Virtual Reality Exposure Research Articles

An adaptation algorithm for personalised virtual reality exposure therapy

BackgroundAnxiety disorders are highly prevalent in mental health problems. The lives of people suffering from an anxiety disorder can be severely impaired. Virtual Reality Exposure Therapy (VRET) is an effective treatment, which immerses patients in a controlled Virtual Environment (VE). This creates the opportunity to confront feared stimuli and learn how to deal with them, which may result in the reduction of anxiety. The configuration of these VEs requires extensive effort to maximise the potential of Virtual Reality (VR) and the effectiveness of the therapy. Manual configuration becomes infeasible when the number of possible virtual stimuli combinations is infinite. Due to the growing complexity, acquiring the skills to truly master a VR system is difficult and it increases the threshold for psychotherapists to use such useful systems. We therefore developed a prototype of a supportive algorithm to facilitate the use of VRET in a clinical setting. This automatised system assists psychotherapists to use the wide range of functionalities without burdening them with technical challenges. Thus, psychotherapists can focus their attention on the patient. MethodsIn this paper both the prototype of the algorithm and a first proof of concept are described. The algorithm suggests environment configurations for VRET, tailored to the individual therapeutic needs of each patient. The system aims to maximise learning during exposure therapy for different combinations of stimuli by using the Rescorla–Wagner model as a predictor for learning. In a first proof of concept, the VE configurations suggested by the algorithm for three anonymised clinical vignettes were compared with prior manual configurations by two psychotherapists. ResultsThe prototype of the algorithm and a first proof of concept are described. The first proof of concept demonstrated the relevance and potential of the proposed system, as it managed to propose similar configurations for the clinical vignettes compared to those made by therapists. Nonetheless, because of the exploratory nature of the study, no claims can yet be made about its efficacy. ConclusionsWith the increasing ubiquity of immersive technologies, this technology for assisted configuration of VEs could make VRET a valuable tool for psychotherapists.

Enhancing exposure therapy for posttraumatic stress disorder (PTSD): a randomized clinical trial of virtual reality and imaginal exposure with a cognitive enhancer

Posttraumatic stress disorder (PTSD) is a significant public health issue. Yet, there are limited treatment options and no data to suggest which treatment will work for whom. We tested the efficacy of virtual reality exposure (VRE) or prolonged imaginal exposure (PE), augmented with D-cycloserine (DCS) for combat-related PTSD. As an exploratory aim, we examined whether brain-derived neurotrophic factor (BDNF) and fatty acid amide hydrolase (FAAH) moderated treatment response. Military personnel with PTSD (n = 192) were recruited into a multisite double-blind randomized controlled trial to receive nine weeks of VRE or PE, with DCS or placebo. Primary outcome was the improvement in symptom severity. Randomization was stratified by comorbid depression (MDD) and site. Participants in both VRE and PE showed similar meaningful clinical improvement with no difference between the treatment groups. A significant interaction (p = 0.45) suggested VRE was more effective for depressed participants (CAPS difference M = 3.51 [95% CI 1.17–5.86], p = 0.004, ES = 0.14) while PE was more effective for nondepressed participants (M = −8.87 [95% CI −11.33 to −6.40], p < 0.001, ES = −0.44). The main effect of DCS vs. placebo was not significant. Augmentation by MDD interaction (p = 0.073) suggested that depressed participants improved more on placebo (M = −8.43 [95% CI −10.98 to −5.88], p < 0.001, ES = −0.42); DCS and placebo were equally effective for nondepressed participants. There was an apparent moderating effect of BDNF Val66Met polymorphism on DCS augmentation (ES = 0.67). Met66 allele carriers improved more on DCS (ES = −0.25). FAAH 385 A carriers improved more than non-carriers (ES = 0.33), particularly those with MDD (ES = 0.62). This study provides a step toward precision therapeutics for PTSD by demonstrating that comorbid MDD and genetic markers may help guide treatment selection.ClinicalTrials.gov Identifier: NCT01352637.

Exposure and Response Prevention in Virtual Reality for Patients with Contamination-Related Obsessive-Compulsive Disorder: a Case Series.

