cited 1×
“37 VRE has shown acceptability and efficacy in the treatment of other SPs. Specifically, VR is effective for the treatment of acrophobia (fear of heights) based on within-group 38 and controlled between-group data.”
MethodMorina, N., Ijntema, H., Meyerbröker, K., & Emmelkamp, P. M. G. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.08.010 · Cited by 439 · cited 1×
“15 As such, VRE is a promising treatment approach, and evidence for VRE for specific anxiety disorders will be reviewed.”
BackgroundGarcia-Palacios, A., Botella, C., Hoffman, H., & Fabregat, S. (2007) · CyberPsychology & Behavior · doi:10.1089/cpb.2007.9962 · Cited by 410
Das, D. A., Grimmer, K. A., Sparnon, A. L., McRae, S., & Thomas, B. H. (2005) · BMC Pediatrics · doi:10.1186/1471-2431-5-1 · Cited by 391
Rothbaum, B. O., Price, M., Jovanovic, T., Norrholm, S. D., Gerardi, M., Dunlop, B., Davis, M., Bradley, B., Duncan, E. J., Rizzo, A., et al. (2014) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2014.13121625 · Cited by 388
Self-citationModulation of thermal pain-related brain activity with virtual reality: evidence from fMRI
Hoffman, H. G., Richards, T. L., Coda, B. A., Bills, A. R., Blough, D. K., Richards, A. L., & Sharar, S. R. (2004) · Neuroreport · doi:10.1097/01.wnr.0000127826.73576.91 · Cited by 381
Virtual reality exposure therapy for social anxiety disorder: A randomized controlled trial.
Anderson, P. L., Price, M., Edwards, S. M., Obasaju, M. A., Schmertz, S. K., Zimand, E., & Calamaras, M. R. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0033559 · Cited by 371 · cited 1×
“VR-based CBT for fear of public speaking has demonstrated effects similar to traditional CBT and above that of controls, and effects were maintained one year posttreatment.(47,50) Finally, preliminary data have begun to show efficacy for VR in treating school-based anxiety, including test anxiety.”
Effectiveness of Virtual Reality–Based Pain Control With Multiple Treatments
Hoffman, H. G., Patterson, D. R., Carrougher, G. J., & Sharar, S. R. (2001) · Clinical Journal of Pain · doi:10.1097/00002508-200109000-00007 · Cited by 360 · cited 1×
“79,80 Another RCT of 91 schizophrenic individuals found that in comparison to traditional SST, SST including VR components resulted in increased interest in SST and generalization of skills learned during treatment and an improvement in the ability to converse and be assertive, although patients…”
ResultDifede, J., & Cukor, J. (2007) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v68n1102 · Cited by 357 · cited 1×
“16,57,58 A preliminary study comparing VR based exposure therapy for PTSD following the World Trade Center Attacks (n=13) with a waitlist control (n=8) found that the VR group demonstrated a significant decline in PTSD scores compared to the waitlist group and that this improvement was maintained…”
BackgroundMitchell, P., Parsons, S., & Leonard, A. (2006) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-006-0189-8 · Cited by 345 · cited 1×
“100 As such, extant literature provides preliminary support for the efficacy of incorporating VR into the treatment of different types of eating pathology and weight problems, as results suggest that VR may result in comparable treatment effects to traditional CBT approaches and may results in…”
BackgroundVirtual reality exposure therapy for PTSD Vietnam veterans: A case study
Rothbaum, B. O., Hodges, L., Alarcon, R., Ready, D., Shahar, F., Graap, K., Pair, J., Hebert, P., Gotz, D., Wills, B., et al. (1999) · Journal of Traumatic Stress · doi:10.1023/a:1024772308758 · Cited by 328 · cited 1×
“53 Early investigations into VRE for PTSD suggested that this treatment approach held promise for PTSD treatment in case studies 54–56 and open trial designs across a broad range of traumatic experiences.”
