Examining the comparative effectiveness of virtual reality and in-vivo exposure therapy on social anxiety and specific phobia: A systematic review & meta-analysis

IF 1.7 Q3 PSYCHIATRY Journal of Behavioral and Cognitive Therapy Pub Date : 2025-03-10 DOI:10.1016/j.jbct.2025.100524

Damla Kuleli , Philip Tyson , Nyle H. Davies , Biao Zeng

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Abstract

Background

Virtual Reality Exposure Therapy (VRET) is the most widely used Virtual Reality psychotherapeutic intervention. There is empirical evidence supporting the effectiveness of VRET on Specific Phobia and Social Anxiety Disorder. Since it has an advantage over in-vivo Exposure Therapy (IVET) in being cost-effective, adaptable and controllable, previous studies suggest it is a suitable alternative psychotherapeutic intervention for IVET. However, there is a need for a meta-analysis to compare the effectiveness of VRET and IVET.

Aim

The present meta-analysis aimed to examine the effectiveness of VRET and IVET in the treatment of social anxiety disorder and specific phobia.

Methods

Eligible studies needed to be randomised controlled trials which included adults diagnosed with social anxiety or specific phobia according to the DSM-4 and DSM-5 or ICD 10. Studies needed to include two treatment conditions, VRET (using a head-mounted display) and IVET, and these should be accompanied by an additional control condition. Studies also needed to include pre-and post-assessment measures to allow for the calculation of effect size estimates. The electronic databases, PubMed, PsycNet, ProQuest and ScienceDirect were systematically searched for the relevant randomised controlled studies.

Data collection and results

A random effects meta-analysis was conducted to examine the comparable effectiveness of VRET and IVET on symptomology. The analysis suggested that both are equally effective at reducing social phobia and anxiety symptoms with both approaches reporting moderate effect sizes.

Conclusions

Results of the meta-analysis demonstrate that VRET generates positive outcomes in the treatment of Specific Phobia and Social Anxiety Disorders which are comparable to IVET. However, due to the limited nature of the literature examined it is not possible to identify which approach is optimal.

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