Virtual reality in mental health

A review of the literature
ORIGINAL PAPER

Abstract

Background

Several virtual reality (VR) applications for the understanding, assessment and treatment of mental health problems have been developed in the last 10 years. The purpose of this review is to outline the current state of virtual reality research in the treatment of mental health problems.

Methods

PubMed and PsycINFO were searched for all articles containing the words “virtual reality”. In addition a manual search of the references contained in the papers resulting from this search was conducted and relevant periodicals were searched. Studies reporting the results of treatment utilizing VR in the mental health field and involving at least one patient were identified.

Results

More than 50 studies using VR were identified, the majority of which were case studies. Seventeen employed a between groups design: 4 involved patients with fear of flying; 3 involved patients with fear of heights; 3 involved patients with social phobia/public speaking anxiety; 2 involved people with spider phobia; 2 involved patients with agoraphobia; 2 involved patients with body image disturbance and 1 involved obese patients. There are both advantages in terms of delivery and disadvantages in terms of side effects to using VR. Although virtual reality based therapy appears to be superior to no treatment the effectiveness of VR therapy over traditional therapeutic approaches is not supported by the research currently available.

Conclusions

There is a lack of good quality research on the effectiveness of VR therapy. Before clinicians will be able to make effective use of this emerging technology greater emphasis must be placed on controlled trials with clinically identified populations.