BackgroundSelf-citationKlinger, E., Bouchard, S., Légeron, P., Roy, S., Lauer, F., Chemin, I., & Nugues, P. (2005) · CyberPsychology & Behavior · doi:10.1089/cpb.2005.8.76 · Cited by 327 · cited 1×
“44 In summary, there have been numerous studies showing efficacy for VR-based CBT for the treatment of SPs.”
BackgroundTreatment of acrophobia in virtual reality: The role of immersion and presence
Krijn, M., Emmelkamp, P. M. G., Biemond, R., de Wilde de Ligny, C., Schuemie, M. J., & van der Mast, C. A. P. G. (2004) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(03)00139-6 · Cited by 320 · cited 1×
“In particular, VR is effective in treating acrophobia based on both within-group,(38) and controlled between-group, data.(10,39,40) Similar effects have been observed in RCTs for treating arachnophobia (fear of spiders) and, in one multiple-baseline study, fear of driving.”
BackgroundDifede, J., & Hoffman, H. G. (2002) · CyberPsychology & Behavior · doi:10.1089/109493102321018169 · Cited by 320
Brief Virtual Reality Therapy for Public Speaking Anxiety
Harris, S. R., Kemmerling, R. L., & North, M. M. (2002) · CyberPsychology & Behavior · doi:10.1089/109493102321018187 · Cited by 314 · cited 2×
“VR-based CBT for fear of public speaking has demonstrated effects similar to traditional CBT and above that of controls 47–49 and effects were maintained at one-year post treatment.”
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Virtual reality graded exposure in the treatment of acrophobia: A case report
ROTHBAUM, B. O., Hodges, L. F., Rob Kooper, A., Opdyke, D., Williford, J. S., & North, M. M. (1995) · Behavior Therapy · doi:10.1016/s0005-7894(05)80100-5 · Cited by 278 · cited 1×
“1,2,4,22 While initial cost to begin VR continues to be a potential disadvantage, prices have decreased over time, and, vendors have recently began selling smartphone-based VR therapy systems which currently start at $600.”
BackgroundSelf-citationEfficacy of Virtual Reality Exposure Therapy in the Treatment of PTSD: A Systematic Review
Gonçalves, R., Pedrozo, A. L., Coutinho, E. S. F., Figueira, I. L. D. V., & Ventura, P. R. (2012) · PLoS ONE · doi:10.1371/journal.pone.0048469 · Cited by 263 · cited 1×
“Across several studies, VRE for PTSD demonstrates a medium-to-large treatment-effect size,(13) superior treatment outcomes compared to wait-list controls, and outcomes comparable to standard exposure treatment.(53) Early case studies”
ResultPark, K., Ku, J. H., Choi, S., Jang, H.-J., Park, J., Kim, S. I., & Kim, J. (2011) · Psychiatry Research · doi:10.1016/j.psychres.2011.04.003 · Cited by 256 · cited 1×
“Another RCT of 91 schizophrenic individuals found that in comparison to traditional SST, SST with VR components resulted in increased interest in SST, in generalization of skills learned during treatment, and in improved ability to converse and be assertive, although patients receiving traditional SST demonstrated bet…”
ResultSelf-citationFreeman, D. H., Bradley, J., Antley, A., Bourke, E., DeWeever, N., Evans, N., Černis, E., Sheaves, B., Waite, F., Dunn, G., et al. (2016) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.115.176438 · Cited by 243 · cited 1×
“One small RCT found that combining VR-based social interactions with exposure and cognitive therapy led to decreases both in persecutory delusions and in distress during in vivo social interactions.(78) Three studies have used VR as an adjunct to social-skills training (SST) for schizophrenic patients, two of which we…”
BackgroundVirtual reality exposure in the treatment of panic disorder and agoraphobia: A controlled study
Botella, C., García‐Palacios, A., Villa, H., Baños, R. M., Quero, S., Alcañiz, M., & Riva, G. (2007) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.524 · Cited by 242
Virtual Reality Treatment in Acrophobia: A Comparison with Exposure in Vivo
Emmelkamp, P. M. G., Bruynzeel, M., Drost, L., & van der Mast, C. P. A. G. (2001) · CyberPsychology & Behavior · doi:10.1089/109493101300210222 · Cited by 241 · cited 1×
“37 VRE has shown acceptability and efficacy in the treatment of other SPs. Specifically, VR is effective for the treatment of acrophobia (fear of heights) based on within-group 38 and controlled between-group data.”
