Skip to main content
SpringerLink
Log in

Virtual Reality Exposure Therapy for Post-Traumatic Stress Disorder and Other Anxiety Disorders

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Anxiety disorders, including phobias and post-traumatic stress disorder, are common and disabling disorders that often involve avoidance behavior. Cognitive-behavioral treatments, specifically imaginal and in vivo forms of exposure therapy, have been accepted and successful forms of treatment for these disorders. Virtual reality exposure therapy, an alternative to more traditional exposure-based therapies, involves immersion in a computer-generated virtual environment that minimizes avoidance and facilitates emotional processing. In this article, we review evidence on the application of virtual reality exposure therapy to the treatment of specific phobias and post-traumatic stress disorder and discuss its advantages and cautions.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Kessler RC, Chiu WT, Demler O, et al.: Prevalence, severity and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005, 62:617–627. (Published erratum appears in Arch Gen Psychiatry 2005, 62:709.)

    Article  PubMed  Google Scholar 

  2. Butler AC, Chapman JE, Forman EM, Beck AT: The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev 2006, 26:17–31.

    Article  PubMed  Google Scholar 

  3. Foa E, Kozak M: Emotional processing of fear: exposure to corrective information. Psychol Bull 1986, 99:20–35.

    Article  CAS  PubMed  Google Scholar 

  4. 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 2007, 10:722–724.

    Article  CAS  PubMed  Google Scholar 

  5. • Parsons TD, Rizzo AA: Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis. J Behav Ther Exp Psychiatry 2008, 39:250–261. This article presents a quantitative meta-analysis of 21 studies (300 participants) examining the variability and clinical significance of treatment outcomes following VRE therapy.

  6. • Powers MB, Emmelkamp PM: Virtual reality exposure therapy for anxiety disorders: a meta-analysis. J Anxiety Disord 2008, 22:561–569. This meta-analysis includes 13 studies (397 participants) and examines effect sizes for VRE therapy compared with in vivo exposure and control conditions.

  7. Rothbaum BO, Hodges LF, Kooper R, et al.: Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia. Am J Psychiatry 1995, 152:626–628.

    CAS  PubMed  Google Scholar 

  8. Emmelkamp PM, Bruynzel M, Drost L, van der Mast CA: Virtual reality treatment in acrophobia: a comparison with exposure in vivo. Cyberpsychol Behav 2001, 4:335–339.

    Article  CAS  PubMed  Google Scholar 

  9. Emmelkamp PM, Krijn M, Hulsbosch AM, et al.: Virtual reality treatment vs. exposure in vivo: a comparative evaluation in acrophobia. Behav Res Ther 2002, 40:509–516.

    Article  CAS  PubMed  Google Scholar 

  10. Carlin A, Hoffman H, Weghorst S: Virtual reality and tactile augmentation in the treatment of spider phobia: a case report. Behav Res Ther 1997, 35:153–158.

    Article  CAS  PubMed  Google Scholar 

  11. Garcia-Palacios A, Hoffman H, See SK, et al.: Redefining therapeutic success with virtual reality exposure therapy. Cyberpsychol Behav 2001, 4:341–348.

    Article  CAS  PubMed  Google Scholar 

  12. Garcia-Palacios A, Hoffman H, Carlin A, et al.: Virtual reality in the treatment of spider phobia: a controlled study. Behav Res Ther 2002, 40:983–993.

    Article  CAS  PubMed  Google Scholar 

  13. Bouchard S, Côté S, St-Jacques J, et al.: Effectiveness of virtual reality exposure in the treatment of arachnophobia using 3D games. Technol Health Care 2006, 14:19–27.

    PubMed  Google Scholar 

  14. Hoffman H, Garcia-Palacios A, Carlin A, et al.: Interfaces that heal: coupling real and virtual objects to treat spider phobia. Int J Hum Comput Interact 2003, 16:283–300.

    Article  Google Scholar 

  15. Rothbaum BO, Hodges L, Smith S, et al.: A controlled study of virtual reality exposure therapy for the fear of flying. J Consult Clin Psychol 2000, 68:1020–1026.

