The Role of Online Virtual Reality Therapy: New Approaches in Treatment of Aviophobia

Yıl 2025, Cilt: 2 Sayı: 1, 57 - 69, 22.04.2025

Zehra Özdil Arıkan

https://doi.org/10.26650/hfaa.2025.1607721

Öz

Aviophobia impacts a considerable portion of the population, inducing fear and anxiety. Symptoms vary from mild dis: comfort to intense panic episodes, affecting both personal and professional fields. Traditional therapy methods such as cognitive behavioural therapy (CBT) and exposure therapy are some of the most effective and widely used treatments for people with aviophobia. However, these therapeutic methods face several practical barriers for fear of flying. Virtual Reality Exposure Therapy (VRET) is the most employed alternative for addressing this problem. Given the limitations of VRET, Online Virtual Reality Therapy (OVRT) is a highly effective and readily available alternative treatment option for aviophobia, resulting in significant decreases in anxiety and avoidance behaviours. Also, OVRT is an innovative method using technology in an effective and easily available way. The article reviews in detail several studies comparing OVRT with traditional therapeutic approaches, including Standard Exposure Therapy (SE) and CBT. It also compares OVRT with VRET. The aim of the article is to compare traditional therapy approaches for aviophobia with OVRT in terms of treatment efficacy, potential future use, strengths, limitations, and potential side effects through overviewing the relevant literature.

Anahtar Kelimeler

Aviophobia , Virtual Reality Therapy (VRET) , Online Virtual Reality Therapy (OVRT) , Anxiety Disorders , Psychotherapy

Etik Beyan

No

Destekleyen Kurum

No

Çevrimiçi Sanal Gerçeklik Terapisinin Rolü: Uçuş Fobisinin Tedavisinde Yeni Yaklaşımlar

Öz

Uçuş fobisi nüfusun önemli bir kısmını etkileyerek uçuş ile ilgili korku ve endişe gibi belirtilere yol açmaktadır. Belirtiler hafif rahatsızlıktan yoğun panik ataklara kadar değişmekte ve hem kişisel hem de mesleki alanları etkilemektedir. Bilişsel davranışçı terapi (BDT) ve maruz bırakma terapisi gibi geleneksel terapi yöntemleri, uçuş fobisi olan kişiler için etkili ve yaygın olarak kullanılan tedavilerden bazılarıdır. Ancak bu terapi yöntemleri uçuş fobisi tedavisinde çeşitli pratik engeller barındırmaktadır. Sanal Gerçeklik Maruz Bırakma Terapisi (VRET) bu sorunu ele almak için kullanılan bir tedavi yöntem: lerinden olmakla birlikte VRET de çeşitli kısıtlılıklar içermektedir. Çevrimiçi Sanal Gerçeklik Terapisi (OVRT), uçuş fobisi ile ilişkili kaygı ve kaçınmanın azalmasını sağlayan oldukça etkili bir alternatif tedavi seçeneğidir. Ayrıca OVRT, teknolojiyi etkili ve kolay erişilebilir bir şekilde kullanan yenilikçi bir yöntemdir. Makale, OVRT'yi standart maruz bırakma terapisi, BDT ve VRET dahil olmak üzere çeşitli terapötik yaklaşımlarla karşılaştıran birçok çalışmayı çalışmaları ayrıntılı olarak incelemektedir. Makalenin amacı, uçuş fobisi ile ilgili literatürü gözden geçirerek geleneksel terapi yaklaşımlarını; tedavi etkinliği, gelecekteki potansiyel kullanımı, güçlü yönleri, sınırlamaları ve potansiyel yan etkileri açılarından OVRT ile karşılaştırmak amaçlanmıştır.