MethodRothbaum, B. O., Anderson, P., Zimand, E., Hodges, L., Lang, D., & Wilson, J. (2006) · Behavior Therapy · doi:10.1016/j.beth.2005.04.004 · Cited by 240
Self-citationReger, G. M., Koenen-Woods, P., Zetocha, K., Smolenski, D. J., Holloway, K. M., Rothbaum, B. O., Difede, J., Rizzo, A. A., Edwards-Stewart, A., Skopp, N. A., et al. (2016) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000134 · Cited by 226 · cited 1×
“domly assigned 162 active-duty soldiers to ten sessions of prolonged exposure, VRE, or minimal-attention wait-list.(66) At”
BackgroundSelf-citationVirtual Reality Cognitive Behavior Therapy for Public Speaking Anxiety: A Randomized Clinical Trial
Wallach, H. S., Safir, M. P., & Bar-Zvi, M. (2009) · Behavior Modification · doi:10.1177/0145445509331926 · Cited by 218
Difede, J., Cukor, J., Wyka, K., Olden, M., Hoffman, H., Lee, F. S., & Altemus, M. (2014) · Neuropsychopharmacology · doi:10.1038/npp.2013.317 · Cited by 212
McLay, R. N., Wood, D. P., Webb-Murphy, J. A., Spira, J. L., Wiederhold, M. D., Pyne, J. M., & Wiederhold, B. K. (2011) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2011.0003 · Cited by 211 · cited 2×
“For patients with PTSD, a thorough assessment of the patient’s index trauma will facilitate the therapist being able to prepare in advance what VR program to utilize (e.g., Virtual Iraq) and the specific setting and stimuli (e.g., time of day, specific weapon noises) that may be used.”
ResultTwelve-month follow-up of virtual reality and standard exposure therapies for the fear of flying.
ROTHBAUM, B. O., Hodges, L. F., Anderson, P. L., Price, L. R., & Smith, S. G. (2002) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.70.2.428 · Cited by 197 · cited 1×
“26 32 Further investigation revealed that these treatment gains were maintained at one-33,34 and 3-years 35 post-treatment.”
BackgroundSelf-citationWalshe, D. G., Lewis, E. J., Kim, S. I., O'Sullivan, K., & Wiederhold, B. K. (2003) · CyberPsychology & Behavior · doi:10.1089/109493103322011641 · Cited by 193 · cited 1×
“53 Early investigations into VRE for PTSD suggested that this treatment approach held promise for PTSD treatment in case studies 54–56 and open trial designs across a broad range of traumatic experiences.”
BackgroundSelf-citationReger, G. M., Holloway, K. M., Candy, C., Rothbaum, B. O., Difede, J., Rizzo, A. A., & Gahm, G. A. (2011) · Journal of Traumatic Stress · doi:10.1002/jts.20574 · Cited by 188 · cited 1×
“59 Results demonstrated statistical and clinical significance, as baseline scores in both groups fell within the severe range, whereas at post-treatment the mean score for the VR group was in the mild range and 7 of the 10 VR completers did not meet PTSD diagnostic criteria.”
BackgroundSelf-citationRepeated exposure of flight phobics to flights in virtual reality
Mühlberger, A., Herrmann, M. J., Wiedemann, G., Ellgring, H., & Pauli, P. (2001) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(00)00076-0 · Cited by 187
Rizzo, A. “., Difede, J., Rothbaum, B. O., Reger, G., Spitalnick, J., Cukor, J., & Mclay, R. (2010) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2010.05755.x · Cited by 185
Self-citationVirtual reality in anxiety disorders: the past and the future
Gorini, A., & Riva, G. (2008) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.8.2.215 · Cited by 184 · cited 1×
“The concept of VR was eventually formalized in 1989 when Jaron Lanier coined the term virtual reality, at which point VR began to gain greater presence in research and psychiatric treatment.(8,9) During the 1990s and early 2000s, psychologists began to utilize VRwith prolonged exposure therapy.”
