Skip to main content

Part of the book series: Studies in Computational Intelligence ((SCI,volume 337))

Abstract

In the past 10 years virtual reality exposure therapy (VRET) has become a viable alternative for exposure in vivo, the gold standard for the treatment of anxiety disorders. VRET is often regarded as a natural extension of the systematic exposure component of (cognitive) behavior therapy. The objective of this chapter is to discuss the treatment of anxiety disorders with VRET and review research into the outcome of VRET and the presumed (underlying) mechanisms of VRET. We discuss variables, which could play an important role during therapy such as the capability of people to experience the virtual world as real (presence), cognitions, psychophysiology, and the therapeutic alliance. Treatment procedures will be illustrated with case vignettes for different anxiety disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Emmelkamp, P.M.G.: Phobic and obsessive-compulsive disorders. Plenum, New York (1982)

    Google Scholar 

  2. Foa, E., Kozak, M.J.: Emotional Processing of Fear: Exposure to Corrective Information. Psychological Bulletin 99, 20–35 (1986)

    Article  Google Scholar 

  3. Foa, E., McNally, R.J.: Mechanisms of change in exposure therapy. In: Rapee, R.M. (ed.) Current controversies in the anxiety disorders, pp. 214–227. Guilford Press, New York (1996)

    Google Scholar 

  4. Emmelkamp, P.M.G.: Behavior therapy with adults. In: Bergin, A., Garfield, S. (eds.) Handbook of Behavior Therapy and Behavior Change. Wiley, New York (1996)

    Google Scholar 

  5. Emmelkamp, P.M.G.: Behavior therapy with adults. In: Lambert, M. (ed.) Bergin & Garfield’s Handbook of Behavior Therapy and Behavior Change, pp. 396–448. Wiley, New York (2004)

    Google Scholar 

  6. Krijn, M., Emmelkamp, P.M.G., Olafsson, R.P., Biemond, R.: Virtual reality exposure therapy of anxiety disorders: A review. Clinical Psychology Review 24, 259–281 (2004a)

    Article  Google Scholar 

  7. Emmelkamp, P.M.G., Powers, M.B.: Agoraphobia. In: Thomas, J., Hersen, M. (eds.) Handbook of Clinical Psychology Competencies, pp. 723–758. Springer, New York (2010)

    Chapter  Google Scholar 

  8. Craske, M.G., Barlow, D.H.: Panic disorder and agoraphobia. In: Barlow, D.H. (ed.) Clinical handbook of psychological disorders, pp. 1–64. Guilford, New York (2008)

    Google Scholar 

  9. Van Hout, W.J.P.J., Emmelkamp, P.M.G., Scholing, A.: The role of negative self-statements during exposure in vivo: A process study of eight panic disorder patients with agoraphobia. Behavior Modification 18, 389–410 (1994)

    Article  Google Scholar 

  10. Van Hout, W.J.P.J., Emmelkamp, P.M.G.: Exposure in vivo. In: Hersen, M., Sledge, W. (eds.) The Encyclopedia of Psychotherapy, vol. I, pp. 761–768. Academic Press, New York (2002)

    Google Scholar 

  11. Parsons, T.D., Rizzo, A.A.: Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: A meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry 39, 250–261 (2008)

    Article  Google Scholar 

  12. Powers, M.B., Emmelkamp, P.M.G.: Virtual reality exposure therapy for anxiety disorders: A meta-analysis. Journal of Anxiety Disorders 22, 561–569 (2008)

    Article  Google Scholar 

  13. Côté, S., Bouchard, S.: Virtual reality exposure for phobias: A critical review. Journal of CyberTherapy and Rehabilitation 1, 75–91 (2008)

    Google Scholar 

  14. Meyerbröker, K., Emmelkamp, P.M.G.: Virtual reality exposure therapy in anxiety disorders: A systematic review of process- and outcome studies. Depression and Anxiety 27, 933–944

    Google Scholar 

  15. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: Fourth Edition-Text revision. APA, Arlington (2000)

    Google Scholar 

  16. Emmelkamp, P.M.G., Bruynzeel, M., Drost, L., van der Mast, C.P.A.G.: Virtual reality treatment in acrophobia: A comparison with exposure in vivo. CyberPsychology & Behavior 4, 335–339 (2001)

    Article  Google Scholar 

  17. Emmelkamp, P.M.G., Krijn, M., Hulsbosch, A.M., De Vries, S., Schuemie, M.J., Van der Mast, C.A.P.G.: Virtual reality treatment versus exposure in vivo: A comparative evaluation in acrophobia. Behaviour Research and Therapy 40, 509–516 (2002)

    Article  Google Scholar 

  18. Krijn, M., Emmelkamp, P.M.G., Biemond, R., De Wilde de Ligny, C., Schuemie, M.J., Van der Mast, C.A.P.G.: Treatment of acrophobia in virtual reality: The role of immersion and presence. Behaviour Research and Therapy 42, 229–239 (2004b)

