Single-session gamified virtual reality exposure therapy for spider phobia vs. traditional exposure therapy: study protocol for a randomized controlled non-inferiority trial
Open accessAbstract
BACKGROUND: Traditional one-session exposure therapy (OST) in which a patient is gradually exposed to feared stimuli for up to 3 h in a one-session format has been found effective for the treatment of specific phobias. However, many individuals with specific phobia are reluctant to seek help, and access to care is lacking due to logistic challenges of accessing, collecting, storing, and/or maintaining stimuli. Virtual reality (VR) exposure therapy may improve upon existing techniques by facilitating access, decreasing cost, and increasing acceptability and effectiveness. The aim of this study is to compare traditional OST with in vivo spiders and a human therapist with a newly developed single-session gamified VR exposure therapy application with modern VR hardware, virtual spiders, and a virtual therapist. METHODS/DESIGN: Participants with specific phobia to spiders (N = 100) will be recruited from the general public, screened, and randomized to either VR exposure therapy (n = 50) or traditional OST (n = 50). A behavioral approach test using in vivo spiders will serve as the primary outcome measure. Secondary outcome measures will include spider phobia questionnaires and self-reported anxiety, depression, and quality of life. Outcomes will be assessed using a non-inferiority design at baseline and at 1, 12, and 52 weeks after treatment. DISCUSSION: VR exposure therapy has previously been evaluated as a treatment for specific phobias, but there has been a lack of high-quality randomized controlled trials. A new generation of modern, consumer-ready VR devices is being released that are advancing existing technology and have the potential to improve clinical availability and treatment effectiveness. The VR medium is also particularly suitable for taking advantage of recent phobia treatment research emphasizing engagement and new learning, as opposed to physiological habituation. This study compares a market-ready, gamified VR spider phobia exposure application, delivered using consumer VR hardware, with the current gold standard treatment. Implications are discussed. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02533310. Registered on 25 August 2015.
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VRET is more accessible, confidential, and resource-effective compared to traditional exposure in vivo.
“and is more accessible, confidential, and resource-effective compared to traditional exposure in vivo (Carl et al., 2019; Emmelkamp, 2005; Miloff et al., 2016; Reeves et al., 2022).”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Miloff et al., 2016
The Background says VR exposure therapy may improve access and reduce cost compared with traditional one-session exposure, and the Discussion describes better access and cost-effectiveness as potential benefits. The paper does not say VRET is more confidential, and it presents these benefits as possibilities rather than established comparative findings. (LLM, conf=0.88)
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Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765 · see citing works
CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials
the CONSORT Group, Schulz, K. F., Altman, D. G., & Moher, D. (2010) · BMC Medicine · doi:10.1186/1741-7015-8-18 · Cited by 13,371 · see citing works
From game design elements to gamefulness: defining "gamification"
Deterding, S., Dixon, D., Khaled, R., & Nacke, L. (2011) · Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments · doi:10.1145/2181037.2181040 · Cited by 8,402 · cited 1× · see citing works
“Serious games designed for purposes other than entertainment and allowing users to experience situations impossible or dangerous in real life [23], with gamified elements such as points and goals to increase engagement [24], may provide a particularly promising advancement in exposure therapy.”
BackgroundSPIRIT 2013 Statement: Defining Standard Protocol Items for Clinical Trials
Chan, A.-W., Tetzlaff, J. M., Altman, D. G., Laupacis, A., Gøtzsche, P. C., Krleža-Jerić, K., Hróbjartsson, A., Mann, H., Dickersin, K., Berlin, J. A., et al. (2013) · Annals of Internal Medicine · doi:10.7326/0003-4819-158-3-201302050-00583 · Cited by 7,363 · cited 1× · see citing works
“All design, implementation, and reporting will be carried out in accordance with CONSORT and SPIRIT guidelines [49–51].”
MethodThe PHQ-9: A New Depression Diagnostic and Severity Measure
Kroenke, K., & Spitzer, R. L. (2002) · Psychiatric Annals · doi:10.3928/0048-5713-20020901-06 · Cited by 5,898 · cited 3× · see citing works
“The Generalized Anxiety Disorder 7-item scale (GAD-7) [39] will be used to measure generic anxiety symptoms, and the Patient Health Questionnaire-9 (PHQ-9) [40] will be used to evaluate depression symptoms.”
MethodSimulator Sickness Questionnaire: An Enhanced Method for Quantifying Simulator Sickness
Kennedy, R. S., Lane, N. E., Berbaum, K. S., & Lilienthal, M. G. (1993) · The International Journal of Aviation Psychology · doi:10.1207/s15327108ijap0303_3 · Cited by 5,457 · cited 3× · see citing works
“Immediately following treatment, VR-treated participants will answer the Simulator Sickness Questionnaire (SSQ) [43], a measure of participant discomfort during treatment.”
BackgroundAn Empirical Evaluation of the System Usability Scale
Bangor, A., Kortum, P. T., & Miller, J. T. (2008) · International Journal of Human–Computer Interaction · doi:10.1080/10447310802205776 · Cited by 5,181 · cited 3× · see citing works
“At postmeasurement, VR-treated participants will further complete the iGroup Presence Questionnaire (IPQ) [44], a measure of the sense of actually being in the virtual environment, and the System Usability Scale (SUS) [45], which assesses product complexity and ease of use.”
MethodKessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. (2012) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1359 · Cited by 2,947 · see citing works
Piaggio, G., Elbourne, D. R., Pocock, S. J., Evans, S. J. W., Altman, D. G., & CONSORT Group, F. T. (2012) · JAMA · doi:10.1001/jama.2012.87802 · Cited by 2,428 · cited 1× · see citing works
“All design, implementation, and reporting will be carried out in accordance with CONSORT and SPIRIT guidelines [49–51].”
MethodMaximizing exposure therapy: An inhibitory learning approach
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.04.006 · Cited by 2,339 · cited 2× · see citing works
“Recent evidence indicates that treatment benefits of exposure therapy accrue as a result of new inhibitory learning and not habituation of the conditioned response to phobic stimuli [55].”
BackgroundThe Experience of Presence: Factor Analytic Insights
Schubert, T., Friedmann, F., & Regenbrecht, H. (2001) · Presence: Teleoperators and Virtual Environments · doi:10.1162/105474601300343603 · Cited by 2,303 · cited 3× · see citing works
“At postmeasurement, VR-treated participants will further complete the iGroup Presence Questionnaire (IPQ) [44], a measure of the sense of actually being in the virtual environment, and the System Usability Scale (SUS) [45], which assesses product complexity and ease of use.”
MethodPsychometric properties of the credibility/expectancy questionnaire
Devilly, G. J., & Borkovec, T. D. (2000) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/s0005-7916(00)00012-4 · Cited by 2,295 · cited 3× · see citing works
“At premeasurement, all participants complete the treatment Credibility/Expectancy Questionnaire (CEQ) [42] for both the traditional OST and VR treatments (in quasirandomized order).”
