Does engagement with exposure yield better outcomes? Components of presence as a predictor of treatment response for virtual reality exposure therapy for social phobia

Abstract

Virtual reality exposure (VRE) has been shown to be effective for treating a variety of anxiety disorders, including social phobia. Presence, or the level of connection an individual feels with the virtual environment, is widely discussed as a critical construct both for the experience of anxiety within a virtual environment and for a successful response to VRE. Two published studies show that whereas generalized presence relates to fear ratings during VRE, it does not relate to treatment response. However, presence has been conceptualized as multidimensional, with three primary factors (spatial presence, involvement, and realness). These factors can be linked to other research on the facilitation of fear during exposure, inhibitors of treatment response (e.g., distraction), and more recent theoretical discussions of the mechanisms of exposure therapy, such as Bouton’s description of expectancy violation. As such, one or more of these components of presence may be more strongly associated with the experience of fear during VRE and treatment response than the overarching construct. The current study (N = 41) evaluated relations between three theorized components of presence, fear ratings during VRE, and treatment response for VRE for social phobia. Results suggest that total presence and realness subscale scores were related to in-session peak fear ratings. However, only scores on the involvement subscale significantly predicted treatment response. Implications of these findings are discussed.

Virtual reality exposure using three-dimensional images for the treatment of social phobia

“…[8][9][10][11][12][13]22 However, many of these studies [8][9][10]12,13,22 employed virtual reality systems with immersive headsets, while the virtual reality system used in this study is easier for clinicians to obtain and use in their offices. One study used computer-generated 3D scenes, but the sample was composed only by individuals with public-speaking anxiety, 11 which limits the generalizability of its results.…”

“…The psychological assessments carried out in the present study were more complete; other studies have measured only the decrease in anxiety, omitting the impact of therapy on social, family, and business aspects. 8,[11][12][13]22 Price et al 22 assessed the experience of people who underwent VRE, and reported the importance of immersion in the virtual world by darkening the environment and requiring participants to wear the same kind of clothes they would wear in real-life situations, or hold relevant objects. The present study also provided a strongly immersive experience.…”

“…20,21 VRE has advantages over imagined or in vivo exposures. [9][10][11]13,22 It can provide standardized and controlled environments, and scenes can be repeated to achieve therapeutic goals. 23,24 Moreover, exposure to virtual environments bridges the gap between an imagined situation and a real one; it allows the patient to be exposed to anxiety-generating stimuli as if he or she were in a real situation.…”

Sleep enhances exposure therapy

“…Presence in the virtual environment, i.e. the level of connection an individual feels with the virtual environment, is a critical construct for the experience of anxiety and for successful response to the VR (Price et al 2011) and was assessed with the Immersive Tendencies Questionnaire (Scheuchenpflug, 2001). …”

Exposição à realidade virtual no tratamento da fobia social: um estudo aberto

“…Este estudo sugere o uso da exposição à realidade virtual para facilitar o tratamento do fóbico social, e corrobora com os estudos que demonstraram a sua eficácia (Klinger et al, 2005;Wallack et al, 2009, Lister et al, 2010Robillard et al, 2010;Price et al, 2011) Lister et al, 2010;Robillard et al, 2010;Safir et al, 2012, Anderson et al, 2013 Outra limitação da exposição ao vivo é pelo fator do medo exagerado do paciente ao se expor à situação proposta (Jang et al, 2000;Garcia Palacios et al, 2001;Jang et al, 2002;Cárdenas et al, 2006 O instrumento tem base, sobretudo, nos pressupostos da Teoria das…”