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A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders
Open accessAbstract
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.
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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.
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In the paper
“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).”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results > 3.4 Effect size across different technology characteristics
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In the paper
“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).”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results > 3.4 Effect size across different technology characteristics
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results > 3.4 Effect size across different technology characteristics
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Discussion and Conclusions · hedged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, for social phobia no correlation between self-reported presence and anxiety was found.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Discussion and Conclusions
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- 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.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results > 3.1 Effect size across different measurements
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: A common among-study variance component across the subgroups.
- Also stated in: § Abstract · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The results showed a non-significant relation between presence and anxiety with neither spatial resolution (Q 1 = 0.90, p = .34) nor field of view (Q 1 = 2.48, p = .12).”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results > 3.4 Effect size across different technology characteristics
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A subgroup analysis on the correlation between presence and anxiety for the group of large field of view displays (FOV>94°) separated from the group of small field of view displays (FOV<71°) showed a significantly higher correlation (Q 1 = 4.10, p = 04) for studies using a large field of view display r = .51, 95% CI [0.28–0.68], p<.001 compared to studies using a small field of view display r = .”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results > 3.4 Effect size across different technology characteristics
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The summary effect for the group of studies with non-clinical participants was r = .22, 95% CI [0.10–0.34], p<.001, while the summary effect for the group of studies using clinical participants was r = .42, 95% CI [0.25–0.57], p<.001.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results > 3.3 Effect size across different participants' characteristics
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- The authors state this as an assumption: A common among-study variance component across the subgroups.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“No significant differences were found for display type (Q 1 = 1.56, p = .21), stereoscopy (Q 1 = 0.014, p = .91), whether a tracker was used or not (Q 1 = 2.65, p = .10), tracker's update frequency (Q 4 = 3.58, p = .47), audio type (Q 2 = 3.90, p = .14) and audio player (Q 2 = 1.66, p = .44) (see again Table 4).”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results > 3.4 Effect size across different technology characteristics
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: A common among-study variance component across the subgroups.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Correlations between presence and anxiety were significantly different among the various disorders, varying from almost zero for social phobia and claustrophobia to a large effect for fear of animals and fear of flying (see Table 3). Subgroup analyses showed significant differences between different anxiety disorders (Q 6 = 17.28, p = .008).”
- Also stated in: § Abstract · plain
“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).”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results > 3.2 Effect size across different anxiety disorders
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- The authors state this as an assumption: A common among-study variance component across the subgroups.
- Also stated in: § Abstract · plain
- It may state two separate claims as one. 16
- The quote only partly states this claim. 1
- Probably not a substantial claim. 16
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § Abstract · plain
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In the paper
“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).”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results > 3.5 Effect size as a function of sample size and publication year
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Abstract
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: A common among-study variance component across the subgroups.
- Also stated in: § 3.3 Effect size across different participants' characteristics · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Abstract
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: A common among-study variance component across the subgroups.
- Also stated in: § 3.2 Effect size across different anxiety disorders · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For claustrophobia the summary correlation was not found to deviate significantly from zero, but this result was only based on two correlations.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results > 3.2 Effect size across different anxiety disorders
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: A common among-study variance component across the subgroups.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results
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In the paper
“The resulting model did not show a significant effect of gender on the correlation (Q 1 = 1.82, p = .18).”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results > 3.3 Effect size across different participants' characteristics
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe quote only partly states this claim.
- The authors state this as an assumption: A common among-study variance component across the subgroups.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results > 3.2 Effect size across different anxiety disorders
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: A common among-study variance component across the subgroups.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results > 3.4 Effect size across different technology characteristics
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: A common among-study variance component across the subgroups.
- Also stated in: § Abstract · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The moderating effect was found in the studies with less immersive technology, but not in studies with more immersive technology.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Discussion and Conclusions
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In the paper
“In VRET, the sense of presence has been considered the principal mechanism that leads to the experience of anxiety [12].”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Introduction
What the sources say
- Not checked yetcites [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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: There are no published quantitative syntheses on the relationship between presence and anxiety.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Methods > 2.4 publication bias
What the sources say
- Not checked yetcites [54] Rosenthal R (1991) Meta-analytic procedures for social research. London, UK: Sage. 168 p. source
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“Recently, Slater [81] also argued that presence at least has two independent components: place illusion and plausibility.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Discussion and Conclusions
What the sources say
- Not checked yetcites [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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“For the subgroup analyses, effects had to be demonstrated by at least two different research teams in each subgroup.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Methods > 2.3 Effect size calculation
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In the paper
“Both place illusion and plausibility contribute to realistic responses in the virtual environment.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Discussion and Conclusions
What the sources say
- Not checked yetcites [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
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results > 3.4 Effect size across different technology characteristics
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The summary effect size was calculated using the random effects model due to the heterogeneity of the studies.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Methods > 2.3 Effect size calculation
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In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Results
What the sources say
- Not checked yetcites [2] American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders. Washington, DC: Author. 991 p. source
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None of the sources cited for this claim have been checked yet.
