Stand-alone virtual reality exposure therapy as a treatment for social anxiety symptoms: a systematic review and meta-analysis
Keywords:
Social fears, simulated reality, computer modelling, help
Abstract
Introduction: Social anxiety is common and can have far-reaching implications for affected individuals, both on social life and working performance. Usage of virtual reality exposure therapy (VRET) has gained traction. The aim of the present systematic review was to evaluate the effect of stand-alone VRET on social anxiety symptoms.
Method: We searched systematically in PubMed, Embase, PSYCinfo, and ERIC in May 2022 for studies with participants with social anxiety symptoms receiving stand-alone VRET. Two reviewers independently selected relevant studies in a two-step procedure, and the risk of bias was assessed.
Results: Of 158 hits, 7 studies were selected for full-text reading, 6 were chosen for evaluation, and 5 were included in meta-analyses. VRET resulted in a significantly lower anxiety score in treated individuals with a standard mean difference of −0.82, 95% confidence interval –1.52 to –0.13, compared to controls.
Conclusion: Stand-alone VRET may reduce social anxiety symptoms. However, despite promising results, there is still uncertainty as the effect estimate is based on few studies with few participants each and a high risk of bias.
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References
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2. Furmark T, Tillfors M, Everz P, Marteinsdottir I, Gefvert O, Fredrikson M. Social phobia in the general population: prevalence and sociodemographic profile. Soc Psychiatry Psychiatr Epidemiol. 1999;34(8):416–24. doi: 10.1007/s001270050163
3. Tillfors M, Furmark T. Social phobia in Swedish university students: prevalence, subgroups and avoidant behavior. Soc Psychiatry Psychiatr Epidemiol. 2007;42:79–86. doi: 10.1007/s00127-006-0143-2
4. Schneier FR. 29th ed. [ebook] Waltham, MA: UpToDate; 2021. Available from: https://www.uptodate.com/contents/social-anxiety-disorder-in-adults-epidemiology-clinical-manifestations-and-diagnosis [cited 22 July 2022].
5. Stuhldreher N, Leibing E, Leichsenring F, Beutel ME, Herpertz S, Hoyer J, et al. The costs of social anxiety disorder: the role of symptom severity and comorbidities. J Affect Disord. 2014;165:87–94. doi: 10.1016/j.jad.2014.04.039
6. Stein BM, Taylor TC. Approach to treating social anxiety disorder in adults. 11th ed. Waltham, MA: UpToDate; 2022.
7. Lowood EH. Virtual reality. Encyclopedia Britannica; 2021. Available from: https://www.britannica.com/technology/virtual-reality [cited 22 July 2022].
8. Barnard D. History of VR – timeline of events and tech development. Virtualspeech; n.d. Available from: https://virtualspeech.com/blog/history-of-vr [cited 22 July 2022].
9. Virtual Reality Society. History of virtual reality. n.d. Available from: https://www.vrs.org.uk/virtual-reality/history.html [cited 22 July 2022].