Key words

virtual reality simulations exposure therapy mental health 

References

  1. 1.
    Anderson PL, Zimand E, Hodges LF, Rothbaum BO (2005) Cognitive behavioural therapy for public-speaking anxiety using virtual reality for exposure. Depr Anxiety 22:156–158CrossRefGoogle Scholar
  2. 2.
    Blade RA, Padgett ML (2002) Virtual environments standards and terminology. In: Stanney KM (ed) Handbook of virtual environments: design, implementation and applications. New Jersey, Lawrence ErlbaumGoogle Scholar
  3. 3.
    Borenstein M, Rothstein H (1999) Comprehensive meta-analysis. A computer program for research synthesis. Biostat®, USA (http://www.metaanalysis.com)
  4. 4.
    Botella CM, Juan MC, Banos RM, Alcaniz M, Guillen V, Rey B (2005) Mixing realities? An application of augmented reality for the treatment of cockroach phobia. Cyberpsychol Behav 8:162–171PubMedCrossRefGoogle Scholar
  5. 5.
    Carlin AS, Hoffman HG, Weghorst S (1997) Virtual reality and tactile augmentation in the treatment of spider phobia: a case report. Behav Res Therapy 35:153–158CrossRefGoogle Scholar
  6. 6.
    Choi YH, Jang DP, Ku JH, Shin MB, Kim SI (2001) Short-term treatment of Acrophobia with virtual reality therapy (VRT): a case report. CyberPsychol Behav 4:349–354PubMedCrossRefGoogle Scholar
  7. 7.
    Cobb SVG, Nichols S, Ramsey A, Wilson JR (1999) Virtual reality-induced symptoms and effects (VRISE). Presence 8:169–186CrossRefGoogle Scholar
  8. 8.
    Difede J, Hoffman HG (2002) Virtual reality exposure therapy for world trade centre post-traumatic stress disorder: a case report. CyberPsychol Behav 5:529–535PubMedCrossRefGoogle Scholar
  9. 9.
    Emmelkamp PMG, Bruynzeel M, Drost L, van der Mast CAPG (2001) Virtual reality treatment in Acrophobia: a comparison with exposure in vivo. CyberPsychol Behav 4:335–339PubMedCrossRefGoogle Scholar
  10. 10.
    Emmelkamp PMG, Krijn M, Hulsbosch AM, de Vries S, Schuemie MJ, van der Mast CAPG (2002) Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia. Behav Res Therapy 40:509–516CrossRefGoogle Scholar
  11. 11.
    Flynn D, Schaik PV, Blackman T, Hobbs B, Calderdon C (2003) Developing a virtual reality based methodology for people with Dementia: a feasibility study. CyberPsychol Behav 6:591–611PubMedCrossRefGoogle Scholar
  12. 12.
    Freeman D, Slater M, Bebbington PE, Garety PA, Kuipers E, Fowler D, Met A, Read CM, Jordan J, Vinayagamoorthy V (2003) Can virtual reality be used to investigate persecutory ideation? J Nervous Mental Dis 191:509–514CrossRefGoogle Scholar
  13. 13.
    Garcia-Palacios A, Hoffman H, Carlin A, Furness T, Botella C (2002) Virtual reality in the treatment of spider phobia: a controlled study. Behav Res Therapy 40:983–993CrossRefGoogle Scholar
  14. 14.
    Gershon J, Anderson P, Graap K, Zimand E, Hodges L, Rothbaum B (2002) Virtual reality exposure therapy in the treatment of anxiety disorders. Sci Rev Ment Health Prac 1:76–81Google Scholar
  15. 15.
    Glantz K, Rizzo A, Graap K (2003) Virtual reality for psychotherapy: current reality and future possibilities. Psychotherapy: theory. Res Practice Training 40:55–67CrossRefGoogle Scholar
  16. 16.
    Harris SR, Kemmerling RL, North ML (2002) Brief virtual reality therapy for public speaking anxiety. CyberPsychol Behav 6:543–550CrossRefGoogle Scholar
  17. 17.
    Hodges LF, Rothbaum BO, Kooper R, Opdyke D, Meyer T, North M, de Graff J, Williford J (1995) Virtual environments for treating the fear of heights. IEEE Comp 28:27–34Google Scholar
  18. 18.
    Hoffman HG, Garcia-Palacios A, Carlin A, Furness TA, Botella-Arbona C (2003) Interfaces that heal: coupling real and virtual objects to treat spider phobia. Int J Hum-Comp Interact 16:283–300CrossRefGoogle Scholar
  19. 19.
    Kahan M, Tanzer J, Darvin D, Borer F (2000) Virtual reality-assisted cognitive-behavioral treatment for fear of flying: acute treatment and follow-up. CyberPsychol Behav 3:387–392CrossRefGoogle Scholar
  20. 20.
    Kazdin AE, Bass P (1989) Power to detect differences between alternative treatments in comparative psychotherapy outcome research. J Consult Clin Psychol 57:138–147PubMedCrossRefGoogle Scholar
  21. 21.
    Klein RA (1998) Virtual reality exposure therapy (fear of flying): From a private practice perspective. CyberPsychol Behav 1:311–316Google Scholar
  22. 22.
    Klinger E, Legeron P, Roy S, Chemin I, Lauer F, Nugues P (2004) Virtual reality exposure in the treatment of social phobia. Stud Health Technol Inform 99:91–119PubMedGoogle Scholar
  23. 23.
    Krijn M, Emmelkamp PM, Olafsson RP, Biemond R (2004) Virtual reality exposure therapy of anxiety disorders: a review. Clin Psychol Rev 24:259–281PubMedCrossRefGoogle Scholar
  24. 24.
