CoChat
Sign Up
Cited by 215Virtual Reality Applications and ImpactsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesDigital Mental Health Interventions

A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders

Open access
Ling, Yun, Nefs, Harold T., Morina, Nexhmedin, Heynderickx, Ingrid, Brinkman, Willem-Paul·2014·PLoS ONE
DOI 10.1371/journal.pone.0096144PMC PMC4011738
Open this paper in CoChat — free accountOpen PDF

Abstract

In virtual reality exposure therapy (VRET) for anxiety disorders, sense of presence in the virtual environment is considered the principal mechanism that enables anxiety to be felt. Existing studies on the relation between sense of presence and level of anxiety, however, have yielded mixed results on the correlation between the two. In this meta-analysis, we reviewed publications on VRET for anxiety that included self-reported presence and anxiety. The comprehensive search of the literature identified 33 publications with a total of 1196 participants. The correlation between self-reported sense of presence and anxiety was extracted and meta-analyzed. Potential moderators such as technology characteristics, sample characteristics including age, gender and clinical status, disorder characteristics and study design characteristics such as measurements were also examined. The random effects analysis showed a medium effect size for the correlation between sense of presence and anxiety (r = .28; 95% CI: 0.18-0.38). Moderation analyses revealed that the effect size of the correlation differed across different anxiety disorders, with a large effect size for fear of animals (r = .50; 95% CI: 0.30-0.66) and a no to small effect size for social anxiety disorder (r = .001; 95% CI: -0.19-0.19). Further, the correlation between anxiety and presence was stronger in studies with participants who met criteria for an anxiety disorder than in studies with a non-clinical population. Trackers with six degrees of freedom and displays with a larger field of view resulted in higher effect sizes, compared to trackers with three degrees of freedom and displays with a smaller field of view. In addition, no difference in effect size was found for the type of presence measurement and the type of anxiety measurement. This meta-analysis confirms the positive relation between sense of presence and anxiety and demonstrates that this relation can be affected by various moderating factors.

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-analysis of 33 publications with 52 correlations and 1,196 participants found a medium positive association between self-reported presence and anxiety in virtual reality exposure therapy (r = .28; 95% CI: 0.18–0.38). The relation varied by anxiety disorder, clinical status, tracker degrees of freedom, and display field of view.

Key findings

  • The random-effects weighted mean correlation between self-reported presence and anxiety was r = .28, 95% CI [0.18–0.38], p < .001; excluding the OCD study, it was r = .29, 95% CI [0.19–0.39], p < .001.
  • Disorder type significantly moderated the correlation (Q₆ = 17.28, p = .008): fear of animals r = .50 [0.30–0.66], fear of flying r = .52 [0.16–0.75], acrophobia r = .39 [0.22–0.54], and social phobia r = .001 [−0.19–0.19].
  • Clinical samples showed a higher correlation than non-clinical samples: r = .42 [0.25–0.57] vs. r = .22 [0.10–0.34], with the moderator approaching significance (Q₁ = 3.47, p = .06); excluding OCD, the difference was significant (clinical r = .47 [0.29–0.61] vs. non-clinical r = .22 [0.10–0.34], Q₁ = 5.15, p = .02).
  • Technology moderated the relation: 6 DoF trackers r = .46 [0.30–0.60] vs. 3 DoF trackers r = .23 [0.09–0.36] (Q₁ = 4.81, p = .03), and large FOV displays (>94°) r = .51 [0.28–0.68] vs. small FOV displays (<71°) r = .24 [0.13–0.35] (Q₁ = 4.10, p = .04); presence and anxiety measurement types did not significantly moderate the effect.

Methods

  • Systematic literature search in PsycINFO, PubMed, Web of Knowledge, and Scopus through March 19, 2013, plus reference and conference screening; inclusion required human participants in VR/AR for anxiety disorder treatment, self-reported presence and anxiety, and peer-reviewed journal or conference publication.
  • The analysis included 33 articles, 52 correlations, and 1,196 participants; the correlation between self-reported presence and anxiety served as the effect size, converted to Fisher’s z, with random-effects meta-analysis, subgroup analyses for categorical moderators, and REML meta-regressions for continuous moderators using Comprehensive Meta-analysis Version 3.
  • Moderators examined included anxiety disorder type, age, gender, clinical status, technology characteristics (display, stereoscopy, resolution, FOV, audio, tracker DoF/update frequency), measurement type, sample size, and publication year; publication bias was assessed with Fail-safe N, funnel plot, and Egger’s test.