MethodOptimizing inhibitory learning during exposure therapy
Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.10.003 · Cited by 1,607 · cited 1× · see citing works
“, reduced heart rate and galvanic skin response) may serve as a safety signal alleviating fear in the short term but inhibiting long-term learning and extinction [56].”
BackgroundCONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials.
Schulz, K. F., Altman, D. G., & Moher, D. (2010) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.02.005 · Cited by 1,022 · see citing works
Susi, T., Johannesson, M. P., & Backlund, P. (2007) · University Library of Skövde (University of Skövde) · Cited by 942 · see citing works
Virtual reality exposure therapy for anxiety disorders: A meta-analysis
Powers, M. B., & Emmelkamp, P. M. G. (2008) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2007.04.006 · Cited by 904 · cited 1× · see citing works
“Previous generations of VR have already been used successfully in mental health treatments [17] for fear of flying, heights, public speaking, and spider phobia, among others [18].”
BackgroundPsychometric description of some specific-fear questionnaires
Klorman, R., Weerts, T. C., Hastings, J. E., Melamed, B. G., & Lang, P. J. (1974) · Behavior Therapy · doi:10.1016/s0005-7894(74)80008-0 · Cited by 763 · cited 2× · see citing works
“In addition to the BAT, subjects will complete two selfreport measures of fear toward spiders: the Spider Phobia Questionnaire (SPQ) [37] and the Fear of Spiders Questionnaire (FSQ) [38].”
MethodFear Extinction and Relapse: State of the Art
Vervliet, B., Craske, M. G., & Hermans, D. (2013) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050212-185542 · Cited by 671 · cited 1× · see citing works
“Return of fear of the feared stimuli following treatment can also occur at a later date [14].”
BackgroundA Meta-Analytic Review of Adult Cognitive-Behavioral Treatment Outcome Across the Anxiety Disorders
Norton, P. J., & Price, E. C. (2007) · Journal of Nervous & Mental Disease · doi:10.1097/01.nmd.0000253843.70149.9a · Cited by 612 · cited 1× · see citing works
“tematically and repeatedly presented with a feared or avoided internal or external cue is highly effective in reducing anxiety disorders [7, 8].”
BackgroundTreatment of specific phobia in adults
Choy, Y., Fyer, A. J., & Lipsitz, J. D. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2006.10.002 · Cited by 573 · cited 3× · see citing works
“Compared with imaginal exposure, evidence indicates that an in vivo (naturalistic setting) stimulus is the preferable exposure treatment method for specific phobia [6].”
BackgroundPsychological approaches in the treatment of specific phobias: A meta-analysis
Wolitzky-Taylor, K. B., Horowitz, J. D., Powers, M. B., & Telch, M. J. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2008.02.007 · Cited by 530 · cited 1× · see citing works
“7 %) [2].”
One-session treatment for specific phobias
Öst, L.-G. (1989) · Behaviour Research and Therapy · doi:10.1016/0005-7967(89)90113-7 · Cited by 498 · cited 1× · see citing works
“OST sessions typically last up to 3 h and consist of graduated exposure to phobic stimuli, positive reinforcement, therapist modeling of non-phobic behavior, and cognitive restructuring of catastrophic beliefs [11].”
BackgroundNewman, M. G., Szkodny, L. E., Llera, S. J., & Przeworski, A. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.09.008 · Cited by 480 · see citing works
Fear of spiders’ questionnaire
Szymanski, J., & O'Donohue, W. (1995) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/0005-7916(94)00072-t · Cited by 450 · cited 2× · see citing works
“In addition to the BAT, subjects will complete two selfreport measures of fear toward spiders: the Spider Phobia Questionnaire (SPQ) [37] and the Fear of Spiders Questionnaire (FSQ) [38].”
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× · see citing works
“The authors of a recent metaanalysis [54] provided additional evidence based on”
BackgroundGarcia-Palacios, A., Botella, C., Hoffman, H., & Fabregat, S. (2007) · CyberPsychology & Behavior · doi:10.1089/cpb.2007.9962 · Cited by 410 · cited 1× · see citing works
“has a negative impact on life, work, and leisure activities [6] but goes largely untreated [3].”
BackgroundConsensus statement on defining and measuring negative effects of internet interventions
Rozental, A., Andersson, G., Boettcher, J., Ebert, D. D., Cuijpers, P., Knaevelsrud, C., Ljótsson, B., Kaldo, V., Titov, N., & Carlbring, P. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.02.001 · Cited by 371 · cited 1× · see citing works
“[46].”
Self-citationSTINSON, F. S., DAWSON, D. A., PATRICIA CHOU, S., SMITH, S., GOLDSTEIN, R. B., JUNE RUAN, W., & GRANT, B. F. (2007) · Psychological Medicine · doi:10.1017/s0033291707000086 · Cited by 320 · cited 1× · see citing works
“Some phobias are far more common than others [4], with half of reported phobias being fear of either heights or animals [5].”
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× · see citing works
“VR exposure therapy has already been theoretically and empirically evaluated to be well-suited for the treatment of specific phobias [53].”
BackgroundVirtual reality in mental health: A review of the literature
Gregg, L., & Tarrier, N. (2007) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-007-0173-4 · Cited by 304 · see citing works
Handbook of computer game studies
Nagenborg, M. (2005) · The International Review of Information Ethics · doi:10.29173/irie176 · Cited by 292 · see citing works
The Cruelest Cure? Ethical Issues in the Implementation of Exposure-Based Treatments
Olatunji, B. O., Deacon, B. J., & Abramowitz, J. S. (2009) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2008.07.003 · Cited by 273 · cited 1× · see citing works
“[25], game elements may reduce distress as compared with traditional exposure therapy [26].”
BackgroundOne-session therapist-directed exposure vs. self-exposure in the treatment of spider phobia
Öst, L.-G., Salkovskis, P. M., & Hellström, K. (1991) · Behavior Therapy · doi:10.1016/s0005-7894(05)80374-0 · Cited by 220 · cited 9× · see citing works
“The BAT [35] will feature 13 steps (scored 0–12) corresponding to sequentially closer contact with the spider.”
BackgroundInfluentialRedefining therapeutic success with virtual reality exposure therapy
Garcia-Palacios, A., Hoffman, H. G., Kwong See, S., Tsai, A., & Botella, C. (2001) · CyberPsychology & Behavior · doi:10.1089/109493101300210231 · Cited by 212 · cited 1× · see citing works
“In a survey of 777 undergraduate students who scored high in fear of spiders, more than 80 % expressed a preference for VR exposure treatment over in vivo treatment [19].”