Exposure therapy in virtual reality is successful in treating anxiety disorders. Studies on exposure and response prevention in virtual reality (VERP) in obsessive-compulsive disorder (OCD) are rare, and it is unclear whether distress associated with other emotions than anxiety (e.g., disgust) can be evoked. The present study aimed to investigate whether distress can be induced during VERP in patients with contamination-related OCD (C-OCD) and a primary feeling of disgust. We treated eight female patients with C-OCD with the primary emotion of disgust over six weeks with VERP and assessed their OC symptoms before and after the intervention period with the Y-BOCS. We measured subjective units of distress (SUD), heart rate and skin conductivity (arousal), sense of presence, and simulator sickness during four consecutive exposure sessions. VERP was able to induce distress and arousal. The qualitative feedback was heterogeneous and sense of presence moderate. Patients' OC symptoms reduced over the treatment period with medium to large effect sizes, but only two patients were considered responders; two patients discontinued treatment due to lack of treatment success. Although VERP was able to induce distress and arousal associated with disgust and evoked a moderate sense of presence, the low rate of symptom reduction diminishes the positive results. Possible reasons for the heterogeneous results and implications are discussed. Trial registration: German Registry for Clinical Studies (DRKS00016929), 10.04.2019.

Neuronal Abnormalities Induced by an Intelligent Virtual Reality System for Methamphetamine Use Disorder.

Methamphetamine use disorder (MUD) is a brain disease that leads to altered regional neuronal activity. Virtual reality (VR) is used to induce the drug cue reactivity. Previous studies reported significant frequency-specific neuronal abnormalities in patients with MUD during VR induction of drug craving. However, whether those patients exhibit neuronal abnormalities after VR induction that could serve as the treatment target remains unclear. Here, we used an integrated VR system for inducing drug related changes and investigated the neuronal abnormalities after VR exposure in patients. Fifteen patients with MUD and ten healthy subjects were recruited and exposed to drug-related VR environments. Resting-state EEG were recorded for 5 minutes twice-before and after VR and transformed to obtain the frequency-specific data. Three self-reported scales for measurement of the anxiety levels and impulsivity of participants were obtained after VR task. Statistical tests and machine learning methods were employed to reveal the differences between patients and healthy subjects. The result showed that patients with MUD and healthy subjects significantly differed in Θ, α, and γ power changes after VR. These neuronal abnormalities in patients were associated with the self-reported behavioral scales, indicating impaired impulse control. Our findings of resting-state EEG abnormalities in patients with MUD after VR exposure have the translational value and can be used to develop the treatment strategies for methamphetamine use disorder.

PROTOCOL: Effects of virtual reality exposure therapy versus in vivo exposure in treating social anxiety disorder in adults: A systematic review and meta-analysis.

This is the protocol for a Campbell systematic review. The objectives are as follows: (a) to quantify the effect sizes for virtual reality exposure therapy (VRET) in the treatment of social anxiety disorder (SAD), targeting primary social anxiety symptoms, comorbid anxiety and depression symptoms and improvements in quality of life, when compared to WL, information control, care-as-usual and placebo; (b) to compare VRET to in vivo cognitive and cognitive-behavioral interventions in treating SAD, at posttest and follow-up, using between-group design; (c) to identify the key features which are linked to beneficial outcomes in the two formats in treating SAD and (d) to collect and interpret information on differences in treatment uptake, adherence and attrition, as well as clinical significance and therapist-time in both treatment formats.

Window Access to Nature Restores: A Virtual Reality Experiment with Greenspace Views, Sounds, and Smells

Exposure to nature can improve psychological well-being such as attention restoration. These restorative benefits may be provided by windows looking onto nature, yet studies on the restorative qualities of windows have largely taken place in calm environments where restoration demands are relatively low. Thus, the restorative effects of windows in busy environments warrant examination. This virtual reality (VR) experimental study measured the restorative qualities of windows with nature views in a busy setting. We exposed 88 undergraduate participants to an open, closed, or no window condition by creating a Computer Automatic Virtual Environment (CAVE)-like VR environment. The participants saw a 6-min wall-projected video of a busy university café along with indoor sounds played in the background and the scent of coffee created by an essential oil diffuser. Birdsongs and dirt smells were added to the open window condition. The Perceived Restorativeness Scale (PRS) and Restoration Outcomes Scale (ROS) were administered after VR exposure. Results showed that compared with no window, the open window was more restorative in terms of the ROS, PRS, and the PRS subscales related to fascination and being away. The closed window was more restorative in terms of the ROS and being away subscale. Unexpectedly, the addition of sounds and smells virtually coming through the open window did not provide restorative qualities beyond what was provided by the closed window. These findings provide suggestive evidence that virtual windows looking onto nature provide restorative effects for people in busy indoor environments.