    Article  CAS  PubMed  Google Scholar 

  16. Rothbaum BO, Hodges L, Anderson PL, et al.: Twelve month follow up of virtual reality and standard exposure therapies for fear of flying. J Consult Clin Psychol 2002, 70:428–432.

    Article  PubMed  Google Scholar 

  17. Rothbaum BO, Anderson P, Zimand E, et al.: Virtual reality exposure therapy and standard (in vivo) exposure therapy in the treatment of fear of flying. Behav Ther 2006, 37:80–90.

    Article  PubMed  Google Scholar 

  18. Mühlberger A, Herrmann MJ, Wiedemann GC, et al.: Repeated exposure of flight phobics to flights in virtual reality. Behav Res Ther 2001, 39:1033–1050.

    Article  PubMed  Google Scholar 

  19. Maltby N, Kirsch I, Mayers M, Allen GJ: Virtual reality exposure therapy for the treatment of fear of flying: a controlled investigation. J Consult Clin Psychol 2002, 70:1112–1118.

    Article  PubMed  Google Scholar 

  20. Krijn M, Emmelkamp PM, Olafsson RP, et al.: Fear of flying treatment methods: virtual reality exposure vs. cognitive behavioral therapy. Aviat Space Environ Med 2007, 78:121–128.

    PubMed  Google Scholar 

  21. Botella C, Baños RM, Perpiña C, et al.: Virtual reality treatment of claustrophobia: a case report. Behav Res Ther 1998, 36:239–246.

    Article  CAS  PubMed  Google Scholar 

  22. Wald J, Taylor S: Preliminary research on the efficacy of virtual reality exposure therapy to treat driving phobia. Cyberpsychol Behav 2003, 6:459–465.

    Article  PubMed  Google Scholar 

  23. North M, North S, Coble L: Virtual reality therapy: an effective treatment for the fear of public speaking. Int J Virtual Real 1998, 3:1–6.

    Article  Google Scholar 

  24. Harris SR, Kemmerling RL, North MM: Brief virtual reality therapy for public speaking anxiety. Cyberpsychol Behav 2002, 5:543–550.

    Article  PubMed  Google Scholar 

  25. Klinger E, Bouchard S, Légeron P, et al.: Virtual reality therapy vs. cognitive behavior therapy for social phobia: a preliminary controlled study. Cyberpsychol Behav 2005, 8:76–88.

    Article  CAS  PubMed  Google Scholar 

  26. Anderson P, Rothbaum BO, Hodges LF: Virtual reality exposure in the treatment of social anxiety. Cogn Behav Pract 2006, 10:240–247.

    Article  Google Scholar 

  27. Botella C, Garcia-Palacios A, Villa H, et al.: Virtual reality exposure in the treatment of panic disorder and agoraphobia: a controlled study. Clin Psychol Psychother 2007, 14:164–175.

    Article  Google Scholar 

  28. Rothbaum BO, Hodges L, Alarcon R, et al.: Virtual reality exposure therapy for PTSD Vietnam veterans: a case study. J Trauma Stress 1999, 12:263–271.

    Article  CAS  PubMed  Google Scholar 

  29. Rothbaum BO, Hodges LF, Ready D, et al.: Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder. J Clin Psychiatry 2001, 62:617–622

    CAS  PubMed  Google Scholar 

  30. Ready DJ, Pollack S, Rothbaum BO, Alarcon RD: Virtual reality exposure for veterans with posttraumatic stress disorder. J Aggress Maltreat Trauma 2006, 12:199–220.

    Article  Google Scholar 

  31. Difede J, Hoffman HG, Jayasinghe N: Innovative use of virtual reality technology in the treatment of PTSD in the aftermath of September 11. Psychiatr Serv 2002, 53:1083–1085.

    Article  PubMed  Google Scholar 

  32. Difede J, Hoffman HG: Virtual reality exposure therapy for World Trade Center post-traumatic stress disorder: a case report. Cyberpsychol Behav 2002, 5:529–535.

