The effectiveness of virtual reality based interventions for symptoms of anxiety and depression: A meta-analysis

Abstract

We report a meta-analysis of virtual reality (VR) interventions for anxiety and depression outcomes, as well as treatment attrition. We included randomized controlled trials comparing VR interventions, alone or in combination, to control conditions or other active psychological interventions. Effects sizes (Hedges’ g) for anxiety and depression outcomes, as post-test and follow-up, were pooled with a random-effects model. Drop-outs were compared using odds ratio (OR) with a Mantel-Haenszel model. We included 39 trials (52 comparisons). Trial risk of bias was unclear for most domains, and high for incomplete outcome data. VR-based therapies were more effective than control at post-test for anxiety, g = 0.79, 95% CI 0.57 to 1.02, and depression, g = 0.73, 95% CI 0.25 to 1.21, but not for treatment attrition, OR = 1.34, 95% CI 0.95 to 1.89. Heterogeneity was high and there was consistent evidence of small study effects. There were no significant differences between VR-based and other active interventions. VR interventions outperformed control conditions for anxiety and depression but did not improve treatment drop-out. High heterogeneity, potential publication bias, predominant use of waitlist controls, and high or uncertain risk of bias of most trials question the reliability of these effects.

Virtual reality exposure therapy for posttraumatic stress disorder (PTSD): a meta-analysis

“…Effect sizes for PTSD symptom reduction in favour of VRET were medium (g = 0.62 for PTSD symptoms; g = 0.50 for depressive symptoms), and effects for treatment-related changes in anxiety symptoms were non-significant (g = 0.47, p = .387). These results are in line with previous research (Carl et al, 2019), but depict better outcomes than another meta-analysis (Fodor et al, 2018). Furthermore, our findings suggest that there is no significant difference between VRET and active controls regarding the improvement of PTSD symptoms (g = 0.25) and depressive symptoms (g = 0.24).…”

“…In sum, the evidence from the present metaanalysis was insufficient to assume efficacy of VRET for particular trauma types. While a considerable body of research supports the efficacy of VRET for the treatment of specific phobias (for an overview, see Carl et al, 2019;Fodor et al, 2018;Opriş et al, 2012), only a small number of controlled studies have investigated the efficacy of VRET in patients with PTSD. As such, we have to state that despite the moderately positive results of the present meta-analysis, more research is required to determine whether VRET constitutes a valuable tool for PTSD treatment.…”

“…Similarly, VRET has been included in the ISTSS Guidelines (2018), for instance as a treatment with emerging evidence for PTSD, although the guidelines also emphasize that while the evidence is promising, it is still insufficient to fully support VRET as a standard treatment. To date, most meta-analytic research on the efficacy of VRET has considered anxiety disorders in general, and the analyses have only included small numbers of PTSD related studies (Carl et al, 2019;Fodor et al, 2018;Opriş et al, 2012;Parsons & Rizzo, 2008;Powers & Emmelkamp, 2008), rendering it difficult to draw specific conclusions for PTSD. Two recently published meta-analyses on VRET for anxiety disorders found small (Fodor et al, 2018) and medium (Carl et al, 2019) effect sizes in favour of VRET versus control comparisons in terms of reducing PTSD symptom severity.…”

“…To date, most meta-analytic research on the efficacy of VRET has considered anxiety disorders in general, and the analyses have only included small numbers of PTSD related studies (Carl et al, 2019;Fodor et al, 2018;Opriş et al, 2012;Parsons & Rizzo, 2008;Powers & Emmelkamp, 2008), rendering it difficult to draw specific conclusions for PTSD. Two recently published meta-analyses on VRET for anxiety disorders found small (Fodor et al, 2018) and medium (Carl et al, 2019) effect sizes in favour of VRET versus control comparisons in terms of reducing PTSD symptom severity. Nevertheless, due to the small sample sizes of the included studies and the lack of active treatment controls, these results have to be regarded as a first step, and further evidence is needed.…”

Gamified, Automated Virtual Reality Exposure Therapy for Fear of Spiders: A Single-Subject Trial Under Simulated Real-World Conditions

“…VRET is structured in a manner similar as traditional exposure therapy (1): via graded, systematic exposure to feared stimuli under controlled conditions and without safety behaviors, the fear response gradually habituates and inhibitory learning occurs (2). Since the first clinical applications of VR technology in the early 2000's, meta-analyses have revealed that VRET is efficacious (3), and even on par with traditional exposure therapy (4). Importantly, results generalize to reduced fear of real-world stimuli (5), there are low rates of deterioration (6) and efficacy has been demonstrated also among adolescents (7).…”