The Walls Are Closing In: Postural Responses to a Virtual Reality Claustrophobic Simulation

Background: Changes in the visual environment and thereby, the spatial orientation, can induce postural instability leading to falls. Virtual reality (VR) has been used to expose individuals to virtual environments (VE) that increase postural threats. Claustrophobia is an anxiety disorder categorized under situational phobias and can induce such postural threats in a VE. Purpose: The purpose of the study was to investigate if VR-generated claustrophobic simulation has any impact on postural threats that might lead to postural instability. Methods: Thirty healthy men and women (age: 20.7 ± 1.2 years; height: 166.5 ± 7.3 cm; mass: 71.7 ± 16.2 kg) were tested for postural stability while standing on a force platform, upon exposure to five different testing trials, including a normal stance (NoVR), in stationary VE (VR), and three consecutive, randomly initiated, unexpected claustrophobia trials (VR CP1, VR CP2, VR CP3). The claustrophobia trials involved all four walls closing in towards the center of the room. Center of pressure (COP)-derived postural sway variables were analyzed with a one-way repeated measures analysis of variance at an alpha level of 0.05. Results: Significant main effect differences existed in all but one dependent COP-derived postural sway variables, at p &lt; 0.05. Post-hoc pairwise comparisons with a Bonferroni correction revealed that, predominantly, postural sway excursions were significantly lower in claustrophobia trials compared to NoVR and VR, but only accomplished with significantly increased sway velocity. Conclusion: The VR CP trials induced lower postural sway magnitude, but with increased velocity, suggesting a bracing and co-contraction strategy when exposed to virtual claustrophobic postural threats. Additionally, postural sway decreased with subsequent claustrophobia trials, suggesting potential motor learning effects. Findings from the study offer insights to postural control behavior under virtual claustrophobic simulations and can aid in VR exposure therapy for claustrophobia.

Electrophysiological correlates of in vivo and virtual reality exposure therapy in spider phobia.

Specific phobia can be treated successfully with exposure therapy. Although exposure therapy has strong effects on self-reported ratings and behavioral avoidance, effects on measures derived from electroencephalography (EEG) are scant and unclear. To fill this gap, spider-phobic individuals received either in-vivo or virtual reality exposure treatment. Patients were tested twice (one week before and after treatment), and control subjects once. In each session, EEG was recorded to spider pictures as well as other positive, negative, and neutral pictures. During EEG recording, participants performed a simple detection task while task-irrelevant pictures were shown in the background. The task was used to reduce potential confounding effects from shifts of attention. After the task, subjects were shown the pictures again and rated each in terms of their emotional reaction (arousal and pleasantness). The results showed that before treatment, patients rated spiders as more negative than did control subjects. Patients also showed elevated early posterior negativity (EPN) and late positive potential (LPP) to spiders. After treatment, the negative emotional ratings of spiders were substantially reduced. Critically, Bayesian analyses suggested that EPN and LPP were unaffected by treatment and that the treatment groups did not differ in their responses (EPN, LPP, and ratings). These findings suggest that the effects of in vivo and virtual reality exposure therapy are similar and that the initial stages of motivated attention (EPN and LPP) are unaffected by treatment.

Children’s perception of phobogenic stimuli in virtual reality

There has been a growing interest in treatments involving exposure in virtual reality (VR) for a number of anxiety disorders and phobias. Contrary to expectations, this technique has proven less popular with phobic children and is less appealing to them than to adults. The hypothesis is that children may be more apprehensive about virtual aversive stimuli than adults. In Study 1, the perception of virtual phobogenic stimuli was assessed in 523 participants between the ages of 7 and 60. To analyze to what extent anxiety and phobic fear predict apprehension, 38 school-aged children took part in Study 2. The results show that children apprehend phobic virtual stimulus more than adults and that apprehension is associated with specific phobic fear rather than a general anxiety state. Results are discussed in terms of clinical interest, children’s cognitive development, and a priori fear of virtual reality stimuli. • Virtual reality to treat phobias is not always attracting for children. • Children and adolescents showed more apprehension than adults toward virtual spiders. • Apprehension is specifically associated with the intensity of phobic fears. • It is important to address people’s apprehension when proposing to use VR in therapy.