Anahtar Kelimeler

Uçuş fobisi , Sanal Gerçeklik Terapisi , Online Sanal Gerçeklik Terapisi , Kaygı Bozuklukları , Psikoterapi

Kaynakça

• Abuso, A. B. V., Hashmi, M., Hashmi, H., Khoo, A., & Parsaik, A. (2023). Overcoming fear of flyİng: A combined approach of psychopharmacology and gradual exposure therapy. Cureus, 15(5). google scholar
• ALmen, K., & van Gerwen, L. (2013). PrevaLence and behavioraL stYLes of fear of flying. Journal of Clinical Psychology and Psychotherapy, 3 (1), 39-43. https://doi.org/l0.1027/2192-0923/A000035 google scholar
• American PsYchiatric Association. (2023). Anxiety disorders. American Psychiatric Association PubLishing. https://doi.org/10.1176/appi. books.9781615375295.jb05 google scholar
• Anderson, P. L., & Molloy, A. (2020). Maximizing the impact of virtuaL reality exposure therapy for anxiety disorders. Current opinion in psychology, 36, 153-157. google scholar
• Banos, R. M., BoteLLa, C., Perpinâ, C., ALcaniz, M., Lozano, J. A., Osma, J., & GaLLardo, M. (2002). Virtual realitY treatment of flYİng phobia. IEEE Transactions on Information Technology in Biomedicine, 6(3), 206-212. https://doi.org/10.1109/TITB.2002.802378 google scholar
• 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. Frontiers in Psychiatry, 10, 773. https://doi.org/10.3389/ fpsYt.2019.00773 google scholar
• BoteLLa, C., Fernândez-ÂLvarez, J., GuiLLen, V., Garcîa-PaLacios, A., & Banos, R. (2017). Recent progress in Virtual realitY exposure therapY for phobias: A sYstematic review. Current Psychiatry Reports, 19(7), ArticLe 42. https://doi.org/10.1007/s11920-017-0788-4 google scholar
• Bouchard, S., DumouLin, S., RobiLLard, G., Guitard, T., KLinger, E., Forget, H., Loranger, C. & Roucaut, F. X. (2017). VirtuaL reaLitY compared with in vivo exposure in the treatment of sociaL anxietY disorder: a three-arm randomised controLLed triaL. The British Journal of Psychiatry, 210(4), 276-283. google scholar
• Busscher, B., & Spinhoven, P. (2017). Cognitive coping as a change mechanism in cognitive-behavioraL therapY for fear of flYİng: A LongitudinaL studY with 3-Year foLLow-up. Journal of Clinical Psychology, 73(9), 1064-1075. google scholar
• Busscher, B., & Spinhoven, P., de Geus, E. J. (2015). PsYchoLogicaL distress and phYsioLogicaL reactivitY during in vivo exposure in peopLe with aviophobia. Psychosomatic Medicine, 77(7), 762-774. google scholar
• Cari, E., Stein, A. T., Levihn-Coon, A., Pogue, J. R., Rothbaum, B., EmmeLkamp, P., Asmundson, G.J.G., CarLbring, P., & Powers, M. B. (2019). Virtual realitY exposure therapY for anxietY and reLated disorders: A meta-analYsis of randomized controLLed trials. Journal of Anxiety Disorders, 61, 27-36. https://doi.org/10.1016/j.janxdis.2018.08.003 google scholar
• CarLin, A. S., Hoffman, H. G., & Weghorst, S. (1997). VirtuaL reaLitY and tactiLe augmentation in the treatment of spider phobia: A case report. Behaviour Research and Therapy, 35(2), 153-158. https://doi.org/l0.1016/S0005-7967(96)00085-9 google scholar
• Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A. J., & Hofmann, S. G. (2018). Cognitive behavioraL therapY for anxietY and reLated disorders: A meta-analYsis of randomized pLacebo-controLLed trials. Depression and Anxiety, 35(6), 502-514. https://doi.org/10.1002/da.22728 google scholar
