Virtual Reality Therapy in Social Anxiety Disorder

Purpose of Review This review provides an overview of current methods and important aspects to consider when applying virtual worlds in the treatment of social anxiety disorder (SAD). Recent Findings Different aspects such as dialogs between avatars and patients have been investigated as well as virtual audiences, emotional facial expression, and verbal interaction with avatars. Results of these studies are promising. Few randomized controlled trials (RCTs) have investigated the efficacy of virtual reality exposure therapy (VRET) in SAD. Unfortunately, most RCTs into the efficacy of VRET in comparison with exposure in vivo in SAD have been conducted with a combination of cognitive interventions and VRET. No differences between these conditions were found, but the pure effect of VRET as a stand-alone treatment has only been investigated in one RCT, wherein VRET was not superior to exposure in vivo. Summary Current research into different facets of SAD and VRET has produced promising results with respect to technological aspects. No differences in efficacy between cognitive behavior therapy and VRET were found, but there is a clear need for studies investigating the efficacy of VRET as a stand-alone treatment and the therapeutic processes involved before this therapy can be disseminated in routine clinical practice.

[1]  C. Darren Piercey,et al.  The effectiveness of 3-D video virtual reality for the treatment of fear of public speaking , 2010 .

[2]  Miguel Barreda-Ángeles,et al.  Users’ psychophysiological, vocal, and self-reported responses to the apparent attitude of a virtual audience in stereoscopic 360°-video , 2019, Virtual Reality.

[3]  T. Kashdan,et al.  PSYCHOLOGICAL SCIENCE Research Article Expanding the Topography of Social Anxiety An Experience-Sampling Assessment of Positive Emotions, Positive Events, and Emotion Suppression , 2022 .

[4]  D. Kessler,et al.  Personality disorder , 2013, BMJ : British Medical Journal.

[5]  P. Pauli,et al.  Social anxiety changes the way we move—A social approach-avoidance task in a virtual reality CAVE system , 2019, PloS one.

[6]  P. Anderson,et al.  Virtual Reality and Exposure Group Therapy for Social Anxiety Disorder: Results from a 4–6 Year Follow-Up , 2017, Cognitive Therapy and Research.

[7]  Cheri A. Levinson,et al.  D-Cycloserine Augmentation of Exposure-Based Cognitive Behavior Therapy for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders: A Systematic Review and Meta-analysis of Individual Participant Data , 2017, JAMA psychiatry.

[8]  P. Kendall,et al.  Cognitive–Behavioral Therapy for Youth Anxiety: An Effectiveness Evaluation in Community Practice , 2018, Journal of consulting and clinical psychology.

[9]  H. Holling,et al.  D-cycloserine augmentation of behavior therapy for anxiety and obsessive-compulsive disorders: A meta-analysis , 2017, PloS one.

[10]  Mark B. Powers,et al.  Yohimbine Enhancement of Exposure Therapy for Social Anxiety Disorder: A Randomized Controlled Trial , 2014, Biological Psychiatry.

[11]  Stéphane Bouchard,et al.  Virtual Reality Therapy Versus Cognitive Behavior Therapy for Social Phobia: A Preliminary Controlled Study , 2005, Cyberpsychology Behav. Soc. Netw..

[12]  Isabel L. Kampmann,et al.  Meta-analysis of technology-assisted interventions for social anxiety disorder. , 2016, Journal of anxiety disorders.

[13]  Isabel L. Kampmann,et al.  Exposure to virtual social interactions in the treatment of social anxiety disorder: A randomized controlled trial. , 2016, Behaviour research and therapy.

[14]  Christian Wolff,et al.  Potential of virtual reality as a diagnostic tool for social anxiety: A pilot study , 2017, Comput. Hum. Behav..

[15]  P. Anderson,et al.  A meta-analytic examination of attrition in virtual reality exposure therapy for anxiety disorders. , 2019, Journal of anxiety disorders.

[16]  P. Anderson,et al.  Long-Term Improvements in Probability and Cost Biases Following Brief Cognitive Behavioral Therapy for Social Anxiety Disorder , 2018, Cognitive Therapy and Research.

[17]  Mark B. Powers,et al.  Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. , 2019, Journal of anxiety disorders.

