The DOI matches its Crossref record; 66 of the 66 references it cites were found in a registry or an index.
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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
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?
In the citing paper
“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
In the citing paper
“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]
Citations
Cites
Emotional processing of fear: Exposure to corrective information.
Foa, E. B., & Kozak, M. J. (1986) · Psychological Bulletin · doi:10.1037/0033-2909.99.1.20 · Cited by 5,396
The size and burden of mental disorders and other disorders of the brain in Europe 2010
Wittchen, H. U., Jacobi, F., Rehm, J., Gustavsson, A., Svensson, M., Jönsson, B., Olesen, J., Allgulander, C., Alonso, J., Faravelli, C., et al. (2011) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2011.07.018 · Cited by 3,754
Looking at pictures: Affective, facial, visceral, and behavioral reactions
LANG, P. J., GREENWALD, M. K., BRADLEY, M. M., & HAMM, A. O. (1993) · Psychophysiology · doi:10.1111/j.1469-8986.1993.tb03352.x · Cited by 3,190
Rheingold, H. (1991) · Cited by 1,804
Cost of disorders of the brain in Europe 2010
Gustavsson, A., Svensson, M., Jacobi, F., Allgulander, C., Alonso, J., Beghi, E., Dodel, R., Ekman, M., Faravelli, C., Fratiglioni, L., et al. (2011) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2011.08.008 · Cited by 1,723
Fear and anxiety: Animal models and human cognitive psychophysiology
Lang, P. J., Davis, M., & Öhman, A. (2000) · Journal of Affective Disorders · doi:10.1016/s0165-0327(00)00343-8 · Cited by 1,162
Bradley, M. M., & Lang, P. J. (2009) · Cambridge University Press eBooks · doi:10.1017/cbo9780511546396.025 · Cited by 1,071
Ressler, K. J., Rothbaum, B. O., Tannenbaum, L., Anderson, P., Graap, K., Zimand, E., Hodges, L., & Davis, M. (2004) · Archives of General Psychiatry · doi:10.1001/archpsyc.61.11.1136 · Cited by 1,063
Neural organization of the defensive behavior system responsible for fear
Fanselow, M. S. (1994) · Psychonomic Bulletin & Review · doi:10.3758/bf03210947 · Cited by 1,000
Virtual reality exposure therapy for anxiety disorders: A meta-analysis
Powers, M. B., & Emmelkamp, P. M. G. (2008) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2007.04.006 · Cited by 904
Bandelow, B., Zohar, J., Hollander, E., Kasper, S., Möller, H., & WFSBP Task Force on Treatment Guide (2008) · The World Journal of Biological Psychiatry · doi:10.1080/15622970802465807 · Cited by 887
Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis
Opriş, D., Pintea, S., García-Palacios, A., Botella, C., Szamosközi, Ş., & David, D. (2012) · Depression and Anxiety · doi:10.1002/da.20910 · Cited by 636
Treatment of specific phobia in adults
Choy, Y., Fyer, A. J., & Lipsitz, J. D. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2006.10.002 · Cited by 571 · cited 1×
“Cognitive behavioural therapy (CBT), in particular exposure therapy, has proven the most effective psychotherapeutic intervention (Choy et al. 2007; Otte 2011), with benefi cial effects in the majority of patients.”
BackgroundPhysiological measures of presence in stressful virtual environments
Meehan, M., Insko, B. E., Whitton, M. C., & Brooks, F. P. (2002) · ACM SIGGRAPH Conference (SIGGRAPH) · doi:10.1145/566570.566630 · Cited by 479
Physiological measures of presence in stressful virtual environments
Meehan, M., Insko, B. E., Whitton, M. C., & Brooks, F. P. (2002) · ACM Transactions on Graphics · doi:10.1145/566654.566630 · Cited by 474
A psychophysiological analysis of fear modification using an automated desensitization procedure
Lang, P. J., Melamed, B. G., & Hart, J. (1970) · Journal of Abnormal Psychology · doi:10.1037/h0029875 · Cited by 463
Garcia-Palacios, A., Botella, C., Hoffman, H., & Fabregat, S. (2007) · CyberPsychology & Behavior · doi:10.1089/cpb.2007.9962 · Cited by 410 · cited 1×
“The following variables were collected: type of analysis (challenge or habituation), indication (anxiety disorder or type of stressor used), type of sample (clinical, fearful, healthy), sample size, (Garcia-Palacios et al. 2007).”