In the paper
“Due to habituation to the virtual stimuli in the virtual environment, participants' anxiety would decrease over time [48], [49].”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Methods > 2.2. Procedure
What the sources say
- Not checked yetcites [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 yetcites [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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Discussion and Conclusions
What the sources say
- Not checked yetcites [80] C Qu, 2013, Human perception of a conversational virtual human: An empirical study on the effect of emotion and culture, Virtual Reality source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“Publication bias was also assessed with a funnel plot visually, and qualified with Egger's weighted regression method [55].”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Methods > 2.4 publication bias
What the sources say
- Not checked yetcites [55] M Egger, 1997, Bias in meta-analysis detected by a simple, graphical test, British Medical Journal source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“To test whether the overall effect that we found was robust, the classic Fail-safe N value as proposed by Rosenthal [54] was calculated.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Methods > 2.4 publication bias
What the sources say
- Not checked yetcites [54] Rosenthal R (1991) Meta-analytic procedures for social research. London, UK: Sage. 168 p. source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Discussion and Conclusions
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Discussion and Conclusions
Tests✗ Asserted: fails✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. The authors may not put it forward as true.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Discussion and Conclusions
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Discussion and Conclusions
What the sources say
- Not checked yetcites [86] Y Ling, 2013, The relationship between individual characteristics and experienced presence, Computers in Human Behavior source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Discussion and Conclusions
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders > Discussion and Conclusions
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
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.”
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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
In the citing paper
“A 2014 meta-analysis reported an overall significant correlation of r = .28(95% CI: 0.18-0.38)between self-reported distress and presence during exposure”
From Better, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy (2021) · cites this paper as Ling et al. 2014
In the citing paper
“albeit with significant differences across sample clinical characteristics and type of VR equipment used (Ling et al. 2014).”
From Better, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy (2021) · cites this paper as Ling et al. 2014
In the citing paper
“Congruently, reported correlation coefficients between presence and pain are typically of stronger magnitude than those reported between presence and distress during VRET [34,38,39].”
From Experiences of gamified and automated virtual reality exposure therapy for spider phobia: qualitative study (2020) · cites this paper as [34]
In the citing paper
“Meta-analytic research has confirmed a robust but relatively weak association between self-rated distress and sense of presence during exposure [34]”
From Experiences of gamified and automated virtual reality exposure therapy for spider phobia: qualitative study (2020) · cites this paper as [34]
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”
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
MinorThe 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.
“This model was approaching significant (Q 1 = 3.78, p = .051)”
“| Interval | −0.026 | .0051 |”
Tracker categories exceed the number reported as using trackers
MinorTable 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
“| Yes | 42 | .32 | <.001 | .21 | .42 | | Tracker's DoF | | | | | | | 3 DoF | 27 | .23 | .001 | .09 | .36 | | 6 DoF | 16 | .46 | <.001 | .30 | .60 |”
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Items 101–200 of 213
Effects of system- and media-driven immersive capabilities on presence and affective experience
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“Indeed, larger FoV has been associated with larger effect sizes in anxiety generation in VRET studies (Ling et al. 2014).”
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Fajnerová, I., Francová, A., Taranzová, K., Darmová, B., Nosková, E., & Stopková, P. (2023) · Virtual Reality · doi:10.1007/s10055-023-00837-5 · Cited by 14
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Dopamine D3 receptor agonists as pharmacological tools
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Cued fear conditioning in humans using immersive Virtual Reality
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Virtual Reality Self-help Treatment for Aviophobia: Protocol for a Randomized Controlled Trial
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(No) escape from reality? Cigarette craving in virtual smoking environments
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“, 2016) and exposure therapy effects (Ling et al., 2014).”
