A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders

Abstract

In virtual reality exposure therapy (VRET) for anxiety disorders, sense of presence in the virtual environment is considered the principal mechanism that enables anxiety to be felt. Existing studies on the relation between sense of presence and level of anxiety, however, have yielded mixed results on the correlation between the two. In this meta-analysis, we reviewed publications on VRET for anxiety that included self-reported presence and anxiety. The comprehensive search of the literature identified 33 publications with a total of 1196 participants. The correlation between self-reported sense of presence and anxiety was extracted and meta-analyzed. Potential moderators such as technology characteristics, sample characteristics including age, gender and clinical status, disorder characteristics and study design characteristics such as measurements were also examined. The random effects analysis showed a medium effect size for the correlation between sense of presence and anxiety (r = .28; 95% CI: 0.18–0.38). Moderation analyses revealed that the effect size of the correlation differed across different anxiety disorders, with a large effect size for fear of animals (r = .50; 95% CI: 0.30–0.66) and a no to small effect size for social anxiety disorder (r = .001; 95% CI: −0.19–0.19). Further, the correlation between anxiety and presence was stronger in studies with participants who met criteria for an anxiety disorder than in studies with a non-clinical population. Trackers with six degrees of freedom and displays with a larger field of view resulted in higher effect sizes, compared to trackers with three degrees of freedom and displays with a smaller field of view. In addition, no difference in effect size was found for the type of presence measurement and the type of anxiety measurement. This meta-analysis confirms the positive relation between sense of presence and anxiety and demonstrates that this relation can be affected by various moderating factors.

A virtual reality approach to the Trier Social Stress Test: Contrasting two distinct protocols

“…In other words, those participants reporting higher stress levels were also more likely to feel involved and spatially present during the task, regardless of the manner in which the virtual audience was presented. These results concur with those of Ling, Nefs, Morina, Heynderickx, and Brinkman (2014), who found a correlation between sense of presence and anxiety, but not for sex or type of projection of the virtual environment (e.g., field of view, degree of freedom of the tracker, etc.). Since we did not measure anxiety levels in the present study, we cannot say whether a greater spatial presence leads to a higher level of anxiety, but we did find that those participants with higher levels of stress prior to the TSST-VR protocol showed a higher level of involvement and a greater sense of spatial presence, as measured by the IPQ.…”

Virtual Reality Training for Public Speaking—A QUEST-VR Framework Validation

“…As already briefly defined above, presence can be described as a user's subjective psychological response to a VR system or the sense of "being there" (Reeves, 1991;Slater, 2003). Researchers agree that presence should trigger the experience of fear and anxiety in virtual environments for phobia treatment and training (Ling et al, 2014). Inducing these emotional states is crucial for clients to confront them and train certain skills to overcome their fear (Wiederhold and Wiederhold, 1998).…”

“…Inducing these emotional states is crucial for clients to confront them and train certain skills to overcome their fear (Wiederhold and Wiederhold, 1998). However, recent research revealed that the correlation between presence measures and anxiety showed mixed results and differed between phobias (Ling et al, 2014). A recent meta-analysis (Ling et al, 2014) even showed a null-effect for social anxiety [see also Felnhofer et al (2014)].…”

“…A recent meta-analysis (Ling et al, 2014) even showed a null-effect for social anxiety [see also Felnhofer et al (2014)]. Ling et al (2014) argue that "one might conclude that subjective presence measures do not capture the essential sense of presence that is responsible for activating fear related to social anxiety in individuals" (p. 8f.…”

Letter to the Editor: Affordable virtual reality tools for the treatment of mental health problems

“…For example, using 360 o cameras, we can take images and videos of real-life situations and view them in 360 o surround view using a smartphone and low-cost VR headset (costing under $25). These VR tools hold great potential to assess how individuals with mental health problems respond in 'emotionally charged' environments, and to individualize and tailor exposure scenarios to target specific fears, whilst maintaining immersion and presence thought to be key components of VR (Ling et al 2014).…”