MethodMcNally, R. J. (2007) · Clinical Psychology Review · doi:10.1016/j.cpr.2007.01.003 · Cited by 348
Non-adherence and non-response in the treatment of anxiety disorders
Taylor, S., Abramowitz, J. S., & McKay, D. (2012) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.02.010 · Cited by 317
Brief Virtual Reality Therapy for Public Speaking Anxiety
Harris, S. R., Kemmerling, R. L., & North, M. M. (2002) · CyberPsychology & Behavior · doi:10.1089/109493102321018187 · Cited by 314
Cognitive behavioral therapy in anxiety disorders: current state of the evidence
Otte, C. (2011) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2011.13.4/cotte · Cited by 313
Virtual reality in mental health: A review of the literature
Gregg, L., & Tarrier, N. (2007) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-007-0173-4 · Cited by 304
Relevant and irrelevant fear in flooding—A crossover study of phobic patients
Watson, J. P., & Marks, I. M. (1971) · Behavior Therapy · doi:10.1016/s0005-7894(71)80062-x · Cited by 302
Meyerbröker, K., & Emmelkamp, P. M. G. (2010) · Depression and Anxiety · doi:10.1002/da.20734 · Cited by 290
Glucocorticoids enhance extinction-based psychotherapy
de Quervain, D. J. ‐., Bentz, D., Michael, T., Bolt, O. C., Wiederhold, B. K., Margraf, J., & Wilhelm, F. H. (2011) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1018214108 · Cited by 272
An Experimental Study on Fear of Public Speaking Using a Virtual Environment
Slater, M., Pertaub, D.-P., Barker, C., & Clark, D. M. (2006) · CyberPsychology & Behavior · doi:10.1089/cpb.2006.9.627 · Cited by 239
Walshe, D. G., Lewis, E. J., Kim, S. I., O'Sullivan, K., & Wiederhold, B. K. (2003) · CyberPsychology & Behavior · doi:10.1089/109493103322011641 · Cited by 193
Repeated exposure of flight phobics to flights in virtual reality
Mühlberger, A., Herrmann, M. J., Wiedemann, G., Ellgring, H., & Pauli, P. (2001) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(00)00076-0 · Cited by 187
Self-citationPossible mechanisms for why desensitization and exposure therapy work
Tryon, W. W. (2004) · Clinical Psychology Review · doi:10.1016/j.cpr.2004.08.005 · Cited by 180
Neuropeptide S receptor gene — converging evidence for a role in panic disorder
Domschke, K., Reif, A., Weber, H., Richter, J., Hohoff, C., Ohrmann, P., Pedersen, A., Bauer, J., Suslow, T., Kugel, H., et al. (2010) · Molecular Psychiatry · doi:10.1038/mp.2010.81 · Cited by 174
Self-citationJönsson, P., Wallergård, M., Österberg, K., Hansen, Å. M., Johansson, G. I., & Karlson, B. (2010) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2010.04.003 · Cited by 168
Wiederhold, B. K., Jang, D. P., Gevirtz, R. G., Kim, S. I., Kim, I. Y., & Wiederhold, M. D. (2002) · IEEE Transactions on Information Technology in Biomedicine · doi:10.1109/titb.2002.802378 · Cited by 150
Villani, D., Repetto, C., Cipresso, P., & Riva, G. (2012) · Interacting with Computers · doi:10.1016/j.intcom.2012.04.008 · Cited by 143 · cited 2×
“…x 26 Orman (2003) Performance anxiety Case study x x 8 Orman (2004) Performance anxiety Case study x 3 Simeonov et al. (2005) Height Crossover x 24 Villani et al. (2012) Social stress test Crossover x 20 Wiederhold et al. (2005) Hospital/Injection Randomized x 20 Ch., Challenge; Hab., Habituation.”
