Examining the impact of virtual reality exposure therapy on phobia treatment outcomes: a randomized controlled trial

Authors

  • Rachel Maliyoni Kabudula Mzuzu University, Malawi

Keywords:

Comparative effectiveness, Fear generalization, Phobia treatment, Treatment outcomes, Virtual Reality Exposure Therapy (VRET)

Abstract

This randomized controlled trial aimed to examine the impact of Virtual Reality Exposure Therapy (VRET) on phobia treatment outcomes compared to traditional Exposure Therapy (ET). Participants diagnosed with specific phobias were randomly assigned to either the VRET or ET group. Both groups underwent a standardized treatment protocol consisting of exposure sessions targeting their specific phobic stimuli. Outcome measures included phobia symptom severity, treatment adherence, treatment satisfaction, fear generalization, and long-term maintenance of treatment gains. The results revealed comparable effectiveness between VRET and ET, with both groups showing significant reductions in phobia symptoms. Treatment adherence rates were high in both groups, indicating participants' engagement with the interventions. Additionally, participants in the VRET group reported high treatment satisfaction ratings, highlighting the acceptability of virtual reality technology in therapy. Fear generalization was successful in both groups, suggesting that treatment effects extended beyond the targeted phobic stimuli. Follow-up assessments at three and six months post-treatment demonstrated the maintenance of treatment gains in both groups. These findings provide evidence for the effectiveness of VRET as a viable alternative to traditional ET in treating specific phobias. The study contributes to the growing literature on virtual reality-based interventions and highlights the potential of VRET as an accessible and immersive treatment option for individuals with specific phobias

References

Albakri, G., Bouaziz, R., Alharthi, W., Kammoun, S., Al-Sarem, M., Saeed, F., & Hadwan, M. (2022). Phobia exposure therapy using virtual and augmented reality: a systematic review. Applied Sciences, 12(3), 1672.

Amin, K. P., Griffiths, M. D., & Dsouza, D. D. (2020). Online gaming during the COVID-19 pandemic in India: strategies for work-life balance. International Journal of Mental Health and Addiction, 1–7.

Babaei-Ghazani, A., Roomizadeh, P., Forogh, B., Moeini-Taba, S.-M., Abedini, A., Kadkhodaie, M., Jahanjoo, F., & Eftekharsadat, B. (2018). Ultrasound-guided versus landmark-guided local corticosteroid injection for carpal tunnel syndrome: a systematic review and meta-analysis of randomized controlled trials. Archives of Physical Medicine and Rehabilitation, 99(4), 766–775.

Batterham, P. J., Calear, A. L., Farrer, L., Gulliver, A., & Kurz, E. (2021). Efficacy of a transdiagnostic self-help internet intervention for reducing depression, anxiety, and suicidal ideation in adults: Randomized controlled trial. Journal of Medical Internet Research, 23(1), e22698.

Boeldt, D., McMahon, E., McFaul, M., & Greenleaf, W. (2019). Using virtual reality exposure therapy to enhance treatment of anxiety disorders: Identifying areas of clinical adoption and potential obstacles. Frontiers in Psychiatry, 10, 773.

Botella, C., Fernández-Álvarez, J., Guillén, V., García-Palacios, A., & Baños, R. (2017). Recent progress in virtual reality exposure therapy for phobias: a systematic review. Current Psychiatry Reports, 19, 1–13.

Botella, C., Serrano, B., Baños, R. M., & Garcia-Palacios, A. (2015). 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. Neuropsychiatric Disease and Treatment, 2533–2545.

Caponnetto, P., Triscari, S., Maglia, M., & Quattropani, M. C. (2021). The simulation game—virtual reality therapy for the treatment of social anxiety disorder: A systematic review. International Journal of Environmental Research and Public Health, 18(24), 13209.

Costa, R. T. da, Carvalho, M. R. de, Ribeiro, P., & Nardi, A. E. (2018). Virtual reality exposure therapy for fear of driving: analysis of clinical characteristics, physiological response, and sense of presence. Brazilian Journal of Psychiatry, 40, 192–199.

Delarue, J., & Lageat, T. (2019). Conducting contextualized and real-life product tests: Benefits and experimental challenges. In Context (pp. 457–473). Elsevier.

Donker, T., Van Esveld, S., Fischer, N., & Van Straten, A. (2018). 0Phobia–towards a virtual cure for acrophobia: study protocol for a randomized controlled trial. Trials, 19, 1–11.

Dumford, A. D., & Miller, A. L. (2018). Online learning in higher education: exploring advantages and disadvantages for engagement. Journal of Computing in Higher Education, 30, 452–465.

Eshuis, L. V, van Gelderen, M. J., van Zuiden, M., Nijdam, M. J., Vermetten, E., Olff, M., & Bakker, A. (2021). Efficacy of immersive PTSD treatments: A systematic review of virtual and augmented reality exposure therapy and a meta-analysis of virtual reality exposure therapy. Journal of Psychiatric Research, 143, 516–527.

