Virtual Reality for the Treatment of Anxiety Disorders: A Scoping Review

Abstract

Importance: Virtual reality in head-mounted displays (HMD-VR) may be a valuable tool in occupational therapy to address anxiety. Findings from the virtual reality exposure therapy (VRET) literature may facilitate translation of HMD-VR to occupational therapy psychosocial practice. Objective: To explore how HMD-VR has been used to treat anxiety through VRET and could be translated to occupational therapy. Data Sources: We searched seven electronic databases for articles published between 2000 and 2020: CINAHL, Cochrane Library, Embase, ERIC, Ovid MEDLINE, PsycINFO, and Web of Science. Search terms included HMD-VR constructs, products, and therapy concepts. Study Selection and Data Collection: We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to report studies implementing VRET to treat anxiety. At least two reviewers assessed each citation, and a third resolved disagreements. Articles were included if they were in English, reported experimental data, and used HMD-VR. Letters, commentaries, book chapters, technical descriptions, theoretical papers, conference proceedings (≤4 pages), and reviews were excluded. Findings: Twenty-eight studies used HMD-VR to treat posttraumatic stress disorder (n = 3), specific phobias (n = 19), and performance-based social anxiety (n = 6); protocols and levels of evidence varied (randomized controlled trials, n = 11; controlled trials without randomization, n = 6; case–control or cohort studies, n = 11). Qualitative examination indicates HMD-VR is an effective treatment tool. Conclusions and Relevance: HMD-VR can be a valuable tool for occupational therapy to simulate environments where clients with anxiety disorders participate. Eliciting presence through multisensory features and body representation may enhance outcomes. What This Article Adds: Drawing from the VRET literature, this scoping review suggests that HMD-VR can be used by occupational therapy practitioners to simulate ecologically valid environments, evaluate client responses to fearful stimuli, and remediate anxiety though immersion in virtual tasks when participation in natural contexts is unfeasible. Having ecologically valid environments is particularly important for people with anxiety disorders because they need support to cope when they encounter triggers in everyday life environments.

Experiences of Patients and Therapists Testing a Virtual Reality Exposure App for Symptoms of Claustrophobia: Mixed Methods Study

“…The t tests showed significant differences in the total score between technology commitment (t 28 =2. 19…”

“…Studies show promising results for the treatment of social anxiety disorders and fear of public speaking [ 15 , 16 ] by including virtual humans that may be controlled by a therapist [ 17 ]. A comparable effectiveness of VRE in the treatment of anxiety disorders compared to in vivo treatment has been successfully identified in the broad spectrum of anxiety-related disorders [ 18 , 19 ] and specific phobias [ 20 , 21 ]. Deterioration rates are likely to occur randomly and could not be traced back to the application of VRE therapy in a meta-analysis with several treatment approaches for anxiety [ 22 ].…”

Efficacy of a Relaxation Scenario in Virtual Reality for the Comorbid Symptoms of Anxiety and Asthenia in a General Hospital Setting: A Pilot Comparative Randomized Open-Label Study

“…A wide review of VR studies [32] published between 2000 and 2020 and indexed in major electronic databases (a total of 28 studies analyzed) confirms the effectiveness of using various programs based on VR technology for the treatment of many negative mental conditions, including post-traumatic stress disorder, specific phobias, and social anxiety.…”

Virtual reality exposure therapy to decrease anxiety before surgical invasive procedures in hemodialysis patients: an interventional study

“…In addition, Shah et al [ 28 ] study indicated the effectiveness of virtual reality exposure therapy in reducing stress and depression in patients suffering from mood disorders. Donnelley et al [ 29 ] indicated that head-mounted VR is a valuable device for occupational therapy to simulate the environments in which patients with anxiety disorders participate. Evoking presence via multi-sensory features and body representation may enhance the effectiveness.…”