Özgül Fobilerde Sanal Gerçeklik ile Maruz Bırakma Terapisinin Etkinliği: Sistematik Bir Gözden Geçirme

Year 2023, Volume: 15 Issue: 4, 562 - 576, 25.12.2023

Merve Demir , Tolga Köskün

https://doi.org/10.18863/pgy.1192543

Cited By: 2

Abstract

Özgül fobi, günlük yaşamı ve işlevselliği önemli derecede olumsuz etkileyen belirli nesne ya da duruma yönelik belirgin ve sürekli bir korku olarak tanımlanmaktadır. Aynı zamanda, en sık görülen psikolojik bozukluklar arasında olduğu bildirilmektedir. Özgül fobilerin tedavisinde maruz bırakma temelli müdahalelerin yaygın olarak kullanıldığı bilinmekle birlikte standart yöntemlerin bazı sınırlılıklarının bulunması farklı yaklaşımlara ihtiyaç duyulduğuna işaret etmektedir. Bu çerçevede, son yıllarda psikoterapi bağlamında sanal gerçeklik teknolojisinin kullanımı giderek yaygınlaşmış ve maruz bırakma terapisi ile bütünleştirilmiştir. Bilgisayar tarafından oluşturulan üç boyutlu ortamla çeşitli teknolojik araçlar aracılığıyla gerçek zamanlı etkileşim sağlayan sanal gerçekliğin, maruz bırakma terapisi ile kullanımının özellikle özgül fobiler gibi psikopatolojilerin tedavisinde önemli bir müdahale yöntemi haline geldiği görülmektedir. Bu çalışma kapsamında, özgül fobilerin tedavisinde sanal gerçeklik ile maruz bırakma müdahaleleri sistematik olarak gözden geçirilmiştir. PRISMA yöntemi izlenerek APA (PsycINFO), EBSCO, PubMed, Scopus, Web of Science, Science Direct, Ulakbim ve TRDizin veri tabanlarında yapılan taramada dahil etme ölçütleri kapsamında; özgül fobi tanı kriterlerini karşılayan yetişkin katılımcıların yer aldığı, sanal gerçeklik ile maruz bırakma terapisinin kontrol grubuna kıyasla etkinliğinin incelendiği ve tam metnine ulaşılabilen 10 seçkisiz kontrollü çalışma bu sistematik derlemeye dahil edilmiştir. Dahil edilen makaleler örneklem özellikleri, temel ölçüm araçları, araştırma deseni, müdahalenin özellikleri ve etkisi açısından değerlendirilmiştir. Bulgular, sanal gerçeklik ile maruz bırakma terapisinin, özgül fobi belirtilerini azaltmadaki etkinliğine işaret etmektedir. Yapılan izlem çalışmaları tedavi sonuçlarının uzun vadede korunduğuna yönelik destek sağlamaktadır.

Keywords

fobi, korku, sanal gerçeklik, sanal gerçeklik ile maruz bırakma terapisi, sistematik gözden geçirme

Supporting Institution

Destekleyen kurum bulunmamaktadır.

Project Number

Çalışma bir proje kapsamında yürütülmemiştir.

Efficacy of Virtual Reality Exposure Therapy in the Treatment of Specific Phobias: A Systematic Review

Abstract

Specific phobia is defined as a notable and continuous fear of a certain object or a situation that particularly impairs daily life and functioning. It is also one of the most common psychological disorders. Exposure-based interventions are commonly used in the treatment of specific phobias. However, some limitations of the standard methods require the need for alternative approaches. In light of this, the use of virtual reality technology in psychotherapy has become increasingly widespread in recent years and is now integrated with exposure therapy. Virtual reality provides real-time interaction using the computer-generated three-dimensional environment via variety oftechnological tools. Applications of virtual reality in exposure therapy have proven to be an important intervention method, especially in the psychopathologies such as specific phobias. In this study, virtual reality exposure therapy for the treatment of specific phobias is systematically reviewed. Inclusion criteria were taken into account in the scanning performed in APA (PsycINFO), EBSCO, PubMed, Scopus, Web of Science, Science Direct, Ulakbim ve TRDizin databses following the PRISMA method. Following that, ten randomized controlled trials, which included adult participants meeting the diagnostic criteria for specific phobia, examined the efficacy of virtual reality and exposure therapy compared to the control group, and the ones with full text could be accessed, were included in this systematic review. The included studies were evaluated in terms of sample attributes, primary measurement tools, research design, characteristics of the intervention and its efficacy. In general, the findings indicate the efficacy of virtual reality exposure therapy in reducing specific phobia symptoms. Follow-up studies support the long-term maintenance of the results.