BackgroundThe Brunnsviken Brief Quality of Life Scale (BBQ): development and psychometric evaluation
Lindner, P., Frykheden, O., Forsström, D., Andersson, E., Ljótsson, B., Hedman, E., Andersson, G., & Carlbring, P. (2016) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2016.1143526 · Cited by 212 · cited 3× · see citing works
“The Brunnsviken Brief Quality of life scale (BBQ): Development and psychometric evaluation.”
MethodSelf-citationOugrin, D. (2011) · BMC Psychiatry · doi:10.1186/1471-244x-11-200 · Cited by 201 · cited 1× · see citing works
“tematically and repeatedly presented with a feared or avoided internal or external cue is highly effective in reducing anxiety disorders [7, 8].”
BackgroundTechnological innovations in clinical assessment and psychotherapy
Emmelkamp, P. M. G. (2005) · Psychotherapy and Psychosomatics · doi:10.1159/000087780 · Cited by 200 · cited 1× · see citing works
“Virtual reality (VR) technology involving head-mounted, motion-tracked displays, accompanied by realistically rendered 3D computer-animated environments [15], offers researchers the opportunity to recreate phobic stimuli, manipulate and tailor key variables associated with stimulus presentation (color, size, and movem…”
BackgroundHesser, H. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.02.003 · Cited by 192 · cited 1× · see citing works
“Data will be analyzed on an intention-to-treat basis, using mixed effects models [48].”
MethodOne-Session Treatment of Specific Phobias: A Detailed Description and Review of Treatment Efficacy
Zlomke, K. R., & Davis, T. E. (2008) · Behavior Therapy · doi:10.1016/j.beth.2007.07.003 · Cited by 178 · cited 1× · see citing works
“One-session therapy (OST) is considered the intervention of choice for in vivo specific phobia treatment in adults and children [9, 10].”
BackgroundHoffman, H. G., Meyer, W. J., Ramirez, M., Roberts, L., Seibel, E. J., Atzori, B., Sharar, S. R., & Patterson, D. R. (2014) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2014.0058 · Cited by 175 · cited 1× · see citing works
“A new generation of VR systems produced by some of the world’s largest technology companies, such as Sony (Project Morpheus), Microsoft (Hololens), HTC (Vive), and Facebook (Oculus Rift), promises to change VR from a professional niche product costing as much as $35,000 to a consumer product priced around $599 plus th…”
BackgroundMental Reinstatement of Context and Return of Fear in Spider-Fearful Participants
Mystkowski, J. L., Craske, M. G., Echiverri, A. M., & Labus, J. S. (2006) · Behavior Therapy · doi:10.1016/j.beth.2005.04.001 · Cited by 154 · see citing works
Treatment context and return of fear in spider phobia
Mystkowski, J. L., Craske, M. G., & Echiverri, A. M. (2002) · Behavior Therapy · doi:10.1016/s0005-7894(02)80035-1 · Cited by 153 · cited 1× · see citing works
“to inexpensively and relatively easily alter the context of exposure, an important moderator of treatment resurgence [20].”
BackgroundBotella, C., Bretón-López, J., Quero, S., Baños, R., García-Palacios, A., Zaragozá, I., & Alcañíz, M. (2011) · Computers in Human Behavior · doi:10.1016/j.chb.2010.07.043 · Cited by 152 · cited 2× · see citing works
“Recommendations that patients continue to confront phobic stimuli posttreatment [12] may be facilitated by gamified VR content that can be played again and again [25].”
BackgroundManipulations of exposure-based therapy to reduce return of fear: a replication
Lang, A. J., & Craske, M. G. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00031-5 · Cited by 149 · see citing works
Pretreatment attrition and dropout in an outpatient clinic for anxiety disorders
Issakidis, C., & Andrews, G. (2004) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0047.2004.00264.x · Cited by 149 · cited 1× · see citing works
“Once explained, exposure therapy is turned down by 30 % of subjects [13], and this percentage is estimated to be significantly higher for OST if the endpoint is discussed beforehand [12].”
BackgroundVansteenwegen, D., Vervliet, B., Iberico, C., Baeyens, F., Van den Bergh, O., & Hermans, D. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.08.023 · Cited by 148 · cited 1× · see citing works
“ronments [21], and participants treated by exposure to spiders using video recordings of multiple areas of a house rather than a single area [22], were less likely to have return of fear following an aversive event.”
BackgroundHellström, K., & Öst, L.-G. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(95)00028-v · Cited by 137 · see citing works
McCann, 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 · cited 1× · see citing works
“The potential of VR notwithstanding, the quality of past VR exposure therapy research has historically been poor [27].”
BackgroundAndersson, G., Waara, J., Jonsson, U., Malmaeus, F., Carlbring, P., & Öst, L. (2009) · Cognitive Behaviour Therapy · doi:10.1080/16506070902931326 · Cited by 101 · cited 2× · see citing works
“A pretreatment score of 9 or less [36] will be required for study inclusion.”
BackgroundMethodSelf-citationOllendick, T. H., & Davis, T. E. (2013) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2013.773062 · Cited by 97 · cited 1× · see citing works
“One-session therapy (OST) is considered the intervention of choice for in vivo specific phobia treatment in adults and children [9, 10].”
BackgroundVirtual reality Stroop task for assessment of supervisory attentional processing
Parsons, T. D., Courtney, C. G., & Dawson, M. E. (2013) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2013.824556 · Cited by 97 · cited 1× · see citing works
“lack of high-quality randomized controlled trials [52], suggest that this is an opportune time to make use of”
BackgroundExtinction in multiple virtual reality contexts diminishes fear reinstatement in humans
Dunsmoor, J. E., Ahs, F., Zielinski, D. J., & LaBar, K. S. (2014) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2014.02.010 · Cited by 93 · cited 1× · see citing works
“ronments [21], and participants treated by exposure to spiders using video recordings of multiple areas of a house rather than a single area [22], were less likely to have return of fear following an aversive event.”
BackgroundViability of virtual reality exposure therapy as a treatment alternative
Bush, J. (2007) · Computers in Human Behavior · doi:10.1016/j.chb.2007.03.006 · Cited by 93 · cited 2× · see citing works
“VR exposure therapy may provide improvements in efficacy [15], access, standardization of protocols, and cost-effectiveness [31].”
BackgroundIntensive one-session treatment of specific phobias
Davis, T. E., Ollendick, T., & Öst, L.-G. (2012) · Autism and child psychopathology series · doi:10.1007/978-1-4614-3253-1 · Cited by 79 · see citing works
Using humor in systematic desensitization to reduce fear.
Ventis, W. L., Higbee, G., & Murdock, S. A. (2001) · The Journal of General Psychology · doi:10.1080/00221300109598911 · Cited by 76 · cited 1× · see citing works
“Humor can be used to put the patient’s reactions into perspective and reduce the patient’s anxiety [47].”
