Wechsler Theresa F, Kümpers Franziska, Mühlberger Andreas
Department for Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Regensburg, Germany.
Front Psychol. 2019 Sep 10;10:1758. doi: 10.3389/fpsyg.2019.01758. eCollection 2019.
Convincing evidence on Virtual Reality (VR) exposure for phobic anxiety disorders has been reported, however, the benchmark and golden standard for phobia treatment is exposure. For direct treatment comparisons, the control of confounding variables is essential. Therefore, the comparison of VR and exposure in studies applying an equivalent amount of exposure in both treatments is necessary. We conducted a systematic search of reports published until June 2019. Inclusion criteria covered the diagnosis of Specific Phobia, Social Phobia, or Agoraphobia, and a randomized-controlled design with an equivalent amount of exposure in VR and . We qualitatively reviewed participants' characteristics, materials, and the treatment procedures of all included studies. For quantitative synthesis, we calculated Hedges' effect sizes for the treatment effects of VR exposure, exposure, and the comparison of VR to exposure in all studies and separately for studies on each diagnosis. Nine studies ( = 371) were included, four on Specific Phobia, three on Social Phobia, and two on Agoraphobia. VR and exposure both showed large, significant effect sizes. The comparison of VR to exposure revealed a small, but non-significant effect size favoring ( = -0.20). Specifically, effect sizes for Specific Phobia ( = -0.15) and Agoraphobia ( = -0.01) were non-significant, only for Social Phobia we found a significant effect size favoring ( -). Except for Agoraphobia, effect sizes varied across studies from favoring VR to favoring exposure. We found no evidence that VR exposure is significantly less efficacious than exposure in Specific Phobia and Agoraphobia. The wide range of study specific effect sizes, especially in Social Phobia, indicates a high potential of VR, but also points to the need for a deeper investigation and empirical examination of relevant working mechanisms. In Social Phobia, a combination of VR exposure with cognitive interventions and the realization of virtual social interactions targeting central fears might be advantageous. Considering the advantages of VR exposure, its dissemination should be emphasized. Improvements in technology and procedures might even yield superior effects in the future.
已有关于虚拟现实（VR）暴露疗法治疗恐惧症焦虑症的令人信服的证据，然而，恐惧症治疗的基准和金标准是暴露疗法。为了进行直接的治疗比较，控制混杂变量至关重要。因此，在两种治疗中应用等量暴露的研究中比较VR和暴露疗法是必要的。我们对截至2019年6月发表的报告进行了系统检索。纳入标准包括特定恐惧症、社交恐惧症或广场恐惧症的诊断，以及VR和暴露疗法中应用等量暴露的随机对照设计。我们对所有纳入研究的参与者特征、材料和治疗程序进行了定性综述。为了进行定量综合分析，我们计算了所有研究中VR暴露疗法、暴露疗法以及VR与暴露疗法比较的治疗效果的Hedges'效应量，并分别针对每种诊断的研究进行计算。共纳入9项研究（n = 371），其中4项针对特定恐惧症，3项针对社交恐惧症，2项针对广场恐惧症。VR和暴露疗法均显示出较大且显著的效应量。VR与暴露疗法的比较显示出有利于暴露疗法的较小但不显著的效应量（g = -0.20）。具体而言，特定恐惧症（g = -0.15）和广场恐惧症（g = -0.01）的效应量不显著，仅在社交恐惧症中我们发现有利于暴露疗法的显著效应量（g = -）。除广场恐惧症外，不同研究的效应量从有利于VR到有利于暴露疗法各不相同。我们没有发现证据表明在特定恐惧症和广场恐惧症中VR暴露疗法的疗效显著低于暴露疗法。研究特定效应量的广泛范围，尤其是在社交恐惧症中，表明VR具有很高的潜力，但也指出需要对相关工作机制进行更深入的研究和实证检验。在社交恐惧症中，将VR暴露疗法与认知干预相结合以及实现针对核心恐惧的虚拟社交互动可能具有优势。考虑到VR暴露疗法的优势，应强调其推广。技术和程序的改进甚至可能在未来产生更好的效果。
