Virtual Reality Exposure Therapy for Anxiety Disorders: Small Samples and No Controls?
Open accessAbstract
OPINION article Front. Psychol., 11 March 2016Sec. Psychology for Clinical Settings Volume 7 - 2016 | https://doi.org/10.3389/fpsyg.2016.00326
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
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?
Concerns have been raised about research quality of trials examining VR exposure therapy for anxiety disorders, primarily reliance on small samples and no or questionable control conditions.
“Concerns have been raised about research quality of trials examining VR exposure therapy for anxiety disorders, primarily the reliance on small samples, and no or questionable control conditions (Page and Coxon 2016).”
From Better, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy (2021) · cites this paper as Page and Coxon 2016
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. (2012) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1359 · Cited by 2,947 · cited 1× · see citing works
“The lower prevalence of individuals developing PTSD than specific phobias (Kessler et al., 2012) means a smaller population of potential participants for studies.”
BackgroundParsons, T. D., & Rizzo, A. A. (2008) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2007.07.007 · Cited by 994 · see citing works
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 · see citing works
Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia
(1995) · American Journal of Psychiatry · doi:10.1176/ajp.152.4.626 · Cited by 694 · see citing works
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 · see citing works
A controlled study of virtual reality exposure therapy for the fear of flying.
Rothbaum, B. O., Hodges, L., Smith, S., Lee, J. H., & Price, L. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.6.1020 · Cited by 501 · see citing works
Virtual reality in the treatment of spider phobia: a controlled study
Garcia-Palacios, A., Hoffman, H., Carlin, A., Furness, T. A., & Botella, C. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00068-7 · Cited by 490 · see citing works
Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia
Emmelkamp, P. M. G., Krijn, M., Hulsbosch, A. M., de Vries, S., Schuemie, M. J., & van der Mast, C. A. P. G. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(01)00023-7 · Cited by 475 · see citing works
Morina, N., Ijntema, H., Meyerbröker, K., & Emmelkamp, P. M. G. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.08.010 · Cited by 439 · cited 2× · see citing works
“…the evidence base is weakened by three key methodological limitations: the use of small sample sizes (e.g., McLay et al., 2014; Castro et al., 2014; Morina et al., 2015); a lack of appropriate control groups (e.g., Nelson, 2012; McCann et al., 2014); and, more broadly, a lack of randomized…”
BackgroundVirtual reality exposure therapy for PTSD Vietnam veterans: A case study
Rothbaum, B. O., Hodges, L., Alarcon, R., Ready, D., Shahar, F., Graap, K., Pair, J., Hebert, P., Gotz, D., Wills, B., et al. (1999) · Journal of Traumatic Stress · doi:10.1023/a:1024772308758 · Cited by 328 · see citing works
Virtual reality exposure in the treatment of panic disorder and agoraphobia: A controlled study
Botella, C., García‐Palacios, A., Villa, H., Baños, R. M., Quero, S., Alcañiz, M., & Riva, G. (2007) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.524 · Cited by 242 · see citing works
McLay, R. N., Wood, D. P., Webb-Murphy, J. A., Spira, J. L., Wiederhold, M. D., Pyne, J. M., & Wiederhold, B. K. (2011) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2011.0003 · Cited by 211 · see citing works
Virtual reality therapy for anxiety disorders: Advances in evaluation and treatment.
Wiederhold, B. K., & Wiederhold, M. D. (2005) · doi:10.1037/10858-000 · Cited by 199 · see citing works
Coping responses and posttraumatic stress symptomatology in urban fire service personnel
Beaton, R. D., Murphy, S. A., Johnson, C., Pike, K., & Corneil, W. (1999) · Journal of Traumatic Stress · doi:10.1023/a:1024776509667 · Cited by 162 · see citing works
Effectiveness of virtual reality exposure in the treatment of arachnophobia using 3D games
Bouchard, S., Côté, S., St-Jacques, J., Robillard, G., & Renaud, P. (2006) · Technology and Health Care · doi:10.3233/thc-2006-14103 · Cited by 156 · see citing works