    Krijn M, Emmelkamp PMG, Biemind R, de Wilde de Ligny C, Schuemiue J, van der Mast CAPG (2004) Treatment of acrophobia in virtual reality: the role of immersion and presence. Behav Res Therapy 42:229–239CrossRefGoogle Scholar
  25. 25.
    Ku JH, Cho W, Kim J, Peled A, Wiederhold BK, Wiederhold MD, Kim IY, Lee JH, Kim SI (2003) A virtual environment for investigating schizophrenic patients’ characteristics: assessment of cognitive and navigation ability. CyberPsychol Behav 6:397–404PubMedCrossRefGoogle Scholar
  26. 26.
    Lee JH, Ku JH, Cho W, Hahn WY, Kim IY, Lee S, Kang Y, Deog YK, Yu T, Wiederhold BK, Wiederhold MD, Kim SI (2003) A virtual reality system for the assessment and rehabilitation of the activities of daily living. CyberPsychol Behav 6:383–388PubMedCrossRefGoogle Scholar
  27. 27.
    Lewis CH, Griffin MJ (1997) Human factors consideration in clinical applications of virtual reality. In: Riva G (ed) Virtual reality in neuropsychophsiology. Amsterdam, IOS PressGoogle Scholar
  28. 28.
    Maltby N, Kirsch I, Mayers M, Allen GJ (2002) Virtual reality exposure therapy for the treatment of fear of flying: a controlled investigation. J Consult Clin Psychol 70:1112–1118PubMedCrossRefGoogle Scholar
  29. 29.
    Muhlberger A, Hermann MJ, Wiedemann G, Ellgring H, Pauli P (2001) Repeated exposure of flight phobics to flights in virtual reality. Behav Res Therapy 39:1033–1050CrossRefGoogle Scholar
  30. 30.
    Muhlberger A, Wiedemann G, Pauli P (2003) Efficacy of a one session virtual reality exposure treatment for fear of flying. Psychother Res 13:323–336CrossRefGoogle Scholar
  31. 31.
    North MM, North SM, Coble JR (1995) Effectiveness of virtual environment desensitization in the treatment of agoraphobia. Int J Virtual Reality 1:25–34Google Scholar
  32. 32.
    North MM, North SM, Coble JR (1997a) Virtual reality therapy for fear of flying. Am J Psychiat 154:130Google Scholar
  33. 33.
    North M, North S, Coble J (1997b) Virtual reality therapy: an effective treatment for the fear of public speaking. Int J Virt Reality 3:2–7Google Scholar
  34. 34.
    North MM, North SM, Crunk J (2004) Virtual reality combats test anxiety: a case study report. Stud Health Technol Inform 98:278–280PubMedGoogle Scholar
  35. 35.
    North MM, Schoeneman CM, Mathis JR (2002) Virtual reality therapy: case study of fear of public speaking. Stud Health Technol Inform 85:318–320PubMedGoogle Scholar
  36. 36.
    Optale G, Marin S, Pastore M, Nasta A, Pianon C (2003) Male sexual dysfunctions and multimedia immersion therapy (Follow-Up). CyberPsychol Behav 6:289–294PubMedCrossRefGoogle Scholar
  37. 37.
    Pertaub DP, Slater M, Barker C (2002) An experiment on fear of public speaking in virtual reality. Stud Health Technol Inform 81:372–378Google Scholar
  38. 38.
    Pull CB (2005) Current status of virtual reality exposure therapy in anxiety disorders. Curr Opin Psychiat 18:7–14Google Scholar
  39. 39.
    Riva G (2002) Virtual reality for health care: The status of research. CyberPsychol Behav 5:219–225PubMedCrossRefGoogle Scholar
  40. 40.
    Riva G (2003) Virtual environments in clinical psychology. Psychotherapy: theory, research, practice. Training 40:68–76Google Scholar
  41. 41.
    Riva G (2005). Virtual reality in psychotherapy: review. CyberPsychol Behav 8:220–230PubMedCrossRefGoogle Scholar
  42. 42.
    Riva G, Bacchetta M, Baruffi M, Molinari E (2001) Virtual reality-based multidimensional therapy for the treatment of body image disturbances in obesity: a controlled study. CyberPsychol Behav 4:511–526PubMedCrossRefGoogle Scholar
  43. 43.
    Riva G, Bacchetta M, Baruffi M, Molinari E (2002) Virtual-reality based multidimensional therapy for the treatment of body image disturbances in binge eating disorders: a preliminary controlled study. IEEE Trans Inform Technol Biomed 6:224–234CrossRefGoogle Scholar
  44. 44.
    Riva G, Bacchetta M, Cesa G, Conti S, Castelnuovo G, Mantovani F, Molinari E (2006) Is severe obesity a form of addiction? Rationale, clinical approach and controlled clinical trial. CyberPsychol Behav 9:457–479PubMedCrossRefGoogle Scholar
  45. 45.
    Rizzo A, Buckwalter J, Bowerly T, Van der Zaag C, Humphrey L, Neumann U, Chua C, Kyriakakis C, Van Rooyen A, Sisemore D (2000) The virtual classroom: a virtual reality environment for the assessment and rehabilitation of attention deficits. CyberPsychol Behav 3:483–501CrossRefGoogle Scholar
  46. 46.
    Rizzo A, Pair J, McNerney PJ, Eastlund E, Manson B, Gratch J, Hill R, Swartout B (2005) Development of a VR therapy application for Iraq war military personnel. Stud Health Technol Inform 111:407–413PubMedGoogle Scholar
  47. 47.