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The Relationship between Immersion and Psychophysiological Indicators
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“…(Lohani, Payne, & Strayer, 2019), which have been shown to affect presence (Felton & Jackson, 2022; Lackey, Salcedo, Szalma, & Hancock, 2016; Ling, Nefs, Morina, Heynderickx, & Brinkman, 2014; Ma & Kaber, 2006; Nalivaiko, Davis, Blackmore, Vakulin, & Nesbitt, 2015; Riley et al., 2004; Riva…”
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Koller, M., Schäfer, P., Lochner, D., & Meixner, G. (2019) · IEEE International Conference on Healthcare Informatics (ICHI) · doi:10.1109/ichi.2019.8904768 · Cited by 9
“Research indicates that patient’s presence influences the therapy outcome [11] and has a correlation to anxiety [22].”
BackgroundAn interactive VR platform with emotion recognition for self-attachment intervention
Polydorou, N., & Edalat, A. (2021) · EAI Endorsed Transactions on Pervasive Health and Technology · doi:10.4108/eai.14-9-2021.170951 · Cited by 9
“Ling et al. [23] carried out a meta-analysis in order to investigative ‘the relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy (VRET) for Anxiety Disorders’ and showed that these two are correlated during VRET.”
BackgroundColman, M. D., Millar, J. F. A., Patil, B., Finnegan, D. J., Russell, A., Higson‐Sweeney, N., Aguiar, M. D. S., & Fraser, D. S. (2024) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2024.100893 · Cited by 9
“Research on VR exposure consistently demonstrates that increased levels of telepresence results in increased emotional response (Diemer et al., 2015; Ling et al., 2014).”
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“STAI (Spielberger 1989) represents the most widely used method of measuring anxiety and is often used to measure subjectively experienced anxiety in the context of VR exposure (Ling et al. 2014).”
The impact of virtual reality exposure therapy in the treatment of PTSD and anxiety disorders
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Sanal Gerçeklik Ortamlarında Bulunma Hissi
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An internet-based treatment for flying phobia using 360° images: A feasibility pilot study
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“Given the bidirectional relationship between emotions and presence [38,39], and the role of (voice) presence in AT outcomes [41], VRT delivery must balance optimizing (voice) presence with avoiding excessive anxiety [40] to optimize outcomes.”
InfluentialVirtual Reality for the Treatment of Body Image Disturbances in Eating and Weight Disorders
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Take a Look at Me Now: The Use of Virtual Reality in the Treatment of Social Anxiety Disorder
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“Results about the role of presence in the treatment of VRET have been inconclusive (Ling et al. 2014).”
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Letter to the Editor: Affordable virtual reality tools for the treatment of mental health problems
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“…hold great potential to assess how individuals with mental health problems respond in ‘ emotionally charged ’ environments, and to individualize and tailor exposure scenarios to target specific fears, whilst maintaining immersion and presence thought to be key components of VR (Ling et al. 2014).”
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Virtual reality for MRI preparation: Participant perceptions from a feasibility study
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“Similarly, VR-sup-ported aquatic therapy has been shown to help individuals overcome anxiety and fears related to water-based activities [55, 56].”
Scientific Landscape of Embodied Experience in the Virtual Environment: A Bibliometric Analysis
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“, 2014 [67] A meta-analysis on the relationship between self-reported presence and anxiety in virtual reality exposure therapy for anxiety disorders 78 181”
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“…stereoscopic monitors or one-screen projection displays, were able to elicit the desired response, be it anxiety, fear or craving, in VRT studies focusing on social anxiety, phobias and substance use disorders treatment, respectively (Ling et al., 2014; Ghit¸ ˘ a & Guti ´ errez-Maldonado, 2018).”
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Next Generation Virtual Reality Exposure Therapy Systems - A Study exploring Design Implications
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“Research indicates that presence correlates with the anxiety [41], and as stated, the locomotion modality influences presence, it should be chosen wisely and based on empirical data.”