Limitations

  • The paper states that presence and anxiety were self-reported and therefore prone to demand characteristics, and that very few studies covered OCD, claustrophobia, and fear of flying, so caution is needed when generalizing to underrepresented disorders.
  • The paper notes that the meta-analysis was based on correlations and could not model the shape of the presence–anxiety relationship, which may not be linear.
  • Evident from the text: no PTSD studies were included because authors could not provide correlations; although the search included spatial, social, and co-presence, included publications only reported spatial presence; and the publication-year effect may have been confounded with anxiety disorder type.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1371/journal.pone.0096144

Cites

87 of 87 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 24 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The meta-regression model with tracker's degrees of freedom and field of view as independent variables (step 2) significantly predicted the correlation between presence and anxiety (Q2 = 7.00, p = .03).

    “As expected, the meta-regression models were all significant in both steps; Q 1 = 4.51, p = .03 and Q 2 = 7.00, p = .03 for step1 and step 2 individually (Table 5).”
    Quote in the paperSubstantial claim
  • Findingown data

    There was a significant interaction effect between participants' clinical status and tracker's degree of freedom (Q1 = 13.66, p < .001).

    “The results showed a significant interaction effect between participants' clinical status and display field of view (Q 1 = 4.19, p = .04) and between participants' clinical status and tracker's degree of freedom (Q 1 = 13.66, p<.001).”
    Quote in the paperSubstantial claim
  • Findingown data

    Only tracker's degrees of freedom and display field of view significantly moderated the correlation between presence and anxiety.

    “Since only tracker's DoF and display field of view significantly moderated the correlation between presence and anxiety, we conducted multiple meta-regression analyses to test whether the combination of these two variables could have a better overall prediction of the weighted mean correlation.”
    • Also stated in: § Discussion and Conclusions · hedged
      “The meta-analysis also found moderating effects for some technology characteristics such as the degrees of freedom of the tracker and the display's field of view.”
    Quote in the paperSubstantial claim
  • Findingown data

    For social phobia, no correlation between self-reported presence and anxiety was found.

    “However, for social phobia no correlation between self-reported presence and anxiety was found.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The self-reported presence measures used in the included studies validly capture the sense of presence relevant to anxiety in VRET.
  • Findingown data

    No significant moderating effect was found for the type of presence measurement (Q 4 = 6.06, p = .20).

    “The subgroup analyses showed no significant moderating effect for the type of anxiety measurement (Q 2 = 1.35, p = .51; see Table 2), and the type of presence measurement (Q 4 = 6.06, p = .20; see Table 2).”
    • Also stated in: § Abstract · plain
      “In addition, no difference in effect size was found for the type of presence measurement and the type of anxiety measurement.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: A common among-study variance component across the subgroups.
  • May combine two claims. 16
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 16

  • May combine two claims.

    Findingown data

    The meta-analysis included 33 articles with 52 correlations and a total sample size of 1196 participants.

    “On the basis of the standardized methodology, we included 33 articles with 52 correlations, with a total sample size of 1196 participants.”
    • Also stated in: § Abstract · plain
      “The comprehensive search of the literature identified 33 publications with a total of 1196 participants.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The meta-regression using publication year as a continuous variable was approaching significance (Q1 = 3.78, p = .051) with 9.62% of the variability in the correlation coefficients accounted for by publication year.

    “This model was approaching significant (Q 1 = 3.78, p = .051) with 9.62% of the variability in the correlation coefficients accounted for by the publication year (see Table 7).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The correlation between presence and anxiety was stronger in studies with participants who met criteria for an anxiety disorder than in studies with a non-clinical population, but the effect of this moderator was only approaching significance (Q 1 = 3.47, p = .06).

    “Further, the correlation between anxiety and presence was stronger in studies with participants who met criteria for an anxiety disorder than in studies with a non-clinical population.”
    • Also stated in: § 3.3 Effect size across different participants' characteristics · plain
      “Hence, the correlation between presence and anxiety was higher for the clinical sample of people than for the non-clinical sample, but the effect of this moderator was only approaching significance (Q 1 = 3.47, p = .06).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: A common among-study variance component across the subgroups.

  • May combine two claims.

    Findingown data

    For social phobia, the summary correlation between presence and anxiety was no to small, r = .001, 95% CI [−0.19-0.19], and did not deviate significantly from zero.