Firth, J., Torous, J., Nicholas, J., Carney, R., Rosenbaum, S., & Sarris, J. (2017). Can smartphone mental health interventions reduce symptoms of anxiety? A meta-analysis of randomized controlled trials. Journal of Affective Disorders, 218, 15–22.

Foa, E. B., & Kozak, M. J. (2019). Treatment of anxiety disorders: Implications for psychopathology. In Anxiety and the anxiety disorders (pp. 421–452). Routledge.

Freitas, J. R. S., Velosa, V. H. S., Abreu, L. T. N., Jardim, R. L., Santos, J. A. V., Peres, B., & Campos, P. F. (2021). Virtual reality exposure treatment in phobias: a systematic review. Psychiatric Quarterly, 92(4), 1685–1710.

Fuhr, K., Meisner, C., Broch, A., Cyrny, B., Hinkel, J., Jaberg, J., Petrasch, M., Schweizer, C., Stiegler, A., & Zeep, C. (2021). Efficacy of hypnotherapy compared to cognitive behavioral therapy for mild to moderate depression-Results of a randomized controlled rater-blind clinical trial. Journal of Affective Disorders, 286, 166–173.

Garcia, R. (2017). Neurobiology of fear and specific phobias. Learning & Memory, 24(9), 462–471.

Heyse, J., Depreeuw, B., Van Daele, T., Daeseleire, T., Ongenae, F., De Backere, F., & De Turck, F. (2022). An adaptation algorithm for personalised virtual reality exposure therapy. Computer Methods and Programs in Biomedicine, 225, 107077.

Holmberg, T. T., Eriksen, T. L., Petersen, R., Frederiksen, N. N., Damgaard-Sørensen, U., & Lichtenstein, M. B. (2020). Social anxiety can be triggered by 360-degree videos in virtual reality: A pilot study exploring fear of shopping. Cyberpsychology, Behavior, and Social Networking, 23(7), 495–499.

Horigome, T., Kurokawa, S., Sawada, K., Kudo, S., Shiga, K., Mimura, M., & Kishimoto, T. (2020). Virtual reality exposure therapy for social anxiety disorder: a systematic review and meta-analysis. Psychological Medicine, 50(15), 2487–2497.

Khan, A. N., Bilek, E., Tomlinson, R. C., & Becker-Haimes, E. M. (2021). Treating social anxiety in an era of social distancing: adapting exposure therapy for youth during COVID-19. Cognitive and Behavioral Practice, 28(4), 669–678.

Kothgassner, O. D., & Felnhofer, A. (2021). Lack of research on efficacy of virtual reality exposure therapy (VRET) for anxiety disorders in children and adolescents: A systematic review. Neuropsychiatrie, 35(2), 68–75.

Kothgassner, O. D., Goreis, A., Kafka, J. X., Van Eickels, R. L., Plener, P. L., & Felnhofer, A. (2019). Virtual reality exposure therapy for posttraumatic stress disorder (PTSD): a meta-analysis. European Journal of Psychotraumatology, 10(1), 1654782.

Krzystanek, M., Surma, S., Stokrocka, M., Romańczyk, M., Przybyło, J., Krzystanek, N., & Borkowski, M. (2021). Tips for effective implementation of virtual reality exposure therapy in phobias—a systematic review. Frontiers in Psychiatry, 1553.

Lavoie, R., Main, K., King, C., & King, D. (2021). Virtual experience, real consequences: the potential negative emotional consequences of virtual reality gameplay. Virtual Reality, 25, 69–81.

Lin, J.-H. T. (2017). Fear in virtual reality (VR): Fear elements, coping reactions, immediate and next-day fright responses toward a survival horror zombie virtual reality game. Computers in Human Behavior, 72, 350–361.

Lindner, P., Dagöö, J., Hamilton, W., Miloff, A., Andersson, G., Schill, A., & Carlbring, P. (2021). Virtual Reality exposure therapy for public speaking anxiety in routine care: a single-subject effectiveness trial. Cognitive Behaviour Therapy, 50(1), 67–87.

Lindner, P., Miloff, A., Hamilton, W., Reuterskiöld, L., Andersson, G., Powers, M. B., & Carlbring, P. (2017). Creating state of the art, next-generation Virtual Reality exposure therapies for anxiety disorders using consumer hardware platforms: design considerations and future directions. Cognitive Behaviour Therapy, 46(5), 404–420.

Maples-Keller, J. L., Yasinski, C., Manjin, N., & Rothbaum, B. O. (2017). Virtual reality-enhanced extinction of phobias and post-traumatic stress. Neurotherapeutics, 14, 554–563.

Maskey, M., Rodgers, J., Ingham, B., Freeston, M., Evans, G., Labus, M., & Parr, J. R. (2019). Using virtual reality environments to augment cognitive behavioral therapy for fears and phobias in autistic adults. Autism in Adulthood, 1(2), 134–145.

McMurtry, C. M., Taddio, A., Noel, M., Antony, M. M., Chambers, C. T., Asmundson, G. J. G., Pillai Riddell, R., Shah, V., MacDonald, N. E., & Rogers, J. (2016). Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research. Cognitive Behaviour Therapy, 45(3), 217–235.