McCann, R. A., Armstrong, C. M., Skopp, N. A., Edwards-Stewart, A., Smolenski, D. J., June, J. D., Metzger-Abamukong, M., & Reger, G. M. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.05.010 · Cited by 134 · see citing works
Effectiveness of Virtual Environment Desensitization in the Treatment of Agoraphobia
North, M. M., North, S. M., & Coble, J. R. (1996) · PRESENCE Virtual and Augmented Reality · doi:10.1162/pres.1996.5.3.346 · Cited by 127 · see citing works
Efficacy of a One-Session Virtual Reality Exposure Treatment for Fear of Flying
Mühlberger, A., Wiedemann, G., & Pauli, P. (2003) · Psychotherapy Research · doi:10.1093/ptr/kpg030 · Cited by 125 · see citing works
Ready, D. J., Gerardi, R. J., Burridge, A. B., Mascaro, N., & ROTHBAUM, B. O. (2010) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2009.0239 · Cited by 103 · see citing works
Côté, S., & Bouchard, S. (2005) · Applied Psychophysiology and Biofeedback · doi:10.1007/s10484-005-6379-x · Cited by 101 · see citing works
A controlled study of agoraphobia and the independent effect of virtual reality exposure therapy
Malbos, E., Rapee, R. M., & Kavakli, M. (2013) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867412453626 · Cited by 91 · see citing works
Mühlberger, A., Weik, A., Pauli, P., & Wiedemann, G. (2005) · Psychotherapy Research · doi:10.1080/10503300500090944 · Cited by 68 · see citing works
VR PTSD Exposure Therapy Results with Active Duty OIF/OEF Combatants
Rizzo, A., JoAnn, D., ROTHBAUM, B. O., Johnston, S. L., McLay, R. N., Reger, G. M., Gahm, G., Parsons, T. D., Graap, K. M., & Pair, J. (2009) · Studies in health technology and informatics · doi:10.3233/978-1-58603-964-6-277 · Cited by 65 · see citing works
Brown, N. B., & Bruce, S. E. (2015) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000082 · Cited by 65 · see citing works
Castro, W. P., Sánchez, M. J. R., González, C. T. P., Pérez, J. M. B., Portero, J. A. D. L. F., & Marco, R. G. (2013) · International Journal of Clinical and Health Psychology · doi:10.1016/s1697-2600(14)70032-8 · Cited by 57 · see citing works
Peñate, W., Pitti, C. T., Pérez, J. M. B., de la Fuente, J., & Gracia, R. (2008) · DOAJ (DOAJ: Directory of Open Access Journals) · Cited by 51 · see citing works
Virtual Reality Exposure for Veterans with Posttraumatic Stress Disorder
Ready, D. J., Pollack, S. J., ROTHBAUM, B. O., & Alarcón, R. D. (2006) · Journal of Aggression Maltreatment & Trauma · doi:10.1300/j146v12n01_11 · Cited by 48 · see citing works
Effect of Virtual Reality PTSD Treatment on Mood and Neurocognitive Outcomes
McLay, R. N., Ram, V., Murphy, J. L., Spira, J. L., Wood, D. P., Wiederhold, M. D., Wiederhold, B. K., Johnston, S. L., & Reeves, D. (2014) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2013.0383 · Cited by 45 · see citing works
Pélissolo, A., Zaoui, M., Aguayo, G., Yao, S. N., Roche, S., Écochard, R., Gueyffier, F., Pull, C., Berthoz, A., Jouvent, R., et al. (2012) · HAL · Cited by 38 · see citing works
Nelson, R. J. (2012) · Traumatology An International Journal · doi:10.1177/1534765612459891 · Cited by 19 · see citing works
Williford, J. S., Hodges, L. F., North, M. M., & North, S. M. (1993) · Proceedings · doi:10.20380/gi1993.21 · Cited by 2 · see citing works
Randomized Controlled Trial of CBT with Virtual Reality Exposure Therapy for PTSD
Roy, M., Law, W., Patt, I. S., Difede, J., Rizzo, A., Graap, K., & ROTHBAUM, B. O. (2006) · PsycEXTRA Dataset · doi:10.1037/e695432011-005 · Cited by 1 · see citing works
Flagged first, then by citations
1 of the 33 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Lamson R. Meisner M. (1994). The effects of virtual reality immersion in the treatment of anxiety, panic and phobia of heights, in Proceedings of the 2nd Annual Conference on Virtual Reality and Persons With Disabilities, ed Murphy H. (Northridge, CA: California State University, Northridge), 63– 68.
Cited by
Sorted by citations
The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders
Maples-Keller, J. L., Bunnell, B. E., Kim, S.-J., & Rothbaum, B. O. (2017) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000138 · Cited by 862 · see citing works
“Lahiri and colleagues 101 found preliminary evidence for the use of a VR-based computer task in improving social communication performance in autistic teenagers.”