[18]  A. Pelissolo,et al.  Therapeutic strategies for social anxiety disorder: where are we now? , 2019, Expert review of neurotherapeutics.

[19]  R. Graaf,et al.  The Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2): design and methods. , 2010 .

[20]  A. Wells A cognitive model of social phobia , 1995 .

[21]  Dwi Hartanto,et al.  Home-Based Virtual Reality Exposure Therapy with Virtual Health Agent Support , 2015, MindCare.

[22]  Stéphane Bouchard,et al.  Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial , 2017, British Journal of Psychiatry.

[23]  Cheri A. Levinson,et al.  Changes in Dosing and Dose Timing of D-Cycloserine Explain Its Apparent Declining Efficacy for Augmenting Exposure Therapy for Anxiety-related Disorders: An Individual Participant-data Meta-analysis. , 2019, Journal of anxiety disorders.

[24]  P. Carlbring,et al.  Deterioration rates in Virtual Reality Therapy: An individual patient data level meta-analysis. , 2019, Journal of anxiety disorders.

[25]  Tomoko Kishimoto,et al.  The influences of virtual social feedback on social anxiety disorders , 2019, Behavioural and Cognitive Psychotherapy.

[26]  S. Bouchard,et al.  A randomized control trial for the use of in virtuo exposure in the treatment of social phobia: final results , 2011 .

[27]  P. Emmelkamp Attention bias modification: the Emperor's new suit? , 2012, BMC Medicine.

[28]  P. Bordnick,et al.  Feasibility of Virtual Reality Environments for Adolescent Social Anxiety Disorder , 2016 .

[29]  B. Wampold,et al.  How important are the common factors in psychotherapy? An update , 2015, World psychiatry : official journal of the World Psychiatric Association.

[30]  G. Riva,et al.  The Past, Present, and Future of Virtual and Augmented Reality Research: A Network and Cluster Analysis of the Literature , 2018, Front. Psychol..

[31]  Isabel L. Kampmann,et al.  Self-report questionnaires, behavioral assessment tasks, and an implicit behavior measure: do they predict social anxiety in everyday life? , 2018, PeerJ.

[32]  P. Emmelkamp,et al.  Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments. , 2015, Behaviour research and therapy.

[33]  P. Anderson,et al.  Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial. , 2013, Journal of consulting and clinical psychology.

[34]  R. Baños,et al.  Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review , 2017, Current Psychiatry Reports.

[35]  J. Hokanson,et al.  A comparison of self-esteem lability and low trait self-esteem as vulnerability factors for depression. , 1994, Journal of personality and social psychology.

[36]  Mark B Powers,et al.  Do conversations with virtual avatars increase feelings of social anxiety? , 2013, Journal of anxiety disorders.

[37]  P. Emmelkamp,et al.  The Wiley handbook of anxiety disorders , 2014 .

[38]  Paul M. G. Emmelkamp,et al.  Therapeutic processes in virtual reality exposure therapy: The role of cognitions and the therapeutic alliance , 2008 .

[39]  G. Andersson,et al.  Attentional Bias Modification in Virtual Reality – A VR-Based Dot-Probe Task With 2D and 3D Stimuli , 2019, Front. Psychol..

[40]  Lina Gega The virtues of virtual reality in exposure therapy , 2017, British Journal of Psychiatry.

[41]  W. Veling,et al.  Virtual reality-based cognitive behavioural therapy for patients with generalized social anxiety disorder: a pilot study , 2019, Behavioural and Cognitive Psychotherapy.

[42]  R. Kessler,et al.  Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States , 2012, International journal of methods in psychiatric research.

[43]  Jeffrey L. Geller,et al.  Social Phobia: Diagnosis, Assessment, and Treatment , 1997 .

[44]  Jae-Jin Kim,et al.  Aversive eye gaze during a speech in virtual environment in patients with social anxiety disorder , 2018, The Australian and New Zealand journal of psychiatry.

[45]  Deborah C. Beidel,et al.  Can Virtual Reality Effectively Elicit Distress Associated with Social Anxiety Disorder? , 2015 .

[46]  Helmut Hlavacs,et al.  Salivary cortisol and cardiovascular reactivity to a public speaking task in a virtual and real-life environment , 2016, Comput. Hum. Behav..