BackgroundGromala, D., Tong, X., Choo, A., Karamnejad, M., & Shaw, C. (2015) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/2702123.2702344 · Cited by 182 · cited 1×
“85 VR has also been used to help individuals with chronic pain learn and practice pain management techniques in combination with existing cognitive and/or behavioral interventions, as VR may help non-responders to conventional treatment and can provide the ability to standardize instructions and…”
MethodVirtual Reality and Cognitive Rehabilitation: A Brief Review of the Future
Rizzo, A., Buckwalter, J. G., & Neumann, U. (1997) · Journal of Head Trauma Rehabilitation · doi:10.1097/00001199-199712000-00002 · Cited by 178
Virtual reality for persistent pain: A new direction for behavioral pain management
Keefe, F. J., Huling, D. A., Coggins, M. J., Keefe, D. F., Rosenthal, Z. M., Herr, N. R., & Hoffman, H. G. (2012) · Pain · doi:10.1016/j.pain.2012.05.030 · Cited by 178
Rus‐Calafell, M., Gutiérrez‐Maldonado, J., & Ribas‐Sabaté, J. (2013) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2013.09.002 · Cited by 169 · cited 1×
“78 Three studies have used VR as an adjunct to social skill training (SST) for schizophrenic patients, two of which were uncontrolled pilot investigations that provide preliminary support for the efficacy of this approach in improving social skills and interactivity.”
BackgroundEffect of multiple context exposure on renewal in spider phobia
Shiban, Y., Pauli, P., & Mühlberger, A. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.10.007 · Cited by 162
Virtual reality in the treatment of claustrophobic fear: A controlled, multiple-baseline design
Botella, C., Baños, R., Villa, H., Perpiñá, C., & García‐Palacios, A. (2000) · Behavior Therapy · doi:10.1016/s0005-7894(00)80032-5 · Cited by 161 · cited 3×
“Early data that made use of multiple-baseline designs found initial support for the use of VR in treating PDA.(67) Although RCTs generally have found positive effects for VRE for PDA, studies have varied regarding the differences between VRE and traditional exposure therapy.”
Influentialvan Twillert, B., Bremer, M., & Faber, A. W. (2007) · Journal of Burn Care & Research · doi:10.1097/bcr.0b013e318148c96f · Cited by 159
Beck, J. G., Palyo, S. A., Winer, E. H., Schwagler, B. E., & Ang, E. J. (2006) · Behavior Therapy · doi:10.1016/j.beth.2006.04.001 · Cited by 154 · cited 3×
“An early study on VRE with patients with PTSD due to motor vehicle crashes suggested that patients reported very high satisfaction with VRE.”
BackgroundApplications of virtual reality for pain management in burn-injured patients
Sharar, S. R., Miller, W. M., Teeley, A., Soltani, M., Hoffman, H. G., Jensen, M. P., & Patterson, D. R. (2008) · Expert Review of Neurotherapeutics · doi:10.1586/14737175.8.11.1667 · Cited by 154 · cited 1×
“87 A study in a sample of patients with fibromyalgia found that the use of VR with activity management treatment, which included VR based sessions involving activity management instructions, motivation enhancement, overcoming activity-related barriers, and acknowledgement of personal strengths, led…”
BackgroundWiederhold, B. K., Jang, D. P., Gevirtz, R. G., Kim, S. I., Kim, I. Y., & Wiederhold, M. D. (2002) · IEEE Transactions on Information Technology in Biomedicine · doi:10.1109/titb.2002.802378 · Cited by 150 · cited 1×
“26 32 Further investigation revealed that these treatment gains were maintained at one-33,34 and 3-years 35 post-treatment.”
BackgroundSelf-citationVirtual reality exposure therapy for the treatment of fear of flying: A controlled investigation.
