Abstract
Virtual Reality (VR) Therapy has emerged in the 90s as an appealing way of delivering exposure treatment. Throughout these years, ample evidence has been published. Although there is an agreed consensus regarding its efficacy, currently a quick shift in the field is being experienced, especially due to the advent of off-the-shelf technology that is greatly facilitating its dissemination. In this context, theoretical discussions of the field appear as an important action in order to take stock of the mounting evidence that has been produced and the main challenges for the coming future. To stimulate the discussion in a burgeoning field, a SWOT analysis is proposed, which may help to map the field of VR therapy for anxiety and stress-related disorders. Overall, it is undoubted that VR appears as a well-established technology for the treatment of ASRD and the main challenges are in line with the possibility of hurdling the same obstacles that the whole field of clinical psychology and psychotherapy has to deal with: How to bridge the gap between research and clinical practice.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Bandelow, B., Michaelis, S.: Epidemiology of anxiety disorders in the 21st century. Dialogues Clin. Neurosci. 17(3), 327 (2015)
Watson, D.: Differentiating the mood and anxiety disorders: a quadripartite model. Ann. Rev. Clin. Psychol. 5, 221–247 (2009). https://doi.org/10.1146/annurev.clinpsy.032408.153510
Olatunji, B.O., Cisler, J.M., Deacon, B.J.: Efficacy of cognitive behavioral therapy for anxiety disorders: a review of meta-analytic findings (2010). https://doi.org/10.1016/j.psc.2010.04.002
Alonso, J., et al.: Treatment gap for anxiety disorders is global: results of the world mental health surveys in 21 countries. Depress. Anxiety (2018). https://doi.org/10.1002/da.22711
WHO: Prevalence, severity, and unmet need for treatment of mental disorders in the world health organization world mental health surveys. J. Am. Med. Assoc. 2581–2590 (2004). https://doi.org/10.1001/jama.291.21.2581
Wagner, R., Silove, D., Marnane, C., Rouen, D.: Delays in referral of patients with social phobia, panic disorder and generalized anxiety disorder attending a specialist anxiety clinic. J. Anxiety Disord. (2006). https://doi.org/10.1016/j.janxdis.2005.02.003
Kazdin, A.E., Blase, S.L.: Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspect. Psychol. Sci. (2011). https://doi.org/10.1177/1745691610393527
Hoyer, J., Beesdo, K., Gloster, A.T., Runge, J., Höfler, M., Becker, E.S.: Worry exposure versus applied relaxation in the treatment of generalized anxiety disorder. Psychother. Psychosom. (2009). https://doi.org/10.1159/000201936
Pittig, A., Kotter, R., Hoyer, J.: The struggle of behavioral therapists with exposure: self-reported practicability, negative beliefs, and therapist distress about exposure-based interventions. Behav. Ther. (2019). https://doi.org/10.1016/j.beth.2018.07.003
Cook, J.M., Biyanova, T., Elhai, J., Schnurr, P.P., Coyne, J.C.: What do psychotherapists really do in practice? An internet study of over 2,000 practitioners. Psychotherapy (2010). https://doi.org/10.1037/a0019788
Schumacher, S., Weiss, D., Knaevelsrud, C.: Dissemination of exposure in the treatment of anxiety disorders and post-traumatic stress disorder among German cognitive behavioural therapists. Clin. Psychol. Psychother. (2018). https://doi.org/10.1002/cpp.2320
Garcia-Palacios, A., Botella, C., Hoffman, H., Fabregat, S.: Comparing acceptance and refusal rates of virtual reality exposure vs. in vivo exposure by patients with specific phobias. CyberPsychol. Behav 10, 722–724 (2007). https://doi.org/10.1089/cpb.2007.9962
Garcia-Palacios, A., Hoffman, H.G., Kwong See, S., Tsai, A., Botella, C.: Redefining therapeutic success with virtual reality exposure therapy. CyberPsychol. Behav. 4, 341–348 (2002). https://doi.org/10.1089/109493101300210231