Keywords

Phobia, fear, virtual reality, exposure therapy, systematic review

Project Number

Çalışma bir proje kapsamında yürütülmemiştir.

References

• Albakri G, Bouaziz R, Alharthi W, Kammoun S, Al-Sarem M, Saeed F et al. (2022) Phobia exposure therapy using virtual and augmented reality: a systematic review. Appl Sci, 12:1672.
• APA (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington D.C., American Psychiatric Association.
• APA Presidential Task Force on Evidence-Based Practice (2006) Evidence-based practice in psychology. Am Psychol, 61:271-285.
• Anderson PL, Rothbaum BO, Hodges L (2001) Virtual reality: using the virtual world to improve quality of life in the real world. Bull Menninger Clin, 65:78-91.
• Antony MM, Barlow DH (2002) Specific phobias. In Anxiety and its Disorders - The Nature and Treatment of Anxiety and Panic (Ed. DH Barlow): 380-417. London, Guilford Press.
• Barlow DH, Conklin LR, Bentley KH (2015) Psychological treatments for panic disorders, phobias, and social and generalized anxiety disorders. In A Guide to Treatments That Work (Eds PE Nathan, JM Gorman): 409-461. New York, Oxford University Press.
• Boeldt D, McMahon E, McFaul M, Greenleaf W (2019) Using virtual reality exposure therapy to enhance treatment of anxiety disorders: identifying areas of clinical adoption and potential obstacles. Front Psychiatry, 10:773.
• Botella C, Fernández-Álvarez J, Guillén V, García-Palacios A, Baños R (2017) Recent progress in virtual reality exposure therapy for phobias: a systematic review. Curr Psychiatry Rep, 19:42.
• Chambless DL, Baker MJ, Baucom DH, Beutler LE, Calhoun KS, Daiuto A (1998) Update on empirically validated therapies, II. Clin Psychol, 51:3-16.
• Choy Y, Fyer AJ, Lipsitz JD (2007) Treatment of specific phobia in adults. Clin Psychol Rev, 27:266-286.
• Cohen DC (1977) Comparison of self-report and overt-behavioral procedures for assessing acrophobia. Behav Ther, 8:17-23.
• Depp C, Lebowitz BD (2007) Clinical trials: bridging the gap between efficacy and effectiveness. Int Rev Psychiatry, 19:531-539.
• Dickinson ER, Adelson, JL, Owen J (2012) Gender balance, representativeness, and statistical power in sexuality research using undergraduate student samples. Arch Sex Behav, 41:325-327.
• Dinh HQ, Walker N, Hodges LF, Song C, Kobayashi A (1999) Evaluating the importance of multi-sensory input on memory and the sense of presence in virtual environments (p. 222-228). IEEE Comput Soc, Houston.
• Donker T, Cornelisz I, Van Klaveren C, Van Straten A, Carlbring P, Cuijpers P et al. (2019) Effectiveness of self-guided app-based virtual reality cognitive behavior therapy for acrophobia: a randomized clinical trial. JAMA Psychiatry, 76:682-690.
• Dunsmoor JE, Ahs F, Zielinski DJ, LaBar KS (2014) Extinction in multiple virtual reality contexts diminishes fear reinstatement in humans. Neurobiol Learn Mem, 113:157-164.
• Eaton WW, Bienvenu OJ, Miloyan B (2018) Specific phobias. Lancet Psychiatry, 5:678-686.
• Eaton WW, Dryman A, Weissman MM (1991) Panic and phobia. In Psychiatric Disorders in America: The Epidemiologic Catchment Area Study (Eds LA Robins, DA Regier):155-179. Los Angeles, CA, Free Press.
• Elkins DN (2012) Toward a common focus in psychotherapy research. Psychotherapy, 49:450-454.
