JMIR Publications

ABSTRACT

Background:

Within recent years Virtual Reality Exposure Treatment (VRET) has shown good treatment results in (subclinical) anxiety disorders, and seems to be a good alternative to exposure in vivo in regular cognitive behavioral therapy (CBT). However, previous meta-analyses on the efficacy of VRET on anxiety disorders included studies on specific phobia and subthreshold anxiety, and therefore, these results may not be generalizable to patients with more severe and disabling anxiety disorders.

Objective:

The objective of our study was to determine the efficacy of VRET in more severe anxiety disorders, excluding specific phobias and subthreshold anxiety disorders. Meta-analyses were conducted to examine the efficacy of VRET versus (1) waitlist and (2) regular CBT. Our secondary objectives were to examine whether the efficacy differs for type of anxiety disorder, type of recruitment, and type of VRET (either pure VRET or VRET with regular CBT). Furthermore, attrition in VRET and CBT was compared.

Methods:

Studies published until August 20th, 2020 were retrieved through systematic literature searches in PubMed, PsycINFO and Embase. We calculated the effect sizes (Hedges’ g) for the difference between the conditions and their 95% confidence intervals (CI) for post-test, and at follow-up in a random-effects model. A separate meta-analysis was performed to compare attrition between VRET and CBT conditions.

Results:

A total of 16 trials with 805 participants were included. We identified 10 comparisons between VRET and a waitlist condition, and 13 comparisons between VRET and a CBT condition. With regard to risk of bias, information on random sequence generation, allocation concealment, and risk of bias for selective outcome reporting was often absent unclear. The mean effect size of VRET compared to waitlist (Nco=10) was medium and significant, favouring VRET; g=−0.526 (95% CI: −0.85 to −0.21, P<.001). The mean effect size of VRET compared to CBT (Nco=13) was and small and non-significant, favouring CBT; g=0.083 (95% CI: −0.13 to 0.30, P=.45). The dropout rates between VRET and CBT (Nco=10) showed no significant difference (OR=0.79, 95% CI: 0.49 to 1.27, P=.32). There were no indications of small study effects and publication bias.

Conclusions:

The results of our study show that VRET is more effective than waitlist and equally effective as CBT in the treatment of more severe anxiety disorders. Therefore, VRET may be considered a promising alternative to CBT for patients with more severe anxiety disorders. To verify the robustness of these findings, higher quality RCT’s are needed.