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Using VR for Obsessive-Compulsive and Related Disorders
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A VR Game for Obsessive-Compulsive Disorders Therapy
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Multisensory aversive stimuli differentially modulate negative feelings in near and far space
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Impact of Virtual Embodiment on the Perception of Virtual Heights
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Bettahi, L., Remacle, A., Schyns, M., Etienne, E., Etienne, A.-M., & Leclercq, A. (2026) · Frontiers in Virtual Reality · doi:10.3389/frvir.2026.1755571 · Cited by 3
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“Next, a meta-analysis (Ling et al., 2014) of 33 studies found a medium effect size for the correlation between the sense of presence and self-reported”
MethodSelf-citationLohse, L., Jelinek, L., Moritz, S., Blömer, J., Bücker, L., & Miegel, F. S. (2023) · BMC Psychology · doi:10.1186/s40359-023-01116-3 · Cited by 3
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Extinction-Based Exposure Therapies Using Virtual Reality
Maples‐Keller, J. L., Sherrill, A. M., Reddi, P. J., Norrholm, S. D., & ROTHBAUM, B. O. (2023) · Current topics in behavioral neurosciences · doi:10.1007/7854_2023_437 · Cited by 3
Badeja, D., Schier, F., McGinity, M., & Hoyer, J. (2026) · Psychotherapy Research · doi:10.1080/10503307.2025.2534978 · Cited by 2
“Present data illustrates this: concerns about scenario realism and treatment effect transfer ranked high initially, both scientifically unjustified (Ling et al., 2014; Morina et al., 2015) and conceivably due to unfamiliarity with VRET.”
Arnfred, B., Bang, P., Hjorthøj, C., Winding, C., Møller, K., Hvenegaard, M., Gausbøl, U. K., Sø, D., Rosenberg, N., & Nordentoft, M. (2019) · doi:10.21203/rs.2.504/v1 · Cited by 2
Terapide Sanal Gerçeklik Uygulamalarının Etkililiği: Bir Meta-Analiz Çalışması
YILDIRIM, N. H., & Çolak, T. S. (2024) · Ayna Klinik Psikoloji Dergisi · doi:10.31682/ayna.1208024 · Cited by 2
Development of Immersive 360° Virtual Reality Videos for Intervention with Test Anxiety
Doğan, U., Üzmez, H., Dağılgan, E. B., Sarıcaoğlu, H., Sinem, A. C. A. R., & Özkaraca, O. (2024) · International Journal of Human-Computer Interaction · doi:10.1080/10447318.2024.2434959 · Cited by 4
“To determine whether the concept that causes anxiety and fear is realistic or not, clients in CBT are exposed to a fear hierarchy that increases in intensity from low to high.”
Validation of an Upgraded Virtual Reality Platform Designed for Real-Time Dialogical Psychotherapies
Simoes-Gomes, T., Potvin, S., Giguère, S., Beaudoin, M., Phraxayavong, K., & Dumais, A. (2025) · BioMedInformatics · doi:10.3390/biomedinformatics5010004 · Cited by 2
“It has been hypothesized that personalizing emotional narratives increases the sense of presence in VR environments [31,32].”
Miegel, F. S., Lindner, P., Schultz, J., Lohse, L., Yassari, A. H., & Jelinek, L. (2025) · Current Psychology · doi:10.1007/s12144-024-07194-9 · Cited by 2
“Thus, patients felt more present in the VR-PSA group, which, as already discussed above, is crucial for the efficacy of VR interventions (Ling et al., 2014).”
Virtual Reality to Enhance Engagement in Exposure-Based Treatments
Sherrill, A. M., Hellman, N. M., & Rothbaum, B. O. (2025) · CBT: science into practice · doi:10.1007/978-3-031-91439-3_8 · Cited by 2
Delangle, M., Moïse-Richard, A., Leclercq, A.-L., Labbé, D., Bouchard, S., Andrews, S., & Ménard, L. (2026) · Journal of Fluency Disorders · doi:10.1016/j.jfludis.2026.106194 · Cited by 1
Exploring Women’s State-Level Anxiety in Response to Virtual Reality Erotica
Brown, N. B., Milani, S., Jabs, F., Kingstone, A. F., & Brotto, L. A. (2023) · Journal of Sex & Marital Therapy · doi:10.1080/0092623x.2023.2265924 · Cited by 3
“A meta-analysis that reviewed 33 VRET studies examined the link between presence and anxiety, and showed a positive relationship with a medium effect (Ling, Nefs, Morina, Heynderickx, & Brinkman, 2014).”
MethodThe Impact of Adding Multisensory Stimulation to a Fear of Heights Virtual Reality Experience
Ribé-Viñes, J. M., Gutiérrez‐Maldonado, J., Zabolipour, Z., Aguilar‐Gil, M., & Ferrer‐García, M. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70107 · Cited by 2
Sviridova, M. K., & Ershova, R. V. (2025) · Психолог · doi:10.25136/2409-8701.2025.4.75119 · Cited by 1
Huang, W. F., & Zhang, J. (2025) · Frontiers in Sustainable Food Systems · doi:10.3389/fsufs.2025.1724665 · Cited by 1
Gray, H. G., Tchao, D., Lewis-Fung, S. E., Carman-Gray, G., Pardini, S., Harris, L. R., & Appel, L. G. (2026) · Epilepsy & Behavior Reports · doi:10.1016/j.ebr.2025.100845 · Cited by 1
“Previous research has reported mixed findings on the role of presence in the efficacy of VR-ET [46 – 49]; here, we offer an example where a lack of presence may have hindered VR-ET's success.”