Botella, C., Fernández-Álvarez, J., Guillén, V., García-Palacios, A., Baños, R.: Recent progress in virtual reality exposure therapy for phobias: a systematic review. Curr. Psychiatry Rep. 19 (2017). https://doi.org/10.1007/s11920-017-0788-4
Fernández-Álvarez, J., et al.: Deterioration rates in virtual reality therapy: an individual patient data level meta-analysis. J. Anxiety Disord. 61, 3–17 (2019). https://doi.org/10.1016/j.janxdis.2018.06.005
Cipresso, P., Giglioli, I.A.C., Raya, M.A., Riva, G.: The past, present, and future of virtual and augmented reality research: a network and cluster analysis of the literature. Front. Psychol. (2018). https://doi.org/10.3389/fpsyg.2018.02086
Rozental, A., et al.: Negative effects in psychotherapy: commentary and recommendations for future research and clinical practice. BJPsych Open (2018). https://doi.org/10.1192/bjo.2018.42
Craske, M.G., Treanor, M., Conway, C.C., Zbozinek, T., Vervliet, B.: Maximizing exposure therapy: an inhibitory learning approach. Behav. Res. Ther. 58, 10–23 (2014). https://doi.org/10.1016/j.brat.2014.04.006
Botella, C., Serrano, B., Baños, R.M., Garcia-Palacios, A.: Virtual reality exposure-based therapy for the treatment of post-traumatic stress disorder: a review of its efficacy, the adequacy of the treatment protocol, and its acceptability (2015). https://doi.org/10.2147/NDT.S89542
Carl, E., et al.: Virtual reality exposure therapy for anxiety and related disorders: a meta-analysis of randomized controlled trials (2018)
Morina, N., Ijntema, H., Meyerbröker, K., Emmelkamp, P.M.G.: Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments. Behav. Res. Ther. 74, 18–24 (2015). https://doi.org/10.1016/j.brat.2015.08.010
Loucks, L., et al.: You can do that?!: Feasibility of virtual reality exposure therapy in the treatment of PTSD due to military sexual trauma. J. Anxiety Disord. 61, 55–63 (2019). https://doi.org/10.1016/j.janxdis.2018.06.004
Côté, S., Bouchard, S.: Documenting the efficacy of virtual reality exposure with psychophysiological and information processing measures. Appl. Psychophysiol. Biofeedback 30, 217–232 (2005). https://doi.org/10.1007/s10484-005-6379-x
Benbow, A.A., Anderson, P.L.: A meta-analytic examination of attrition in virtual reality exposure therapy for anxiety disorders. J. Anxiety Disord. 61, 18–27 (2019). https://doi.org/10.1016/j.janxdis.2018.06.006
Birckhead, B., et al.: Recommendations for methodology of virtual reality clinical trials in health care by an international working group: iterative study. JMIR Ment. Health 6, e11973 (2018). https://doi.org/10.2196/11973
McCann, R.A., et al.: Virtual reality exposure therapy for the treatment of anxiety disorders: an evaluation of research quality. J. Anxiety Disord. 28, 625–631 (2014). https://doi.org/10.1016/j.janxdis.2014.05.010
Page, S., Coxon, M.: Virtual reality exposure therapy for anxiety disorders: small samples and no controls? Front. Psychol. 7, 1–4 (2016). https://doi.org/10.3389/fpsyg.2016.00326
Meyerbröker, K., Emmelkamp, P.M.G.: Therapeutic processes in virtual reality exposure therapy: the role of cognitions and the therapeutic alliance. J. CyberTher. Rehabil. 1 (2008)
Reger, G.M., et al.: Randomized controlled trial of prolonged exposure using imaginal exposure vs. virtual reality exposure in active stress disorder (PTSD). J. Consult. Clin. Psychol. 84, 946–959 (2016). https://doi.org/10.1037/ccp0000134
Donker, T., et al.: Effectiveness of self-guided app-based virtual reality cognitive behavior therapy for acrophobia. JAMA Psychiatry (2019). https://doi.org/10.1001/jamapsychiatry.2019.0219
Freeman, D., et al.: Automated psychological therapy using immersive virtual reality for treatment of fear of heights: a single-blind, parallel-group, randomised controlled trial. Lancet Psychiatry 5, 625–632 (2018). https://doi.org/10.1016/S2215-0366(18)30226-8