BackgroundLindner, P., Nyström, M. B. T., Hassmén, P., Andersson, G., & Carlbring, P. (2015) · Internet Interventions · doi:10.1016/j.invent.2015.04.002 · Cited by 51 · cited 1× · see citing works
“To recruit a diverse sample, multiple recruitment methods will be used, primarily postings in online forums and through coverage in national television, newspapers, and magazines [32].”
MethodSelf-citationSPIRIT 2013 statement: Defining standard protocol items for clinical trials
Chan, A., Tetzlaff, J., Altman, D. G., Laupacis, A., Gotzsche, P. C., Krleža-Jerić, K., Hróbjartsson, A., Mann, H., Dickersin, K., Berlin, J. A., et al. (2017) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 48 · see citing works
Prevalence of self-reported specific phobia symptoms in an Israeli sample of young conscripts
Iancu, I., Levin, J. B., Dannon, P. N., Poreh, A., Yehuda, Y. B., & Kotler, M. (2006) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2006.11.001 · Cited by 17 · cited 1× · see citing works
“Some phobias are far more common than others [4], with half of reported phobias being fear of either heights or animals [5].”
Background(2015) · NOVA (University of Newcastle Australia)
Flagged first, then by citations
Research works printed but not linked: 1
- [33]First MB Spitzer RL Gibbon M Williams JBW Structured Clinical Interview for DSM-IV-TR, Axis I Disorders, Research Version, Patient Edition (SCID-I/P) 2002 New York Biometrics Research, New York State Psychiatric Institute
Cited by
Sorted by citations
Carl, E., Stein, A. T., Levihn-Coon, A., Pogue, J. R., Rothbaum, B., Emmelkamp, P., Asmundson, G. J. G., Carlbring, P., & Powers, M. B. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.08.003 · Cited by 889 · see citing works
Self-citationRecent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review
Botella, C., Fernández-Álvarez, J., Guillén, V., García-Palacios, A., & Baños, R. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0788-4 · Cited by 460 · see citing works
Fodor, L. A., Coteț, C. D., Cuijpers, P., Szamoskozi, Ș., David, D., & Cristea, I. A. (2018) · Scientific Reports · doi:10.1038/s41598-018-28113-6 · Cited by 284 · see citing works
Applying Modern Virtual and Augmented Reality Technologies to Medical Images and Models
Sutherland, J., Bélec, J., Sheikh, A. M., Chepelev, L. L., Althobaity, W., Chow, B. J. W., Mitsouras, D., Christensen, A. M., Rybicki, F. J., & Russa, D. J. L. (2018) · Journal of Imaging Informatics in Medicine · doi:10.1007/s10278-018-0122-7 · Cited by 298 · see citing works
Wechsler, T. F., Kümpers, F., & Mühlberger, A. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01758 · Cited by 282 · see citing works
Virtual reality exposure therapy for posttraumatic stress disorder (PTSD): a meta-analysis
Kothgassner, O. D., Goreis, A., Kafka, J. X., Van Eickels, R. L., Plener, P. L., & Felnhofer, A. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1654782 · Cited by 246 · see citing works
“It carries the advantages of increased control over stimuli, the possibility to repeat exposure infinitely, and the unique option to simulate environments that challenge the boundaries of everyday surroundings (Difede et al., 2007; Gamito et al., 2010; Miloff et al., 2016).”
BackgroundLindner, P., Miloff, A., Hamilton, W., Reuterskiöld, L., Andersson, G., Powers, M. B., & Carlbring, P. (2017) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2017.1280843 · Cited by 187 · see citing works
“…self-help VRET application (designated VIMSE) for spider phobia we recently developed for the Samsung Gear VR platform which is being used in an ongoing randomized controlled non-inferiority trial comparing this VRET to traditional, in vivo one-session exposure therapy (Miloff et al., 2016).”
MethodSelf-citationLindner, P., Miloff, A., Fagernäs, S., Andersen, J., Sigeman, M., Andersson, G., Furmark, T., & Carlbring, P. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.07.003 · Cited by 175 · see citing works
Self-citationMiloff, A., Lindner, P., Dafgård, P., Deak, S., Garke, M., Hamilton, W., Heinsoo, J., Kristoffersson, G., Rafi, J., Sindemark, K., et al. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.04.004 · Cited by 155 · see citing works
Self-citationBetter, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy
Lindner, P. (2021) · International Journal of Cognitive Therapy · doi:10.1007/s41811-020-00090-7 · Cited by 120 · see citing works
Self-citationLindner, P., Miloff, A., Zetterlund, E., Reuterskiöld, L., Andersson, G., & Carlbring, P. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00176 · Cited by 118 · see citing works
Self-citationThe Past, Present, and Future of Virtual Reality in Pharmacy Education
Coyne, L., Merritt, T. A., Parmentier, B. L., Sharpton, R. A., & Takemoto, J. K. (2019) · American Journal of Pharmaceutical Education · doi:10.5688/ajpe7456 · Cited by 113 · see citing works
Stigma-Stop: A Serious Game against the Stigma toward Mental Health in Educational Settings
Cangas, A. J., Gómez, N. N., Aguilar-Parra, J. M., Ojeda-Castelo, J. J., Cangas, D., Piedra-Fernandez, J. A., & Gallego, J. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.01385 · Cited by 103 · see citing works
“For example, virtual reality has been utilized in the treatment of various phobias such as acrophobia (Levy et al., 2016), social anxiety disorder (Gebara et al., 2016), agoraphobia (Quero et al., 2014), and arachnophobia (Miloff et al., 2016).”
MethodA Bibliometric Analysis of Gamification Research
Trinidad, M., Ruiz, M., & Calderón, A. (2021) · IEEE Access · doi:10.1109/access.2021.3063986 · Cited by 118 · see citing works
Reeves, R., Elliott, A., Curran, D., Dyer, K., & Hanna, D. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102451 · Cited by 82 · see citing works
New Technologies for the Understanding, Assessment, and Intervention of Emotion Regulation
Colombo, D., Fernández-Álvarez, J., García Palacios, A., Cipresso, P., Botella, C., & Riva, G. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.01261 · Cited by 75 · see citing works
“Other examples are VR-based intrapersonal biofeedback (Gaggioli et al., 2014), a mobile biofeedback with serious games (Dillon et al., 2016), gamified virtual reality (Miloff et al., 2016), or fMRI neurofeedback in virtual environments (Lorenzetti et al., 2018).”
BackgroundLindner, P., Rozental, A., Jurell, A., Reuterskiöld, L., Andersson, G., Hamilton, W., Miloff, A., & Carlbring, P. (2020) · JMIR Serious Games · doi:10.2196/17807 · Cited by 71 · see citing works
“Participants recruited for the interview study had completed the screening battery for the parallel clinical trial [19,25] but were not among the first 100 participants to be scheduled for and complete the on-site pretreatment assessment.”