    “and a no to small effect size for social anxiety disorder (r = .001; 95% CI: −0.19–0.19).”
    • Also stated in: § 3.2 Effect size across different anxiety disorders · plain
      “In contrast, 11 correlations were included in the calculation of the summary effect for social phobia, and still the mean correlation did not deviate significantly from zero.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: A common among-study variance component across the subgroups.

  • May combine two claims.

    Findingown data

    For claustrophobia, the summary correlation was not found to deviate significantly from zero, but this result was only based on two correlations.

    “For claustrophobia the summary correlation was not found to deviate significantly from zero, but this result was only based on two correlations.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: A common among-study variance component across the subgroups.

  • May combine two claims.

    Findingown data

    Preliminary analyses indicated substantial heterogeneity in the data (fixed effects: Q 51 = 126.17, p<.001 for the entire dataset, and Q 50 = 123.04, p<.001 for the dataset without the study on OCD).

    “Additionally, preliminary analyses indicated substantial heterogeneity in the data (fixed effects: Q 51 = 126.17, p<.001 for the entire dataset, and Q 50 = 123.04, p<.001 for the dataset without the study on OCD) suggesting that the data are heterogeneous, which supports the choice for a random-effects model.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    The resulting model did not show a significant effect of gender on the correlation between presence and anxiety (Q 1 = 1.82, p = .18).

    “The resulting model did not show a significant effect of gender on the correlation (Q 1 = 1.82, p = .18).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: A common among-study variance component across the subgroups.

  • May combine two claims.

    Findingown data

    For fear of flying, the summary correlation was found to be significantly above zero, but the exact size of the correlation is not precise.

    “For fear of flying, the summary correlation was found to be significantly above zero, but still as the confidence interval shows, the exact size of the correlation is not precise.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: A common among-study variance component across the subgroups.

  • May combine two claims.

    Findingown data

    The subgroup analyses showed a significant moderating effect for the degrees of freedom of the tracker (Q 1 = 4.81, p = .03), with a tracker with 6 DoF resulting in higher correlations than a tracker with 3 DoF.

    “The subgroup analyses showed a significant moderating effect for the degrees of freedom of the tracker (Q 1 = 4.81, p = .03) with a tracker with 6 DoF resulting in higher correlations than a tracker with 3 DoF (see Table 4).”
    • Also stated in: § Abstract · plain
      “Trackers with six degrees of freedom and displays with a larger field of view resulted in higher effect sizes, compared to trackers with three degrees of freedom and displays with a smaller field of view.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: A common among-study variance component across the subgroups.

  • May combine two claims.

    Findingown data

    The shape of the funnel plots did not reveal any indication of funnel plot asymmetry, confirmed by Egger's test with p = .67, two-tailed.

    “The shape of the funnel plots in Figure S1 did not reveal any indication of funnel plot asymmetry. This visual impression was also confirmed by Egger's test with p = .67, two-tailed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The moderating effect of individuals' clinical status was found in studies with less immersive technology, but not in studies with more immersive technology.

    “The moderating effect was found in the studies with less immersive technology, but not in studies with more immersive technology.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    In VRET, the sense of presence has been considered the principal mechanism that leads to the experience of anxiety.

    “In VRET, the sense of presence has been considered the principal mechanism that leads to the experience of anxiety [12].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Wiederhold BK, Wiederhold MD (2005) Virtual reality therapy for anxiety disorders: Advances in evaluation and treatment. Washington, DC: Amrican Psychological Association. 225 p. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    This meta-analysis confirms the positive relation between sense of presence and anxiety and demonstrates that this relation can be affected by various moderating factors.

    “This meta-analysis confirms the positive relation between sense of presence and anxiety and demonstrates that this relation can be affected by various moderating factors.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: There are no published quantitative syntheses on the relationship between presence and anxiety.

  • Classified as probably not a substantial claim.

    Premisecitation

    Rosenthal suggested that findings could be considered robust if the required number of studies to reduce the overall effect size to a non-significant level exceeded 5 × number of included studies + 10.

    “Rosenthal [54] suggested that findings could be considered as robust if the required number of studies to reduce the overall effect size to a non-significant level exceeded 5 × number of included studies (effect sizes)+10.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [54] Rosenthal R (1991) Meta-analytic procedures for social research. London, UK: Sage. 168 p. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Presence has at least two independent components: place illusion and plausibility.