Maltby, N., Kirsch, I., Mayers, M., & Allen, G. J. (2002) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.70.5.1112 · Cited by 147
Vincelli, F., Anolli, L., Bouchard, S., Wiederhold, B. K., Zurloni, V., & Riva, G. (2003) · CyberPsychology & Behavior · doi:10.1089/109493103322011632 · Cited by 145 · cited 2×
“68 These equivalent longer-term treatment effects have remained stable for three-, 68 six, 72 nine, 73 and 12-months 74 post-treatment.”
BackgroundGershon, J., Zimand, E., Lemos, R., ROTHBAUM, B. O., & Hodges, L. F. (2003) · CyberPsychology & Behavior · doi:10.1089/109493103322725450 · Cited by 141
Self-citationMarco, J. H., Perpiñá, C., & Botella, C. (2013) · Psychiatry Research · doi:10.1016/j.psychres.2013.02.023 · Cited by 140 · cited 1×
“Copyright © 2017 President and Fellows of Harvard Colle group received additional treatment sessions.(101) As such, the current literature provides preliminary support for the efficacy of incorporating VR into the treatment of different types of eating pathology and weight problems; results suggest that VR may result…”
MethodMcCann, R. A., Armstrong, C. M., Skopp, N. A., Edwards-Stewart, A., Smolenski, D. J., June, J. D., Metzger-Abamukong, M., & Reger, G. M. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.05.010 · Cited by 134
Riva, G., Bacchetta, M., Baruffi, M., & Molinari, E. (2001) · CyberPsychology & Behavior · doi:10.1089/109493101750527079 · Cited by 127 · cited 1×
“A follow-up, controlled investigation of 28 obese patients randomized to VR treatment or CBT-based groups found that VR treatment resulted in significantly greater improvements with body satisfaction, anxiety level, and problematic eating.(99) No significant differences were found for self-efficacy or stages of change…”
BackgroundEfficacy of a One-Session Virtual Reality Exposure Treatment for Fear of Flying
Mühlberger, A., Wiedemann, G., & Pauli, P. (2003) · Psychotherapy Research · doi:10.1093/ptr/kpg030 · Cited by 125 · cited 1×
“Additional studies have found that VRE for fear of flying may be enhanced by the inclusion of physiological feedback(36) and motion simulation.(37) VRE has shown acceptability and efficacy in the treatment of other SPs.”
BackgroundThree-Year Follow-Up for Virtual Reality Exposure for Fear of Flying
Wiederhold, B. K., & Wiederhold, M. D. (2003) · CyberPsychology & Behavior · doi:10.1089/109493103322278844 · Cited by 117 · cited 1×
“26 32 Further investigation revealed that these treatment gains were maintained at one-33,34 and 3-years 35 post-treatment.”
BackgroundSoldier Attitudes about Technology-Based Approaches to Mental Health Care
Wilson, J. A. B., Onorati, K., Mishkind, M., Reger, M. A., & Gahm, G. A. (2008) · CyberPsychology & Behavior · doi:10.1089/cpb.2008.0071 · Cited by 114
Saladin, M. E., Brady, K. T., Graap, K. M., & ROTHBAUM, B. O. (2006) · Addictive Behaviors · doi:10.1016/j.addbeh.2006.01.004 · Cited by 114 · cited 1×
“Another investigation found that a VR crack-cocaine environment was effective at eliciting craving and physiological arousal in a sample dependent upon crack cocaine.(92) AVR casino environment was shown to be effective in eliciting psychophysiological arousal and urges to gamble in a sample of recreational gamblers,(…”
BackgroundSelf-citationVirtual Reality Exposure Therapy
ROTHBAUM, B. O. (2010) · The Corsini Encyclopedia of Psychology · doi:10.1002/9780470479216.corpsy1024 · Cited by 110
Self-citationVirtual Reality in the Treatment of Generalized Anxiety Disorders
Alessandra, G., Federica, P., Davide, A., Claudia, R., Andrea, G., & Giuseppe, R. (2010) · Studies in Health Technology and Informatics · doi:10.3233/978-1-60750-561-7-39 · Cited by 107 · cited 1×
“68 These equivalent longer-term treatment effects have remained stable for three-, 68 six, 72 nine, 73 and 12-months 74 post-treatment.”