10. Maples-Keller JL, Bunnell BE, Kim SJ, Rothbaum BO. The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders. Harv Rev Psychiatry. 2017;25(3):103–13. doi: 10.1097/HRP.0000000000000138
11. Emmelkamp PMG, Meyerbröker K, Morina N. Virtual reality therapy in social anxiety disorder. Curr Psychiatry Rep. 2020;22(7):32. doi: 10.1007/s11920-020-01156-1
12. Leary MR. A brief version of the fear of negative evaluation scale. Pers Soc Psychol Bull. 1983;9(3):371–5. doi: 10.1177/0146167283093007
13. Mattick RP, Clarke JC. Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behav Res Ther. 1998;36(4):455–70. doi: 10.1016/s0005-7967(97)10031-6
14. Collins K, Westra H, Dozois D, Stewart S. The validity of the brief version of the fear of negative evaluation scale. J Anxiety Disord. 2005;19(3): 345–59. doi: 10.1016/j.janxdis.2004.02.003
15. Anderson PL, Price M, Edwards SM, Obasaju MA, Schmertz SK, Zimand E, et al. Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial. J Consult Clin Psychol. 2013;81(5):751–60. doi: 10.1037/a0033559
16. Anderson PL, Edwards SM, Goodnight JR. Virtual reality and exposure group therapy for social anxiety disorder: results from a 4–6 year follow-up. Cogn Ther Res. 2017;41:230–6. doi: 10.1007/s10608-016-9820-y
17. Kampmann IL, Emmelkamp PM, Hartanto D, Brinkman WP, Zijlstra BJ, Morina N. Exposure to virtual social interactions in the treatment of social anxiety disorder: a randomized controlled trial. Behav Res Ther. 2016;77:147–56. doi: 10.1016/j.brat.2015.12.016
18. Zainal NH, Chan WW, Saxena AP, Taylor CB, Newman MG. Pilot randomized trial of self-guided virtual reality exposure therapy for social anxiety disorder. Behav Res Ther. 2021;147:103984. doi: 10.1016/j.brat.2021.103984
19. Lindner P, Miloff A, Fagernäs S, Andersen J, Sigeman M, Andersson G, et al. Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: a randomized controlled trial. J Anxiety Disord. 2019;61:45–54. doi: 10.1016/j.janxdis.2018.07.003
20. Reeves R, Elliott A, Curran D, Dyer K, Hanna D. 360° Video virtual reality exposure therapy for public speaking anxiety: a randomized controlled trial. J Anxiety Disord. 2021;83:102451. doi: 10.1016/j.janxdis.2021.102451
21. Critical Appraisal Skills Programme. CASP randomised controlled trial checklist. 2020. Available from: https://casp-uk.net/images/checklist/documents/CASP-Randomised-Controlled-Trial-Checklist/CASP-RCT-Checklist-PDF-Fillable-Form.pdf [cited 8 October 2022].
22. GRADEpro. Gradepro.org. Available from: https://www.gradepro.org/ [cited 15 October 2022].
23. Benbow AA, Anderson PL. Long-term improvements in probability and cost biases following brief cognitive behavioral therapy for social anxiety disorder. Cogn Ther Res. 2019;43:412–18. doi: 10.1007/s10608-018-9947-0
24. Wu J, Sun Y, Zhang G, Zhou Z, Ren Z. Virtual reality-assisted cognitive behavioral therapy for anxiety disorders: a systematic review and meta-analysis. Front Psychiatry. 2021;12:575094. doi: 10.3389/fpsyt.2021.575094
25. Wechsler T, Kümpers F, Mühlberger A. Inferiority or even superiority of virtual reality exposure therapy in Phobias? – a systematic review and quantitative meta-analysis on randomized controlled trials specifically comparing the efficacy of virtual reality exposure to gold standard in vivo exposure in Agoraphobia, specific Phobia, and social Phobia. Front Psychol. 2019;10:01758. doi: 10.3389/fpsyg.2019.01758
26. Horigome T, Kurokawa S, Sawada K, Kudo S, Shiga K, Mimura M, et al. Virtual reality exposure therapy for social anxiety disorder: a systematic review and meta-analysis. Psychol Med. 2020;50(15):2487–97. doi: 10.1017/S0033291720003785
27. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions. 2nd Edition. Chichester (UK): John Wiley & Sons, 2019.
28. Faraone SV. Interpreting estimates of treatment effects: implications for managed care. P T. 2008;33(12):700–11.
Published
2023-09-15
How to Cite
Rejbrand C., Fure B., & Sonnby K. (2023). Stand-alone virtual reality exposure therapy as a treatment for social anxiety symptoms: a systematic review and meta-analysis. Upsala Journal of Medical Sciences, 128(1). https://doi.org/10.48101/ujms.v128.9289
Section
Meta-analysis
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