Tailored Immersion: Implementing Personalized Components Into Virtual Reality for Veterans With Post-Traumatic Stress Disorder

IntroductionWith the application of virtual reality (VR), tailored interventions can be created that mirror the traumatic experiences of veterans with post-traumatic stress disorder (PTSD). Visual elements can be mimicked, and auditory and other senses stimulated. In doing so, the degree of immersion can be adjusted to optimize the therapeutic process. Objectively measuring the sensory immersion is key to keep subjects within their personal window of tolerance. Based on this information the therapist can decide manipulate the sensory stimulation embedded in the treatment.ObjectivesThe objectives of this study are to explore the different immersive design aspects of VRET that can be modified to influence the experienced presence in veterans with PTSD, and to discuss possible methods of measuring the emotional response facilitated by immersive design aspects and experienced presence.MethodsFour design aspects are discussed: system, sensory cues, narrative and challenge. We also report on a user experiment in three veterans that informed on quality and depth of immersion.ResultsBelievability of the neutral virtual environment was important for maintaining the veterans’ presence within the VR experience. The immersive design aspects that were personalized and supportive in the narrative of the veteran such as music and self-selected images appeared to have a strong influence on recall and reliving of the traumatic events.ConclusionsFinally, in order to increase the therapeutic effect in veterans with PTSD, the highlighted design aspects should be recognized and tailored to maximize immersion in virtual reality exposure therapy.DisclosureNo significant relationships.

Angsterkrankungen in der Rehabilitation

Anxiety disorders are among the most common and socio-medically relevant mental illnesses. Correct diagnosis and initiation of appropriate therapy are of the utmost importance for patients' prognosis and for ensuring their social and occupational participation. This article therefore aims to provide an overview of new developments in the field of anxiety disorders relevant to rehabilitation.Within the framework of the changes in ICD-11, anxiety disorders now receive an independent chapter with a focus appropriate to their frequency and relevance. Further innovations concern the revised S3 guideline (2020) with the increasing consideration of digital therapy options, such as virtual reality exposure therapy (VER) as well as Internet-supported therapy methods as part of the therapy recommendations. Systemic therapy is also considered for the first time. However, the evidence for both procedures is significantly lower than for behavioral therapy, psychodynamic therapy, or pharmacotherapy. Online interventions are therefore not recommended as the sole therapy.Important for the practice in rehabilitation is the knowledge of the core symptoms of each of the above mentioned diagnoses as well as the diagnostic possibilities taking into account especially the correlations and interactions with physical diseases.Both psychotherapy and psychopharmacotherapy are available for treatment. In the field of psychotherapy, cognitive behavioral therapy (CBT) is the therapy of first choice due to the broadest base of evidence. In consideration of comorbid somatic diseases, attention must be paid to possible contraindications for antidepressants. Psychosomatic rehabilitation is an important resource in the overall treatment spectrum, especially if chronification or a threat to participation is foreseeable, in order to give the affected person confidence and motivation for further successful treatment of the anxiety disorder in an intensified treatment setting, in addition to teaching anxiety management strategies and socio-medical clarification. An important task of somatic rehabilitation is to recognize comorbid anxiety disorders and to provide the affected persons with an appropriate explanatory model of their complaints and to be able to initiate targeted treatment.

Haphephobia: a rare specific phobia of being touched

IntroductionHaphephobia is a morbid fear of being touched or touching. The symptoms of Haphephobia are very similar to other specific phobias.ObjectivesPresentation of a case of haphephobia due to childhood sexual abuseMethods Mrs. X., A 22-year-old Bangladeshi female, presents to the psychiatric consult service with an intense fear of being touched by her husband. She told that whenever her husband comes closer to her, her heart starts to pound fast, she feels discomfort in the chest, a burning sensation on her whole body, and loses control over the environment. Furthermore, she can’t sleep properly for the fear of being touched. Her in-laws’ parents concluded that some ‘evil spirits’ might cause the symptoms. So her husband brought her to a Psychiatrist. On an in-depth assessment session, ensuring all the confidentiality issues, she told the Psychiatrist that she has a history of brutal sexual abuse followed by the threat to kill her by her stepfather at the age of fourteen.Results After a thorough medical workup and history gathering, her consultant psychiatrist could elucidate the source of the presenting picture and told her that she developed haphephobia, and suggested taking psychotherapy along with prescribed medicines.Conclusions Fear of being touched is a particularly difficult fear to cope with. Patients with haphephobia after sexual assault should be handled very cautiously by the experts keeping confidentiality issues in mind. Cognitive-behavior therapy, Exposure therapy, Virtual reality exposure therapy, practicing mindfulness, using daily coping strategies, and medications like beta-blockers, anxiolytics, antidepressants can help a person to overcome haphephobia.DisclosureNo significant relationships.