MethodSelf-citationReeves, R., Curran, D., Gleeson, A., & Hanna, D. (2022) · Behavior Modification · doi:10.1177/0145445521991102 · Cited by 69 · see citing works
“It is less time consuming and cumbersome (Emmelkamp, 2005), has lower treatment costs (Miloff et al., 2016) and facilitates easy access to stimuli which can be controlled by the therapist (Hartanto et al., 2014).”
BackgroundInfluentialLindner, P., Miloff, A., Bergman, C., Andersson, G., Hamilton, W., & Carlbring, P. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00116 · Cited by 66 · see citing works
Self-citationHalkiopoulos, C., & Gkintoni, E. (2025) · Electronics · doi:10.3390/electronics14061110 · Cited by 60 · see citing works
Kritikos, I., Alevizopoulos, G. A., & Koutsouris, D. (2021) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2021.596980 · Cited by 58 · see citing works
“These parameters and their functions were created following the guideless from several publications that have studied VR simulation for Spider Phobias (Shiban et al., 2013, 2015a,b, 2016; Miloff et al., 2016, 2019; Lindner et al., 2017; Juvrud et al., 2018; Tardif et al., 2019).”
MethodEffectiveness 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 · see citing works
Lindner, P., Miloff, A., Hamilton, W., & Carlbring, P. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00132 · Cited by 47 · see citing works
Self-citationNeurophilosophical and Ethical Aspects of Virtual Reality Therapy in Neurology and Psychiatry
Kellmeyer, P. (2018) · Cambridge Quarterly of Healthcare Ethics · doi:10.1017/s0963180118000129 · Cited by 46 · see citing works
Vogt, L., Klasen, M., Rossaint, R., Goeretz, U., Ebus, P., & Sopka, S. (2021) · Journal of Medical Internet Research · doi:10.2196/28018 · Cited by 45 · see citing works
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 46 · see citing works
“VR-EBT has been used to treat a diverse range of specific phobias such as fear of spiders (Miloff et al., 2016), height (Emmelkamp et al., 2002; Rothbaum et al., 1995), driving (Wiederhold & Bouchard, 2014), and flying (Rothbaum et al., 2006; Wiederhold & Wiederhold, 2003).”
BackgroundMethodSelf-citationVirtual Reality in the Neurosciences: Current Practice and Future Directions
Scott, H. W., Griffin, C., Coggins, W. S., Elberson, B., Abdeldayem, M., Virmani, T., Larson‐Prior, L. J., & Petersen, E. (2022) · Frontiers in Surgery · doi:10.3389/fsurg.2021.807195 · Cited by 43 · see citing works
Understanding the Effects of Gamification and Juiciness on Players
Hicks, K., Gerling, K., Richardson, G., Pike, T., Burman, O. H. P., & Dickinson, P. (2019) · IEEE Conference on Games (CoG) · doi:10.1109/cig.2019.8848105 · Cited by 41 · see citing works
“Relevant work studying how gamification can be leveraged to increase engagement with VR simulations strongly focuses on healthcare settings; for example, to treat arachnophobia [27], and to train users in the use of hearing aids [29].”
BackgroundVianez, A., Marques, A. J., & de Almeida, R. S. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010464 · Cited by 47 · see citing works
“It carries the advantages of increased control over stimuli, the possibility to repeat exposure infinitely, and the unique option to simulate environments that challenge patients according to their specific needs [30].”
BackgroundExtended reality for biomedicine
Yuan, J., Hassan, S. S., Wu, J., Koger, C. R., Packard, R. R. S., Shi, F., Fei, B., & Ding, Y. (2023) · Nature Reviews Methods Primers · doi:10.1038/s43586-023-00198-y · Cited by 40 · see citing works
Effects of Manipulating Physiological Feedback in Immersive Virtual Environments
Dey, A., Chen, H., Billinghurst, M., & Lindeman, R. W. (2018) · Annual Symposium on Computer-Human Interaction in Play · doi:10.1145/3242671.3242676 · Cited by 36 · see citing works
“used to treat various phobias [34, 23] and disorders [28].”
Tuerk, P. W., Schaeffer, C. M., Mcguire, J. F., Larsen, M. A., Capobianco, N. B., & Piacentini, J. C. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-1092-2 · Cited by 34 · see citing works
Zeng, W., Xu, J., Yu, J., & Chu, X. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1553290 · Cited by 40 · see citing works
Immersive 3D exposure-based treatment for spider fear: A randomized controlled trial
Minns, S. A., Levihn‐Coon, A., Carl, E., Smits, J. A. J., Miller, W., Howard, D., Papini, S., Quiroz, S., Lee-Furman, E., Telch, M. J., et al. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.12.003 · Cited by 34 · see citing works
Self-citationFelnhofer, A., Pfannerstill, F., Gänsler, L., Kothgassner, O. D., Humer, E., Büttner, J., & Probst, T. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1549090 · Cited by 35 · see citing works
Virtual Reality for Anxiety Disorders: Rethinking a Field in Expansion
Fernández‐Álvarez, J., Lernia, D. D., & Riva, G. (2020) · Advances in experimental medicine and biology · doi:10.1007/978-981-32-9705-0_21 · Cited by 33 · see citing works
Immersive 3D exposure-based treatment for spider fear: a randomized controlled trial
Minns, S., Levihn-Coon, A., Carl, E., Smits, J. A. J., Miller, W., Howard, D., Papini, S., Quiroz, S., Lee-Furman, E., Telch, M., et al. (2018) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.05.006 · Cited by 31 · see citing works
Physical Versus Virtual Reality–Based Calm Rooms for Psychiatric Inpatients: Quasi-Randomized Trial
Ilioudi, M., Lindner, P., Ali, L., Wallström, S., Thunström, A. O., Ioannou, M., Anving, N., Johansson, V., Hamilton, W., Falk, Ö., et al. (2023) · Journal of Medical Internet Research · doi:10.2196/42365 · Cited by 29 · see citing works
“Studies have shown the potential for VR to treat mental conditions including social anxiety disorder [15,16], posttraumatic stress disorder [17], generalized anxiety disorder [18], and phobias [19,20].”
Self-citationJeon, S., Han, J., Jo, Y., & Han, K. (2019) · ACM Symposium on Virtual Reality Software and Technology (VRST) · doi:10.1145/3359996.3364268 · Cited by 30 · see citing works
“This survey has been extensively used in many VR studies (e.g., therapy treatment [Miloff et al. 2016], museum [George et al. 2018], safety training [Buttussi and Chittaro 2017], and social behaviors [Felnhofer et al. 2018]) to measure the presence of users in a VR environment.”