    “Recently, Slater [81] also argued that presence at least has two independent components: place illusion and plausibility.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] M Slater, 2009, Place illusion and plausibility can lead to realistic behaviour in immersive virtual environments, Philosophical Transactions of the Royal Society B-Biological Sciences source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    For subgroup analyses, effects had to be demonstrated by at least two different research teams in each subgroup.

    “For the subgroup analyses, effects had to be demonstrated by at least two different research teams in each subgroup.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Both place illusion and plausibility contribute to realistic responses in the virtual environment.

    “Both place illusion and plausibility contribute to realistic responses in the virtual environment.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] M Slater, 2009, Place illusion and plausibility can lead to realistic behaviour in immersive virtual environments, Philosophical Transactions of the Royal Society B-Biological Sciences source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    A potential explanation for the pattern that advancements in immersive technology coincide with higher presence-anxiety correlations is that advancements in immersive technology reduce the moderating effect of other factors, such as personality, clinical status and the surrounding real world.

    “A potential explanation for this observation is that advancements in immersive technology reduce the moderating effect of other factors, such as personality, clinical status and the surrounding real world.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The summary effect size was calculated using a random effects model due to the heterogeneity of the studies.

    “The summary effect size was calculated using the random effects model due to the heterogeneity of the studies.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductcitation

    All analyses were conducted twice, first with all 33 publications and then without the study on OCD.

    “Since OCD is not listed as an anxiety disorder in DSM-V [2], the new version published in 2013, we conducted all analyses twice, i.e., first with all 33 publications, and then with the same dataset, but without the study on OCD.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders. Washington, DC: Author. 991 p. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Due to habituation to virtual stimuli, participants' anxiety would decrease over time.

    “Due to habituation to the virtual stimuli in the virtual environment, participants' anxiety would decrease over time [48], [49].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [48] E Malbos, 2013, A controlled study of agoraphobia and the independent effect of virtual reality exposure therapy, Australian and New Zealand Journal of Psychiatry source

      Not checked in the free run.

    • cites [49] Hofmann SG, Otto MW (2008) Cognitive Behavioral Therapy for Social Anxiety Disorder: Evidence-Based and Disorder-Specific Treatment Techniques. New York: Routledge. 232 p. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Social anxiety centers on the perception of negative human evaluation.

    “Social anxiety centers on the perception of negative human evaluation, and thus individuals' perception of the appearance of both verbal and non-verbal behavior of virtual characters [80] seems a relevant cue for activating the fear structure.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [80] C Qu, 2013, Human perception of a conversational virtual human: An empirical study on the effect of emotion and culture, Virtual Reality source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Publication bias was assessed with a funnel plot visually and qualified with Egger's weighted regression method.

    “Publication bias was also assessed with a funnel plot visually, and qualified with Egger's weighted regression method [55].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] M Egger, 1997, Bias in meta-analysis detected by a simple, graphical test, British Medical Journal source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The classic Fail-safe N value as proposed by Rosenthal was calculated to test whether the overall effect was robust.

    “To test whether the overall effect that we found was robust, the classic Fail-safe N value as proposed by Rosenthal [54] was calculated.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Rosenthal R (1991) Meta-analytic procedures for social research. London, UK: Sage. 168 p. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The meta-analysis was based on correlations between presence and anxiety, so the shape of the relationship between presence and anxiety could not be modeled.

    “Our current meta-analysis study, however, was based on correlations between presence and anxiety, where the shape of the relationship between presence and anxiety could not be modeled.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S1 (asserted).

    Interpretationreasoning

    Applying more advanced immersive technology leaves less room for other factors to moderate the correlation between presence and anxiety.

    “These findings put forward the hypothesis that applying more advanced immersive technology leaves less room for other factors to moderate the correlation between presence and anxiety.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    For both clinical and non-clinical individuals, the reported presence can be seen as the degree in which real life cues have been imitated.

    “Nonetheless, for both clinical and non-clinical individuals, the reported presence can be seen as the degree in which real life cues have been imitated.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The role of participants' absorption may be larger in less immersive virtual environments.

    “This finding is also in line with what Ling et al. [86] suggested, namely that the role of participants' absorption may be larger in less immersive virtual environments.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [86] Y Ling, 2013, The relationship between individual characteristics and experienced presence, Computers in Human Behavior source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Advanced immersive technology dominates the relationship and reduces the noise from other factors such as individuals' characteristics, personality or previous experiences which may affect experienced presence and anxiety in virtual environments.