Self-guided digital treatment with virtual reality for panic disorder and agoraphobia: a study protocol for a randomized controlled trial

BackgroundCognitive behavioral therapy is the first-line treatment for patients with panic disorder (PD) and agoraphobia (AG). Yet, many patients remain untreated due to limited treatment resources. Digital self-guided short-term treatment applications may help to overcome this issue. While some therapeutic applications are already supported by health insurance companies, data on their efficacy is limited. The current study investigates the effect of self-guided digital treatment comprising psychoeducation and virtual reality exposure therapy (VRET).MethodsThirty patients diagnosed with PD, AG, or panic disorder with agoraphobia (PDA) will be randomly assigned to either the experimental group (EG) or the control group (CG). Participants of both groups will undergo baseline diagnostics in the first two sessions. The subsequent treatment for the EG consists of a self-guided 6-week phase of application-based psychoeducation, one therapy session preparing for the VRET, and 4 weeks of application-based self-guided VRET. To control for the potential effects of the therapy session with the therapist, the CG will receive relaxation and stress-reduction training instead. All patients will then undergo a closing session which terminates with the post-assessment (~ 10 weeks after baseline assessment) and a follow-up assessment 6 weeks following the closing session. Symptom severity (primary outcome) will be assessed at baseline, interim, post-treatment, and follow-up. Additionally, remission status (secondary outcome) will be obtained at follow-up. Both measures will be compared between the groups.DiscussionThe current study aims at providing insights into the efficacy of short-term treatment applications including psychoeducation and self-guided VRET. If successful, this approach might be a feasible and promising way to ease the burden of PD, AG, and PDA on the public health system and contribute to a faster access to treatment.Trial registrationISRCTN ISRCTN10661970. Prospectively registered on 17 January 2022.

P667. Stimulating the Ventromedial Prefrontal Cortex in the Context of Virtual Reality Exposure for PTSD: Examining the Role of Emotional Arousal and Electrical Field Distributions

Neurocircuit models of posttraumatic stress disorder (PTSD) point to ventromedial prefrontal cortex (VMPFC) hypoactivation, amygdala hyperreactivity, and hippocampus dysfunction. Non-invasive neuromodulation to boost VMPFC-assisted top-down inhibition of the amygdala in the context of exposure therapy might improve symptoms of PTSD. Here we report data on individual differences in 1) changes in psychophysiological arousal in response to transcranial direct current stimulation (tDCS) targeting the VMPFC combined with virtual reality exposure for PTSD, and 2) tDCS-induced electrical field distributions in VMPFC, amygdala, and hippocampus.

Effectiveness of virtual reality exposure treatment for posttraumatic stress disorder due to motor vehicle or industrial accidents

Effectiveness of virtual reality exposure treatment for posttraumatic stress disorder due to motor vehicle or industrial accidents

Using Virtual Reality to Improve Classroom Behavior in People With Down Syndrome: Within-Subjects Experimental Design.

BackgroundPeople with Down syndrome face various learning challenges. Introducing new and enjoyable experiences in learning settings may improve learning outcomes. Immersive and interactive technologies such as virtual reality can be used to deliver rich visual experiences in classrooms.ObjectiveThe aim of this study was to investigate the feasibility and benefits of virtual reality exposure for people with Down syndrome in learning settings.MethodsTo address this aim, we used a within-subjects design to assess the effect of a brief virtual reality drawing experience and conventional drawing experience on subsequent behavior in 16 participants.ResultsLarge positive effects were found for virtual reality drawing (t15=5.020, P<.001) and conventional drawing (t15=3.720, P=.002) in improving subsequent behavior in a learning setting. Irrespective of the intervention, the participant’s mood, attention, and overall behavior significantly improved. No significant differences were found between the interventions (t15=–0.648; P=.53).ConclusionsThis study’s results are encouraging for researchers and educators interested in using virtual reality for people with Down syndrome, as virtual reality was found to be highly feasible. Recommendations are made for researchers and educators interested in providing virtual reality experiences for people with Down syndrome.

Attention guidance augmentation of virtual reality exposure therapy for social anxiety disorder: a pilot randomized controlled trial

ABSTRACT Biased attention to social threats has been implicated in social anxiety disorder. Modifying visual attention during exposure therapy offers a direct test of this mechanism. We developed and tested a brief virtual reality exposure therapy (VRET) protocol using 360°-video and eye tracking. Participants (N = 21) were randomized to either standard VRET or VRET + attention guidance training (AGT). Multilevel Bayesian models were used to test (1) whether there was an effect of condition over time and (2) whether post-treatment changes in gaze patterns mediated the effect of condition at follow-up. There was a large overall effect of the intervention on symptoms of social anxiety, as well as an effect of the AGT augmentation on changes in visual attention to audience members. There was weak evidence against an effect of condition on fear of public speaking and weak evidence supporting a mediation effect, however these estimates were strongly influenced by model priors. Taken together, our findings suggest that attention can be modified within and during VRET and that modification of visual gaze avoidance may be casually linked to reductions in social anxiety. Replication with a larger sample size is needed.