BackgroundRecent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review
Botella, C., Fernández-Álvarez, J., Guillén, V., García-Palacios, A., & Baños, R. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0788-4 · Cited by 460 · see citing works
Lindner, P., Miloff, A., Hamilton, W., Reuterskiöld, L., Andersson, G., Powers, M. B., & Carlbring, P. (2017) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2017.1280843 · Cited by 187 · see citing works
Miloff, A., Lindner, P., Dafgård, P., Deak, S., Garke, M., Hamilton, W., Heinsoo, J., Kristoffersson, G., Rafi, J., Sindemark, K., et al. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.04.004 · Cited by 155 · see citing works
Better, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy
Lindner, P. (2021) · International Journal of Cognitive Therapy · doi:10.1007/s41811-020-00090-7 · Cited by 120 · see citing works
Pilot randomized trial of self-guided virtual reality exposure therapy for social anxiety disorder
Zainal, N. H., Chan, W. W., Saxena, A. P., Taylor, C. B., & Newman, M. G. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.103984 · Cited by 84 · see citing works
Deterioration rates in Virtual Reality Therapy: An individual patient data level meta-analysis
Fernández-Álvarez, J., Rozental, A., Carlbring, P., Colombo, D., Riva, G., Anderson, P. L., Baños, R. M., Benbow, A. A., Bouchard, S., Bretón-López, J. M., et al. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2018.06.005 · Cited by 79 · see citing works
Lindner, P., Dagöö, J., Hamilton, W., Miloff, A., Andersson, G., Schill, A., & Carlbring, P. (2020) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2020.1795240 · Cited by 84 · see citing works
Lanier, M., Waddell, T. F., Elson, M., Tamul, D. J., Ivory, J., & Przybylski, A. K. (2019) · Computers in Human Behavior · doi:10.1016/j.chb.2019.06.015 · Cited by 75 · see citing works
Ma, L., Mor, S., Anderson, P. L., Baños, R., Botella, C., Bouchard, S., Cárdenas‐López, G., Donker, T., Fernández‐Álvarez, J., Lindner, P., et al. (2021) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2021.1939410 · Cited by 46 · see citing works
Fowler, C. A., Ballistrea, L. M., Mazzone, K. E., Martin, A. M., Kaplan, H., Kip, K. E., Ralston, K., Murphy, J. L., & Winkler, S. L. (2019) · JMIR Formative Research · doi:10.2196/11266 · Cited by 36 · see citing works
Virtual Reality for Anxiety Disorders: Rethinking a Field in Expansion
Fernández‐Álvarez, J., Lernia, D. D., & Riva, G. (2020) · Advances in experimental medicine and biology · doi:10.1007/978-981-32-9705-0_21 · Cited by 33 · see citing works
Scheveneels, S., Boddez, Y., Van Daele, T., & Hermans, D. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.02849 · Cited by 33 · see citing works
Wang, T.-C., Tsai, C.-L., Tang, T.-W., Wang, W.-L., & Lee, K.-T. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8070973 · Cited by 27 · see citing works
Die Entwicklung virtueller Realität als Expositionsverfahren
Diemer, J., & Zwanzger, P. (2019) · Der Nervenarzt · doi:10.1007/s00115-019-0678-6 · Cited by 20 · see citing works
Arnfred, B. T., Bang, P., Hjorthøj, C. R., Winding, C., Moeller, K. S., Hvenegaard, M., Agerskov, L., Gausbøl, U. K., Soe, D., Wiborg, P., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-051147 · Cited by 17 · see citing works
Anksiyete Bozukluklarında Sanal Gerçeklik
Üzümcü, E., Akın-Sarı, B., Nergız, H., İnözü, M., & Çelikcan, U. (2017) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.336593 · Cited by 16 · see citing works
Dhunnoo, P., Wetzlmair-Kephart, L.-C., & O’Carroll, V. (2024) · Sci · doi:10.3390/sci6020019 · Cited by 10 · see citing works
Polak, M., Tanzer, N. K., & Carlbring, P. (2022) · Campbell Systematic Reviews · doi:10.1002/cl2.1259 · Cited by 9 · see citing works
Treatment of Anxiety Disorders in the Digital Age
Blackburn, A. M., & Goetter, E. M. (2019) · Current clinical psychiatry · doi:10.1007/978-3-030-30687-8_16 · Cited by 8 · see citing works
DEMİR, M., & KÖSKÜN, T. (2023) · Psikiyatride Güncel Yaklaşımlar · doi:10.18863/pgy.1192543 · Cited by 7 · see citing works
Scheveneels, S., & Carpentier, N. (2024) · Behavior Therapy · doi:10.1016/j.beth.2024.08.004 · Cited by 7 · see citing works
Psychotherapy Using Electronic Media
Mucić, D., & Hilty, D. M. (2019) · Springer eBooks · doi:10.1007/978-3-030-24082-0_15 · Cited by 5 · see citing works
Lanier, M., Waddell, T. F., Elson, M., Tamul, D., Ivory, J., & Przybylski, A. K. (2019) · doi:10.31234/osf.io/6hk89 · Cited by 6 · see citing works
