Virtual reality exposure therapy for social anxiety disorder: a systematic review and meta-analysis

Abstract

Background Virtual reality exposure therapy (VRET) is currently being used to treat social anxiety disorder (SAD); however, VRET's magnitude of efficacy, duration of efficacy, and impact on treatment discontinuation are still unclear. Methods We conducted a meta-analysis of studies that investigated the efficacy of VRET for SAD. The search strategy and analysis method are registered at PROSPERO (#CRD42019121097). Inclusion criteria were: (1) studies that targeted patients with SAD or related phobias; (2) studies where VRET was conducted for at least three sessions; (3) studies that included at least 10 participants. The primary outcome was social anxiety evaluation score change. Hedges' g and its 95% confidence intervals were calculated using random-effect models. The secondary outcome was the risk ratio for treatment discontinuation. Results Twenty-two studies (n = 703) met the inclusion criteria and were analyzed. The efficacy of VRET for SAD was significant and continued over a long-term follow-up period: Hedges' g for effect size at post-intervention, −0.86 (−1.04 to −0.68); three months post-intervention, −1.03 (−1.35 to −0.72); 6 months post-intervention, −1.14 (−1.39 to −0.89); and 12 months post-intervention, −0.74 (−1.05 to −0.43). When compared to in vivo exposure, the efficacy of VRET was similar at post-intervention but became inferior at later follow-up points. Participant dropout rates showed no significant difference compared to in vivo exposure. Conclusion VRET is an acceptable treatment for SAD patients that has significant, long-lasting efficacy, although it is possible that during long-term follow-up, VRET efficacy lessens as compared to in vivo exposure.

Tips for Effective Implementation of Virtual Reality Exposure Therapy in Phobias—A Systematic Review

“…Regarding the combination of different treatment methods, although VRET is an effective method used in monotherapy (11)(12)(13)(14)(15)(16), however, it may be much more effective when combined with pharmacotherapy (30). When VRET is used with pharmacotherapy, the number of sessions can be shortened [e.g., 4 sessions in agoraphobia; (30)].…”

“…In the most recent meta-analysis of 22 clinical trials with 703 participants by Horigome et al the effectiveness of the use of VR in the treatment of social phobia was analyzed ( 13 ). The effectiveness of VR in treating social phobia was shown to be significant and sustained over a long observation period.…”

The Effectiveness of Self-Guided Virtual-Reality Exposure Therapy for Public-Speaking Anxiety

“…Over the last two decades, virtual-reality exposure therapy (VRET) has become a popular digital intervention for various psychological disorders ( 13 , 14 ). A systematic review of 10 studies showed that VRET was as effective as in vivo exposure therapy post-intervention ( 15 ). Moreover, a meta-analysis found a large effect size favoring VRET for SAD over waitlist, but a small effect size favoring in vivo (i.e., face-to-face) exposure therapy with a therapist over VRET based on six studies ( 13 ).…”

Ethical Challenges of Using Virtual Environments in the Assessment and Treatment of Psychopathological Disorders

“…While much of this discussion can be applied to the growing research base (and practice) of virtual reality exposure therapy [4,5,128,129], the advent of algorithmic devices (e.g., smartphones), VEoT, and virtual humans, add new ethical issues given potential for extending the patient's cognitive and affective processes beyond the wetware of their brains. The idea of "extended mind" characterizes human cognizing as comprising complex feedforward and feedback loops among brain, body, and the external world.…”