BackgroundVirtual Reality Cognitive-Behavior Therapy for Public Speaking Anxiety: One-Year Follow-Up
Safir, M. P., Wallach, H. S., & Bar-Zvi, M. (2012) · Behavior Modification · doi:10.1177/0145445511429999 · Cited by 107 · cited 1×
“VR-based CBT for fear of public speaking has demonstrated effects similar to traditional CBT and above that of controls 47–49 and effects were maintained at one-year post treatment.”
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Self-citationThe effect of repeated exposure to virtual gambling cues on the urge to gamble
Park, C.-B., Park, S. M., Gwak, A. R., Sohn, B. K., Lee, J.-Y., Jung, H. Y., Choi, S.-W., Kim, D. J., & Choi, J.-S. (2015) · Addictive Behaviors · doi:10.1016/j.addbeh.2014.09.027 · Cited by 102 · cited 1×
“While this presumably relates to cognitive distraction, specific mechanisms are currently unknown 89 and future research could investigate mechanisms underlying this effect.”
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“In a randomized trial with 13 eating-disordered patients comparing VR-based CBT for body-image disturbances to traditional CBT, VR-based CBTwas found to result in significantly greater symptom improvement in body-image disturbances; no differences were found for eating-disorder symptoms across the two groups.(100) In…”
Virtual Reality Modeling Language
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Fear of flying treatment methods: virtual reality exposure vs. cognitive behavioral therapy.
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Virtual reality exposure therapy for the treatment of fear of flying: A controlled investigation.
Maltby, N., Kirsch, I., Mayers, M., et al. (2002) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.70.5.1112 · Cited by 97
Garcia-Palacios, A., Herrero, R., Vizcaíno, Y., Belmonte, M. A., Castilla, D., Molinari, G., Baños, R. M., & Botella, C. (2015) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000196 · Cited by 96 · cited 1×
“A study of patients with fibromyalgia found that using VR with activity-management treatment—which included VR-based sessions involving activity-management instructions, motivation enhancement, overcoming activity-related barriers, and acknowledgment of personal strengths—was significantly more effective than treatmen…”
BackgroundVirtual Reality Versus Computer-Aided Exposure Treatments for Fear of Flying
Tortella-Feliu, M., Botella, C., Llabrés, J., Bretón-López, J. M., del Amo, A. R., Baños, R. M., & Gelabert, J. M. (2011) · Behavior Modification · doi:10.1177/0145445510390801 · Cited by 93
A controlled study of agoraphobia and the independent effect of virtual reality exposure therapy
Malbos, E., Rapee, R. M., & Kavakli, M. (2013) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867412453626 · Cited by 91 · cited 1×
“Findings from some investigations suggest that whereas VRE may result in better treatment response 68,69 and fewer required treatment sessions, 70 it may not differ from traditional CBT, 71 particularly when considering long-term outcome.”
BackgroundA Randomized, Controlled Clinical Trial of In Virtuo and In Vivo Exposure for Spider Phobia
Michaliszyn, D., Marchand, A., Bouchard, S., Martel, M.-O., & Poirier-Bisson, J. (2010) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2009.0277 · Cited by 90
Immersive Virtual Environments in Cue Exposure
Kuntze, M. F., Stoermer, R., Mager, R., Roessler, A., Müller-Spahn, F., & Bullinger, A. H. (2001) · CyberPsychology & Behavior · doi:10.1089/109493101750527051 · Cited by 87 · cited 1×
“, a virtual bar, syringe, needle) was effective at eliciting physiological arousal, subjective craving, and urges to use drugs in men with opioid dependence.(91) Another investigation found that a VR crack-cocaine environment was effective at eliciting craving and physiological arousal in a sample dependent upon crack…”
BackgroundLahiri, U., Bekele, E., Dohrmann, E. H., Warren, Z. E., & Sarkar, N. (2014) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-014-2240-5 · Cited by 84
Virtual reality: Using the virtual world to improve quality of life in the real world
Anderson, P. L., Rothbaum, B. O., & Hodges, L. F. (2001) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.65.1.78.18713 · Cited by 76
Self-citationEffects of Group Experiential Cognitive Therapy for the Treatment of Panic Disorder with Agoraphobia
Choi, Y.-H., Vincelli, F., Riva, G., Wiederhold, B. K., Lee, J.-H., & Park, K.-H. (2005) · CyberPsychology & Behavior · doi:10.1089/cpb.2005.8.387 · Cited by 74 · cited 1×
“Findings from some investigations suggest that whereas VRE may result in better treatment response 68,69 and fewer required treatment sessions, 70 it may not differ from traditional CBT, 71 particularly when considering long-term outcome.”