BackgroundInfluence of real and virtual heights on standing balance
Cleworth, T. W., Horslen, B. C., & Carpenter, M. G. (2012) · Gait & Posture · doi:10.1016/j.gaitpost.2012.02.010 · Cited by 136
Physiological Monitoring as an Objective Tool in Virtual Reality Therapy
Wiederhold, B. K., Jang, D. P., Kim, S. I., & Wiederhold, M. D. (2002) · CyberPsychology & Behavior · doi:10.1089/109493102753685908 · Cited by 122
Borkovec, T. D., & Sides, J. K. (1979) · Behaviour Research and Therapy · doi:10.1016/0005-7967(79)90096-2 · Cited by 116
Virtual Social Interactions in Social Anxiety—The Impact of Sex, Gaze, and Interpersonal Distance
Wieser, M. J., Pauli, P., Grosseibl, M., Molzow, I., & Mühlberger, A. (2010) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2009.0432 · Cited by 115
Self-citationPsychosocial Stress Evoked by a Virtual Audience: Relation to Neuroendocrine Activity
Kelly, O., Matheson, K., Martinez, A., Merali, Z., & Anisman, H. (2007) · CyberPsychology & Behavior · doi:10.1089/cpb.2007.9973 · Cited by 112
Cornwell, B. R., Johnson, L., Berardi, L., & Grillon, C. (2006) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.09.015 · Cited by 103
Analysis of Physiological Response to Two Virtual Environments: Driving and Flying Simulation
Jang, D. P., Kim, I. Y., Nam, S. W., Wiederhold, B. K., Wiederhold, M. D., & Kim, S. I. (2002) · CyberPsychology & Behavior · doi:10.1089/109493102753685845 · Cited by 102
Mühlberger, A., Bülthoff, H., Wiedemann, G., & Pauli, P. (2007) · Psychological Assessment · doi:10.1037/1040-3590.19.3.340 · Cited by 101
Self-citationSocially Anxious and Confident Men Interact with a Forward Virtual Woman: An Experimental Study
Pan, X., Gillies, M. F. P., Barker, C., Clark, D. M., & Slater, M. (2012) · PLoS ONE · doi:10.1371/journal.pone.0032931 · Cited by 96
Panic and Agoraphobia in a Virtual World
Moore, K., Wiederhold, B. K., Wiederhold, M. D., & Riva, G. (2002) · CyberPsychology & Behavior · doi:10.1089/109493102760147178 · Cited by 92
Wilhelm, F. H., Pfaltz, M. C., Gross, J. J., Mauss, I. B., Kim, S. I., & Wiederhold, B. K. (2005) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-005-6383-1 · Cited by 81
Fear of Flying: A Case Report Using Virtual Reality Therapy with Physiological Monitoring
Wiederhold, B. K., Gevirtz, R., & Wiederhold, M. D. (1998) · CyberPsychology & Behavior · doi:10.1089/cpb.1998.1.97 · Cited by 79
Ling, Y., Brinkman, W.-P., Nefs, H. T., Qu, C., & Heynderickx, I. (2012) · Presence: Teleoperators and Virtual Environments · doi:10.1162/pres_a_00111 · Cited by 74
Height Effects in Real and Virtual Environments
Simeonov, P. I., Hsiao, H., DotsonM, B. W., & Ammons, D. E. (2005) · Human Factors The Journal of the Human Factors and Ergonomics Society · doi:10.1518/0018720054679506 · Cited by 73
Physiological response to a speech stressor presented in a virtual reality environment.
Kotlyar, M. E., Donahue, C. B., Thuras, P., Kushner, M., O'Gorman, N., Smith, E., & Adson, D. (2008) · Psychophysiology · doi:10.1111/j.1469-8986.2008.00690.x · Cited by 70
Measuring emotion in therapy: Imagery, activation, and feeling
Lang, P. J., Cuthbert, B. N., & Bradley, M. M. (1998) · Behavior Therapy · doi:10.1016/s0005-7894(98)80024-5 · Cited by 68
Current status of virtual reality exposure therapy in anxiety disorders: editorial review.