MethodGorinelli, S., Gallego, A., Lappalainen, P., & Lappalainen, R. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.05.004 · Cited by 28 · see citing works
Lindner, P., Miloff, A., Reuterskiöld, L., Andersson, G., & Carlbring, P. (2019) · Scandinavian Journal of Psychology · doi:10.1111/sjop.12508 · Cited by 29 · see citing works
Self-citationSeuling, P. D., Czernin, N. S., & Schiele, M. A. (2024) · Neuroscience Applied · doi:10.1016/j.nsa.2024.104074 · Cited by 28 · see citing works
“This significantly reduces the resource investment needed for exposure-based treatments, including time and finances (Hartanto et al., 2014; Carl et al., 2019; Emmelkamp, 2005; Miloff et al., 2016; Reeves et al., 2022; Boeldt et al., 2019; Robillard et al., 2011).”
Saab, M. M., Landers, M. G., Cooke, E., Murphy, D., & Hegarty, J. M. (2018) · Virtual Reality · doi:10.1007/s10055-018-0368-x · Cited by 28 · see citing works
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
“In some VRET simulations basic interaction is provided: user input could be strictly gazederived [31], while motion feedback is provided via standard interfaces (i.”
BackgroundMertens, G., Wagensveld, P., & Engelhard, I. M. (2018) · Computers in Human Behavior · doi:10.1016/j.chb.2018.10.006 · Cited by 23 · see citing works
Internet-Based Cognitive Behavior Therapy
Andersson, G., Carlbring, P., & Hadjistavropoulos, H. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-803457-6.00021-0 · Cited by 24 · see citing works
Self-citationIlioudi, M., Wallström, S., Steingrímsson, S., Lindner, P., Thunström, A. O., & Ali, L. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-076285 · Cited by 21 · see citing works
“12 25 29 A previous study has suggested that VR nature relaxation immediately reduced negative affective states and psychological stress in patients with psychiatric disorders.”
BackgroundSelf-citationMazzolenis, M. V., Mourra, G. N., Moreau, S., Mazzolenis, M. E., Cerda, I. H., Vega, J., Khan, J. S., & Thérond, A. (2024) · Current Pain and Headache Reports · doi:10.1007/s11916-024-01270-2 · Cited by 23 · see citing works
Cloud Based Virtual Reality Exposure Therapy Service for Public Speaking Anxiety
Šalkevičius, J., Miškinytė, A., & Navickas, L. (2019) · Information · doi:10.3390/info10020062 · Cited by 21 · see citing works
“During OST, the patient is gradually exposed to the stimuli for up to 3 h, which can use up significant financial resources—while a VR system can help to reuse the same 3D environment for multiple patients [15].”
BackgroundLopez-Montoyo, A., Quero, S., Montero-Marin, J., Barcelo-Soler, A., Beltran, M., Campos, D., & Garcia-Campayo, J. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2298-x · Cited by 19 · see citing works
Wong, S. F., Aardema, F., Mendel, B., Trespalacios, F., & Radomsky, A. S. (2020) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2020.100585 · Cited by 19 · see citing works
Li, Y., Peng, J., Yang, P., Weng, J., Lu, Y., Liu, J., Xu, S., Guan, L., Huang, D., Wang, Q., et al. (2024) · General Psychiatry · doi:10.1136/gpsych-2023-101434 · Cited by 19 · see citing works
“More study is needed to increase the evidence regarding the effectiveness of this technology and its long-term effect on the mental health of patients with serious illness conditions.”
The Persuasive Roles of Digital Games: The Case of Cancer Games
Conde-Pumpido, T. D. L. H. (2018) · Media and Communication · doi:10.17645/mac.v6i2.1336 · Cited by 17 · see citing works
“Digital games are being used with excellent results to, among other things, overcome phobias (Miloff et al., 2016), support rehabili- tation therapies (Reid, 2002) and carry out neuropsychology therapies (Hardy, Bonner, & Willard, 2010).”
BackgroundMethods and Tools for Using BCI with Augmented and Virtual Reality
Putze, F. (2019) · Springer eBooks · doi:10.1007/978-3-030-14323-7_16 · Cited by 16 · see citing works
Review of Benefit Using Gamification Element for Countryside Tourism
Prakasa, F. B. P., & Emanuel, A. W. R. (2019) · International Conference of Artificial Intelligence and Information Technology (ICAIIT) · doi:10.1109/icaiit.2019.8834467 · Cited by 16 · see citing works
Premkumar, P., Heym, N., Myers, J. A. C., Formby, P., Battersby, S., Sumich, A. L., & Brown, D. J. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1467141 · Cited by 15 · see citing works
Electrophysiological correlates of in vivo and virtual reality exposure therapy in spider phobia
Wiens, S., Eklund, R., Szychowska, M., Miloff, A., Cosme, D., Pierzchajlo, S., & Carlbring, P. (2022) · Psychophysiology · doi:10.1111/psyp.14117 · Cited by 15 · see citing works
“The other treatment was a gamified virtual reality exposure therapy (VRET; Miloff et al., 2016) composed of multiple levels of increasingly realistic spiders, game- playing elements such as points and puzzles, and a virtual embodied therapist (Miloff et al., 2020) to help guide the patient,…”
BackgroundMethodSelf-citationLindner, P., Dafgård, P., Miloff, A., Andersson, G., Reuterskiöld, L., Hamilton, W., & Carlbring, P. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.645273 · Cited by 14 · see citing works
Self-citationOxley, J. A., Santa, K., Meyer, G. F., & Westgarth, C. (2022) · Frontiers in Virtual Reality · doi:10.3389/frvir.2022.782023 · Cited by 16 · see citing works
“For example, the use of VR and/or AR for animal phobias, in the form of exposure therapy, is well established and includes a range of species such as spiders (Miloff et al., 2016; Tardif et al., 2019), cockroaches (Botella et al.”
BackgroundYalcin, M., Halbig, A., Fischbach, M., & Latoschik, M. E. (2024) · Frontiers in Virtual Reality · doi:10.3389/frvir.2024.1364207 · Cited by 13 · see citing works
Gamifikasi sebagai Metode untuk Mendapatkan Customer Loyalty: Review Literatur
Perkasa, F. B. P., & Emanuel, A. W. R. (2020) · AITI · doi:10.24246/aiti.v17i1.11-21 · Cited by 13 · see citing works
“Referensi Penerapan Konteks Permasalahan [32] Virtual Reality Medis [33] Augmented Reality Pariwisata”
BackgroundShirtcliff, E. A., Finseth, T., Winer, E. H., Glahn, D. C., Conrady, R. A., & Drury, S. S. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-03129-x · Cited by 14 · see citing works
Mixed Reality in Undergraduate Mental Health Education: A Systematic Review
Rincón, E., Rodríguez-Guidonet, I., Andrade-Pino, P., & Monfort-Vinuesa, C. (2023) · Electronics · doi:10.3390/electronics12041019 · Cited by 12 · see citing works
Using Serious Games for Antismoking Health Campaigns: Experimental Study
Kim, J., Song, H., Merrill, K., Jung, Y., & Kwon, J.-H. (2020) · JMIR Serious Games · doi:10.2196/18528 · Cited by 13 · see citing works
“The exposure therapy strategy provides repeated cues that trigger anxiety, often employed to diminish the anxiety or urge as a treatment for anxiety disorders such as acrophobia and arachnophobia [37-40].”
