Virtual Reality (VR) is starting to be used in psychological therapy around the world. However, a thorough understanding of the reason why VR is effective and what effect it has on the human psyche is still missing. Most research on this subject is related to the concept of presence. This paper gives an up-to-date overview of research in this diverse field. It starts with the most prevailing definitions and theories on presence, most of which attribute special roles for the mental process of attention and for mental models of the virtual space. A review of the phenomena thought to be effected by presence shows that there is still a strong need for research on this subject because little conclusive evidence exists regarding the relationship between presence and phenoma such as emotional responses to virtual stimuli. An investigation shows there has been substantial research for developing methods for measuring presence and research regarding factors that contribute to presence. Knowledge of these contributing factors can play a vital role in development of new VR applications, but key knowledge elements in this area are still missing. 183

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There is a clear need for more detailed analysis of the role of cognitive self-statements in virtual reality exposure therapy (VRET). To date, no research on this topic has been done. The primary aim of this study was to investigate whether coping self-statements would enhance the effectiveness of VRET. In a randomized crossover design, 26 patients with acrophobia (DSM-IV diagnosis of specific phobia) were randomly assigned to two sessions of VRET followed by two sessions of VRET plus coping self-statements, or the other way around: first two sessions of VRET plus coping self-statements followed by two sessions of VRET. Results showed that VRET, regardless of addition of coping self-statements, decreased anxiety of heights, decreased avoidance of height situations, and improved attitudes towards heights. However, at 6-month follow-up, most gains during treatment were not fully retained.