Virtual reality exposure-based therapy for the treatment of post-traumatic stress disorder: a review of its efficacy, the adequacy of the treatment protocol, and its acceptability
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INTRODUCTION: The essential feature of post-traumatic stress disorder (PTSD) is the development of characteristic symptoms following exposure to one or more traumatic events. According to evidence-based intervention guidelines and empirical evidence, one of the most extensively researched and validated treatments for PTSD is prolonged exposure to traumatic events; however, exposure therapy can present some limitations. Virtual reality (VR) can help to improve prolonged exposure because it creates fictitious, safe, and controllable situations that can enhance emotional engagement and acceptance. OBJECTIVE: In addition to carrying out a review to evaluate the efficacy of VR exposure-based therapy (VR-EBT) for the treatment of PTSD, the aim of this study was to contribute to analyzing the use of VR-EBT by: first, evaluating the adequacy of psychological treatment protocols that use VR-EBT to treat PTSD; and second, analyzing the acceptability of VR-EBT. METHOD: We performed a replica search with descriptors and databases used in two previous reviews and updated to April 2015. Next, we carried out an evaluation of the efficacy, adequacy, and acceptability of VR-EBT protocols. RESULTS: Results showed that VR-EBT was effective in the treatment of PTSD. The findings related to adequacy showed that not all studies using VR-EBT reported having followed the clinical guidelines for evidence-based interventions in the treatment of PTSD. Regarding acceptability, few studies evaluated this subject. However, the findings are very promising, and patients reported high acceptability and satisfaction with the inclusion of VR in the treatment of PTSD. CONCLUSION: The main weaknesses identified in this review focus on the need for more controlled studies, the need to standardize treatment protocols using VR-EBT, and the need to include assessments of acceptability and related variables. Finally, this paper highlights some directions and future perspectives for using VR-EBT in PTSD treatment.
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VR is considered as a promising facilitator of exposure therapy for the improvement of psychological wellbeing offering opportunities to tackle mental and developmental disorders such as acute stress, PTSD, dementia, anxiety disorders and ASD.
“VR is considered as a promising facilitator of exposure therapy for the improvement of psychological wellbeing offering opportunities to tackle mental and developmental disorders such as acute stress (Serino et al., 2014), PTSD (Botella et al., 2015; Rizzo et al., 2015), dementia (Garcia-Betances et al., 2015), anxiety disorders (Diemer et al., 2014) and ASD (Grynszpan et al., 2014; Maskey et al.,”
From iSenseVR: bringing VR exposure therapy outside the laboratory (2019) · cites this paper as Botella et al., 2015
VR exposure therapy has demonstrated to be at least as effective as conventional exposure therapy for certain types of disorders.
“It has demonstrated to be at least as effective as conventional exposure therapy for certain types of disorders (Morina et al., 2015; Botella et al., 2015).”
From iSenseVR: bringing VR exposure therapy outside the laboratory (2019) · cites this paper as Botella et al., 2015
VR-assisted therapies offer numerous benefits for the clinician and the patient, including availability, potential for being used in a more ecological way, and possibility of molding the virtual environment according to the specific pathology and needs of the patient.
“VR-assisted therapies offer numerous benefits, both for the clinician and the patient, highlighted by most authors cited in this paper, such as: availability, the potential of being used in a more ecological way, and the possibility of molding the virtual environment according to the specific pathology and needs of the patient (Aminov et al., 2018; Botella et al., 2015; Clu”
From Virtual reality and psychedelics for the treatment of psychiatric disease: A systematic literature review (2020) · cites this paper as Botella et al., 2015
The effects of VR interventions on treatment attrition remained unclear, with some speculation of possible superiority, but no assessment in a meta-analysis.
“The effects of VR interventions on treatment attrition remained unclear, with some speculation of possible superiority1,5,8, but no assessment in a meta-analysis.”
From The effectiveness of virtual reality based interventions for symptoms of anxiety and depression: A meta-analysis (2018) · cites this paper as [8]
These findings contradict previous speculation of possible comparative benefit of VR-enhanced interventions.
“These findings contradict previous speculation of possible comparative benefit1,5,8.”
From The effectiveness of virtual reality based interventions for symptoms of anxiety and depression: A meta-analysis (2018) · cites this paper as [8]
Emerging approaches like artificial intelligence, natural language processing, and virtual reality create entirely new ways to intervene.
“New technologies and methods, such as artificial intelligence (12), natural language processing (13), and virtual reality (14), open fundamentally new intervention paradigms.”