Minns, S., et al.: Immersive 3D exposure-based treatment for spider fear: a randomized controlled trial. J. Anxiety Disord. 61, 37–44 (2019). https://doi.org/10.1016/j.janxdis.2018.12.003
Lindner, P., 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. J. Anxiety Disord. 61, 45–54 (2019). https://doi.org/10.1016/j.janxdis.2018.07.003
Miragall, M., Baños, R.M., Cebolla, A., Botella, C.: Working alliance inventory applied to virtual and augmented reality (WAI-VAR): psychometrics and therapeutic outcomes. Front. Psychol. 6, 1–10 (2015). https://doi.org/10.3389/fpsyg.2015.01531
Ngai, I., Tully, E.C., Anderson, P.L.: The course of the working alliance during virtual reality and exposure group therapy for social anxiety disorder. Behav. Cogn. Psychother. 43, 167–181 (2015). https://doi.org/10.1017/S135246581300088X
Wrzesien, M., Burkhardt, J.M., Botella, C., Alcañiz, M.: Towards a virtual reality- and augmented reality-mediated therapeutic process model: a theoretical revision of clinical issues and HCI issues. 16, 124–153 (2015). https://doi.org/10.1080/1463922X.2014.903307
Wrzesien, M., et al.: How technology influences the therapeutic process: evaluation of the patient-therapist relationship in augmented reality exposure therapy and in vivo exposure therapy. Behav. Cogn. Psychother. 41, 505–509 (2013). https://doi.org/10.1017/S1352465813000088
Anderson, P.L., et al.: Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial. J. Consult. Clin. Psychol. 81, 751–760 (2013). https://doi.org/10.1037/a0033559
Moldovan, R., David, D.: One session treatment of cognitive and behavioral therapy and virtual reality for social and specific phobias. Preliminary results from a randomized clinical trial. J. Evid.-Based Psychother. 14, 67–83 (2014)
Bouchard, S., et al.: Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: a three-arm randomised controlled trial. Br. J. Psychiatry. 1–9 (2016). https://doi.org/10.1192/bjp.bp.116.184234
Levy, F., Leboucher, P., Rautureau, G., Komano, O., Millet, B., Jouvent, R.: Fear of falling: efficacy of virtual reality associated with serious games in elderly people. Neuropsychiatr. Dis. Treat. 12, 877–881 (2016). https://doi.org/10.2147/NDT.S97809
Price, M., Anderson, P., Henrich, C.C., Rothbaum, B.O.: Greater expectations: using hierarchical linear modeling to examine expectancy for treatment outcome as a predictor of treatment response. Behav. Ther. 39, 398–405 (2008). https://doi.org/10.1016/j.beth.2007.12.002
Price, M., Anderson, P.L.: Outcome expectancy as a predictor of treatment response in cognitive behavioral therapy for public speaking fears within social anxiety disorder. Psychotherapy 49, 173–179 (2012). https://doi.org/10.1037/a0024734
Price, M., Maples, J.L., Jovanovic, T., Norrholm, S.D., Heekin, M., Rothbaum, B.O.: An investigation of outcome expectancies as a predictor of treatment response for combat veterans with PTSD: comparison of clinician, self-report, and biological measures. Depress. Anxiety 32, 392–399 (2015). https://doi.org/10.1002/da.22354
Norrholm, S.D., et al.: Fear load: The psychophysiological over-expression of fear as an intermediate phenotype associated with trauma reactions. Int. J. Psychophysiol. 98, 270–275 (2014). https://doi.org/10.1016/j.ijpsycho.2014.11.005
Price, M., Mehta, N., Tone, E.B., Anderson, P.L.: Does engagement with exposure yield better outcomes? Components of presence as a predictor of treatment response for virtual reality exposure therapy for social phobia. J. Anxiety Disord. 25, 763–770 (2011). https://doi.org/10.1016/j.janxdis.2011.03.004
Reger, G.M., Smolenski, D., Norr, A., Katz, A., Buck, B., Rothbaum, B.O.: Does virtual reality increase emotional engagement during exposure for PTSD? Subjective distress during prolonged and virtual reality exposure therapy. J. Anxiety Disord. 61, 75–81 (2019). https://doi.org/10.1016/j.janxdis.2018.06.001