    Article  Google Scholar 

  19. Krijn, M., Emmelkamp, P.M.G., Olafsson, R.P., Schuemie, M.J., Van der Mast, C.A.P.G.: Do self-statements enhance the effectiveness of virtual reality exposure therapy? A comparative evaluation in acrophobia. CyberPsychology & Behavior 10, 362–370 (2007a)

    Article  Google Scholar 

  20. Maltby, N., Kirsch, I., Mayers, M., Allen, G.J.: Virtual Reality Exposure Therapy for the Treatment of Fear of Flying: A controlled investigation. Journal of Consulting and Clinical Psychology 70, 1112–1118 (2002)

    Article  Google Scholar 

  21. Rothbaum, B.O., Hodges, L., Smith, S., Lee, J.H.: A controlled study of virtual reality exposure therapy for fear of flying. Journal of Consulting and Clinical Psychology 68, 1020–1026 (2000)

    Article  Google Scholar 

  22. Rothbaum, B.O., Hodges, L., Anderson, P., Price, L., Smith, S.: Twelve-months follow-up of virtual reality and standard exposure therapies for fear of flying. Journal of Consulting & Clinical Psychology 70, 428–432 (2002)

    Article  Google Scholar 

  23. Rothbaum, B.O., Zimand, E., Hodges, L., Lang, D., Wilson, J.: Virtual reality exposure therapy and standard (in vivo) exposure therapy in the treatment of fear of flying. Behavior Therapy 37, 80–90 (2006)

    Article  Google Scholar 

  24. Mühlberger, A., Herrmann, M.J., Wiedemann, G., Ellgring, H., Pauli, P.: Repeated exposure of flight phobics to flights in virtual reality. Behavior Research and Therapy 39, 1033–1050 (2001)

    Article  Google Scholar 

  25. Mühlberger, A., Wiedemann, G., Pauli, P.: Efficacy of a one-session virtual reality exposure treatment for fear of flying. Psychotherapy Research 13, 323–336 (2003)

    Article  Google Scholar 

  26. Mühlberger, A., Weik, A., Pauli, P., Wiedemann, G.: One-session virtual reality exposure treatment for fear of flying: 1-year follow-up and graduation flight accompaniment effects. Psychotherapy Research 16, 26–40 (2006)

    Article  Google Scholar 

  27. Wiederhold, B.K., Wiederhold, M.D.: Three year follow-up for virtual reality exposure for fear of flying. Cyberpsychology & Behavior 6, 441–445 (2003)

    Article  Google Scholar 

  28. Krijn, M., Emmelkamp, P.M.G., Olafsson, R.P., Bouwman, M., van Gerwen, E.J., Spinhoven, P., Schuemie, M.J., Van der Mast, C.A.P.G.: Fear of flying treatment methods: Virtual reality exposure vs. cognitive behavioral therapy. Aviation Space and Environmental Medicine 78, 121–128 (2007b)

    Google Scholar 

  29. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: 4th edn. APA, Arlington (1994)

    Google Scholar 

  30. Powers, M.B., Sigmarsson, S.R., Emmelkamp, P.M.G.: A meta-analytic review of psychological treatments for social anxiety disorder. International Journal of Cognitive Therapy 1, 94–113 (2008)

    Article  Google Scholar 

  31. Klinger, E., Bouchard, S., Legeron, P., Roy, S., Lauer, F., Chemin, I., Nugues, P.: Virtual reality therapy versus cognitive behavior therapy for social phobia: A preliminary controlled study. CyberPsychology & Behavior 8, 76–88 (2005)

    Article  Google Scholar 

  32. Wallach, H.S., Safir, M.P., Bar-Zvi, M.: Virtual reality cognitive behavior therapy for public speaking anxiety; a randomized clinical trial. Behavior Modification 33, 314–338 (2009)

    Article  Google Scholar 

  33. Pertaub, D.P., Slater, M., Barker, C.: An experiment on public speaking anxiety in response to three different types of virtual audience. Presence 11, 68–78 (2002)

    Article  Google Scholar 

  34. Choi, Y.H., Vincelli, F., Riva, G., Wiederhold, B.K., Lee, J.H., Park, K.H.: Effects of group experiential cognitive therapy for the treatment of panic disorder with agoraphobia. CyberPsychology & Behavior 8, 387–393 (2005)

    Article  Google Scholar 

  35. Botella, C., Garcia-Palacios, A., Villa, H., Baños, R.M., Quero, S., Alcaniz, M., Riva, G.: Virtual reality exposure in the treatment of panic disorder and agoraphobia: A controlled study. Clinical Psychology and Psychotherapy 14, 164–175 (2007)

    Article  Google Scholar 

  36. Peñate, W., Pitti, C.T., Bethencourt, J.M., de la Fuente, J., Gracia, R.: The effects of a treatment based on the use of virtual reality exposure and cognitive-behavioral therapy applied to patients with agoraphobia. International Journal of Clinical and Health Psychology 8, 5–22 (2008)

