Virtual Reality Therapy in Social Anxiety Disorder

Emmelkamp, Paul M. G.; Meyerbröker, Katharina; Morina, Nexhmedin

doi:10.1007/s11920-020-01156-1

Cited by 60 publications

(24 citation statements)

References 63 publications

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“…Over the past decade, great endeavors have been made to provide VR-based therapeutic interventions for social anxiety disorder [ 36 ]. Individuals with social anxiety disorder continuously allocate their attentional resources to their self-evaluation and self-referential processing.…”

Section: Discussionmentioning

confidence: 99%

Virtual Reality–Based Psychotherapy in Social Anxiety Disorder: fMRI Study Using a Self-Referential Task

Hur¹,

Shin²,

Jung³

et al. 2021

JMIR Ment Health

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Background Although it has been well demonstrated that the efficacy of virtual reality therapy for social anxiety disorder is comparable to that of traditional cognitive behavioral therapy, little is known about the effect of virtual reality on pathological self-referential processes in individuals with social anxiety disorder. Objective We aimed to determine changes in self-referential processing and their neural mechanisms following virtual reality treatment. Methods We recruited participants with and without a primary diagnosis of social anxiety disorder to undergo clinical assessments (Social Phobia Scale and Post-Event Rumination Scale) and functional magnetic resonance imaging (fMRI) scans. Participants with social anxiety disorder received virtual reality–based exposure treatment for 6 sessions starting immediately after baseline testing. After the sixth session, participants with social anxiety disorder completed follow-up scans during which they were asked to judge whether a series of words (positive, negative, neutral) was relevant to them. Results Of 25 individuals with social anxiety disorder who participated in the study, 21 completed the sessions and follow-up; 22 control individuals also participated. There were no significant differences in age (P=.36), sex (P=.71), or handedness (P=.51) between the groups. Whole-brain analysis revealed that participants in the social anxiety disorder group had increased neural responses during positive self-referential processing in the medial temporal and frontal cortexes compared with those in the control group. Participants in the social anxiety disorder group also showed increased left insular activation and decreased right middle frontal gyrus activation during negative self-referential processing. After undergoing virtual reality–based therapy, overall symptoms of the participants with social anxiety disorder were reduced, and these participants exhibited greater activity in a brain regions responsible for self-referential and autobiographical memory processes while viewing positive words during postintervention fMRI scans. Interestingly, the greater the blood oxygen level dependent changes related to positive self-referential processing, the lower the tendency to ruminate on the negative events and the lower the social anxiety following the virtual reality session. Compared with that at baseline, higher activation was also found within broad somatosensory areas in individuals with social anxiety disorder during negative self-referential processing following virtual reality therapy. Conclusions These fMRI findings might reflect the enhanced physiological and cognitive processing in individuals with social anxiety disorder in response to self-referential information. They also provide neural evidence of the effect of virtual reality exposure therapy on social anxiety and self-derogation.

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Section: Discussionmentioning

confidence: 99%

Virtual Reality–Based Psychotherapy in Social Anxiety Disorder: fMRI Study Using a Self-Referential Task

Hur¹,

Shin²,

Jung³

et al. 2021

JMIR Ment Health

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“…With regard to in vivo exposure therapy, there was no significant difference, leading to the conclusion, that VRET is an equivalent treatment technique to in vivo exposure therapy. To date, in most studies that investigated VRET in comparison to in vivo exposure therapy in SAD, VRET has been combined with cognitive interventions (see Emmelkamp et al, 2020). With the incorporation of current technological developments into VRET, sufficient technical conditions could be created to combine exposure therapy and attention training techniques in one strategy.…”

Section: Discussionmentioning

confidence: 99%

Initial Maintenance of Attention to Threat in Children with Social Anxiety Disorder? Findings from an Eye-Tracking Experiment

et al. 2021

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Background Attentional biases are assumed to be a core feature in the etiology and maintenance of clinical anxiety. The present study focuses on initial maintenance of attention to threat, one of three attentional components investigated the least, particularly in child anxiety. Methods Angry and neutral facial expressions were presented in a free-viewing task, while eye-movements were recorded. Participants were N = 96 school-aged children, with n = 50 children with a clinical social anxiety disorder (SAD) and n = 46 healthy control children (HC). Prior to the task, social stress was induced in half of participating children to investigate the impact of increased levels of distress on initial attention allocation. Results The length of first fixation to angry faces in children with SAD neither differed from the length of first fixation to neutral faces nor the length of first fixation to angry faces in HC children. Furthermore, this variable was not affected by a stress induction procedure. However, children with SAD initially fixated longer on faces than HC children. Conclusion Our findings provide evidence for difficulties disengaging attention from faces. This may indicate that attention allocation is determined by the social nature of the stimuli rather than by the specific emotional valence.

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“…Several controlled trials have examined treatment efficacy in SAD (see Emmelkamp et al, 2020 for an overview of research into different aspects of SAD). The first trial was conducted by Klinger et al ( 2005 ) who divided and matched 36 patients with SAD into two groups based on gender, age, duration, SAD severity and ability to use computers.…”

Section: Treatmentmentioning

confidence: 99%

The use of virtual reality in assessment and treatment of anxiety and related disorders

Meyerbröker

Morina

2021

Clin Psychology and Psychoth

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In recent years the development of new virtual environments has been qualitatively high and fast at the same time, but the dissemination of virtual reality (VR) in clinical practice is still scarce. The aim of this review is to give an insight into the state of the art of the use of VR as an assessment tool and treatment intervention in anxiety and related disorders as posttraumatic stress disorder and obsessive-compulsive disorders.Besides an overview into the efficacy of VR, a summary will be given on assumed working mechanisms in virtual reality exposure therapy and how this aligns with current theoretical models. Further, it will be discussed how VR is accepted by patients and research into the reluctance of therapist to use this technology during treatment with focus on the therapeutic alliance and how it may be influenced by the use of VR. Finally, we discuss clinical and future issues as, for

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Virtual Reality Therapy in Social Anxiety Disorder

Cited by 60 publications

References 63 publications

Virtual Reality–Based Psychotherapy in Social Anxiety Disorder: fMRI Study Using a Self-Referential Task

Virtual Reality–Based Psychotherapy in Social Anxiety Disorder: fMRI Study Using a Self-Referential Task

Initial Maintenance of Attention to Threat in Children with Social Anxiety Disorder? Findings from an Eye-Tracking Experiment

The use of virtual reality in assessment and treatment of anxiety and related disorders

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