From Three Problems With Current Digital Mental Health Research . . . and Three Things We Can Do About Them (2017) · cites this paper as [14]
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Sekhon, M., Cartwright, M., & Francis, J. J. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2031-8 · Cited by 3,938 · see citing works
Recommendations for Good Scientific Practice and the Consumers of VR-Technology
Madary, M., & Metzinger, T. K. (2016) · Frontiers in Robotics and AI · doi:10.3389/frobt.2016.00003 · Cited by 435 · see citing works
Riva, G., Baños, R. M., Botella, C., Mantovani, F., & Gaggioli, A. (2016) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00164 · Cited by 425 · see citing works
Self-citationMohr, D. C., Weingardt, K. R., Reddy, M., & Schueller, S. M. (2017) · Psychiatric Services · doi:10.1176/appi.ps.201600541 · Cited by 365 · see citing works
Virtual reality therapy in mental health
Emmelkamp, P. M. G., & Meyerbröker, K. (2021) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-081219-115923 · Cited by 363 · see citing works
Birckhead, B., Khalil, C., Liu, X., Conovitz, S., Rizzo, A., Danovitch, I., Bullock, K., & Spiegel, B. (2019) · JMIR Mental Health · doi:10.2196/11973 · Cited by 372 · see citing works
Is clinical virtual reality ready for primetime?
Rizzo, A. “., & Koenig, S. T. (2017) · Neuropsychology · doi:10.1037/neu0000405 · Cited by 372 · see citing works
Appel, L., Appel, E., Bogler, O., Wiseman, M., Cohen, L., Ein, N., Abrams, H. B., & Campos, J. L. (2020) · Frontiers in Medicine · doi:10.3389/fmed.2019.00329 · Cited by 332 · see citing works
Yu, C.-P., Lee, H., & Luo, X.-Y. (2018) · Urban forestry & urban greening · doi:10.1016/j.ufug.2018.08.013 · Cited by 318 · see citing works
Fodor, L. A., Coteț, C. D., Cuijpers, P., Szamoskozi, Ș., David, D., & Cristea, I. A. (2018) · Scientific Reports · doi:10.1038/s41598-018-28113-6 · Cited by 284 · see citing works
Virtual reality applications toward medical field
Javaid, M., & Haleem, A. (2019) · Clinical Epidemiology and Global Health · doi:10.1016/j.cegh.2019.12.010 · Cited by 272 · see citing works
Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD
Rizzo, A. ‘., & Shilling, R. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2017.1414560 · Cited by 241 · see citing works
Virtual reality in psychiatric disorders: A systematic review of reviews
Cieślik, B., Mazurek, J., Rutkowski, S., Kiper, P., Turolla, A., & Szczepańska-Gieracha, J. (2020) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2020.102480 · Cited by 240 · see citing works
A Systematic Review of a Virtual Reality System from the Perspective of User Experience
Kim, Y. M., Rhiu, I., & Yun, M. H. (2019) · International Journal of Human-Computer Interaction · doi:10.1080/10447318.2019.1699746 · Cited by 238 · see citing works
Virtual reality in the diagnostic and therapy for mental disorders: A systematic review
Wiebe, A., Kannen, K., Selaskowski, B., Mehren, A., Thöne, A.-K., Pramme, L., Blumenthal, N., Li, M., Asché, L., Jonas, S., et al. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102213 · Cited by 223 · see citing works
Virtual reality for supporting the treatment of depression and anxiety: scoping review
Baghaei, N., Chitale, V., Hlasnik, A., Stemmet, L., Liang, H.-N., & Porter, R. (2021) · JMIR Mental Health · doi:10.2196/29681 · Cited by 197 · see citing works
“VR applications and VRETs have also been shown to be effective in the treatment of a variety of other mental health conditions, such as specific phobias (acrophobia and arachnophobia) or social anxiety disorder (SAD), autism, panic disorder, posttraumatic stress disorder, substance abuse, or addiction disorders (alcoh…”
BackgroundSocial Interaction With Agents and Avatars in Immersive Virtual Environments: A Survey
Kyrlitsias, C., & Michael‐Grigoriou, D. (2022) · Frontiers in Virtual Reality · doi:10.3389/frvir.2021.786665 · Cited by 224 · see citing works
A Framework for the Testing and Validation of Simulated Environments in Experimentation and Training
Harris, D., Bird, J. M., Smart, P. A., Wilson, M., & Vine, S. J. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.00605 · Cited by 213 · see citing works
Navarro-Haro, M. V., Modrego-Alarcón, M., Hoffman, H. G., López-Montoyo, A., Navarro-Gil, M., Montero-Marin, J., García-Palacios, A., Borao, L., & García-Campayo, J. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00055 · Cited by 189 · see citing works
“Similarly, patients with Post-traumatic Stress Disorder (PTSD) are much more likely to seek VR exposure therapy for PTSD compared to conventional exposure therapy for PTSD (Botella et al., 2015).”
BackgroundSelf-citationVirtual Reality-Enhanced Extinction of Phobias and Post-Traumatic Stress
Maples‐Keller, J. L., Yasinski, C. W., Manjin, N., & ROTHBAUM, B. O. (2017) · Neurotherapeutics · doi:10.1007/s13311-017-0534-y · Cited by 190 · see citing works
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Development and evaluation of a trauma decision-making simulator in Oculus virtual reality
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Virtual Reality Aided Therapy towards Health 4.0: A Two-Decade Bibliometric Analysis
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Advances in the use of virtual reality to treat mental health conditions
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Virtual Reality for the Enhancement of Emotion Regulation
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Self-citationVirtual reality in the assessment, understanding, and treatment of mental health disorders
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“…their attention on the mindfulness skills exercise in VR. VR could also potentially contribute to treatment efficacy via generalization of learned skills to real life practice (Swan et al., in press) and may increase patient acceptance of therapy (Garcia-Palacios et al., 2007b; Botella et al., 2015).”