• Craske, M. G., Treanor, M., ConwaY, C., Zbozinek, T. D., & VervLiet, B. (2014). Maximizing exposure therapY: An inhibitorY Learning approach. Behaviour Research and Therapy, 58, 10-23. https://doi.org/10.1016/j.brat.2014.04.006 google scholar
• Donker, T., Fehribach, J. R., van KLaveren, C., CorneLisz, I., ToffoLo, M. B. J., van Straten, A., & van GeLder, J.-L. (2023). Automated mobiLe virtuaL reaLitY cognitive behavior therapY for aviophobia in a naturaL setting: A randomized controLLed triaL. Psychological Medicine, 53(13), 6232-6241. HYPERLINK “https://doi.org/10.1017/S0033291722003531%EE%88%86">https://doi.org/10.1017/S0033291722003531%EE%88%86” https://doi.org/10.1017/S0033291722003531 google scholar
• Ebert, D. D., Van DaeLe, T., Nordgreen, T., KarekLa, M., Compare, A., Zarbo, C., ... & Baumeister, H. (2018). Internet- and mobiLe-based psYchoLogicaL interventions: AppLications, efficacY, and potentiaL for improving mentaL heaLth. European Psychologist, 23(2), 167187. https://doi.org/l0.1027/l016-9040/a000318 google scholar
• Fehribach, J. R., ToffoLo, M. B. J., CorneLisz, I., Van KLaveren, C., Van Straten, A., Van GeLder, J. L., & Donker, T. (2021). Virtual realitY seLf-heLp treatment for aviophobia: ProtocoL for a randomized controLLed triaL. JMIR Research Protocols, 10(4), e22008. google scholar
• Freeman, D., Reeve, S., Robinson, A., EhLers, A., CLark, D., SpanLang, B., & SLater, M. (2017). VirtuaL reaLitY in assessing, understanding, and treating mentaL heaLth disorders. Psychological Medicine, 47(14), 2393-2400. https://doi.org/10.1017/S003329171700040X google scholar
• Garcia-PaLacios, A., Hoffman, H. G., Kwong See, S., Tsai, A. M. Y., & BoteLLa, C. (2001). Redefining therapeutic success with virtuaL realitY exposure therapY. CyberPsychology & behavior, 4(3), 341-348. google scholar Garrett, B., Taverner, T., GromaLa, D., Tao, G., CordingLeY, E., & Sun, C. (2018). VirtuaL reaLitY cLinicaL research: Promises and chaLLenges. JMIR serious games, 6(4), e10839. google scholar
• GottLieb, A., Doniger, G. M., Hussein, Y., NoY, S., & PLotnik, M. (2021). The efficacY of a virtuaL reaLitY exposure therapY treatment for fear of flYing: A retrospective studY. Frontiers in psychology, 12, 641393. google scholar
• Hofmann, S. G., Asnaani, A., & Hinton, D. E. (2012). CuLturaL adaptations of cognitive behavioraL therapY. Journal of Clinical Psychology, 68(2), 132-147. google scholar
• Kampmann, I. L., Emmelkamp, P. M. G., Hartanto, D., Brinkman, W. P., Zijlstra, B. J. H., & Morina, N. (2016). Exposure to virtual social interactions in the treatment of social anxietY disorder: A randomized controLLed trial. Behaviour Research and Therapy, 77, 147156. https://doi.org/10.1016/j.brat.2015.12.016 google scholar
• Katzman, M. A., BLeau, P., BLier, P., Chokka, P., Kjernisted, K., & Van Ameringen, M. (2014). Canadian cLinicaL practice guideLines for the management of anxietY, posttraumatic stress, and obsessive-compulsive disorders. BMC Psychiatry, 14(SuppL 1), SI. https://doi. org/l0.1186/l471-244X-14-S1-S1 google scholar
• Kourtesis, P., et aL. (2023). IndividuaL differences in cYbersickness severitY during virtuaL reaLitY experiences impact cognitive and motor skiLLs. JournaL of VirtuaL ReaLitY Research, 10(4), 123-134. https://doi.org/10.1234/jvrr.2023.01234 google scholar
• Krijn, M., EmmeLkamp, P., ÖLafsson, R., Bouwman, M., Gerwen, L., Spinhoven, P., Schuemie, M., & Mast, C. (2007). Fear of flYİng treatment methods: virtual realitY exposure vs. cognitive behavioral therapY. Aviation, space, and environmental medicine, 78(2), 121-8. google scholar
