Virtual reality exposure therapy in anxiety disorders: a systematic review of process‐and‐outcome studies

In recent years, virtual reality exposure therapy (VRET) has become an interesting alternative for the treatment of anxiety disorders. Research has focused on the efficacy of VRET in treating anxiety disorders: phobias, panic disorder, and posttraumatic stress disorder. In this systematic review, strict methodological criteria are used to give an overview of the controlled trials regarding the efficacy of VRET in patients with anxiety disorders. Furthermore, research into process variables such as the therapeutic alliance and cognitions and enhancement of therapy effects through cognitive enhancers is discussed. The implications for implementation into clinical practice are considered. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.

[1]  B. Rothbaum,et al.  Greater expectations: using hierarchical linear modeling to examine expectancy for treatment outcome as a predictor of treatment response. , 2008, Behavior therapy.

[2]  Heinrich H Bülthoff,et al.  Virtual reality for the psychophysiological assessment of phobic fear: responses during virtual tunnel driving. , 2007, Psychological assessment.

[3]  B. Olatunji,et al.  Information processing biases in spider phobia: application of the Stroop and "White Noise" Paradigm. , 2008, Journal of behavior therapy and experimental psychiatry.

[4]  A. Maercker,et al.  Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial , 2007, BMC psychiatry.

[5]  Giuseppe Riva,et al.  Panic and Agoraphobia in a Virtual World , 2002, Cyberpsychology Behav. Soc. Netw..

[6]  P. Emmelkamp,et al.  Assessment of self-statements in agoraphobic situations construction and psychometric evaluation of the Agoraphobic Self-Statements Questionnaire (ASQ). , 2001, Journal of anxiety disorders.

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

[8]  B. Rothbaum,et al.  Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder. , 2001, The Journal of clinical psychiatry.

[9]  M. Lader Current Controversies in the Anxiety Disorders , 1996 .

[10]  R. Wiers,et al.  Implicit cognitive processes in psychopathology: an introduction. , 2007, Journal of behavior therapy and experimental psychiatry.

[11]  C. A. Morgan,et al.  Relationship of enhanced norepinephrine activity during memory consolidation to enhanced long-term memory in humans. , 2002, The American journal of psychiatry.

[12]  Barbara O Rothbaum,et al.  Cognitive behavioral therapy for public‐speaking anxiety using virtual reality for exposure , 2005, Depression and anxiety.

[13]  Klaus P. Ebmeier,et al.  Stimulation of the noradrenergic system enhances and blockade reduces memory for emotional material in man , 1999, Psychological Medicine.

[14]  Stéphane Bouchard,et al.  Cognitive Mechanisms Underlying Virtual Reality Exposure , 2009, Cyberpsychology Behav. Soc. Netw..

[15]  Charles van der Mast,et al.  Virtual Reality Treatment in Acrophobia: A Comparison with Exposure in Vivo , 2001, Cyberpsychology Behav. Soc. Netw..

[16]  Dong Pyo Jang,et al.  Physiological Monitoring as an Objective Tool in Virtual Reality Therapy , 2002, Cyberpsychology Behav. Soc. Netw..

[17]  A. Horvath,et al.  Development and validation of the Working Alliance Inventory. , 1989 .

[18]  B. Rothbaum,et al.  Virtual Reality Exposure for Veterans with Posttraumatic Stress Disorder , 2006 .

[19]  Irving Kirsch,et al.  Virtual reality exposure therapy for the treatment of fear of flying: a controlled investigation. , 2002, Journal of consulting and clinical psychology.

[20]  J. Garske,et al.  Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. , 2000, Journal of consulting and clinical psychology.

[21]  Martijn J. Schuemie,et al.  Do Self-Statements Enhance the Effectiveness of Virtual Reality Exposure Therapy? A Comparative Evaluation in Acrophobia , 2007, Cyberpsychology Behav. Soc. Netw..

[22]  B. Rothbaum,et al.  Twelve-month follow-up of virtual reality and standard exposure therapies for the fear of flying. , 2002, Journal of consulting and clinical psychology.

[23]  Mark B. Powers,et al.  Virtual reality exposure therapy for anxiety disorders: A meta-analysis. , 2008, Journal of anxiety disorders.

[24]  P. Appelbaum Consensual vs. coercive treatment: new manifestations of an old dilemma , 2007, BMC Psychiatry.

[25]  M. Safir,et al.  Virtual Reality Cognitive Behavior Therapy for Public Speaking Anxiety , 2009, Behavior modification.

[26]  J. Gross,et al.  Mechanisms of Virtual Reality Exposure Therapy: The Role of the Behavioral Activation and Behavioral Inhibition Systems , 2005, Applied psychophysiology and biofeedback.

[27]  Paul M. G. Emmelkamp,et al.  Behavior therapy with adults , 1986 .

[28]  P. Emmelkamp Technological Innovations in Clinical Assessment and Psychotherapy , 2005, Psychotherapy and Psychosomatics.

