title: Creating state of the art, next-generation Virtual Reality exposure therapies for anxiety disorders using consumer hardware platforms: design considerations and future directions.
abstract: Decades of research and more than 20 randomized controlled trials show that Virtual Reality exposure therapy (VRET) is effective in reducing fear and anxiety. Unfortunately, few providers or patients have had access to the costly and technical equipment previously required. Recent technological advances in the form of consumer Virtual Reality (VR) systems (e.g. Oculus Rift and Samsung Gear), however, now make widespread use of VRET in clinical settings and as self-help applications possible. In this literature review, we detail the current state of VR technology and discuss important therapeutic considerations in designing self-help and clinician-led VRETs, such as platform choice, exposure progression design, inhibitory learning strategies, stimuli tailoring, gamification, virtual social learning and more. We illustrate how these therapeutic components can be incorporated and utilized in VRET applications, taking full advantage of the unique capabilities of virtual environments, and showcase some of these features by describing the development of a consumer-ready, gamified self-help VRET application for low-cost commercially available VR hardware. We also raise and discuss challenges in the planning, development, evaluation, and dissemination of VRET applications, including the need for more high-quality research. We conclude by discussing how new technology (e.g. eye-tracking) can be incorporated into future VRETs and how widespread use of VRET self-help applications will enable collection of naturalistic "Big Data" that promises to inform learning theory and behavioral therapy in general.
authors.affiliation: a Department of Psychology , Stockholm University , Stockholm , Sweden.|b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Philip
authors.identifier: 0000-0002-3061-501X
authors.initials: P
authors.lastname: Lindner
authors.affiliation: a Department of Psychology , Stockholm University , Stockholm , Sweden.
authors.forename: Alexander
authors.identifier: 0000-0002-9125-8060
authors.initials: A
authors.lastname: Miloff
authors.affiliation: a Department of Psychology , Stockholm University , Stockholm , Sweden.|c Mimerse , Stockholm , Sweden.
authors.forename: William
authors.initials: W
authors.lastname: Hamilton
authors.affiliation: a Department of Psychology , Stockholm University , Stockholm , Sweden.
authors.forename: Lena
authors.identifier: 0000-0003-0923-8923
authors.initials: L
authors.lastname: Reuterskiöld
authors.affiliation: b Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden.|d Department of Behavioral Sciences and Learning , Linköping University , Linköping , Sweden.
authors.forename: Gerhard
authors.identifier: 0000-0003-4753-6745
authors.initials: G
authors.lastname: Andersson
authors.affiliation: e Department of Psychology , University of Texas , Austin , TX , USA.|f Baylor University Medical Center , Dallas , TX , USA.
authors.forename: Mark B
authors.identifier: 0000-0001-7898-073X
authors.initials: MB
authors.lastname: Powers
authors.affiliation: a Department of Psychology , Stockholm University , Stockholm , Sweden.
authors.forename: Per
authors.identifier: 0000-0002-2172-8813
authors.initials: P
authors.lastname: Carlbring
mesh_terms: D001008:Anxiety Disorders / Q000628:therapy*; D006801:Humans; D012648:Self Care / Q000639:trends; D012985:Software Design; D013813:Therapy, Computer-Assisted / Q000639:trends; D063367:Virtual Reality Exposure Therapy
keywords: Virtual Reality; anxiety; exposure therapy; fear; self-help