Hofmann, S.G., Hayes, S.C.: The future of intervention science: process-based therapy. Clin. Psychol. Sci. 7, 37–50 (2019). https://doi.org/10.1177/2167702618772296
Norr, A.M., et al.: Virtual reality exposure versus prolonged exposure for PTSD: which treatment for whom? Depress. Anxiety (2018). https://doi.org/10.1002/da.22751
Peskin, M., et al.: The relationship between posttraumatic and depressive symptoms during virtual reality exposure therapy with a cognitive enhancer. J. Anxiety Disord. (2019). https://doi.org/10.1016/j.janxdis.2018.03.001
Côté, S., Bouchard, S.: Cognitive mechanisms underlying virtual reality exposure. CyberPsychol. Behav. 12, 121–129 (2009). https://doi.org/10.1089/cpb.2008.0008
Tardif, N., Therrie, C., Bouchard, S.: Re-examining psychological mechanisms underlying virtual reality-based exposure for spider phobia. Cyberpsychol. Behav. Soc. Netw. 22, 39–45 (2019). https://doi.org/10.1089/cyber.2017.0711
Pizzoli, S.F.M., Mazzocco, K., Triberti, S., Monzani, D., Alcañiz Raya, M.L., Pravettoni, G.: User-centered virtual reality for promoting relaxation: an innovative approach. Front. Psychol. 10, 1–8 (2019). https://doi.org/10.3389/fpsyg.2019.00479
Lindner, P., et al.: Creating state of the art, next-generation virtual reality exposure therapies for anxiety disorders using consumer hardware platforms: design considerations and future direction. Cogn. Behav. Ther. (in press). https://doi.org/10.1080/16506073.2017.1280843
Jerdan, S.W., Grindle, M., Van Woerden, H.C., Kamel Boulos, M.N.: Head-mounted virtual reality and mental health: critical review of current research. J. Med. Internet Res. 20, 1–16 (2018). https://doi.org/10.2196/games.9226
Carlbring, P., 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. J. Anxiety Disord. 61, 45–54 (2018). https://doi.org/10.1016/j.janxdis.2018.07.003
Fernández-Álvarez, J., Fernández-Álvarez, H., Castonguay, L.G.: Resumiendo los nuevos esfuerzos para integrar la práctica y la investigación desde la perspectiva de la investigación orientada por la práctica. Rev. Argent. Clin. Psicol. (2018). https://doi.org/10.24205/03276716.2018.1070
Maples-Keller, J.L., et al.: When translational neuroscience fails in the clinic: dexamethasone prior to virtual reality exposure therapy increases drop-out rates. J. Anxiety Disord. 61, 89–97 (2019). https://doi.org/10.1016/j.janxdis.2018.10.006
Repetto, C., Riva, G.: From virtual reality to interreality in the treatment of anxiety disorders. Neuropsychiatry (London) (2011). https://doi.org/10.2217/npy.11.5
Aderka, I.M., Gutner, C.A., Lazarov, A., Hermesh, H., Hofmann, S.G., Marom, S.: Body image in social anxiety disorder, obsessive-compulsive disorder, and panic disorder. Body Image (2014). https://doi.org/10.1016/j.bodyim.2013.09.002
Aymerich-Franch, L., Kizilcec, R.F., Bailenson, J.N.: The relationship between virtual self similarity and social anxiety. Front. Hum. Neurosci. 8, 944 (2014). https://doi.org/10.3389/fnhum.2014.00944
Chalmers, J.A., Quintana, D.S., Abbott, M.J.A., Kemp, A.H.: Anxiety disorders are associated with reduced heart rate variability: a meta-analysis. Front. Psychiatry. 5 (2014). https://doi.org/10.3389/fpsyt.2014.00080
Goessl, V.C., Curtiss, J.E., Hofmann, S.G.: The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis. Psychol. Med. 47, 2578–2586 (2017). https://doi.org/10.1017/S0033291717001003
Repetto, C., Gaggioli, A., Pallavicini, F., Cipresso, P., Raspelli, S., Riva, G.: Virtual reality and mobile phones in the treatment of generalized anxiety disorders: a phase-2 clinical trial. Pers. Ubiquitous Comput. (2013). https://doi.org/10.1007/s00779-011-0467-0
Lorenzetti, V., et al.: Emotion regulation using virtual environments and real-time fMRI neurofeedback. Front. Neurol. 9, 390 (2018). https://doi.org/10.3389/FNEUR.2018.00390
