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VR exposure as effective as in vivo exposure for phobia

Presented by
Prof. Peter Zwanzger, kbo-Inn-Salzach-Klinikum, Germany
ECNP 2022
In trials, virtual reality (VR) exposure has proven to be as effective as in vivo exposure as a treatment for several types of phobia. VR also has several practical advantages.

VR is a representation and a perception of apparent reality and its physical properties in a real-time, computer-generated, and interactive virtual environment. In psychiatry, VR is used more and more often –both for research and therapeutic purposes– as an alternative for classical exposure of patients to a specific environment. Prof. Peter Zwanzger (kbo-Inn-Salzach-Klinikum, Germany) reviewed the state-of-the-art [1].

Advantages of VR are, amongst others, that it is easy to perform, highly practical, and discrete. This makes VR exposure far more acceptable for patients compared with in vivo exposure [2]. Another advantage of VR is that the situational setting can be manipulated actively and in real time by the doctor or by the patient. Surprisingly, although the quality of the images and technical possibilities of VR have increased over the years, there is no apparent need for a very realistic and high-quality image to induce a strong emotional reaction in the patient [3]. Prof. Zwanzger illustrated the wide variety of situations that can be explored by patients in VR; for example, being exposed to spiders in a room, performing a public speaking task, or climbing heights.

A meta-analysis showed that VR exposure was non-inferior to in vivo exposure for the treatment of specific phobia, social phobia, or agoraphobia [4]. In addition, in patients with social phobia, VR exposure combined with cognitive behaviour therapy proved to be as effective and durable as in vivo exposure combined with cognitive behaviour therapy [5].

Augmented reality (AR) is a variant of VR that combines the real world with virtual elements, using computer graphics mixed in real-time with the real world (e.g. projection of a spider walking over the patient's own hands). The efficacy of this type of exposure was also shown to be comparable to in vivo exposure [6]. Finally, Prof. Zwanzger mentioned that VR training is an effective strategy to decrease hospital anxiety in children [7].

“Future research has to show the full potential of VR as a therapeutic tool in psychiatry,” concluded Prof. Zwanzger.

  1. Zwanzger P, et al. VR based exposure therapy in anxiety disorders. Abstract S06.02, ECNP Congress 2022, 15–18 October, Vienna, Austria.
  2. Garcia-Palacios A, et al. Cyberpsychol Behav. 2007;10:722–724.
  3. Diemer J, et al. J Anxiety Disord. 2016;37:30–39.
  4. Wechsler TF, et al. Front Psychol. 2019;10:1758.
  5. Bouchard S, et al. Br J Psychiatry. 2017;10:276–283.
  6. Botella C, et al. PLoS One. 2016;11:e0148237.
  7. Han S-H, et al. JAMA Pediatr. 2019;173:1026–1031.


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