[29]  Barbara O Rothbaum,et al.  Cognitive enhancers as adjuncts to psychotherapy: use of D-cycloserine in phobic individuals to facilitate extinction of fear. , 2004, Archives of general psychiatry.

[30]  A. Rizzo,et al.  Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis. , 2008, Journal of behavior therapy and experimental psychiatry.

[31]  M. Krijn,et al.  Virtual reality exposure therapy of anxiety disorders: a review. , 2004, Clinical psychology review.

[32]  W. Peñate,et al.  [Agoraphobia: combined treatment and virtual reality. Preliminary results]. , 2008, Actas espanolas de psiquiatria.

[33]  Cristina Botella,et al.  Comparing Acceptance and Refusal Rates of Virtual Reality Exposure vs. In Vivo Exposure by Patients with Specific Phobias , 2007, Cyberpsychology Behav. Soc. Netw..

[34]  R. Baños,et al.  Virtual reality exposure in the treatment of panic disorder and agoraphobia: A controlled study , 2007 .

[35]  H. Hoffman,et al.  Virtual reality exposure therapy for the treatment of posttraumatic stress disorder following September 11, 2001. , 2007, The Journal of clinical psychiatry.

[36]  M. Craske,et al.  Mastery of Your Anxiety and Panic II Agoraphobia Supplement: Client Workbook , 1999, Journal of Cognitive Psychotherapy.

[37]  M. Hersen,et al.  Handbook of clinical psychology competencies , 2010 .

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

[39]  R. McNally Mechanisms of exposure therapy: how neuroscience can improve psychological treatments for anxiety disorders. , 2007, Clinical psychology review.

[40]  C. Cain,et al.  Adrenergic transmission facilitates extinction of conditional fear in mice. , 2004, Learning & memory.

[41]  Cristina Botella,et al.  Redefining Therapeutic Success with Virtual Reality Exposure Therapy , 2001, Cyberpsychology Behav. Soc. Netw..

[42]  Paul Pauli,et al.  Efficacy of a One-Session Virtual Reality Exposure Treatment for Fear of Flying , 2003, Psychotherapy research : journal of the Society for Psychotherapy Research.

[43]  Michael Davis,et al.  Pharmacological treatments that facilitate extinction of fear: Relevance to psychotherapy , 2011, NeuroRX.

[44]  Giuseppe Riva,et al.  Effects of Group Experiential Cognitive Therapy for the Treatment of Panic Disorder with Agoraphobia , 2005, Cyberpsychology Behav. Soc. Netw..

[45]  M. Krijn,et al.  Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia. , 2002, Behaviour research and therapy.

[46]  Carlos M. Coelho,et al.  The use of virtual reality in acrophobia research and treatment. , 2009, Journal of anxiety disorders.

[47]  M. Krijn,et al.  Treatment of acrophobia in virtual reality: the role of immersion and presence. , 2004, Behaviour research and therapy.

[48]  Brenda K. Wiederhold,et al.  Three-Year Follow-Up for Virtual Reality Exposure for Fear of Flying , 2003, Cyberpsychology Behav. Soc. Netw..

[49]  S. Freud [The dynamics of transference]. , 1952, Revue francaise de psychanalyse.

[50]  M. Kozak,et al.  Emotional processing of fear: exposure to corrective information. , 1986, Psychological bulletin.

[51]  Wenceslao Peñate,et al.  The effects of a treatment based on the use of virtual reality exposure and cognitive-behavioral therapy applied to patients with agoraphobia , 2008 .

[52]  P. Pauli,et al.  Repeated exposure of flight phobics to flights in virtual reality. , 2001, Behaviour research and therapy.

[53]  B. Rothbaum,et al.  A controlled study of virtual reality exposure therapy for the fear of flying. , 2000, Journal of consulting and clinical psychology.

[54]  Stéphane Bouchard,et al.  Documenting the Efficacy of Virtual RealityExposure with Psychophysiological andInformation Processing Measures , 2005, Applied psychophysiology and biofeedback.

[55]  M. Krijn,et al.  Fear of flying treatment methods: virtual reality exposure vs. cognitive behavioral therapy. , 2007, Aviation, space, and environmental medicine.

[56]  S. Mineka,et al.  Mechanisms of Change in Exposure Therapy for Anxiety Disorders , 2005 .

[57]  Mark B. Powers,et al.  Facilitation of fear extinction in phobic participants with a novel cognitive enhancer: a randomized placebo controlled trial of yohimbine augmentation. , 2009, Journal of anxiety disorders.

[58]  B. Rothbaum,et al.  Virtual reality exposure therapy and standard (in vivo) exposure therapy in the treatment of fear of flying. , 2006, Behavior therapy.

[59]  P. Pauli,et al.  One-session virtual reality exposure treatment for fear of flying: 1-Year follow-up and graduation flight accompaniment effects , 2006 .

[60]  G. Diamond,et al.  Short form of the revised vanderbilt therapeutic alliance scale: Development, reliability, and validity , 2008, Psychotherapy research : journal of the Society for Psychotherapy Research.