Date of Defense

4-24-2024

Date of Graduation

4-2024

Department

Statistics

First Advisor

Anthony DeFulio

Second Advisor

Hayley Brown

Third Advisor

Page Anderson

Abstract

The World Health Organization (WHO) projects that by 2030, mental disorders will become the primary source of global disease burden [1]. Anxiety-related disorders, including specific phobias, post-traumatic stress disorder (PTSD), and various forms of general or specific anxiety, are the most rapidly growing mental health disorders worldwide [2]. In the United States (US), over 1 in 10 American youths are experiencing depression, resulting in a severe impact on their personal, academic, or professional encounters and social engagements [3]. Similarly, anxiety disorders affect up to one-third of the US population during their lifetime [4].

Due to the growth of mental health disorders, there is an urgent need for effective therapeutic interventions that can be scaled to meet the need for mental health services. Behavior therapy, the application of scientific methods to the treatment of psychological disorders, has shown efficacy in the treatment of mental disorders [5-6]. Exposure therapy is a major component of behavior therapy interventions for anxiety and phobias. The core of this approach is the systematic desensitization of patients, which is achieved by gradually exposing the patient to anxiety- or fearinducing stimuli. The ultimate goal is to minimize the patient's maladaptive responses to the stimuli [7]. Exposure therapy is usually delivered through in-vivo or imaginal exposure, each with its own advantages and disadvantages. In in-vivo exposure therapy, patients are confronted with a live version of the stimulus, which can raise concerns about breaking patient confidentiality, becoming too expensive, or introducing extraneous variables [7]. Patients in imaginal exposure are tasked to trigger the feared scenarios through imagination, which can be difficult for those who struggle to generate vivid mental images [7]. One feasible solution for these barriers is to deliver exposure therapy via virtual reality (VR) technology.

VR creates a computer-generated simulation of 3-dimensional objects or environments to achieve a realisticlooking world with real-time interactivity [8]. VR technology is widely available, and as such, VR-based exposure therapy appears to be a viable means of addressing anxiety at scale. The application of VR in therapeutic settings arose from efforts to enhance the efficiency, advantages, and availability of evidence-based psychotherapies [9]. VR stands out as one of the most promising and rapidly evolving technologies for anxiety and depression treatment [7]. It is potentially a powerful tool for psychiatric service providers because the user experience can be consistently replicated, tested, and modified within a safe environment [10]. The controlled nature of the experience enhances greater reproducibility compared to experimental studies where the environment is constantly changing [11]. Furthermore, the therapist's ability to control and manipulate the virtual environment adds a layer of confidentiality that other exposure therapies (i.e., in-vivo exposure) often lack due to uncontrollable variables (e.g., weather conditions) [12]. In addition, sessions conducted within the therapist's office provide a private space for patients, addressing concerns of being seen in public and stigma [12]. VR offers a cost-effective alternative to conditions where traditional exposure therapies are impractical, dangerous (e.g., driving anxiety), and expensive (e.g., flight anxiety) [13-14].

Recently, virtual reality exposure therapy (VRET) has gained popularity as it presents a unique opportunity to disseminate exposure therapy within the virtual environment [15]. A recent meta-analysis reported a large effect size for VRET on anxiety disorders, which was comparable to in-vivo conditions [15]. Additionally, according to participants suffering from specific phobias, VRET is considered less frightening than in-vivo exposure [16]. A recent synthesis of cognitive behavioral therapy (CBT) approaches applied within VR settings has supported previous findings and proposed a structured framework for combining VR with CBT [17]. The review suggested eight weekly sessions, each lasting about an hour, using a head-mounted display as a potential protocol for future researchers in the field [17]. Findings from the review revealed that, generally, VR treatments were as effective as, or superior to, the “traditional” face-to-face methods, with no specific treatment characteristics linked to the effectiveness [17]. These results are encouraging but only scratch the surface of the capabilities of VR in treating mental health disorders. Specifically, VR may help treat disorders other than anxiety (i.e., depression) and may be helpful in conjunction with behavioral therapies other than exposure therapy or CBT (i.e., acceptance and commitment therapy). A systematic review designed to assess behavior therapy interventions in combination with VR may help advance this emerging field further. Thus, the purpose of the current systematic review is to assess the effectiveness of behavior therapy interventions that incorporate a VR system for the treatment of individuals with depression, anxiety, or PTSD and thereby identify efficacious practices and promising future directions for the application of VR in behavior therapy.

Access Setting

Honors Thesis-Open Access

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