    Rothbaum BO, Hodges L, Anderson PL, Price L, Smith S (2002) Twelve-month follow up of virtual reality and standard exposure therapies for the fear of flying. J Consult Clin Psychol 70:428–432PubMedCrossRefGoogle Scholar
  48. 48.
    Rothbaum BO, Hodges LF, Kooper R, Opdyke D, Williford JS, North M (1995a) Virtual reality graded exposure in the treatment of acrophobia: a case report. Behav Therapy 26:547–554CrossRefGoogle Scholar
  49. 49.
    Rothbaum BO, Hodges LF, Kooper R, Opdyke D, Williford JS, North M (1995b) Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia. Am J Psychiat 152:626–628Google Scholar
  50. 50.
    Rothbaum BO, Hodges L, Ready D, Graap K, Alarcon R (2001) Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder. J Clin Psychiatr 62:617–622CrossRefGoogle Scholar
  51. 51.
    Rothbaum BO, Hodges LF, Smith S, Lee JH, Price L (2000) A controlled study of virtual reality exposure therapy for the fear of flying. J Consult Clin Psychol 68:1020–1026PubMedCrossRefGoogle Scholar
  52. 52.
    Rothbaum BO, Hodges L, Watson BA, Kessler GD, Opdyke D (1996) Virtual reality exposure therapy in the treatment of fear of flying: a case report. Behav Res Therapy 34:477–481CrossRefGoogle Scholar
  53. 53.
    Smith S, Rothbaum BO, Hodges L (1999) Treatment of fear of flying using virtual reality exposure therapy: a single case study. Behav Therapist 154:160Google Scholar
  54. 54.
    Stanney KM (1995) Realizing the full potential of virtual reality: human factors issues that stand in the way. IEEE Proc Virtual Reality Annu Int Symp 1995:28–34CrossRefGoogle Scholar
  55. 55.
    Tarrier N, Liversidge T, Gregg L (2006) The acceptability and preference for the psychological treatment of PTSD. Behav Ther Res 44:1643–1656CrossRefGoogle Scholar
  56. 56.
    Tarrier N, Pilgrim H, Sommerfield C, Faragher B, Reynolds M, Graham EA (1999) A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic post traumatic stress disorder. J Consult Clin Psychol 67:13–18PubMedCrossRefGoogle Scholar
  57. 57.
    Tarrier N, Wykes T (2004) Is there evidence that cognitive behaviour therapy in an effective treatment for schizophrenia: a cautious or cautionary tale? (Invited essay). Behav Res Therapy 42:1377–1401CrossRefGoogle Scholar
  58. 58.
    Viirre E, Bush D (2002) Direct effects of virtual environments on users. In: Stanney KM (ed) Handbook of virtual environments: design, implementation and applications. New Jersey, Lawrence ErlbaumGoogle Scholar
  59. 59.
    Vincelli F, Anolli L, Bouchard S, Wiederhold BK, Zurloni V, Riva G (2003) Experiential cognitive therapy in the treatment of panic disorders with agoraphobia: a controlled study. CyberPsychol Behav 6:321–328PubMedCrossRefGoogle Scholar
  60. 60.
    Wald J (2004). Efficacy of virtual reality exposure therapy for driving phobia: a multiple baseline across-subjects design. Behav Ther 35:621–635CrossRefGoogle Scholar
  61. 61.
    Wald J, Taylor S (2000). Efficacy of virtual reality exposure therapy to treat driving phobia: a case report. J Behav Ther Exp Psychiatr 31:249–257CrossRefGoogle Scholar
  62. 62.
    Walshe DG, Lewis EJ, Kim SI, O’Sullivan K, Wiederhold BK (2003) Exploring the use of computer games and virtual reality in exposure therapy for fear of driving following a motor vehicle accident. CyberPsychol Behav 6:329–334PubMedCrossRefGoogle Scholar
  63. 63.
    Walshe DG, Lewis EJ, O’Sullivan K, Kim SI (2005) Virtually driving: are the driving environments “real enough” for exposure therapy with accident victims? An explorative study. CyberPsychol Behav 8:532–537PubMedCrossRefGoogle Scholar
  64. 64.
    Wiederhold BK, Gevirtz RN, Spira JL (2001) Virtual reality exposure therapy vs. imagery desensitization in the treatment of flying phobia. In: Riva G, Galimberti C (eds) Towards cyberpsychology: mind, cognitions and society in the internet age. Amsterdam, IOS press, pp 253–272Google Scholar
  65. 65.
    Wiederhold BK, Gevirtz R, Wiederhold MD (1998) Fear of flying: a case report using virtual reality therapy with physiological monitoring. CyberPsychol Behav 1:97–103CrossRefGoogle Scholar
  66. 66.
    Wiederhold BK, Wiederhold MD (2003) Three-Year Follow-Up for Virtual Reality Exposure for Fear of Flying. CyberPsychol Behav 6:441–445PubMedCrossRefGoogle Scholar
  67. 67.
    da Costa RMEM, De Carvalho LAV (2004) The acceptance of virtual reality devices for cognitive rehabilitation: a report of positive results with schizophrenia. Comput Methods Programs Biomed 73:173–182PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Academic Division of Clinical PsychologyUniversity of ManchesterManchesterUK
  2. 2.School of Psychological SciencesUniversity of ManchesterManchesterUK

Personalised recommendations