    “It seems that advanced immersive technology dominates the relationship and reduces the ‘noise’ from other factors such as individuals' characteristics, personality or previous experiences which may affect experienced presence and anxiety in virtual environments.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Place illusion is well covered by most presence questionnaires.

    “As suggested above, place illusion is well covered by most presence questionnaires, but future research should investigate the extent to which presence questionnaires also measure plausibility, i.e., the extent to which one takes what is happening in the virtual environment as real, since the latter might be more relevant than spatial presence for VRET for social phobia.”
    Quote in the paperNot a substantial claim
30 of 30

  • The paper relies on this without support.

    There are no published quantitative syntheses on the relationship between presence and anxiety.

    “To our knowledge, there are no published quantitative syntheses on the relationship between presence and anxiety.”

  • The authors state this as an assumption.

    Presence was stable during participants' exposure to the virtual environment.

    “As earlier studies [27], [47] found no order effect on presence during one session, we assumed that presence was stable during participants' exposure to the virtual environment.”

  • The authors state this as an assumption.

    A common among-study variance component across the subgroups.

    “We pooled within-group estimates of tau-squared, assuming a common among-study variance component across the subgroups [51].”

  • The authors state this as an assumption.

    The effect size of all current or future unpublished studies is equal to zero.

    “A conservative method of addressing this problem is to assume that the effect size of all current or future unpublished studies is equal to zero and to compute the number of such studies it would require to reduce the overall effect size to a non-significant level (α = .05, two-tailed).”

  • The paper relies on this without support.

    The relationship between presence and anxiety is linear enough that a correlation coefficient is a meaningful summary of their association.

    “Our current meta-analysis study, however, was based on correlations between presence and anxiety, where the shape of the relationship between presence and anxiety could not be modeled.”

  • The paper relies on this without support.

    The self-reported presence measures used in the included studies validly capture the sense of presence relevant to anxiety in VRET.

    “First, the measurements of presence and anxiety used in this study were self-reported which is prone to well-known demand characteristics.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Immersive technology can help increase the sense of presence and the emotional response experienced in a virtual scenario.

    “Immersive technology can help to increase the sense of presence, defined as the sense of being in a virtual environment (Steuer, 1992), as well as the emotional response experienced in a virtual scenario (Ling et al., 2014).”

    From An internet-based treatment for flying phobia using 360° images: A feasibility pilot study (2022) · cites this paper as Ling et al., 2014

    The Results (section 3.4) and Discussion report that more immersive technology coincided with a stronger correlation between presence and anxiety in virtual-reality exposure therapy. The Discussion also hypothesizes that advanced technology could reduce dropouts associated with a lack of emotional response. Neither passage establishes that immersive technology increases the level of presence or emotional response experienced in a scenario. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Immersive technology can reduce the "noise" of other individual or real-world factors in an exposure scenario, and therefore increase the presence and anxiety experienced in virtual environments.

    “Immersive technology can reduce the “noise” of other individual or real-world factors in an exposure scenario, and, therefore, it can increase the presence and anxiety experienced in these virtual environments (Ling et al., 2014).”

    From An Internet-based treatment for Flying Phobia using 360° images: Study protocol for a feasibility pilot study (2021) · cites this paper as Ling et al., 2014

    The Discussion and Conclusions (page not supplied) says advanced immersive technology appears to reduce ‘noise’ from individual factors affecting the presence–anxiety relationship. The Results, §3.4 (page not supplied), also identifies the surrounding real world as a possible moderating factor. But the paper reports a higher correlation between presence and anxiety, not that immersion increases the levels of both experiences. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

  • The immersion level of the technology is not the only variable that explains the subjective sense of presence, but it does play a role in this relationship.

    “The immersion level of the technology is not the only variable that explains the subjective sense of presence, but it does play a role in this relationship.”

    From An Internet-based treatment for Flying Phobia using 360° images: Study protocol for a feasibility pilot study (2021) · cites this paper as Ling et al., 2014

    The Discussion and Conclusions (page unavailable) say that individual characteristics may affect experienced presence and that more advanced immersive technology may reduce the effect of other factors on presence. This supports the idea that immersion is not the only relevant factor, but the meta-analysis directly tests how immersion moderates the correlation between presence and anxiety, not how much immersion explains the subjective sense of presence itself. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • The ITC-SOPI has been established as a reliable and valid tool for assessing sense of presence and shows a significant relationship with anxiety levels during virtual reality exposure therapy.