Urech, A., Krieger, T., Chesham, A., Mast, F.W., Berger, T.: Virtual reality-based attention bias modification training for social anxiety: a feasibility and proof of concept study. Front. Psychiatry 6, 1–5 (2015). https://doi.org/10.3389/fpsyt.2015.00154
Baños, R.M., Guillen, V., Quero, S., García-Palacios, A., Alcaniz, M., Botella, C.: A virtual reality system for the treatment of stress-related disorders: a preliminary analysis of efficacy compared to a standard cognitive behavioral program. Int. J. Hum Comput Stud. 69, 602–613 (2011). https://doi.org/10.1016/j.ijhcs.2011.06.002
Cipresso, P., Riva, G.: Personality assessment in ecological settings by means of virtual reality. In: The Wiley Handbook of Personality Assessment, pp. 240–248 (2016)
Fleming, T.M., et al.: Maximizing the impact of e-therapy and serious gaming: time for a paradigm shift. Front. Psychiatry 7, 65 (2016)
Kazdin, A.E.: Single-case experimental designs. Evaluating interventions in research and clinical practice (2018). https://doi.org/10.1016/j.brat.2018.11.015
Provoost, S., Lau, H.M., Ruwaard, J., Riper, H.: Embodied conversational agents in clinical psychology: a scoping review (2017). https://doi.org/10.2196/jmir.6553
Schueller, S.M., Tomasino, K.N., Mohr, D.C.: Integrating human support into behavioral intervention technologies: the efficiency model of support (2017). https://doi.org/10.1111/cpsp.12173
Bailenson, J.: Protecting nonverbal data tracked in virtual reality. JAMA Pediatr. (2018). https://doi.org/10.1001/jamapediatrics.2018.1909
Schwartzman, D., Segal, R., Drapeau, M.: Perceptions of virtual reality among therapists who do not apply this technology in clinical practice. Psychol. Serv. 9, 310–315 (2012). https://doi.org/10.1037/a0026801
Segal, R., Bhatia, M., Drapeau, M.: Therapists’ perception of benefits and costs of using virtual reality treatments. Cyberpsychol. Behav. Soc. Netw. 14, 29–34 (2010). https://doi.org/10.1089/cyber.2009.0398
Kramer, T.L., Pyne, J.M., Kimbrell, T.A., Savary, P.E., Smith, J.L., Jegley, S.M.: Clinician perceptions of virtual reality to assess and treat returning veterans. Psychiatr. Serv. 61, 1153–1156 (2014). https://doi.org/10.1176/ps.2010.61.11.1153
Lindner, P., Miloff, A., Zetterlund, E., Reuterskiöld, L., Andersson, G., Carlbring, P.: Attitudes toward and familiarity with virtual reality therapy among practicing cognitive behavior therapists: a cross-sectional survey study in the era of consumer VR platforms. Front. Psychol. 10, 1–10 (2019). https://doi.org/10.3389/fpsyg.2019.00176
Norcross, J.C., Hedges, M., Prochaska, J.O.: The face of 2010: a delphi poll on the future of psychotherapy. Prof. Psychol. Res. Pract. (2002). https://doi.org/10.1037/0735-7028.33.3.316
Norcross, J.C., Pfund, R.A., Prochaska, J.O.: Psychotherapy in 2022 : a delphi poll on its future. 44, 363–370 (2013). https://doi.org/10.1037/a0034633
Acknowledgement
This work was supported by the Marie Skłodowska-Curie Innovative Training Network AffecTech (project ID: 722022) funded by the European Commission H2020.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 ICST Institute for Computer Sciences, Social Informatics and Telecommunications Engineering
About this paper
Cite this paper
Fernández-Alvarez, J., Colombo, D., Botella, C., García-Palacios, A., Riva, G. (2019). Virtual Reality for Anxiety and Stress-Related Disorders: A SWOT Analysis. In: Cipresso, P., Serino, S., Villani, D. (eds) Pervasive Computing Paradigms for Mental Health. MindCare 2019. Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering, vol 288. Springer, Cham. https://doi.org/10.1007/978-3-030-25872-6_4
Download citation
DOI: https://doi.org/10.1007/978-3-030-25872-6_4
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-25871-9
Online ISBN: 978-3-030-25872-6
eBook Packages: Computer ScienceComputer Science (R0)