Odour enhances the sense of presence in a virtual reality environment.

Virtual reality (VR) headsets provide immersive audio-visual experiences for users, but usually neglect to provide olfactory cues that can provide additional information about our environment in the real world. This paper examines whether the introduction of smells into the VR environment enhances users’ experience, including their sense of presence through collection of both psychological and physiological measures. Using precise odour administration with an olfactometer, study participants were exposed to smells while they were immersed in the popular PlayStation VR game “Resident Evil 7”. A within-subject study design was undertaken where participants (n = 22) walked-through the same VR environment twice, with or without the introduction of associated congruent odour stimuli. Directly after each gameplay, participants completed a questionnaire to determine their sense of presence from the overall gameplay and their sense of immersion in each of the virtual scenes. Additionally, physiological measurements (heart rate, body temperature and skin electrodermal activity) were collected from participants (n = 11) for each gameplay. The results showed the addition of odours significantly increased participants’ sense of spatial presence in the VR environment compared to VR with no odour. Participants also rated the realism of VR experience with odour higher compared to no odour, however odour addition did not result in change in emotional state of participants (arousal, pleasure, dominance). Further, the participants’ physiological responses were impacted by the addition of odour. Odour mediated physiological changes were dependent on whether the VR environment was novel, as the effect of odour on physiological response was lost when participants experienced the aroma on the second gameplay. Overall, the results indicate the addition of odours to a VR environment had a significant effect on both the psychological and physiological experience showing the addition of smell enhanced the VR environment. The incorporation of odours to VR environments presents an opportunity to create a more immersive experience to increase a person’s presence within a VR environment. In addition to gaming, the results have broader applications for virtual training environments and virtual reality exposure therapy.

Virtual reality interventions for victims of crime: A systematic review.

In the forensic field, most studies employing virtual reality (VR) interventions have focused on offenders. The validity and safety of VR applications for victims of crime are still unclear. Following PRISMA guidelines, a systematic review on VR interventions for crime victims was performed to assess the efficacy, acceptability by patients, and cost‐effectiveness of these interventions compared to in‐person care. We identified 34 potentially eligible studies from 188 records obtained from database searches (Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus); four additional articles were identified via alternative sources. In total, nine articles were included for the qualitative synthesis. Patient satisfaction with VR interventions was found to be equivalent to face‐to‐face interventions. Both VR exposure and control groups found relief from posttraumatic symptoms, with differences either statistically insignificant or in favor of VR. Despite the increased costs linked to the technology required, VR appears to be a promising alternative to in vivo exposure, but further research is needed. Limitations of the review include the varied experimental protocols, which did not allow us to conduct a quantitative analysis and comparison of findings across different studies, and the generally poor quality of the studies included. Further research, preferably in larger groups, is needed to shed more light on the effectiveness of VR interventions for traumatized victims of crime.

Virtual Reality Exposure Therapy for Treating Social Anxiety: A Scoping Review of Treatment Designs and Adaptation to Stuttering.

Virtual Reality Exposure Therapy (VRET) has been shown to be an effective technique for reducing social anxiety. People who stutter are at greater risk of developing heightened social anxiety. Cognitive behavior therapy protocols have shown promise in reducing social anxiety in people who stutter, but no studies have investigated VRET targeting social anxiety associated with stuttering. The aim of the current review is to provide an overview of VRET techniques used to treat social anxiety and insights into how these techniques might be adopted in the case of comorbid stuttering and social anxiety. Twelve studies were reviewed to understand key distinctions in VRET protocols used to treat social anxiety. Distinctions include exercises targeting public speaking vs. general social anxiety, computer-generated virtual environments vs. 360° video, and therapist guided vs. automated VRET. Based on the review findings, we propose how certain features could be applied in the case of stuttering. Virtual therapists, inhibitory learning techniques and integration into speech therapy may be suitable ways to tailor VRET. Regardless of these different techniques, VRET should consider the situations and cognitive-behavioral processes that underlie the experience of social anxiety amongst people who stutter.