Rutter-Eley, E. L., Craig, T., Garety, P. A., Rus‐Calafell, M., Ball, H., Clancy, M., McDonnell, J., Gumley, A. I., Haddock, G., Bucci, S., et al. (2026) · JMIR Mental Health · doi:10.2196/77566 · Cited by 1
“This is a key mechanism in fear activation [43], promoting emotional processing and generalization of learning [44,45].”
Li, J., Ma, D.-C., Liu, X., Yan, H., Wang, W., Xie, Y., Jiang, N., & Ning, L. (2026) · Digital Health · doi:10.1177/20552076261435080 · Cited by 1
Children’s sense of presence in immersive virtual reality for pediatric surgery
Felnhofer, A., Aberle, J. S., Weiss, L. M., Winder, J., Marceta-Pavlovic, S., Palmisani, F., Giordano, V., Wagner, M., Greber‐Platzer, S., Metzelder, M. L., et al. (2026) · Virtual Reality · doi:10.1007/s10055-026-01419-x · Cited by 1
“…is a defining feature of VR (Min - sky 1980; Souza et al. 2021) and has been associated with greater therapeutic efficacy (Augustin et al. 2024; Ling et al. 2014), improved learning transfer (Palombi et al. 2023), and reduced pain perception (Hoffman et al. 2004) in adults, the observed effect…”
A Virtual Reality Game as a Tool for Psychotherapy With OCD Patients
Torrão, A. R., Natário, J., Carvalho, P. S., Silva, C. M., & Silva, F. G. M. (2022) · International Journal of Creative Interfaces and Computer Graphics · doi:10.4018/ijcicg.311834 · Cited by 1
Instagram, Depression, and Dark Flow - Using Social Media as a Maladaptive Coping Mechanism
(2023) · Journal of Addiction Research · doi:10.33140/jar.07.02.05 · Cited by 1
When Fear Overshadows Perceived Plausibility: The Influence of Incongruencies on Acrophobia in VR
Brübach, L., Celikhan, D., Rüffert, L., Westermeier, F., Latoschik, M. E., & Wienrich, C. (2025) · IEEE Conference on Virtual Reality and 3D User Interfaces (VR) · doi:10.1109/vr59515.2025.00089 · Cited by 1
“Nonetheless, the influence of plausibility on fear seems to be underresearched [22].”
InfluentialEmerging Technology Applications to Promote Physical Activity and Health
Gao, Z., & Lee, J. (2019) · MDPI eBooks · doi:10.3390/books978-3-03897-709-4 · Cited by 1
Cultures of Medicinal Plants In Vitro as a Potential Rich Source of Antioxidants
Ekiert, H., Kubica, P., Kwiecień, I., Jafernik, K., Klimek-Szczykutowicz, M., & Szopa, A. (2021) · Reference series in phytochemistry · doi:10.1007/978-3-030-45299-5_37-1 · Cited by 1
Development and validation of an open-access online Behavioral Avoidance Test (BAT) for spider fearPreprint
Grill, M., Heller, M., & Haberkamp, A. (2023) · doi:10.31234/osf.io/5k497 · Cited by 1
Haydu, V. B., de, M. B. D. P. M. B., Zacarin, M. R. J., dos Santos, A., Borloti, E., & Fornazari, S. A. (2016) · Dialnet (Universidad de la Rioja)
Arias, M. C. (2017) · The Research Repository @ WVU (West Virginia University) · doi:10.33915/etd.5120
Senso de presença: Proposta de uma defiição analítico-comportamental
Zacarin, M. R. J., Borloti, E., dos Santos, A., Perandré, Y. H. T., de Melo, C. M., & Haydu, V. B. (2017)
Nieminen, M. P., & Kirjonen, M. (2020) · Lecture notes in computer science · doi:10.1007/978-3-030-58465-8_4
The effects of nature in virtual reality on psychological wellbeing
Chan, S. H. M. (2021) · doi:10.32657/10356/156158
Virtual Reality in the Assessment, Understanding and Treatment of Mental Health Disorders
Riva, G., & Serino, S. (2021) · MDPI eBooks · doi:10.3390/books978-3-03943-776-4 · Cited by 3
Virtual Reality als Trainingstool in der Klinischen und Gesundheitspsychologie
Schuster, L., Friedrich, A.-S. E., Kothgassner, O. D., & Zemp, M. (2022) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443/a000662
Dilanchian, A. T., & Boot, W. R. (2023) · Research Square · doi:10.21203/rs.3.rs-3433954/v1
Rogti, M. (2025) · Lecture notes in educational technology · doi:10.1007/978-981-96-8931-6_9
