The Equivalence between Virtual and Real Feared Stimuli in a Phobic Adult Sample: A Neuroimaging Study

Abstract

The clinical use of virtual reality (VR) has proven its efficacy, especially when used as an exposure technique. A prominent property of VR’s utility is its equivalence with the reality it represents. In this study, we explored this equivalence in a clinical context using neuroimaging. A sample of 32 adults with specific phobias (i.e., to cockroaches, spiders, or lizards) was divided into two groups: One was exposed to phobic stimuli using VR and the other was exposed to real phobic images (RI). We used brain activations as a dependent measure, focusing specifically on brain areas usually associated with fear processing. Whole-brain analysis detected higher activations for RI in the hippocampus, occipital, and calcarine areas. A specific analysis of the amygdala and insula also detected higher activations and extensions in response to RI, but VR stimuli also activated those areas in a significant manner. These results suggest that even in those cases where RI stimuli activate all of the brain’s fear-processing circuits, VR stimuli do so as well. This implies that VR can be useful as an exposure technique similar to RI and applied as more than a mere training mechanism.

Anomalous static and dynamic functional connectivity of amygdala subregions in individuals with high trait anxiety

“…The SFA is regulated by social information from the environment (Bzdok et al, 2013). Previous studies have demonstrated that the calcarine fissure is associated with fear conditions (Peñate et al 2019). Moreover, Modi et al (2015) showed a significantly reduced functional connectivity in the medial visual network of high‐anxious participants.…”

Organizational principles of amygdalar input-output neuronal circuits

“…Our quantitative anatomical analysis of BLA input-output organization, which indicates a dominant contextual representation in afferent inputs in all types of BLA efferent neurons, gives a cue. Indeed, clinical examinations of healthy human subjects and patients with phobia reported that virtual reality accurately reproduced the physiological and behavioral responses evoked by real stimuli [ 49 , 51 ]. Given the prominent contextual influence in BLA information integration, the real life-mimic virtual situations are expected to be particular powerful in activating and modifying the amygdalar fear-defense system, explaining why virtual reality exposure therapy is particularly effective in treating anxiety disorders [ 49 ].…”

Spider Phobia: Neural Networks Informing Diagnosis and (Virtual/Augmented Reality-Based) Cognitive Behavioral Psychotherapy—A Narrative Review

“…Furthermore, non-inferiority of virtual reality exposure therapy for small animal or spider phobia was demonstrated in comparison to an in-vivo exposure therapy, particularly after 3 ( 87 , 88 ) and 12 months ( 88 ). Research using fMRI to examine brain activation while participants explore VR environments shows that identical anxiety-related brain regions are activated as with real life photographs ( 89 ). Some studies suggest a potentially beneficial augmentative effect of non-invasive brain stimulation such as intermittent Theta Burst Stimulation (iTBS) over the left prefrontal cortex on a VR challenge in spider phobia, supporting the relevance of the prefrontal network in phobia treatment [e.g., ( 86 , 90 )].…”