Miloff, A., Lindner, P., Hamilton, W., Reuterskiöld, L., Andersson, G., & Carlbring, P. (2016). Single-session gamified virtual reality exposure therapy for spider phobia vs. traditional exposure therapy: study protocol for a randomized controlled non-inferiority trial. Trials, 17, 1–8.

Monti, S., Grosso, V., Todoerti, M., & Caporali, R. (2018). Randomized controlled trials and real-world data: differences and similarities to untangle literature data. Rheumatology, 57(Supplement_7), vii54–vii58.

Morina, N., Ijntema, H., Meyerbröker, K., & Emmelkamp, P. M. G. (2015). Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments. Behaviour Research and Therapy, 74, 18–24.

Nazligul, M. D., Yilmaz, M., Gulec, U., Gozcu, M. A., O’Connor, R. V, & Clarke, P. M. (2017). Overcoming public speaking anxiety of software engineers using virtual reality exposure therapy. Systems, Software and Services Process Improvement: 24th European Conference, EuroSPI 2017, Ostrava, Czech Republic, September 6–8, 2017, Proceedings 24, 191–202.

Park, S., Sato, Y., Takita, Y., Tamura, N., Ninomiya, A., Kosugi, T., Sado, M., Nakagawa, A., Takahashi, M., & Hayashida, T. (2020). Mindfulness-based cognitive therapy for psychological distress, fear of cancer recurrence, fatigue, spiritual well-being, and quality of life in patients with breast cancer—a randomized controlled trial. Journal of Pain and Symptom Management, 60(2), 381–389.

Parsons, T. D. (2015). Virtual reality exposure therapy for anxiety and specific phobias. In Encyclopedia of Information Science and Technology, Third Edition (pp. 6475–6483). IGI Global.

Raghav, K., Van Wijk, A. J., Abdullah, F., Islam, M. N., Bernatchez, M., & De Jongh, A. (2016). Efficacy of virtual reality exposure therapy for treatment of dental phobia: a randomized control trial. BMC Oral Health, 16(1), 1–11.

Reeves, R., Elliott, A., Curran, D., Dyer, K., & Hanna, D. (2021). 360 Video virtual reality exposure therapy for public speaking anxiety: A randomized controlled trial. Journal of Anxiety Disorders, 83, 102451.

Rizzo, A. ‘Skip,’ & Shilling, R. (2017). Clinical virtual reality tools to advance the prevention, assessment, and treatment of PTSD. European Journal of Psychotraumatology, 8(sup5), 1414560.

Rizzo, A., Thomas Koenig, S., & Talbot, T. B. (2019). Clinical results using virtual reality. Journal of Technology in Human Services, 37(1), 51–74.

Schumacher, S., Miller, R., Fehm, L., Kirschbaum, C., Fydrich, T., & Ströhle, A. (2015). Therapists’ and patients’ stress responses during graduated versus flooding in vivo exposure in the treatment of specific phobia: A preliminary observational study. Psychiatry Research, 230(2), 668–675.

Suso-Ribera, C., Fernández-Álvarez, J., García-Palacios, A., Hoffman, H. G., Bretón-López, J., Banos, R. M., Quero, S., & Botella, C. (2019). Virtual reality, augmented reality, and in vivo exposure therapy: a preliminary comparison of treatment efficacy in small animal phobia. Cyberpsychology, Behavior, and Social Networking, 22(1), 31–38.

Thompson, D. (2021). Replication of randomized, controlled trials using real-world data: what could go wrong? In Value in health (Vol. 24, Issue 1, pp. 112–115). Elsevier.

Trahan, M. H., Maynard, B. R., Smith, K. S., Farina, A. S. J., & Khoo, Y. M. (2019). Virtual reality exposure therapy on alcohol and nicotine: A systematic review. Research on Social Work Practice, 29(8), 876–891.

Wechsler, T. F., Kümpers, F., & Mühlberger, A. (2019). Inferiority or even superiority of virtual reality exposure therapy in phobias?—A systematic review and quantitative meta-analysis on randomized controlled trials specifically comparing the efficacy of virtual reality exposure to gold standard in vivo exposure in agoraphobia, specific phobia, and social phobia. Frontiers in Psychology, 10, 1758.

Wegmann, E., Oberst, U., Stodt, B., & Brand, M. (2017). Online-specific fear of missing out and Internet-use expectancies contribute to symptoms of Internet-communication disorder. Addictive Behaviors Reports, 5, 33–42.

Zhang, W., Paudel, D., Shi, R., Liang, J., Liu, J., Zeng, X., Zhou, Y., & Zhang, B. (2020). Virtual reality exposure therapy (Vret) for anxiety due to fear of covid-19 infection: A case series. Neuropsychiatric Disease and Treatment, 2669–2675.

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Published

2022-10-30

How to Cite

Kabudula, R. M. (2022). Examining the impact of virtual reality exposure therapy on phobia treatment outcomes: a randomized controlled trial. Acta Psychologia, 1(3), 124–133. Retrieved from https://psychologia.pelnus.ac.id/index.php/Psychologia/article/view/13