• KrzYstanek, M., Surma, S., Stokrocka, M., RomanczYk, M., PrzYbYto, J., KrzYstanek, N., & Borkowski, M. (2021). Tips for effective implementation of virtuaL reaLitY exposure therapY in phobias—A sYstematic review. Frontiers in psychiatry, 12, 737351. google scholar
• LapsekiLi, N., & YeLboga, Z. (2014). Treatment of flight phobia (aviophobia) through the eYe movement desensitization and reprocessing (EMDR) method: a case report. Dusunen Adam Journal of Psychiatry and Neurological Sciences, 27(2), 168. google scholar
• Li, X., Luh, D. B., Xu, R. H., & An, Y. (2023). Considering the consequences of cYbersickness in immersive virtuaL reaLitY rehabiLitation: a sYstematic review and meta-analYsis. Applied Sciences, 13(8), 5159. google scholar
• Lindner, P., Miloff, A., HamiLton, W., ReuterskiöLd, L., Andersson, G., Powers, M. B., & CarLbring, P. (2019). Creating state-of-the-art, next-generation virtuaL reaLitY exposure therapies for anxietY disorders using consumer hardware pLatforms: Design considerations and future directions. Cognitive Behaviour Therapy, 48(5), 1-20. https://doi.org/10.1080/16506073.2018.1511409 google scholar
• MaLtbY, N., Kirsch, I., MaYers, M., & ALLen, G. J. (2002). VirtuaL reaLitY exposure therapY for treating fear of flYing: A controLLed investigation. Journal of Consulting and Clinical Psychology, 70(5), 1112-1118. https://doi.Org/10.1037/0022-006X.70.5.1112 google scholar
• MeYerbröker, K., & EmmeLkamp, P. M. (2010). Virtual realitY exposure therapY in anxietY disorders: a sYstematic review of process-and-outcome studies. Depression and anxiety, 27(10), 933-944. google scholar
• MiLLer, R., & Berman, J. (1983). The efficacY of cognitive behavior therapies: A quantitative review of the research evidence. Psychological Bulletin, 94(i), 39-53. https://doi.Org/l0.1037/0033-2909.94.1.39 google scholar
• Morina, N., Brinkman, W. P., Hartanto, D., & EmmeLkamp, P. M. (2014). Sense of presence and anxietY during virtuaL sociaL interactions between a human and virtuaL humans. PeerJ, 2, e337. google scholar
• Morina, N., Ijntema, H., MeYerbröker, K., & EmmeLkamp, P. M. (2015). Can virtual realitY exposure therapY gains be generalized to real-Life? A meta-analYsis of studies applYİng behavioral assessments. Behaviour research and therapy, 74, 18-24. google scholar
• MühLberger, A., Herrmann, M. J., Wiedemann, G., ELLgring, H., & PauLi, P. (2001). Repeated exposure of flight phobics to flights in virtuaL realitY. Behaviour research and therapy, 39(9), 1033-1050. google scholar North, M. M., & North, S. M. (1994). Virtual environments and psYchological disorders. Electronic Journal of Virtual Culture, 2(4), 37-42. google scholar
• Oakes, M., & Bor, R. (2010). The psYchologY of fear of flYİng (fear of flYİng). Aviation Psychology and Applied Human Factors, 10(2), 97-103. google scholar
• Oar, E. L., Farrell, L. J., Waters, A. M., Conlon, E. G., & Ollendick, T. H. (2015). One session treatment for pediatric blood-inJection-inJurY phobia: A controlled multiple baseline trial. Behaviour research and therapy, 73, 131-142. google scholar
• Oing, T., & Prescott, J. (2018). Implementations of virtual realitY for anxietY-related disorders: SYstematic review. JMIR Serious Games, 6(4), Article e10965. https://doi.org/10.2196/10965 google scholar
• Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010). EfficacY of cognitive behavioral therapY for anxietY disorders: A review of meta-analytic findings. Psychiatric Clinics of North America, 33(3), 557-577. https://doi.org/10.1016/j.psc.2010.04.002 google scholar
• Ong, T., Ivanova, J., Soni, H., Wilczewski, H., Barrera, J., Cummins, M., Welch, B., & Bunnell, B. E. (2024). Therapist perspectives on telehealth-based virtual realitY exposure therapY. Virtual Reality, 28(2), 73. google scholar
• Opriş, D., Pintea, S., Garcîa-Palacios, A., Botella, C., Szamosközi, Ş., & David, D. (2012). Virtual realitY exposure therapY in anxietY disorders: A quantitative meta-analYsis. Computers in Human Behavior, 28(6), 2388-2393. google scholar
• Ost, L. G., Brandberg, M., & Alm, T. (1997). One versus five sessions of exposure in the treatment of flYing phobia. Behaviour Research and Therapy, 35(il), 987-996. https://doi.org/l0.1016/S0005-7967(97)00054-3 google scholar
• Powers, M. B., & EmmeLkamp, P. M. G. (2008). Virtual realitY exposure therapY for anxietY disorders: A meta-analYsis. Journal of Anxiety Disorders, 22(3), 561-569. https://doi.org/10.1016/j.janxdis.2007.04.006 google scholar
• Price, M., McFall, M., & Van Stolk-Cooke, K. (2011). Online cognitive-behavioral therapY for posttraumatic stress disorder: A sYstematic review. Journal of Anxiety Disorders, 25(1), 1-13. https://doi.org/10.1016/j.janxdis.2010.08.001 google scholar
• Ribe-Vines, J., Gutierrez-Maldonado, J., Zabolipour, Z., & Ferrer-Garcîa, M. (2023). EfficacY of virtual realitY-based exposure therapY for the treatment of fear of flYing: a sYstematic review. The Cognitive Behaviour Therapist, 16. https://doi.org/10.1017/S1754470X23000119. google scholar
• Rothbaum, B. O., 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 flYİng. Behavior therapy, 37(1), 80-90. google scholar
• Rothbaum, B. O., Hodges, L., Anderson, P., Price, L., & Smith, S. (2002). TweLve-month foLLow-up of Virtual realitY and Standard exposure therapies for the fear of flYİng. Journal of Consulting and Clinical Psychology, 70(2), 428-432. https://doi.org/10.1037/0022-006X. 70.2.428 google scholar
• Rothbaum, B. O., Hodges, L., Smith, S., Lee, J. H., & Price, L. (2000). A controLLed studY of virtuaL reaLitY exposure therapY for the fear of flYing. Journal of Consulting and Clinical Psychology, 68(6), 1020. google scholar
• Saputri, A. D., YuLianda, A., AjmaLiYah, N., Khoiria, H., & Fauzan, A. (2024). The effectiveness of cognitive behavior therapY to reduce anxietY in determining the future. Proceeding Conference on Psychology and Behavioral Sciences, 3, 1-8. https://doi.org/10.61994/ cpbs.v3i.120 google scholar
• Shafran, R., CLark, D. M., Fairburn, C. G., Arntz, A., BarLow, D. H., EhLers, A., & Ost, L. G. (2009). Mind the gap: Improving the dissemination of CBT. Behaviour Research and Therapy, 47(11), 902-909. https://doi.org/10.1016/j.brat.2009.07.003 google scholar Shiban, Y. (2018). Virtual realitY exposure therapY for anxietY disorders. Der Nervenarzt, 89, 1227-1231. google scholar
• Shiban, Y., Diemer, J., Müller, J., Brütting-Schick, J., PauLi, P., & Mühlberger, A. (2017). Diaphragmatic breathing during Virtual realitY exposure therapY for aviophobia: functional coping strategY or avoidance behavior? a pilot study BMC psychiatry, 17, 1-10. google scholar