Cong, L., Cheng, S., Teng, C., Xiong, K., Huang, M., Ma, J., Hu, W., Wang, J., Dang, W., Sun, K., et al. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1560157 · Cited by 4 · see citing works
Empirische Zugänge zur Virtual Reality
Braun, H., & Frieß, R. (2018) · Springer eBooks · doi:10.1007/978-3-658-16358-7_33-1 · Cited by 4 · see citing works
Virtual Reality for Anxiety and Stress-Related Disorders: A SWOT Analysis
Fernández‐Álvarez, J., Colombo, D., Botella, C., García‐Palacios, A., & Riva, G. (2019) · Lecture notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering · doi:10.1007/978-3-030-25872-6_4 · Cited by 5 · see citing works
Dhunnoo, P., Wetzlmair-Kephart, L.-C., & O’Carroll, V. (2022) · Research Square · doi:10.21203/rs.3.rs-2330671/v1 · Cited by 3 · see citing works
Technological Interventions for Anxiety Disorders
Baños, R., Vara, M., Mira, A., García-Palacios, A., & Botella, C. (2020) · Reference Module in Neuroscience and Biobehavioral Psychology · doi:10.1016/b978-0-12-818697-8.00008-x · Cited by 2 · see citing works
Nazemi, H., Najafi, M., Hosseini, S. M., Maleki, A., & Boger, E. R. (2019) · Journal of Research in Behavioural Sciences · doi:10.52547/rbs.16.3.389 · Cited by 2 · see citing works
Tratamiento de un caso de fobia a las arañas mediante exposición multimedia y progresiva
Ruiz‐García, A. (2021) · Anuario de Psicología/The UB Journal of Psychology · doi:10.1344/anpsic2021.51/2.30971 · Cited by 2 · see citing works
Adults with Animal Phobia: Systematic Replication of Clinical Cases
Ruiz‐García, A., & Aguayo, L. V. (2022) · Behaviour Change · doi:10.1017/bec.2022.20 · Cited by 1 · see citing works
Jónsdóttir, E. K., Konop, M. A., Antonsdóttir, H. F., Skúladóttir, H., Cardenas, P., Georgsdóttir, M. T., Þórisdóttir, M. Í., Valdimarsdóttir, H. B., Vilhjálmsson, H. H., Gudjonsson, G. H., et al. (2024) · Psychology Crime and Law · doi:10.1080/1068316x.2024.2316225 · Cited by 1 · see citing works
Hossan, M. M., Tasnim, R. A., & Eishita, F. Z. (2025) · Intermountain Engineering, Technology and Computing (IETC) · doi:10.1109/ietc64455.2025.11039392 · Cited by 1 · see citing works
Darmová, B., Fajnerová, I., & Appel, L. (2026) · Technologies · doi:10.3390/technologies14050305
Metaverse-Driven Advances in Immersive VR Experiences for Behaviour Analysis and Skill Development
Gupta, N., Sharma, K., Kumar, S., & Kumar, P. (2024) · Advances in e-business research series · doi:10.4018/979-8-3693-2422-6.ch010 · Cited by 1 · see citing works
Virtualna stvarnost kao terapija mucanja
Marušić, P., & Krhen, A. L. (2022) · Hrvatska revija za rehabilitacijska istraživanja · doi:10.31299/hrri.58.1.6 · Cited by 1 · see citing works
Miranda Comprehension and Reasoning: An Investigation of Miranda Abilities in Adult Inpatients
Winningham, D. B. (2017) · doi:10.12794/metadc984150 · Cited by 1 · see citing works
Virtual Reality and Social Work
Vernon, R. F. (2022) · Oxford University Press eBooks · doi:10.1093/obo/9780195389678-0309 · Cited by 1 · see citing works
Empirische Zugänge zur Virtual Reality
Braun, H., & Frieß, R. (2020) · Springer eBooks · doi:10.1007/978-3-658-16342-6_33
马, 前., & 杨, 晓. (2019) · Theory and Practice of Psychological Counseling · doi:10.35534/tppc/0105018
Kia, A. Y., Dinarvand, A., & Vasigh, B. (2022) · Soffeh · doi:10.52547/sofeh.32.1.57
Liu, S. (2024) · Lecture notes in computer science · doi:10.1007/978-3-031-61359-3_6
She, Y., Liu, F., Yang, B., & Hu, B. (2025) · IEEE Transactions on Computational Social Systems · doi:10.1109/tcss.2025.3567776
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
Bozkurt, H. T., Brewer, B. W., Çelikcan, U., Türkçapar, M. H., & Koruç, Z. (2026) · The Sport Psychologist · doi:10.1123/tsp.2025-0127
- Authors
- Page, S., & Coxon, M.
- Affiliations
- York St John University (GB)
- Corresponding author
- Coxon, Matthew
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2016-03-11
- Volume
- 7
- Pages
- 326-326
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC4786550
- OpenAlex
- W2322216919
- Cited by
- 46
- References
- 33
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 5 · 2023: 1 · 2022: 7 · 2021: 3 · 2020: 5 · 2019: 12 · 2018: 2 · 2017: 5
- FWCI
- 9.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at York St John (York St John University) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- York St John University
- 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, small sample size, clinical trials, evidence-based practice
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