University of Twente Student Theses


Treating Anxiety Disorders with VR-based Exposure Therapy- A Scoping Review

Kammerer, Andreas Markus (2023) Treating Anxiety Disorders with VR-based Exposure Therapy- A Scoping Review.

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Abstract:Research indicates that VRET is effective in treating anxiety disorders while mitigating many limitations of traditional exposure therapy. Yet, there are imbalances regarding the researched populations and anxiety disorders, and these imbalances persist in recent literature studies as well. In addition, recent technological advances might improve VRET effectiveness and availability. This scoping review aims to fill these research gaps by reviewing recent literature on the effectiveness of VRET to treat anxiety disorders. A search on the databases Scopus and PsycInfo resulted in selecting 20 relevant studies. From these, data points regarding their participant and study characteristics, as well as their usability, feasibility, and effectiveness were collected. Average sample size was 50.2 (mean age = 29.29, male/female ratio = 137:135). The main focus was on specific phobias and PTSD, particularly in soldiers with PTSD. Most of the studies were RCTs, but there were also single case experimental designs and feasibility studies. VRET was administered in sessions ranging from 4 to 29, with varying lengths, and was typically administered by a professional. The used VR-technology ranged from headsets, to including joysticks and vibration-eliciting platforms. Drop-out rates and levels of cybersickness varied among the studies, and VR was generally accepted by participants. VRET was found to improve anxiety disorder symptoms and other relevant measures such as anxiety and depression in most studies. However, some studies found that effectiveness was not different from control groups or other methods. The positive changes from VRET were generally maintained at follow-up measurements. This study suggests that VRET is effective in treating anxiety disorders. Yet, there are huge imbalances with regards to the studied anxiety disorders and populations which makes generalisations difficult. Future research should incorporate these less researched populations and anxiety disorders, and try to examine possible mediators which influence the effectiveness of VRET. Anxiety disorders are the most frequent mental illnesses in Europe, affecting around 61.5 million people (Wittchen et al., 2011). The current COVID-19 pandemic seems to additionally accelerate the symptoms and prevalence of these disorders (Yang et al., 2020). Therefore, cost-effective treatment interventions are amply needed. Exposure therapy is one of the most effectful interventions for treating anxiety disorders and is based on confronting patients with the feared stimuli. This is usually done by either imagining the stimuli or being exposed to a real version of it which is called in vivo exposure (Bandelow et al., 2015). These two methods, however, contain several limitations. Imaginal exposure often lacks the needed immersion, while in vivo exposure might not be feasible or too costly and often lacks control mechanisms (Gorini & Riva, 2008; Maples-Keller et al., 2017). To circumvent these limitations, Virtual Reality-based Exposure Therapy (VRET) might be applicable (Krijn et al., 2004; Maples-Keller et al., 2017; Powers & Emmelkamp, 2008). Recent literature studies add to the growing body of research attesting that VRET is effective in treating anxiety disorders (Deng et al., 2019; Kothgassner et al., 2019; Wechsler et al., 2019). Yet, these studies focus on one type of anxiety disorder, and therefore a comprehensive overview of VRET’s effectiveness for all anxiety disorder types is missing. In addition, technological advances in VR are growing at a fast pace, with for example improving graphics and novel features, such as eye-tracking (Eira, 2023). This, in turn, might affect VRET effectiveness, and therefore it is important that literature reviews are up-to-date to account for these technological advances (Sygel & Wallinius, 2021). This scoping review aims to fill these research gaps by investigating and presenting current research related to VRET and anxiety disorders.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:77 psychology
Programme:Psychology MSc (66604)
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