Technology: Bridging the Gap from Research to Practice
Powers, M. B., & Carlbring, P. (2016) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2016.1143201 · Cited by 12 · see citing works
“A first step in that direction is the ongoing randomized controlled non-inferiority trial where a single-session gamified virtual reality exposure therapy for spider phobia is compared to traditional exposure therapy (Miloff et al., 2016).”
BackgroundSelf-citationVisual Complexity and Scene Recognition: How Low Can You Go?
Handali, J. P., Schneider, J., Gau, M., Holzwarth, V., & Brocke, J. V. (2021) · IEEE Conference on Virtual Reality and 3D User Interfaces (VR) · doi:10.1109/vr50410.2021.00051 · Cited by 11 · see citing works
“Unlike VEs for VR applications such as scientific visualization [26], data visualization [2], therapy [39], VEs for urban planning applications require a strong adherence to the modelled real-world location.”
BackgroundMartins, S., & Vairinhos, M. (2023) · Virtual Worlds · doi:10.3390/virtualworlds2040018 · Cited by 6 · see citing works
Extended reality for biomedicine
Yuan, J., Hassan, S. S., Wu, J., Koger, C. R., Packard, R. R. S., Shi, F., Fei, B., & Ding, Y. (2023) · Nature Reviews Methods Primers · doi:10.1038/s43586-023-00208-z · Cited by 11 · see citing works
Wechsler, T. F., Kocur, M., Schumacher, S., Rubenbauer, M., Ruider, A., Brockelmann, M., Lankes, M., Wolff, C. G., & Mühlberger, A. (2023) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045231194103 · Cited by 10 · see citing works
“There are already approaches integrating playful elements into VRET for adults with spider phobia (Go et al., 2020; Lindner et al., 2020; McMaster, 2020; Miloff et al., 2016).”
BackgroundKhaleghi, A., Narimani, A., Aghaei, Z., Banaraki, A. K., & Hassani‐Abharian, P. (2024) · JMIR Serious Games · doi:10.2196/34535 · Cited by 13 · see citing works
“The quality of fear elements’behaviors: studying the behavior quality of a stimulus is under investigation [31,32].”
BackgroundInnovations in CBT treatment for hoarding: Transcending office walls
Muroff, J. R., & Otte, S. (2019) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2019.100471 · Cited by 10 · see citing works
Ribé-Viñes, J. M., Gutiérrez‐Maldonado, J., Zabolipour, Z., & Ferrer‐García, M. (2023) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2023.101915 · Cited by 12 · see citing works
Go, C. T. T. H., Leis, E. G., Quiambao, M. J. D., Samonte, M. J. C., Fuentes, G. S., & Pascua, C. A. (2020) · International Conference on Frontiers of Educational Technologies (ICFET) · doi:10.1145/3404709.3404742 · Cited by 10 · see citing works
“Phobic people are gradually exposed to their fears at a distance and going closer as they progress [8][9].”
BackgroundMethodBanakou, D., Johnston, T., Beacco, A., Şenel, G., & Slater, M. (2024) · JMIR Formative Research · doi:10.2196/52212 · Cited by 12 · see citing works
“The paradigm was similar to an earlier one for treatment of spider phobia, which had similar positive results [50].”
ResultThe Disappearing Computer Science in Healthcare VR applications
Lundström, A., & Fernaeus, Y. (2019) · Halfway to the Future Symposium · doi:10.1145/3363384.3363398 · Cited by 9 · see citing works
Wechsler, T. F., Brockelmann, M., Kulik, K., Kopf, F. M., Kocur, M., Lankes, M., Mühlberger, A., & Wolff, C. G. (2021) · Annual Symposium on Computer-Human Interaction in Play · doi:10.1145/3450337.3483463 · Cited by 9 · see citing works
“Another approach transferred exposure therapy elements for spider phobia into a gamified VR application, asking users to focus on a moving spider to gain points, to keep a moving spider save by stopping objects from hitting it, or to keep focusing on an approaching spider which otherwise turns away [13, 16].”
BackgroundRealism in Audiovisual Stimuli for Phobias Treatments Through Virtual Environments
Ortiz, J. S., Velasco, P. M., Quevedo, W. X., Álvarez, M., Sánchez, J. S., Carvajal, C. P., Cepeda, L. F., & Andaluz, V. H. (2017) · Lecture notes in computer science · doi:10.1007/978-3-319-60928-7_16 · Cited by 8 · see citing works
Ørskov, P. T., Runge, E., Holmberg, T. T., Ernst, M. T., Clemmensen, L., Dalsgaard, C., Lichtenstein, M. B., & Bouchard, S. (2025) · Frontiers in Virtual Reality · doi:10.3389/frvir.2025.1588181 · Cited by 7 · see citing works
Freize, V. V., Malyshko, L. V., Grachev, G. I., Борисович, Д. В., Semenova, N. V., & Незнанов, Н. Г. (2021) · V M BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY · doi:10.31363/2313-7053-2021-1-18-24 · Cited by 7 · see citing works
Babatunde, Y. O., Adegbite, M. A., Oladipo, H. J., Omojuyigbe, J. O., Sampson‐Oladipupo, E., Ibrahim, A. A., Oziama, B., Adedeji, O. J., & Ibrahim, A. (2023) · Pharmacy Education · doi:10.46542/pe.2023.231.717 · Cited by 7 · see citing works
Meaningful Spaces, Meaningful Places: Co-creating VR Experiences with People Living with Dementia
Cheung, E. T. H., Ppali, S., Xygkou, A., Covaci, A., Jawharieh, H., Thomas, C. L., & Ang, C. S. (2023) · Designing Interactive Systems Conference · doi:10.1145/3563703.3596624 · Cited by 6 · see citing works
Co-watching 360-Films in Nursing Homes
Lundström, A., Ghebremikael, S., & Fernaeus, Y. (2021) · Lecture notes in computer science · doi:10.1007/978-3-030-85623-6_30 · Cited by 6 · see citing works
Naeem, F., Munshi, T. A., Gratzer, D., Rodie, D. J., Irfan, M., Rao, S., Husain, N., Farooq, S., Sanches, M., Ayub, M., et al. (2019) · BJPsych Open · doi:10.1192/bjo.2019.59 · Cited by 6 · see citing works
Detecting Public Speaking Stress via Real-Time Voice Analysis in Virtual Reality: A Review
Arushi, Dillon, R., Teoh, A. N., & Dillon, D. (2023) · Springer eBooks · doi:10.1007/978-981-99-2909-2_7 · Cited by 5 · see citing works
A Comparative Study Between Different Treatments for Spider Phobia
Ramírez-Fernández, C., Morán, A. L., & Meza-Kubo, V. (2021) · Mexican Conference on Human-Computer Interaction (MexIHC) · doi:10.1145/3492724.3492726 · Cited by 6 · see citing works
“Finally, in condition C4 (IVET), the participant observed an actual spider and interacted with it by touching it directly with his/her hand/fingers.”