    Google Scholar 

  37. Difede, J., Cukor, J., Jayasinghe, N., Patt, I., Jedel, S., Spielman, L., Giosan, C., Hoffman, H.G.: Virtual reality exposure therapy for the treatment of posttraumatic stress disorder following. Journal of Clinical Psychiatry 68, 1639–1647 (2007)

    Article  Google Scholar 

  38. Ready, D.J., Pollack, S., Rothbaum, B.O., Alarcon, R.D.: Virtual reality exposure for veterans with posttraumatic stress disorder. Journal of Aggression, Maltreatment & Trauma 12, 199–220 (2006)

    Article  Google Scholar 

  39. Slater, M.: Measuring Presence: A Response to the Wimer and Singer Presence Questionnaire. Presence: Teleoperators and Virtual Environments 8, 560–565 (1999)

    Article  Google Scholar 

  40. Slater, M., Wilbur, S.: A Framework for immersive virtual environments (five): Speculations on the role of presence in virtual environments. Presence: Teleoperators and Virtual Environments 6, 1–13 (1997)

    Google Scholar 

  41. Juan, C.M., Perez, D.: Comparison of the levels of presence and anxiety in an acrophobic environment viewed via HMD or CAVE. Presence 18, 232–248 (2009)

    Article  Google Scholar 

  42. Price, M., Anderson, P.: The role of presence in virtual reality exposure therapy. Journal of Anxiety Disorders 22, 742–751 (2007)

    Article  Google Scholar 

  43. Tellegen, A., Atkinson, G.: Openness to absorbing and self-altering experiences (“Absorption”), a trait related to hypnotic susceptibility. Journal of Abnormal Psychology 83, 268–277 (1974)

    Article  Google Scholar 

  44. Baños, R.M., Botella, C., Rubio, I., Quero, S., Garcia-Palacios, V.H., Perpina, M., Gallardo, M.: Psychological Variables and Reality jugdement in Virtual Environments: The Role of Absorption and Dissociation. CyberPsychology & Behavior 2, 143–148 (1999)

    Article  Google Scholar 

  45. Murray, C.D., Fox, J., Pettifer, S.: Absorption, dissociation, locus of control and presence in virtual reality. Computers in Human Behavior 23, 1347–1354 (2007)

    Article  Google Scholar 

  46. Alsina-Jurnet, I.A., Carvallo-Beciu, C., Maldonado, J.G.: Individual Differences in the Sense of Presence. Presence, 133–142 (2005)

    Google Scholar 

  47. Wilhelm, F.H., Pfaltz, M.C., Gross, J.J., Mauss, I.B., Kim, S.I., Wiederhold, B.: Mechanisms of Virtual Reality Exposure Therapy: The Role of the Behavioural Activation and Behavioral Inhibition Systems. Applied Psychophysiology and Biofeedback 30, 271–284 (2005)

    Article  Google Scholar 

  48. Moore, K., Wiederhold, B.K., Wiederhold, M.D., Riva, G.: Panic and agoraphobia in a virtual world. CyberPsychology & Behavior 5, 197–202 (2002)

    Article  Google Scholar 

  49. Wiederhold, B.K., Jang, D.P., Kim, S.I., Wiederhold, M.D.: Physiological monitoring as an objective tool in virtual reality therapy. CyberPsychology & Behavior 5, 77–82 (2002)

    Article  Google Scholar 

  50. Mühlberger, A., Bülthoff, H.H., Wiedemann, G., Pauli, P.: Virtual reality for the psychophysiological assessment of phobic fear: responses during virtual driving. Psychological Assessment 19, 340–346 (2007)

    Article  Google Scholar 

  51. Côté, S., Bouchard, S.: Documenting the efficacy of virtual reality exposure with psychophysiological and information processing measures. Applied Psychophysiology and Biofeedback 30, 217–232 (2005)

    Article  Google Scholar 

  52. Meyerbröker, K., Emmelkamp, P.M.G.: Therapeutic processes in virtual reality exposure therapy: The role of cognitions and the therapeutic alliance. Journal of CyberTherapy & Rehabilitation 1, 247–257 (2008)

    Google Scholar 

  53. Emmelkamp, P.M.G.: Technological innovations in clinical assessment and psychotherapy. Psychotherapy & Psychosomatics 74, 336–343 (2005)

    Article  Google Scholar 

  54. Horvath, A.O., Greenberg, L.S.: Development and validation of the Working Alliance Inventory. Journal of Counseling Psychology 36, 223–233 (1989)

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Meyerbröker, K., Emmelkamp, P.M.G. (2011). Virtual Reality Exposure Therapy for Anxiety Disorders: The State of the Art. In: Brahnam, S., Jain, L.C. (eds) Advanced Computational Intelligence Paradigms in Healthcare 6. Virtual Reality in Psychotherapy, Rehabilitation, and Assessment. Studies in Computational Intelligence, vol 337. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-17824-5_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-17824-5_4

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-17823-8

  • Online ISBN: 978-3-642-17824-5

  • eBook Packages: EngineeringEngineering (R0)

Publish with us

Policies and ethics