Abstract
Virtual Reality Exposure Therapy (VRET) has the potential to help clinicians manage a range of symptoms related to anxiety disorders (e.g., Rothbaum et al., 1995; North et al., 1996). On a theoretical level the proposed underlying mechanisms reflect those in traditional exposure therapy; emotional processing is facilitated by activating the underlying fear structure through confrontation with the feared stimuli, allowing responses to be modified in a controlled therapeutic setting, so the stimuli will become less anxiety provoking when subsequently perceived (Rothbaum et al., 2000). In a VRET treatment protocol, an individual is immersed into a virtual environment that allows for sensory exposure to the feared stimuli via computer-generated displays. It permits the individual to face their triggers in a safe environment and allows the therapist to control the intensity and duration of the stimuli, based on their clinical appraisal. The environments can be tailored to represent the individual's fears and, in the case of Post-traumatic Stress Disorder (PTSD), can be used to recreate a traumatic experience (e.g., Roy et al., 2006; Rizzo et al., 2009). VRET is usually delivered via a head-mounted display which tracks the users' head-movements and allows for real-time updating of the scenes they can see (Wiederhold and Wiederhold, 2005).
Highlights
Specialty section: This article was submitted to Psychology for Clinical Settings, a section of the journal Frontiers in Psychology
On a theoretical level the proposed underlying mechanisms reflect those in traditional exposure therapy; emotional processing is facilitated by activating the underlying fear structure through confrontation with the feared stimuli, allowing responses to be modified in a controlled therapeutic setting, so the stimuli will become less anxiety provoking when subsequently perceived (Rothbaum et al, 2000)
Whilst the clinical efficacy of Virtual Reality Exposure Therapy (VRET) is well supported, there continues to be the perception that the strength of the evidence base is weakened by three key methodological limitations: the use of small sample sizes (e.g., McLay et al, 2014; Castro et al, 2014; Morina et al, 2015); a lack of appropriate control groups (e.g., Nelson, 2012; McCann et al, 2014); and, more broadly, a lack of randomized controlled trials (RCTs: e.g., Nelson, 2012; McCann et al, 2014)
Summary
Whilst the clinical efficacy of VRET is well supported, there continues to be the perception that the strength of the evidence base is weakened by three key methodological limitations: the use of small sample sizes (e.g., McLay et al, 2014; Castro et al, 2014; Morina et al, 2015); a lack of appropriate control groups (e.g., Nelson, 2012; McCann et al, 2014); and, more broadly, a lack of randomized controlled trials (RCTs: e.g., Nelson, 2012; McCann et al, 2014) These suggestions are by no means new and have been highlighted repeatedly across the years.
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