Literature Review¶

Fear is a natural physiological reaction to endangering stimuli and serves a critical function in responses necessary for survival (Fendt & Fanselow, 1999). However, when a person is inflicted with a specific phobia, this reaction is elicited to a disproportionate amount, or even by a completely innocuous stimulus, and may thus cause significant distress and difficulty (Davey, 2014). Multiple forms of treatment are available for those diagnosed with specific phobias (Choy, Fyer, & Lipsitz, 2007), but one of the more recent ones is the focus of this review: Exposure therapy through virtual reality (VR).

The literature on this form of exposure therapy is fairly expansive, but still very limited considering how many types of specific phobias there are (Parsons & Rizzo, 2008). Most studies have focused on one of five types of phobias: Acrophobia, agoraphobia, arachnophobia, aviophobia, and social phobia. However, two of those five (agoraphobia and social phobia) are not considered specific phobias in DSM-5 (American Psychiatric Association, 2013) but rather separate mental disorders.

Research on treatments using exposure through VR overall show a positive outcome (Parsons & Rizzo, 2008). Studies on acrophobia reveal that VR exposure is just as effective as in vivo exposure (P. M. G Emmelkamp et al., 2002; Paul M. G. Emmelkamp, Bruynzeel, Drost, & van der Mast, 2001; Krijn et al., 2004) and in some instances even more effective (Paul M. G. Emmelkamp et al., 2001), which may in part be due to some people saying that VR exposure evokes more fear than in vivo exposure (Jang et al., 2002). This also applies to studies on aviophobia, with VR exposure as effective as in vivo exposure both immediately following treatment and at follow-up (Rothbaum et al., 2006; Rothbaum, Hodges, Smith, Lee, & Price, 2000). Arachnophobiacs managed to get on average within 6 inches of a real spider post-exposure whereas they stopped on average 5.5 feet away pre-exposure (Hoffman, Garcia-Palacios, Carlin, Furness III, & Botella-Arbona, 2003) and great progress was seen even when the treatment simply consisted of a video game (Half-Life™) involving spiders instead of a software specifically made for treatment purposes (Bouchard, Côté, St-Jacques, Robillard, & Renaud, 2006).

Despite agoraphobia and social phobia not being specific phobias, the results of VR therapy on them are similar to specific phobias. VR therapy seems to be as good as CBT as a treatment for agoraphobia (North, North, & Coble, 1996), if not better (Vincelli et al., 2003). However, long-term effects are not as strong after VR therapy (Choi et al., 2005). Research on social phobia show that VR therapy works as well as traditional CBT (Harris, Kemmerling, & North, 2002; Klinger et al., 2005), however, most research have only been focused on one aspect of social phobia, i.e. speech anxiety (Anderson, Zimand, Hodges, & Rothbaum, 2005; Harris et al., 2002; Klinger et al., 2005), which is in itself a specific phobia (glossophobia).

There are other phobias that can be found in the literature, but studies are often not varied enough to reach the same conclusions as the aforementioned phobias. Subjects with claustrophobia have been cured using VR and the effect of their treatment remains after at least 3 months (C. Botella, Villa, Baños, Perpiñá, & García-Palacios, 1999; Cristina Botella, Baños, Villa, Perpiñá, & García-Palacios, 2000; Malbos, Mestre, Note, & Gellato, 2008), but no study was found that compared VR to other methods of treatment. The same applies to driving phobia, VR therapy works (Wald & Taylor, 2000; Walshe, Lewis, Kim, O’Sullivan, & Wiederhold, 2003), but no study was found that compared it to another method of treatment. Research on cynophobia has shown that VR can easily bring about the arousal necessary for treatment to occur (Suied, Drettakis, Warusfel, & Viaud-Delmon, 2013; Viaud-Delmon et al., 2008), but no study was found that had the objective of treating cynophobia. The same also applies for needle phobia (B. K. Wiederhold, Mendoza, Nakatani, Bullinger, & Wiederhold, 2005), but VR is still regularly used to assist people with needle or dental phobia, but as a diversion tactic rather than a method of treatment (Hoffman et al., 2001; Brenda K. Wiederhold & Wiederhold, 2005).

Considering the exponential growth of technological innovation, all these results are however rather outdated. The virtual realities used did not have the sort of motion-sensing options that are accessible now and many of them did not have an immersive 3D environment that the user is placed into, just computer screens.

Resources¶

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed). Washington, D.C: American Psychiatric Association.

Anderson, P. L., Zimand, E., Hodges, L. F., & Rothbaum, B. O. (2005). Cognitive behavioral therapy for public-speaking anxiety using virtual reality for exposure. Depression and Anxiety, 22(3), 156–158. http://doi.org/10.1002/da.20090

Botella, C., Baños, R. M., Villa, H., Perpiñá, C., & García-Palacios, A. (2000). Virtual reality in the treatment of claustrophobic fear: A controlled, multiple-baseline design. Behavior Therapy, 31(3), 583–595. http://doi.org/10.1016/S0005-7894(00)80032-5

Botella, C., Villa, H., Baños, R., Perpiñá, C., & García-Palacios, A. (1999). The treatment of claustrophobia with virtual reality: changes in other phobic behaviors not specifically treated. CyberPsychology & Behavior, 2(2), 135–141. http://doi.org/10.1089/cpb.1999.2.135

Bouchard, S., Côté, S., St-Jacques, J., Robillard, G., & Renaud, P. (2006). Effectiveness of virtual reality exposure in the treatment of arachnophobia using 3D games. Technology and Health Care, 14(1), 19–27.