• Ertan T (2008) Psikiyatrik bozukluklarin epidemiyolojisi. Türkiye'de Sık Karşılaşılan Psikiyatrik Hastalıklar Sempozyumu (Eds M Uğur, İ Balcıoğlu, N Kocabaşoğlu):25-30. İstanbul, İstanbul Üniversitesi.
• Freitas JRS, Velosa VHS, Abreu LTN, Jardim RL, Santos JAV, Peres B et al. (2021) Virtual reality exposure treatment in phobias: a systematic review. Psychiatr Q, 92:1685-1710.
• Garcia-Palacios A, Botella C, Hoffman H, Fabregat S (2007) Comparing acceptance and refusal rates of virtual reality exposure vs. in vivo exposure by patients with specific phobias. Cyberpsychol Behav, 10:722-724.
• Garcia-Palacios A, Hoffman HG, See SK, Tsai A, Botella C (2001) Redefining therapeutic success with virtual reality exposure therapy. Cyberpsychol Behav, 4:341-348.
• Garcia-Palacios A, Hoffman H, Carlin A, Furness III TA, Botella C (2002) Virtual reality in the treatment of spider phobia: a controlled study. Behav Res Ther, 40:983-993.
• Geraets CN, Van der Stouwe EC, Pot-Kolder R, Veling W (2021) Advances in immersive virtual reality interventions for mental disorders: a new reality?. Curr Opin Psychol, 41:40-45.
• Götestam KG (2002) One session group treatment of spider phobia by direct or modelled exposure. Cogn Behav Ther, 31:18-24.
• Grenier S, Forget H, Bouchard S, Isere S, Belleville S, Potvin O et al. (2015) Using virtual reality to improve the efficacy of cognitive-behavioral therapy (CBT) in the treatment of late-life anxiety: preliminary recommendations for future research. Int Psychogeriatr, 27:1217-1225.
• Gujjar KR, van Wijk A, Kumar R, de Jongh A (2019) Efficacy of virtual reality exposure therapy for the treatment of dental phobia in adults: a randomized controlled trial. J Anxiety Disord, 62:100-108.
• Hofmann SG, Smits JA (2008) Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. J Clin Psychiatry, 69:621-632.
• Hood HK, Antony MM (2012) Evidence-based assessment and treatment of specific phobias in adults. In Intensive One-Session Treatment of Specific Phobias (Eds TE Davis III, TH Ollendick, LG Öst): 19-41. New York, NY, Springer.
• Humphris GM, Morrison T, Lindsay SJE (1995) The modified dental anxiety scale: validation and United Kingdom norms. Community Dent Health, 12:143-50.
• Jiang MY, Upton E, Newby JM (2020) A randomised wait-list controlled pilot trial of one-session virtual reality exposure therapy for blood-injection-injury phobias. J Affect Disord, 276:636-645.
• Karlsson P, Bergmark A (2015) Compared with what? an analysis of control‐group types in cochrane and campbell reviews of psychosocial treatment efficacy with substance use disorders. Addiction, 110:20-428.
• Kaussner Y, Kuraszkiewicz AM, Schoch S, Markel P, Hoffmann S, Baur-Streubel R et al. (2020) Treating patients with driving phobia by virtual reality exposure therapy - a pilot study. PLoS One, 15:e0226937.
• Kendler KS, Myers J, Prescott CA (2002) The etiology of phobias: an evaluation of the stress-diathesis model. Arch Gen Psychiatry, 59:242-248.
• Kessler RC, Petukhova M, Sampson, NA, Zaslavsky AM, Wittchen HU (2012) Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res, 21:169-184.
• Kristman V, Manno M, Côté P (2004) Loss to follow-up in cohort studies: how much is too much?. Eur J Epidemiol, 19:751-760.
• Krzystanek M, Surma S, Stokrocka M, Romańczyk M, Przybyło J, Krzystanek N et al. (2021) Tips for effective implementation of virtual reality exposure therapy in phobias - a systematic review. Front Psychiatry, 12:737351.