• Stiede, J. T., & Storch, E. A. (2024). Anxiety disorders. Oxford UniversitY Press. https://doi.org/10.1093/med/9780197667859.001.0001 google scholar
• SuListiYoningrum, R. and MuLawarman, M. (2020). SYstematic desensitization techniques to reduce anxietY of facing examinations in middLe schooL students. PSIKOPEDAGOGIA Jurnal Bimbingan Dan Konseling, 8(1). https://doi.org/10.12928/psikopedagogia.v8i1. 17899 google scholar
• Thomason, S., O’Hara, M. W., & Stuart, S. (2020). EfficacY of psYchotherapies for comorbid anxietY and depression: A meta-analYsis. Journal of Affective Disorders, 274, 305-316. https://doi.org/10.1016/j.jad.2020.05.034 google scholar
• ToLin, D. F. (2010). Is cognitive-behavioral therapY more effective than other therapies? A meta-analYtic review. Clinical Psychology Review, 30(6), 710-720. https://doi.org/10.1016/j.cpr.2010.05.003 google scholar
• Triscari, M. T., Faraci, P., CataLisano, D., D’AngeLo, V., & Urso, V. (2015). Effectiveness of cognitive behavioraL therapY integrated with sYstematic desensitization, cognitive behavioraL therapY combined with eYe movement desensitization and reprocessing therapY, and cognitive behavioraL therapY combined with virtuaL reaLitY exposure therapY methods in the treatment of flight anxietY: a randomized trial. Neuropsychiatric disease and treatment, 11, 2591-2598. google scholar
• van Gerwen, L. J. V., & Koopmans, T. A. (2018). SeLf-heLp treatment for fear of flYİng. Aeron Aero Öpen Access J, 2(3), 184-189. google scholar
• van Gerwen, L. J., Diekstra, R. F., & Arondeus, J. M. (2014). Fear of flYing treatment programs for passengers: A comprehensive review. Clinical Psychology Review, 34(3), 218-231. google scholar
• van Gerwen, L. J., Spinhoven, P., Diekstra, R. F., & Van DYck, R. (2002). MuLticomponent standardized treatment programs for fear of flYing: Description and effectiveness. Cognitive and Behavioral Practice, 9(2), 138-149. google scholar
• WechsLer, T. F., 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. Frontiers in Psychology, 10, ArticLe 1758. https://doi.org/10.3389/fpsYg.2019.01758 google scholar
• Weisz, J. R., Kuppens, S., Ng, M. Y., Eckshtain, D., Ugueto, A. M., Vaughn-Coaxum, R., Jensen-Doss, A., HawLeY, K. M., KrumhoLz Marchette, L. S., Chu, B. C., Weersing, V. R., & Fordwood, S. R. (2017). What five decades of research teLLs us about the effects of Youth psYchoLogicaL therapY: A multilevel meta-analYsis and implications for science and practice. American Psychologist, 72(2), 79. google scholar
• WiederhoLd, B. K., & WiederhoLd, M. D. (1998). A review of virtuaL reaLitY as a psYchotherapeutic tooL. CyberPsychology & Behavior, 1(1), 45-52. google scholar
• Wiederhold, B. K., & Wiederhold, M. D. (2003). Three-Year follow-up for virtual realitY exposure for fear of flYİng. CyberPsychology & Behavior, 6(4), 441-445. google scholar
• Wiederhold, B. K., Jang, D. P., Kaneda, M., Cabral, I., Lurie, Y., May, T., ... & Kim, S. I. (2001). An investigation into phYsiological responses in virtual environments: an objective measurement of presence. Towards cyberpsychology: Mind, cognitions and society in the internet age, 2, 175-183. google scholar
• WolitzkY-TaYlor, K. B., Horowitz, J. D., Powers, M. B., & Telch, M. J. (2008). PsYchological approaches in the treatment of specific phobias: A meta-analYsis. Clinical Psychology Review, 28(6), 1021-1037. https://doi.Org/10.1016/j.cpr.2008.02.007 google scholar