Is VR clinically proven for treating phobias ?

Several medical experiments have been conducted over the past 25 years that do conclude on the efficiency of virtual reality to treat phobias. To the extent that this approach has since been given a name and is now refered to as “VRET” (Virtual Reality Exposure Therapy) What are those studies and what do they prove ? We publish an extract of the key ones, with links to the abstracts.

One of the earlier studies was made by B.O. Rothbaum and L.F. Hodges on acrophobia in 1995 (https://pubmed.ncbi.nlm.nih.gov/7694917/) on a group of 12 college students. It concluded that treatment with virtual reality graded exposure was successful in reducing fear of heights. North et al. also did one if the first studies in 1997, this time on Agoraphobia with at the time promising, yet inconclusive, results.

Since then several dozens of studies have ben published that confirm the efficiency of VRET: the most central one is probably a 2007 meta-analysis by Powers and Emmelkamp (https://pubmed.ncbi.nlm.nih.gov/17544252/), based on 13 studies, that confirms a large mean effect size for VRET compared to control conditions. Also in vivo treatment was not significantly more effective than VRET across studies. In fact, there was a small effect size favoring VRET over in vivo conditions.

For specific phobias, the key studies are:

-Aviophobia:
Mühlberger et al. in 2003 (https://pubmed.ncbi.nlm.nih.gov/21827246/) conclude that VRET and CBT is more effective than CBT treatment alone.

-Acrophobia:

Emmelkamp et al. demonstrated in 2002 (https://pubmed.ncbi.nlm.nih.gov/12038644/) that VR and in vivo are equally effective with stable results after 6 months.

-Social Phobia:

Klinger et al.(https://pubmed.ncbi.nlm.nih.gov/15738695/) showed in 2005 that VR and CBT show equally significant improvements in anxiety and avoidance behaviour

-Agoraphobia:

Botella et al. in 2007 (https://psycnet.apa.org/record/2007-09263-002) showed that the improvement achieved using virtual exposure was superior to a waitlist condition and similar to that achieved using invivo exposure (with obvious cost benefits)

-Claustrophobia:

Botella et al. from 2000 (https://www.sciencedirect.com/science/article/abs/pii/S0005789400800325) shows that VR exposure was effective in reducing fear and avoidance in closed spaces and in increasing self-efficacy in claustrophobic situations. Moreover, changes were maintained at 3-month follow-up.

-Arachnophobia:

Bochard et al. (https://pubmed.ncbi.nlm.nih.gov/16556961/) showed in 2006 that modified 3d computer games were effective in the treatment of Arachnophobia
Garcia-Palacios et al. (https://pubmed.ncbi.nlm.nih.gov/12296495/) evidenced in 2002 that 83% of the VR expoure group showed clinically significant improvement.

-PTSD:
Difede et al. in 2006 on survivors of 9/11 that show significantly greater improvement on CAPS scores than the control group.
(https://pubmed.ncbi.nlm.nih.gov/16891607/)

There are not as many studies on the impact of 360 videos as there are for the computer-based imagery used Virtual Reality. Although 360 videos are present in many VR commercial offers and CBT practicians (including our platform’s users!) confirm their impact, more studies in this field would be beneficial. A promising study made at the University of Texas under the supervision of professor Jasper Smits and Mark Powers showed good results for arachnophobia leveraging spiders filmed with 360 cameras. Finally, we suggest that you take a look at our post based on a recent Frontiers in psychology article related to 360° videos compared to computer-generated imagery in sports VR.

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