    Article  PubMed  Google Scholar 

  33. Difede J, Cukor J, Jayasinghe N, et al.: Virtual reality exposure therapy for the treatment of posttraumatic stress disorder following September 11, 2001. J Clin Psychiatry 2007, 68:1639–1647.

    Article  PubMed  Google Scholar 

  34. Josman N, Somer E, Reisberg A, et al.: BusWorld: designing a virtual environment for post-traumatic stress disorder in Israel: a protocol. Cyberpsychol Behav 2006, 9:241–244.

    Article  PubMed  Google Scholar 

  35. Josman N, Reisberg A, Weiss PL, et al.: BusWorld: an analog pilot test of a virtual environment designed to treat posttraumatic stress disorder originating from a terrorist suicide bomb attack. Cyberpsychol Behav 2008, 11:775–777.

    Article  PubMed  Google Scholar 

  36. Beck JG, Palyo SA, Winer EH, et al.: Virtual reality exposure therapy for PTSD symptoms after a road accident: an uncontrolled case series. Behav Ther 2007, 38:39–48.

    Article  PubMed  Google Scholar 

  37. Gerardi M, Rothbaum BO, Ressler K, et al.: Virtual reality exposure therapy using a virtual Iraq: case report. J Trauma Stress 2008, 21:209–213.

    Article  PubMed  Google Scholar 

  38. Reger GM, Gahm GA: Virtual reality exposure therapy for active duty soldiers. J Clin Psychol 2008, 64:940–946.

    Article  PubMed  Google Scholar 

  39. McLay RN, McBrien C, Wiederhold M, Wiederhold B: Exposure therapy with and without virtual reality to treat PTSD while in the combat theater: a parallel case series. Cyberpsychol Behav 2009 Dec 20 (Epub ahead of print.).

  40. Foa EB, Hembree EA, Rothbaum BO: Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences: Therapist Guide. New York: Oxford University Press; 2007.

    Google Scholar 

  41. Becker CB, Zayfert C, Anderson E: A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behav Res Ther 2004, 42:277–292.

    Article  PubMed  Google Scholar 

  42. Feeny NC, Hembree EA, Zoellner LA: Myths regarding exposure therapy for PTSD. Cogn Behav Pract 2003, 10:85–90.

    Article  Google Scholar 

  43. Foa EB, Zoellner LA, Feeny NC, et al.: Does imaginal exposure exacerbate PTSD symptoms? J Consult Clin Psychol 2002, 70:1022–1028.

    Article  PubMed  Google Scholar 

  44. Cahill SP, Foa EB, Hembree EA, et al.: Dissemination of exposure therapy in the treatment of posttraumatic stress disorder. J Trauma Stress 2006, 19:597–610.

    Article  PubMed  Google Scholar 

Download references

Disclosure

Dr. Rothbaum is a consultant to and owns equity in Virtually Better, which is developing products related to the VR research described in this article. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its conflict-of-interest policies. No other potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA, 30322, USA

    Maryrose Gerardi & Barbara Olasov Rothbaum

  2. Weill Cornell Medical College, 525 East 68th Street, Box 200, New York, NY, 10065, USA

    Judith Cukor & JoAnn Difede

  3. Institute for Creative Technologies and School of Gerontology, University of Southern California, 13274 Fiji Way, Marina del Ray, CA, 90292, USA

    Albert Rizzo

Authors
  1. Maryrose Gerardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Judith Cukor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. JoAnn Difede
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Albert Rizzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Barbara Olasov Rothbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Barbara Olasov Rothbaum.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gerardi, M., Cukor, J., Difede, J. et al. Virtual Reality Exposure Therapy for Post-Traumatic Stress Disorder and Other Anxiety Disorders. Curr Psychiatry Rep 12, 298–305 (2010). https://doi.org/10.1007/s11920-010-0128-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-010-0128-4

Keywords

Search

Navigation