BackgroundInfluentialŠalkevičius, J., & Navickas, L. (2018) · International Conference on Future Internet of Things and Cloud Workshops (FiCloudW) · doi:10.1109/w-ficloud.2018.00040 · Cited by 5 · see citing works
“Miloff et al. describes a methodology how VRET can reduce cost of traditional one-session exposure therapy (OST) [12].”
BackgroundInfluentialRamírez-Fernández, C., Morán, A. L., & Meza-Kubo, V. (2018) · International Conference on Ubiquitous Computing and Ambient Intelligence · doi:10.3390/proceedings2191252 · Cited by 5 · see citing works
“With respect to their effectiveness, there are several studies that have shown that both VRET and ARET are equally effective as IVET for the treatment of specific phobias [9–13].”
BackgroundInfluentialOGrES Welcome! Toward a Systematic Theory for Serious Game Design
Blackburn, N. N., & Cardona-Rivera, R. E. (2021) · Annual Symposium on Computer-Human Interaction in Play · doi:10.1145/3450337.3483460 · Cited by 4 · see citing works
“analyses broadly converge on the same findings [9, 12, 16, 28].”
BackgroundAcrophobia and consumer-based automated virtual reality cognitive behavior therapy
Donker, T., & Heinrichs, M. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-85726-0.00035-1 · Cited by 4 · see citing works
VR Mobile Acrophobia Treatment
Alkurdi, A. H. (2017) · Academic Journal of Nawroz University · doi:10.25007/ajnu.v6n3a95 · Cited by 4 · see citing works
The future of virtual reality therapy for phobias: Beyond simple exposures
Miloff, A., Lindner, P., & Carlbring, P. (2020) · Clinical Psychology in Europe · doi:10.32872/cpe.v2i2.2913 · Cited by 4 · see citing works
“In the last few years our research team at Stockholm University have used the device to treat nearly 100 spider phobic patients with virtual reality exposure therapy (VRET) using the Itsy application, developed alongside VR-startup Mimerse (Miloff et al., 2016).”
MethodSelf-citationLewis-Fung, S. E., Tchao, D., Gray, H. G., Nguyen, E., Pardini, S., Harris, L. R., Calabia, D., & Appel, L. (2023) · Frontiers in Virtual Reality · doi:10.3389/frvir.2023.1209535 · Cited by 3 · see citing works
Extended Reality and Phobia Treatments: A Systematic Literature Review
Ferreira, T., Batista, T., Lopes, T., Malheiro, P., Vitorino, J., Vaz, R., & de Sousa, J. (2025) · Procedia Computer Science · doi:10.1016/j.procs.2025.02.213 · Cited by 3 · see citing works
Extended Reality in Patient Care and Pharmacy Practice: A Viewpoint
Takemoto, J. K., Parmentier, B. L., Bratelli, R., & Merritt, T. A. (2020) · Journal of Contemporary Pharmacy Practice · doi:10.37901/jcphp18-00030 · Cited by 3 · see citing works
“VR experiences can be customized to individual phobias and can even be gamified to improve engagement.(31) A meta-analysis conducted by Morina et al.”
BackgroundConquer Catharsis – A VR Environment for Anxiety Treatment of Children and Adolescents
Lenz, A., Hlavacs, H., Kothgassner, O. D., & Felnhofer, A. (2020) · Lecture notes in computer science · doi:10.1007/978-3-030-65736-9_14 · Cited by 3 · see citing works
Smart Devices als Assistive Technologien
Lorenz, T., Pleger, M., & Schiering, I. (2022) · Gesundheit. Politik - Gesellschaft - Wirtschaft · doi:10.1007/978-3-658-34027-8_2 · Cited by 3 · see citing works
Yamauchi, Y., Ino, K., Sakaguchi, M., & Zempo, K. (2025) · ACM Transactions on Computing for Healthcare · doi:10.1145/3723048 · Cited by 2 · see citing works
A Gamified Virtual Reality Exposure Therapy for Individuals with Arachnophobia: A Pilot Study
Lopes, I. S., de Almeida, R. S., Gomes, P. V., & Marques, A. J. (2025) · Virtual Worlds · doi:10.3390/virtualworlds4020015 · Cited by 2 · see citing works
Extended Reality in Patient Care and Pharmacy Practice: A Viewpoint
Takemoto, J. K., Parmentier, B. L., Bratelli, R., Merritt, T. A., & Coyne, L. (2019) · Journal of Contemporary Pharmacy Practice · doi:10.37901/2573-2765-66.4.33 · Cited by 2 · see citing works
Ramírez-Fernández, C., Morán, A. L., & Meza-Kubo, V. (2022) · Interacting with Computers · doi:10.1093/iwc/iwac026 · Cited by 2 · see citing works
- Authors
- Miloff, A., Lindner, P., Hamilton, W., Reuterskiöld, L., Andersson, G., & Carlbring, P.
- Affiliations
- Stockholm University (SE)
- Linköping University (SE)
- Corresponding author
- Miloff, Alexander
- Venue
- Trials
- Published
- 2016-02-02
- Volume
- 17
- Issue
- 1
- Pages
- 60-60
- ISSN
- 1745-6215 (ISSN-L)
- PMC
- PMC4736108
- OpenAlex
- W2272558351
- Cited by
- 141
- References
- 61
- Citations by year
- 2026: 9 · 2025: 17 · 2024: 11 · 2023: 20 · 2022: 8 · 2021: 15 · 2020: 17 · 2019: 19 · 2018: 17 · 2017: 7 · 2016: 1
- FWCI
- 22.86
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Trials (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- Funders
- Vetenskapsrådet (2011-2913)
- Forskningsrådet om Hälsa, Arbetsliv och Välfärd (SE) (2011-2913)
- 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
- spider phobia, virtual reality exposure therapy, specific phobia, non-inferiority, anxiety, depression, quality of life
- MeSH terms
- Equivalence Trials as Topic, Adult, Animals, Clinical Protocols, Humans, Phobic Disorders, Spiders, Outcome Assessment, Health Care, Virtual Reality Exposure Therapy
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