Virtual reality exposure in anxiety disorders: Impact on psychophysiological reactivity
Abstract
OBJECTIVES: Anxiety disorders are among the most frequently encountered psychiatric disorders. Recommended treatments include cognitive behavioural therapy (CBT) and/or medication. In recent years, beneficial effects of virtual reality (VR) exposure therapy have been shown, making this technique a promising addition to CBT. However, the ability of VR to mimic threatening stimuli in a way comparable to in vivo cues has been discussed. In particular, it has been questioned whether VR is capable of provoking psychophysiological symptoms of anxiety. Since psychophysiological arousal is considered a prerequisite for effective exposure treatment, this systematic review aims to evaluate the evidence for the potential of VR exposure to evoke and modulate psychophysiological fear reactions. METHODS: PubMed and PsycINFO/Academic Search Premier databases were searched. Thirty-eight studies investigating challenge or habituation effects were included. RESULTS: VR exposure does provoke psychophysiological arousal, especially in terms of electrodermal activity. Results on psychophysiological habituation in VR are inconclusive. Study design and methodological rigour vary widely. CONCLUSIONS: Despite several limitations, this review provides evidence that VR exposure elicits psychophysiological fear reactions in patients and healthy subjects, rendering VR a promising treatment for anxiety disorders, and a potent research tool for future investigations of psychophysiological processes and their significance during exposure treatment.
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Immersion and presence in VR are believed to enable triggering of strong emotional responses and more particularly the physiological components of anxiety, capable of provoking psychophysiological arousal in all individuals.
“Immersion and presence in VR are believed to enable triggering of strong emotional responses (Wilson and Soranzo, 2015; Miller and Bugnariu, 2016) and more particularly the physiological components of anxiety, capable of provoking psychophysiological arousal in all individuals (Diemer et al., 2014).”
From iSenseVR: bringing VR exposure therapy outside the laboratory (2019) · cites this paper as Diemer et al., 2014
VRET has been shown to be effective for flying phobia treatment in several meta-analyses and systematic reviews.
“VRET has been shown to be effective for FP treatment in several meta-analyses and systematic reviews [28–31].”
From An Internet-based treatment for flying phobia (NO-FEAR Airlines): Study protocol for a randomized controlled trial (2016) · cites this paper as [28]
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“This presence has also been identified as a crucial facilitator of VR’s potential to evoke behavioural (Slater, 2009), physiological (Diemer et al., 2014; Halbig & Latoschik, 2021) and affective (Somarathna et al., 2022) responses resembling those observable in real life – even when the virtual is…”
- Authors
- Diemer, J., Mühlberger, A., Pauli, P., & Zwanzger, P.
- Affiliations
- University Hospital Münster (DE)
- University of Regensburg (DE)
- University of Würzburg (DE)
- Corresponding author
- Diemer, Julia
- Venue
- The World Journal of Biological Psychiatry
- Publisher
- Informa UK Limited
- Published
- 2014-03-25
- Volume
- 15
- Issue
- 6
- Pages
- 427-442
- ISSN
- 1562-2975 (ISSN-L)
- 1814-1412
- OpenAlex
- W2093057972
- Cited by
- 146
- References
- 66
- Citations by year
- 2026: 15 · 2025: 12 · 2024: 12 · 2023: 13 · 2022: 15 · 2021: 15 · 2020: 13 · 2019: 20 · 2018: 8 · 2017: 4 · 2016: 13 · 2015: 5
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The World Journal of Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Deutsche Forschungsgemeinschaft
- H2020 European Research Council
- 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, anxiety disorders, psychophysiological arousal, fear conditioning, electrodermal activity, habituation, cognitive behavioral therapy, virtual reality exposure, threat simulation
- MeSH terms
- Anxiety Disorders, Humans, Virtual Reality Exposure Therapy
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