• Llewellyn-Bennett R, Bowman L, Bulbulia R (2016) Post-trial follow-up methodology in large randomized controlled trials: a systematic review protocol. Syst Rev, 5:214.
• Magee WJ, Eaton WW, Wittchen HU, McGonagle KA, Kessler RC (1996) Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Arch Gen Psychiatry 53:159-168.
• Maples-Keller JL, Bunnell BE, Kim SJ, Rothbaum BO (2017) The use of virtual reality technology in the treatment of anxiety and other psychiatric disorders. Harv Rev Psychiatry, 25:103-113.
• Marks IM (1978) Behavioral psychotherapy of adult neurosis. In Handbook of Psychotherapy and Behavior Change (Eds SL Garfield, AE Bergin):493-547). Chichester, Wiley.
• Michaliszyn D, Marchand A, Bouchard S, Martel MO, Poirier-Bisson J (2010) A randomized, controlled clinical trial of in virtuo and in vivo exposure for spider phobia. Cyberpsychol Behav Soc Netw, 13:689-695.
• Miloff A, Lindner P, Dafgård P, Deak S, Garke M, Hamilton W et al. (2019) Automated virtual reality exposure therapy for spider phobia vs. in-vivo onesession treatment: a randomized non-inferiority trial. Behav Res Ther, 118:130-140.
• Mineka S, Sutton J (2006) Contemporary learning theory perspectives on the etiology of fears and phobias. Fear and Learning: From Basic Processes to Clinical Implications (Eds MG Craske, D Hermans, D Vansteenwegen): 75-97). Washington DC, American Psychological Association.
• Minns, S, Levihn-Coon A, Carl E, Smits JA, Miller W, Howard D et al. (2019) Immersive 3D exposure-based treatment for spider fear: a randomized controlled trial. J Anxiety Disord, 61:37-44.
• Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M et al. (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev, 4:1.
• Nathan PE, Gorman JM (2015) A Guide to Treatments That Work. New York, Oxford University Press.
• Neudeck P, Einsle F (2012) Dissemination of exposure therapy in clinical practice: how to handle the barriers?. In Exposure Therapy: Rethinking the Model - Refining the Method (Eds. P Neudeck, HU Wittchen):23-34. New York, NY, Springer.
• Norcross JCW, Bruce E (2011) Evidence-based therapy relationships: research conclusions and clinical practices. Psychotherapy, 48:98-102.
• North M, North S (1994) Virtual environments and psychological disorders. Electronic Journal of Virtual Culture, 2:37-42.
• North MM, North SM, Coble JR (1996) Effectiveness of virtual environment desensitization in the treatment of agoraphobia. Presence (Camb), 5:346-352.
• Oing, T, Prescott J (2018) Implementations of virtual reality for anxiety-related disorders: systematic review. JMIR Serious Games, 6:e10965.
• Page S, Coxon M (2016) Virtual reality exposure therapy for anxiety disorders: small samples and no controls?. Front Psychol, 7:326.
• Powers MB, Emmelkamp PM (2008) Virtual reality exposure therapy for anxiety disorders: a meta-analysis. J Anxiety Disord, 22:561-569.
• Pull CB (2008) Recent trends in the study of specific phobias. Curr Opin Psychiatry, 21:43-50.
• Price M, Mehta N, Tone EB, Anderson PL (2011) Does engagement with exposure yield better outcomes? Components of presence as a predictor of treatment response for virtual reality exposure therapy for social phobia. J Anxiety Disord, 25:763-770.
• Richardson WS, Wilson MC, Nishikawa J, Hayward RS (1995) The well-built clinical question: a key to evidence-based decisions. ACP J Club, 123:A12-A13.