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Predictive processing and the varieties of psychological trauma
Wilkinson, S., Dodgson, G., & Meares, K. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.01840 · Cited by 91 · see citing works
Fear and loathing in VR: the emotional and physiological effects of immersive games
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Virtual Reality in Higher Education
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Application of virtual reality for crew mental health in extended-duration space missions
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Occupational therapy in the Fourth Industrial Revolution
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Does virtual reality reduce pain in pediatric patients? A systematic review
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Virtual reality: a use case for criminal justice practice
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Deficits in episodic memory and mental time travel in patients with post-traumatic stress disorder
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Virtual and Augmented Reality: New Frontiers for Clinical Psychology
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A Dynamic Model of Post-Traumatic Stress Disorder for Military Personnel and Veterans
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Self-citationLow – Cost Devices Used in Virtual Reality Exposure Therapy
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Clinical Results Using Virtual Reality
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Clinical Virtual Reality: Emerging Opportunities for Psychiatry
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Self-citationVirtual Reality Applications for the Assessment and Treatment of PTSD
Rizzo, A., Roy, M. J., Hartholt, A., Costanzo, M. E., Highland, K. B., Jovanović, T., Norrholm, S. D., Reist, C., ROTHBAUM, B. O., & Difede, J. (2017) · Springer eBooks · doi:10.1007/978-3-319-66192-6_27 · Cited by 37 · see citing works
Application of Virtual Reality Technology in Disaster Medicine
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Virtual Trauma Interventions for the Treatment of Post-traumatic Stress Disorders: A Scoping Review
Knaust, T., Felnhofer, A., Kothgassner, O. D., Höllmer, H., Gorzka, R.-J., & Schulz, H. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.562506 · Cited by 39 · see citing works
Spatial and attentional aftereffects of virtual reality and relations to cybersickness
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Reconstructing Personal Stories in Virtual Reality as a Mechanism to Recover the Self
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Virtual Reality for Anxiety Disorders: Rethinking a Field in Expansion
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What can virtual reality offer to stroke patients? A narrative review of the literature
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Self-citationA bibliometric analysis of metaverse technologies in healthcare services
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Virtual reality as a platform for research in gambling behaviour
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Therapeutic virtual reality in prison: Participatory design with incarcerated women
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Meditating in Virtual Reality 2: Phenomenology of Vividness, Egocentricity and Absorption-Immersion
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Seeing creativity in an augmented experiential learning environment
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Assessment of OLED Head Mounted Display for Vision Research with Virtual Reality
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Positive Technologies for Improving Health and Well-Being
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Enhancing Prolonged Exposure therapy for PTSD using physiological biomarker-driven technology
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A Virtual Home for the Virtual Clinical Trial
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Self-citationEffective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders
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Virtual reality as a psychotherapeutic tool: current uses and limitations
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Virtual reality applications for chronic conditions management: A review.
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From Combat to COVID-19 – Managing the Impact of Trauma Using Virtual Reality
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Virtual Reality and Other Realities
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The academic–industrial complex: navigating the translational and cultural divide
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Enhancing Agency in Posttraumatic Stress Disorder Therapies Through Sensorimotor Technologies
Adrien, V., Bosc, N., Peccia-Galletto, C., Diot, T., Claverie, D., Reggente, N., Trousselard, M., Bui, É., Baubet, T., & Schoeller, F. (2024) · Journal of Medical Internet Research · doi:10.2196/58390 · Cited by 15 · see citing works
- Authors
- Botella, C., Serrano, B., baños, R., & García-Palacios, A.
- Affiliations
- Universitat Jaume I (ES)
- Universitat de València (ES)
- Corresponding author
- Botella, Cristina
- Venue
- Neuropsychiatric Disease and Treatment
- Publisher
- Informa UK Limited
- Published
- 2015-10
- Volume
- 11
- Pages
- 2533
- ISSN
- 1176-6328 (ISSN-L)
- 1178-2021
- PMC
- PMC4599639
- OpenAlex
- W2163457548
- Cited by
- 223
- References
- 86
- Citations by year
- 2026: 12 · 2025: 19 · 2024: 30 · 2023: 19 · 2022: 13 · 2021: 26 · 2020: 28 · 2019: 26 · 2018: 22 · 2017: 18 · 2016: 8 · 2015: 1
- FWCI
- 2.36
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Neuropsychiatric Disease and Treatment (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Repositori UJI (Universitat Jaume I) (acceptedVersion, cc-by-nc)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by-nc)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- post-traumatic stress disorder, virtual reality exposure therapy, prolonged exposure therapy, treatment efficacy, acceptability, patient satisfaction
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.
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 ›
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