Choi, Y.-H., Vincelli, F., Riva, G., Wiederhold, B. K., Lee, J.-H., & Park, K.-H. (2005). Effects of group experiential cognitive therapy for the treatment of panic disorder with agoraphobia. CyberPsychology & Behavior, 8(4), 387–393. http://doi.org/10.1089/cpb.2005.8.387

Choy, Y., Fyer, A. J., & Lipsitz, J. D. (2007). Treatment of specific phobia in adults. Clinical Psychology Review, 27(3), 266–286. http://doi.org/10.1016/j.cpr.2006.10.002

Davey, G. (2014). Psychopathology: Research, assessment and treatment in clinical psychology (Second edition). Chichester, West Sussex: Wiley.

Emmelkamp, P. M. G., Bruynzeel, M., Drost, L., & van der Mast, C. A. P. G. (2001). Virtual reality treatment in acrophobia: A comparison with exposure in vivo. CyberPsychology & Behavior, 4(3), 335–339. http://doi.org/10.1089/109493101300210222

Emmelkamp, P. M. G., Krijn, M., Hulsbosch, A. M., de Vries, S., Schuemie, M. J., & van der Mast, C. A. P. G. (2002). Virtual reality treatment versus exposure in vivo: A comparative evaluation in acrophobia. Behaviour Research and Therapy, 40(5), 509–516. http://doi.org/10.1016/S0005-7967(01)00023-7

Fendt, M., & Fanselow, M. S. (1999). The neuroanatomical and neurochemical basis of conditioned fear. Neuroscience & Biobehavioral Reviews, 23(5), 743–760. http://doi.org/10.1016/S0149-7634(99)00016-0

Harris, S. R., Kemmerling, R. L., & North, M. M. (2002). Brief virtual reality therapy for public speaking anxiety. CyberPsychology & Behavior, 5(6), 543–550. http://doi.org/10.1089/109493102321018187

Hoffman, H. G., Garcia-Palacios, A., Carlin, A., Furness III, T. A., & Botella-Arbona, C. (2003). Interfaces that heal: Coupling real and virtual objects to treat spider phobia. International Journal of Human-Computer Interaction, 16(2), 283–300. http://doi.org/10.1207/S15327590IJHC1602_08

Hoffman, H. G., Garcia-Palacios, A., Patterson, D. R., Jensen, M., Furness, T., & Ammons, W. F. (2001). The effectiveness of virtual reality for dental pain control: a case study. CyberPsychology & Behavior, 4(4), 527–535. http://doi.org/10.1089/109493101750527088

Jang, D. P., Ku, J. H., Choi, Y. H., Wiederhold, B. K., Nam, S. W., Kim, I. Y., & Kim, S. I. (2002). The development of virtual reality therapy (VRT) system for the treatment of acrophobia and therapeutic case. IEEE Transactions on Information Technology in Biomedicine, 6(3), 213–217. http://doi.org/10.1109/TITB.2002.802374

Klinger, E., Bouchard, S., Légeron, P., Roy, S., Lauer, F., Chemin, I., & Nugues, P. (2005). Virtual reality therapy versus cognitive behavior therapy for social phobia: A preliminary controlled study. CyberPsychology & Behavior, 8(1), 76–88. http://doi.org/10.1089/cpb.2005.8.76

Krijn, M., Emmelkamp, P. M. G., Biemond, R., de Wilde de Ligny, C., Schuemie, M. J., & van der Mast, C. A. P. G. (2004). Treatment of acrophobia in virtual reality: The role of immersion and presence. Behaviour Research and Therapy, 42(2), 229–239. http://doi.org/10.1016/S0005-7967(03)00139-6

Malbos, E., Mestre, D. r., Note, I. d., & Gellato, C. (2008). Virtual reality and claustrophobia: multiple components therapy involving game editor virtual environments exposure. CyberPsychology & Behavior, 11(6), 695–697. http://doi.org/10.1089/cpb.2007.0246

North, M. M., North, S. M., & Coble, J. R. (1996). Effectiveness of virtual environment desensitization in the treatment of agoraphobia. Presence: Teleoperators and Virtual Environments, 5(3), 346–352. http://doi.org/10.1162/pres.1996.5.3.346

Parsons, T. D., & Rizzo, A. A. (2008). Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: A meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 39(3), 250–261. http://doi.org/10.1016/j.jbtep.2007.07.007

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Suied, C., Drettakis, G., Warusfel, O., & Viaud-Delmon, I. (2013). Auditory-visual virtual reality as a diagnostic and therapeutic tool for cynophobia. Cyberpsychology, Behavior, and Social Networking, 16(2), 145–152. http://doi.org/10.1089/cyber.2012.1568

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Wiederhold, B. K., & Wiederhold, M. D. (2005). Fear of Medical Procedures. In Virtual reality therapy for anxiety disorders: Advances in evaluation and treatment (pp. 181–188). Washington, DC, US: American Psychological Association.