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).

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
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
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
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
Rothbaum, B. O., Anderson, P., Zimand, E., Hodges, L., Lang, D., & Wilson, J. (2006). Virtual reality exposure therapy and standard (in vivo) exposure therapy in the treatment of fear of flying. Behavior Therapy, 37(1), 80–90. http://doi.org/10.1016/j.beth.2005.04.004
Rothbaum, B. O., Hodges, L., Smith, S., Lee, J. H., & Price, L. (2000). A controlled study of virtual reality exposure therapy for the fear of flying. Journal of Consulting and Clinical Psychology, 68(6), 1020–1026. http://doi.org/10.1037/0022-006X.68.6.1020
Vincelli, F., Anolli, L., Bouchard, S., Wiederhold, B. K., Zurloni, V., & Riva, G. (2003). Experiential Cognitive Therapy in the Treatment of Panic Disorders with Agoraphobia: A Controlled Study. CyberPsychology & Behavior, 6(3), 321–328. http://doi.org/10.1089/109493103322011632