• Rothbaum BO, Anderson P, Zimand E, Hodges L, Lang D, Wilson J (2006) Virtual reality exposure therapy and standard (in vivo) exposure therapy in the treatment of fear of flying. Behav Ther, 37:80-90.
• Rothbaum BO, Hodges LF (1999) The use of virtual reality exposure in the treatment of anxiety disorders. Behav Modif, 23:507-525.
• Rothbaum BO, Hodges L, Smith S, Lee JH, Price L (2000) A controlled study of virtual reality exposure therapy for the fear of flying. J Consult Clin Psychol, 68:1020.
• Shiban Y, Pauli P, Mühlberger A (2013) Effect of multiple context exposure on renewal in spider phobia. Behav Res Ther, 51:68-74.
• Sigström R, Östling S, Karlsson B, Waern M, Gustafson D, Skoog I (2011) A population-based study on phobic fears and DSM-IV specific phobia in 70-year olds. J Anxiety Disord, 25:148-153.
• Spring B (2007) Evidence‐based practice in clinical psychology: what it is, why it matters; what you need to know. J Clin Psychol, 63:611-631.
• Suso-Ribera C, Fernández-Álvarez J, García-Palacios A, Hoffman HG, Bretón-López J, Banos RM et al. (2019) Virtual reality, augmented reality, and in vivo exposure therapy: a preliminary comparison of treatment efficacy in small animal phobia. Cyberpsychol Behav Soc Netw, 22: 31-38.
• Steinman SA, Teachman BA (2011) Cognitive processing and acrophobia: validating the Heights Interpretation Questionnaire? J Anxiety Disord, 25:896-902.
• Szymanski J, O'Donohue W (1995) Fear of spiders questionnaire. J Behav Ther Exp Psychiatry, 26:31-34.
• Trappey A, Trappey CV, Chang CM, Kuo RR, Lin AP, Nieh CH (2020) Virtual reality exposure therapy for driving phobia disorder: system design and development. Appl Sci, 10:4860.
• Wampold BE (2001) The Great Psychotherapy Debate: Models, Methods, and Findings. Mahwah, NJ, Lawrence Erlbaum.
• Wardenaar KJ, Lim C, Al-Hamzawi AO, Alonso J, Andrade LH, Benjet C et al. (2017) The cross-national epidemiology of specific phobia in the World Mental Health Surveys? Psychol Med, 47:1744-1760.
• Wechsler TF, Kümpers F, Mühlberger A (2019) Inferiority or even superiority of virtual reality exposure therapy in phobias? - a systematic review and quantitative meta-analysis on randomized controlled trials specifically comparing the efficacy of virtual reality exposure to gold standard in vivo exposure in agoraphobia, specific phobia, and social phobia. Front Psychol, 10:1758.
• Wiederhold BK, Jang DP, Gevirtz RG, Kim SI, Kim IY, Wiederhold MD (2002) The treatment of fear of flying: a controlled study of imaginal and virtual reality graded exposure therapy. IEEE Trans Inf Technol Biomed, 6:218-223.
• Wiederhold BK, Wiederhold MD (2004) Virtual Reality Therapy for Anxiety Disorders: Advances in Evaluation and Treatment. New York, American Psychological Association Press.
• Vansteenwegen D, Vervliet B, Hermans D, Beckers T, Baeyens F, Eelen P (2006) Stronger renewal in human fear conditioning when tested with an acquisition retrieval cue than with an extinction retrieval cue. Behav Res Ther, 44:1717-1725.
• Vervliet B, Craske MG, Hermans D (2013) Fear extinction and relapse: state of the art. Annu Rev Clin Psychol, 9:215-248.
• Von Allmen RS, Weiss S, Tevaearai HT, Kuemmerli C, Tinner C, Carrel TP et al. (2015) Completeness of follow-up determines validity of study findings: results of a prospective repeated measures cohort study. PloS One, 10:e0140817.