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A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders

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  • Yun Ling
  • Harold T Nefs
  • Nexhmedin Morina
  • Ingrid Heynderickx
  • Willem-Paul Brinkman

Abstract

In virtual reality exposure therapy (VRET) for anxiety disorders, sense of presence in the virtual environment is considered the principal mechanism that enables anxiety to be felt. Existing studies on the relation between sense of presence and level of anxiety, however, have yielded mixed results on the correlation between the two. In this meta-analysis, we reviewed publications on VRET for anxiety that included self-reported presence and anxiety. The comprehensive search of the literature identified 33 publications with a total of 1196 participants. The correlation between self-reported sense of presence and anxiety was extracted and meta-analyzed. Potential moderators such as technology characteristics, sample characteristics including age, gender and clinical status, disorder characteristics and study design characteristics such as measurements were also examined. The random effects analysis showed a medium effect size for the correlation between sense of presence and anxiety (r = .28; 95% CI: 0.18–0.38). Moderation analyses revealed that the effect size of the correlation differed across different anxiety disorders, with a large effect size for fear of animals (r = .50; 95% CI: 0.30–0.66) and a no to small effect size for social anxiety disorder (r = .001; 95% CI: −0.19–0.19). Further, the correlation between anxiety and presence was stronger in studies with participants who met criteria for an anxiety disorder than in studies with a non-clinical population. Trackers with six degrees of freedom and displays with a larger field of view resulted in higher effect sizes, compared to trackers with three degrees of freedom and displays with a smaller field of view. In addition, no difference in effect size was found for the type of presence measurement and the type of anxiety measurement. This meta-analysis confirms the positive relation between sense of presence and anxiety and demonstrates that this relation can be affected by various moderating factors.

Suggested Citation

  • Yun Ling & Harold T Nefs & Nexhmedin Morina & Ingrid Heynderickx & Willem-Paul Brinkman, 2014. "A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-12, May.
    • Handle: RePEc:plo:pone00:0096144
    DOI: 10.1371/journal.pone.0096144
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    References listed on IDEAS

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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    2. Yun Ling & Harold T Nefs & Willem-Paul Brinkman & Chao Qu & Ingrid Heynderickx, 2013. "The Effect of Perspective on Presence and Space Perception," PLOS ONE, Public Library of Science, vol. 8(11), pages 1-18, November.
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    Cited by:

    1. Zhen Liu & Lingfeng Ren & Chang Xiao & Ke Zhang & Peter Demian, 2022. "Virtual Reality Aided Therapy towards Health 4.0: A Two-Decade Bibliometric Analysis," IJERPH, MDPI, vol. 19(3), pages 1-26, January.
    2. Kuo-Liang Ou & Yao-Hui Liu & Wernhuar Tarng, 2021. "Development of a Virtual Ecological Environment for Learning the Taipei Tree Frog," Sustainability, MDPI, vol. 13(11), pages 1-20, May.
    3. Zhimeng Wang & Yue Li & Jingchen An & Wenyi Dong & Hongqidi Li & Huirui Ma & Junhui Wang & Jianping Wu & Ting Jiang & Guangxin Wang, 2022. "Effects of Restorative Environment and Presence on Anxiety and Depression Based on Interactive Virtual Reality Scenarios," IJERPH, MDPI, vol. 19(13), pages 1-27, June.

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