BackgroundKim, K., Kim, C.-H., Cha, K. R., Park, J., Han, K., Kim, Y. K., Kim, J.-J., Kim, I. Y., & Kim, S. I. (2008) · CyberPsychology & Behavior · doi:10.1089/cpb.2008.0003 · Cited by 72 · cited 1×
“24 Gorini and colleagues 75 conducted a small-scale RCT (N=20) which used VR in conjunction with biofeedback for patients to practice relaxation exercises during treatment.”
BackgroundSelf-citationVR-Based Conversation Training Program for Patients with Schizophrenia: A Preliminary Clinical Trial
Ku, J. H., Han, K., Lee, H., Jang, H. J., Kim, K. U., Park, S. H., Kim, J., Kim, C. H., Kim, I. Y., & Kim, S. I. (2007) · CyberPsychology & Behavior · doi:10.1089/cpb.2007.9989 · Cited by 71 · cited 1×
“Three studies have used VR as an adjunct to social-skills training (SST) for schizophrenic patients, two of which were uncontrolled pilot investigations that provide preliminary support for the efficacy of this approach in improving social skills and interactivity.(79,80) Another RCT of 91 schizophrenic individuals fo…”
ResultSelf-citationMühlberger, A., Weik, A., Pauli, P., & Wiedemann, G. (2005) · Psychotherapy Research · doi:10.1080/10503300500090944 · Cited by 68
Preliminary Research on the Efficacy of Virtual Reality Exposure Therapy to Treat Driving Phobia
Wald, J., & Taylor, S. J. (2003) · CyberPsychology & Behavior · doi:10.1089/109493103769710488 · Cited by 67 · cited 1×
“Similar effects have been observed in RCTs for treating arachnophobia (fear of spiders) and, in one multiple-baseline study, fear of driving.(44)”
An adaptive display to treat stress-related disorders: EMMA’s World
Baños, R. M., Botella, C., Guillen, V., García-Palacios, A., Quero, S., Bretón-López, J., & Alcañiz, M. (2009) · British Journal of Guidance & Counselling · doi:10.1080/03069880902957064 · Cited by 65 · cited 3×
“An early study on VRE with patients with PTSD due to motor vehicle crashes suggested that patients reported very high satisfaction with VRE.”
Backgroundve, R. G. E., Bouchard, S., Dumoulin, S., Guitard, T., & Klinger, É. (2010) · PubMed · Cited by 60
Choi, J., Park, S., Lee, J., Jung, H., Lee, H., Jin, C.-H., & Kang, D. (2011) · Psychiatry Investigation · doi:10.4306/pi.2011.8.2.155 · Cited by 53 · cited 1×
“In a nicotine-dependent sample, a VR-based smoking environment elicited, compared to a neutral cue, increased psychophysiological arousal and craving—a response that then decreased over the course of a four-week treatment using VR cue exposure.(94) In a sample of nicotine-dependent cigarette smokers, self-reported”
BackgroundPeñate, W., Pitti, C. T., Pérez, J. M. B., de la Fuente, J., & Gracia, R. (2008) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 51
Kahan, M., Tanzer, J., Darvin, D., & Borer, F. (2000) · CyberPsychology & Behavior · doi:10.1089/10949310050078832 · Cited by 49 · cited 1×
“Two studies on fear of flying using a within-group design have demonstrated significant reductions in flight-related anxiety(25) and also an increased likelihood to fly on an airplane following treatment.(26) Several”
BackgroundVirtual reality exposure therapy for school phobia
Gutiérrez‐Maldonado, J., Magallón-Neri, E. M., Rus‐Calafell, M., & Peñaloza, C. (2009) · RECERCAT (Consorci de Serveis Universitaris de Catalunya) · Cited by 48
Headsight Television System Provides Remote Surveillance
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VIRTUAL REALITY CUE EXPOSURE THERAPY FOR THE TREATMENT OF TOBACCO DEPENDENCE.