    “The ITC-SOPI has been established as a reliable and valid tool for assessing the sense of presence and shows a significant relationship with anxiety levels during virtual reality exposure therapy (Ling et al., 2014).”

    From Speaking face-to-face with a virtual avatar to reduce anxiety in students who stutter: Tool development and pilot study results. (2026) · cites this paper as Ling et al., 2014

    The Introduction identifies ITC-SOPI as a typical questionnaire for measuring presence, and the Discussion and Conclusions reports a moderate association between self-reported presence and anxiety during virtual reality exposure therapy. The paper does not establish ITC-SOPI’s reliability or validity, nor does it report a significant anxiety relationship specifically for ITC-SOPI. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • In VRET, there is a positive correlation between immersive technology and presence and anxiety.

    “In the case of VRET, there is a positive correlation between immersive technology and presence and anxiety (Ling et al., 2014)”

    From An Internet-based treatment for Flying Phobia using 360° images: Study protocol for a feasibility pilot study (2021) · cites this paper as Ling et al., 2014

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentt(50) = 3.5reported p = .001 · recomputed p < .001

    “t(50) = 3.50, p = .001”

1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Publication-year regression has conflicting p-values

    Minor

    The text reports p = .051 for the publication-year model, whereas Table 7 gives p = .0051 for its regression coefficient. These values imply different conclusions about statistical significance.

  • Tracker categories exceed the number reported as using trackers

    Minor

    Table 4 reports 27 correlations for 3-DoF trackers and 16 for 6-DoF trackers, totaling 43, but reports only 42 correlations as using a tracker.

    Reported 42 · recomputed 43

2 of 2

Cites

Flagged first, then by citations

1 of the 88 references couldn’t be matched to a known paper.

Research works printed but not linked: 6

  1. Schuemie MJ, Bruynzeel M, Drost L, Brinckman M, de Haan G, <etal>et al</etal>.. (2000) Treatment of acrophobia in virtual reality: A pilot study. In: Brockx F, Pauwels L, editors; Antwerp, Belgium. pp. 271–275.
  2. S Côté, 2008, Virtual reality exposure for phobias: A critical review, Journal of Cyber Therapy and Rehabilitation, 1, 75
  3. H Ewald, 2009, Fear conditioning in immersive virtual reality, Psychophysiology, 46, S128
  4. M-R Laframboise, 2006, Relation between anxiety and feeling of presence during virtual reality immersion, CyberPsychology & Behavior, 9, 689
  5. Spielberger CD, Krasner SS (1988) The assessment of trait and state anxiety. In: Burrows G, Noyes R, Roth M, editors. Handbook of anixety. Amsterdam: Elsevier Science. pp. 31–51.
  6. S Bouchard, 2011, Exploring new dimensions in the assessment of virtual reality induced side effects, Journal of computer and information technology, 1, 20

Cited by

Sorted by citations

Related

Authors
Ling, Y., Nefs, H. T., Morina, N., Heynderickx, I., & Brinkman, W.-P.
Affiliations
  • Delft University of Technology (NL)
  • Philips (Netherlands) (NL)
Corresponding author
  • Ling, Yun
  • Nefs, Harold T.
  • Heynderickx, Ingrid
  • Brinkman, Willem-Paul
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2014-05-06
Volume
9
Issue
5
Pages
e96144
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0096144
PMC
PMC4011738
OpenAlex
W2164854045
Semantic Scholar
add99bb7a404accb3de776f6554901e83db8cbf3
Cited by
215
References
88
Citations by year
2026: 22 · 2025: 24 · 2024: 15 · 2023: 16 · 2022: 20 · 2021: 24 · 2020: 27 · 2019: 19 · 2018: 14 · 2017: 13 · 2016: 8 · 2015: 10 · 2014: 3
FWCI
2.98
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UvA-DARE (University of Amsterdam) (acceptedVersion, other-oa)
  • TU/e Research Portal (submittedVersion, other-oa)
  • TU/e Research Portal (submittedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Research Repository (Delft University of Technology) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders
Nederlandse Organisatie voor Wetenschappelijk Onderzoek (655.010.207)
Topics
  • Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
virtual reality exposure therapy, presence, anxiety, anxiety disorders, social anxiety disorder, animal phobia, field of view
MeSH terms
Anxiety Disorders, Humans, Self Report, Virtual Reality Exposure Therapy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review