[47]  Xuguo Zhou,et al.  Validation of Reference Housekeeping Genes for Gene Expression Studies in Western Corn Rootworm (Diabrotica virgifera virgifera) , 2014, PloS one.

[48]  P. Delespaul,et al.  Virtual-reality-based cognitive behavioural therapy versus waiting list control for paranoid ideation and social avoidance in patients with psychotic disorders: a single-blind randomised controlled trial. , 2018, The lancet. Psychiatry.

[49]  R. de Graaf,et al.  The Netherlands Mental Health Survey and Incidence Study‐2 (NEMESIS‐2): design and methods , 2010, International journal of methods in psychiatric research.

[50]  P. Emmelkamp,et al.  Virtual reality exposure therapy in anxiety disorders: a systematic review of process‐and‐outcome studies , 2010, Depression and anxiety.

[51]  Robertas Damaševičius,et al.  Anxiety Level Recognition for Virtual Reality Therapy System Using Physiological Signals , 2019, Electronics.

[52]  P. Lindner,et al.  Virtual reality exposure therapy for adolescents with fear of public speaking: a non-randomized feasibility and pilot study , 2019, Child and Adolescent Psychiatry and Mental Health.

[53]  E. Coutinho,et al.  Does D-Cycloserine Enhance Exposure Therapy for Anxiety Disorders in Humans? A Meta-Analysis , 2014, PloS one.

[54]  P. Anderson,et al.  Working alliance does not mediate the relation between outcome expectancy and symptom improvement following cognitive behavioural therapy for social anxiety disorder , 2019, The Cognitive Behaviour Therapist.

[55]  Isabel L. Kampmann,et al.  Does Exposure Therapy Lead to Changes in Attention Bias and Approach-Avoidance Bias in Patients with Social Anxiety Disorder? , 2018, Cognitive Therapy and Research.

[56]  N. Jacobson,et al.  Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance , 1984 .

[57]  P. Kendall,et al.  Anxiety Disorders in Children and Adolescents: Assessment and Treatment , 2014 .

[58]  C. M. Gebara,et al.  Virtual reality exposure using three-dimensional images for the treatment of social phobia , 2015, Revista brasileira de psiquiatria.

[59]  M. Mohammadi,et al.  Social anxiety disorder among children and adolescents: A nationwide survey of prevalence, socio-demographic characteristics, risk factors and co-morbidities. , 2019, Journal of affective disorders.

[60]  P. Philippot,et al.  Attention bias modification for social anxiety: A systematic review and meta-analysis. , 2015, Clinical psychology review.

[61]  J. Malouff,et al.  Meta-Analysis of the Efficacy of Virtual Reality Exposure Therapy for Social Anxiety , 2018, Behaviour Change.

[62]  Dwi Hartanto,et al.  Design and Implementation of Home-Based Virtual Reality Exposure Therapy System with a Virtual eCoach , 2015, IVA.

[63]  Paul M. G. Emmelkamp,et al.  Virtual reality techniques in older adults: exposure therapy, memory training, and training of motor balance , 2014 .

[64]  Helmut Hlavacs,et al.  Physical Presence, Social Presence, and Anxiety in Participants with Social Anxiety Disorder During Virtual Cue Exposure , 2019, Cyberpsychology Behav. Soc. Netw..

[65]  G. Andersson,et al.  Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial. , 2019, Journal of anxiety disorders.

[66]  P. Anderson,et al.  The Course of the Working Alliance during Virtual Reality and Exposure Group Therapy for Social Anxiety Disorder , 2013, Behavioural and Cognitive Psychotherapy.

[67]  Isabel L. Kampmann,et al.  Social interactions in virtual reality exposure therapy: A proof-of-concept pilot study. , 2015, Technology and health care : official journal of the European Society for Engineering and Medicine.

[68]  Isabel L. Kampmann,et al.  Controlling Social Stress in Virtual Reality Environments , 2014, PloS one.

[69]  P. Emmelkamp,et al.  Enhancement of exposure therapy in participants with specific phobia: A randomized controlled trial comparing yohimbine, propranolol and placebo. , 2018, Journal of anxiety disorders.