Culbertson, C. S., Shulenberger, S., Garza, R. D. L., Newton, T. F., & Brody, A. L. (2012) · PubMed · Cited by 46
Virtual Reality Exposure Therapy for Anxiety Disorders: Small Samples and No Controls?
Page, S., & Coxon, M. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.00326 · Cited by 46 · cited 1×
“Lahiri and colleagues 101 found preliminary evidence for the use of a VR-based computer task in improving social communication performance in autistic teenagers.”
BackgroundValidity of virtual reality as a method of exposure in the treatment of test anxiety
Alsina-Jurnet, I., Carvallo-Beciu, C., & Gutiérrez‐Maldonado, J. (2007) · Behavior Research Methods · doi:10.3758/bf03192977 · Cited by 42 · cited 1×
“47,50 Finally, preliminary data has begun to show efficacy for VR in the treatment of school-based anxiety, including test anxiety.”
BackgroundThompson-Lake, D. G. Y., Cooper, K. N., Mahoney, J. J., Bordnick, P. S., Salas, R., Kosten, T. R., Dani, J. A., & Garza, R. D. L. (2014) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntu245 · Cited by 41 · cited 1×
“91 A VR casino environment was shown to be effective in eliciting psychophysiological arousal and urges to gamble in a sample of recreational gamblers, 92 suggesting that VR based cue elicited craving is effective across different addiction populations.”
BackgroundPélissolo, A., Zaoui, M., Aguayo, G., Yao, S. N., Roche, S., Écochard, R., Gueyffier, F., Pull, C., Berthoz, A., Jouvent, R., et al. (2012) · HAL · Cited by 38
Freedman, S., Hoffman, H. G., García‐Palacios, A., Weiss, P. L., Avitzour, S., & Josman, N. (2010) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2009.0271 · Cited by 36 · cited 1×
“53 Early investigations into VRE for PTSD suggested that this treatment approach held promise for PTSD treatment in case studies 54–56 and open trial designs across a broad range of traumatic experiences.”
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Virtual environments and interactivity: windows to the future
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“A double-blind placebo study investigated the effects of D-cycloserine in concurrent cocaine- and nicotine-dependent participants (n = 29) who engaged in VR based cue-exposure therapy in conjunctionwith brief CBT for smoking.(96) Although results indicated no significant effect of D-cycloserine, overall significant de…”
MethodA Cognitive and Virtual Reality Treatment Program for the Fear of Flying
Ferrand, M., Ruffault, A., Tytelman, X., Flahault, C., & Negovanska, V. (2015) · Aerospace Medicine and Human Performance · doi:10.3357/amhp.4211.2015 · Cited by 23 · cited 1×
“Two studies on fear of flying using a within-group design have demonstrated significant reductions in flight-related anxiety 25 as well as an increased likelihood to fly on an airplane following treatment.”
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Virtual reality exposure for OCD: is it feasible?
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Neuroscience of virtual reality: from virtual exposure to embodied medicine
Riva, G., Wiederhold, B. K., & Mantovani, F. (2019) · Cyberpsychology, Behavior, and Social Networking · doi:10.1089/cyber.2017.29099.gri · Cited by 608
“In many articles, attention is focused on the high level of control and customization allowed by this technology.(1,2,9,10,87) VR allows the level of fit between the content of the exposure and the feared stimuli to be optimized.”
BackgroundBrowning, M. H. E. M., Mimnaugh, K. J., van Riper, C. J., Laurent, H. K., & LaValle, S. M. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02667 · Cited by 507
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“A new generation of realistic simulation can therefore (49).”
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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