Pull, C. B. (2005) · PubMed · Cited by 66
Mühlberger, A., Wieser, M. J., & Pauli, P. (2007) · Biological Psychology · doi:10.1016/j.biopsycho.2007.09.004 · Cited by 63
Self-citationVirtual reality as a mechanism for exposure therapy
de Carvalho, M. R., Freire, R. C. R., & Nardi, A. E. (2010) · The World Journal of Biological Psychiatry · doi:10.3109/15622970802575985 · Cited by 60
(1998) · PubMed · Cited by 59
Alpers, G. W., & Sell, R. (2007) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2007.11.009 · Cited by 52
Virtual reality applications for exposure
Bouchard, S., Côté, S., & Richard, D. C. S. (2007) · Elsevier eBooks · doi:10.1016/b978-012587421-2/50017-x · Cited by 46
Effect of Virtual Reality Graded Exposure on Anxiety Levels of Performing Musicians: A Case Study
Orman, E. K. (2004) · Journal of Music Therapy · doi:10.1093/jmt/41.1.70 · Cited by 43
Cornwell, B., Heller, R., Biggs, A. L., Pine, D., & Grillon, C. (2010) · Journal of Clinical Psychiatry · doi:10.4088/jcp.09m05731blu · Cited by 40
ROTHBAUM, B. O., Ruef, A. M., Litz, B. T., Han, H., & Hodges, L. F. (2003) · Journal of Cognitive Psychotherapy · doi:10.1891/jcop.17.2.163.57438 · Cited by 38
Orman, E. K. (2003) · Journal of Research in Music Education · doi:10.2307/3345657 · Cited by 35
Argyropolous, S., Feeney, A., & Nutt, D. (2001) · CRC Press eBooks · doi:10.3109/9780203215418-13 · Cited by 29
Donahue, C. B., Kushner, M. G., THURAS, P. D., Murphy, T. G., Demark, J. V., & Adson, D. E. (2008) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2008.12.004 · Cited by 27
Anxiogenic properties of a computer simulation for panic disorder with agoraphobia
Freire, R. C. R., de Carvalho, M. R., Joffily, M., Zin, W. A., & Nardi, A. E. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.12.031 · Cited by 25
Stimulation of Cortisol During Mental Task Performance in a Provocative Virtual Environment
Bullinger, A. H., Hemmeter, U., Stefani, O., Angehrn, I., Müller-Spahn, F., Bekiaris, E. D., Wiederhold, B. K., Sulzenbacher, H., & Mager, R. (2005) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-005-6378-y · Cited by 22
The Use of VR Exposure in the Treatment of Motor Vehicle PTSD: A Case-report
Saraiva, T., Gamito, P. S., Oliveira, J., Morais, D., Pombal, M., Gamito, L., & Anastacio, M. (2007) · Annual review of Cybertherapy and Telemedicine · Cited by 14
Bullinger, A. H., ROESSLER, A., & Mueller-Spahn, F. (1998) · CyberPsychology & Behavior · doi:10.1089/cpb.1998.1.139 · Cited by 12
Mühlberger, A., Petrusek, S., Herrmann, M. J., & Pauli, P. (2005) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443.34.2.133 · Cited by 12
Self-citation
Flagged first, then by citations
Research works printed but not linked: 9
- Cloos JM, 2005, Curr Opin Psychiatry, 18, 45
- Gamito P, 2007, Annu Rev CyberTherapy Telemed, 5, 191
- Mühlberger A, 2005, Annu Rev CyberTherapy Telemed, 3, 185
- Mühlberger A, 2008, J CyperTherapy Rehabil, 1, 147
- Orman EK, 2003, JRME, 51, 302
- Pull CB, 2005, Curr Opin Psychiatry, 18, 7
- Saraiva T, 2007, Annu Rev Cyber Therapy Telemed, 5, 199
- Wiederhold BK, 1998, Stud Health Technol Inform, 58, 52
- Wiederhold BK, 2005, Annu Rev CyberTherapy Telemed, 3, 109
Cited by
Sorted by citations
Diemer, J., Alpers, G. W., Peperkorn, H. M., Shiban, Y., & Mühlberger, A. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00026 · Cited by 959
Self-citationPhilippe, T. J., Sikder, N., Jackson, A., Koblanski, M. E., Liow, E., Pilarinos, A., & Vasarhelyi, K. (2022) · JMIR Mental Health · doi:10.2196/35159 · Cited by 436
Riva, G., Baños, R. M., Botella, C., Mantovani, F., & Gaggioli, A. (2016) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00164 · Cited by 425
Social interactions in the metaverse: Framework, initial evidence, and research roadmap
Hennig‐Thurau, T., Aliman, D. N., Herting, A. M., Cziehso, G. P., Linder, M., & Kübler, R. V. (2022) · Journal of the Academy of Marketing Science · doi:10.1007/s11747-022-00908-0 · Cited by 496
Virtual Reality Clinical Research: Promises and Challenges
Garrett, B., Taverner, T., Gromala, D., Tao, G., Cordingley, E., & Sun, C. (2018) · JMIR Serious Games · doi:10.2196/10839 · Cited by 265
Metadata
- 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
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 ›
Are you an author, or do you see a problem with this page? Request a review