Aunjitsakul, W., Anantapong, K., Wiwattanaworaset, P., Jiraphan, A., Teetharatkul, T., Sathaporn, K., Jongbovonwiwat, K., & Chaichulee, S. (2025) · Technology and Health Care · doi:10.1177/09287329251360523
“11,48 Future advancements, such as AI-driven interactive verbal feedback and more dynamic, adaptive nonverbal social cues (e.g., eye gaze, facial expressivity) from virtual characters, or internet-integrated communication, may further enhance the immersive experience, improving engagement and…”
The Stability of Plausibility and Presence in Claustrophobic Virtual Reality Exposure Therapy
Grause, J., Brübach, L., Westermeier, F., Wienrich, C., & Latoschik, M. E. (2025) · Mensch und Computer (MuC) · doi:10.1145/3743049.3743068
An Exploratory Study on Gamification and Interactivity in VRET with 6DoF
Hanlon, S., Fitch, C., & Morris, P. (2025) · International Conference Virtual and Augmented Reality Simulations · doi:10.1109/icvars66454.2025.11198751
“The study found a positive correlation between higher presence — often achieved through 6DoF systems — and increased anxiety reduction, indicating that immersive VR setups can enhance the effectiveness of exposure therapy [9].”
Mandolfo, M., Bettiga, D., Reali, P., Chirico, A., & Sarcinella, E. D. (2025) · Communications in computer and information science · doi:10.1007/978-3-032-05778-5_10
Chan, A. T. Y., Li, A. C. M., Tong, A. C. Y., Freeman, D. H., Koh, Y. M., & Mak, W. W. S. (2025) · Psychotherapy and Psychosomatics · doi:10.1159/000549113
“Ling et al. [47] showed negligible correlations for social phobia scenarios as compared to acrophobic scenarios, arguing that standard measurement on presence mainly tap “place illusion” (feeling located in a virtual space), which is critical for place-related fears but less so for fears of social…”
Virtual reality for the treatment of perinatal mental health: a rapid scoping review
Zorzi, C., Jean, J., Côté, S. M., St‐André, M., & MacKinnon, A. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-094901
Jeanningros, A., Bouchard, S., & Potvin‐Desrochers, A. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14248837
“It is now well established that despite being aware that the situation is the result of a computer-generated simulation, participants within the context of VR do experience feelings and responses that are comparable to those experienced in real-world scenarios [53–55].”
Jenuwine, M., Hinchey, L. M.-E., Reardon, M., Gorski, K., Hart, S., Pompeii, M., Acierno, R. E., & Javanbakht, A. (2026) · Military Psychology · doi:10.1080/08995605.2025.2609243
“The present study highlights the potential clinical utility of Augmented Reality Exposure Therapy (ARET) for PTSD. Consistent with Virtual Reality Exposure Therapy (VRET) research, participants emphasized ecological validity, emotional salience, and therapist-guided pacing (Reger et al., 2016; Rothbaum et al., 2001).”
InfluentialWang, F., Nie, J., Wang, Y., & Xue, J. (2025) · International Conference on Artificial Intelligence, Virtual Reality and Interaction Design · doi:10.1145/3777730.3777770
Kim, E., Jang, Y., Park, B., Kim, H. E., Kim, B.-H., & Kim, J.-J. (2026) · Frontiers in Virtual Reality · doi:10.3389/frvir.2026.1729909
Sinem, A. C. A. R., Doğan, U., Sarıcaoğlu, H., Üzmez, H., & Dağılgan, E. B. (2026) · PRESENCE Virtual and Augmented Reality · doi:10.1162/pres.a.429
Maneuvrier, A. (2020) · theses.fr (ABES) · doi:10.70675/3fbb4dbfzc553z459dzba8fz7ee7a2f5ec28 · Cited by 1
Metadata
- 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
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-05-06
- Volume
- 9
- Issue
- 5
- Pages
- e96144
- ISSN
- 1932-6203 (ISSN-L)
- 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
- gold
- doi.org
- 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
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