{"id":30502,"date":"2021-06-06T09:08:36","date_gmt":"2021-06-06T07:08:36","guid":{"rendered":"https:\/\/www.vr-coach.at\/virtual-reality-exposure-in-the-treatment-of-phobias-2\/"},"modified":"2026-06-11T14:38:06","modified_gmt":"2026-06-11T12:38:06","slug":"virtual-reality-exposition-in-der-behandlung-von-phobien","status":"publish","type":"post","link":"https:\/\/www.vr-coach.at\/en\/virtual-reality-exposition-in-der-behandlung-von-phobien\/","title":{"rendered":"Virtual reality exposure in the treatment of phobias"},"content":{"rendered":"\t\t
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Virtual reality exposure in the treatment of phobias <\/h1>\t\t\t\t<\/div>\n\t\t\t\t
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Wirksamkeit, Protokoll und Einsatz in der Praxis<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Dr. Marcus T\u00e4uber & Michael Altenhofer<\/b>
VR Coach GmbH, Austria<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Summary<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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Virtual Reality Exposure Therapy bei Phobien<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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VRET is an effective approach in the treatment of phobia patients. The anxiety stimulus can be exposed under controlled conditions in a gradual and repeated manner and thereby habituated. VR-programmes with sufficient quality and thus sufficient patient acceptance have been limited to clinics and centers due to high developmental costs. <\/p>

In this work we show, how sophisticated VR-solutions can be made accessable to all psychologists and psychotherapists, and we propose a five-steps-protocol to be used in phobia patients. We see computer-generated images as a prospective gold standard for phobia treatment and 360\u00b0 videos as a meaningful supplement of VRET for relaxation response. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Einf\u00fchrung<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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Introduction<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Anxiety disorders are among the most common mental disorders. A meta-analysis of the worldwide prevalence and incidence of anxiety disorders comes to a mean 1-year prevalence of 10.6% for all anxiety disorders. Social phobia (4.5%) and specific phobias (3.0%) are the dominant forms [Bandelow, 2001; Wancata et al., 2011; Bandelow et al. 2015; Boeldt et al. 2019]. Social phobia is characterised by inappropriate, often chronic fear and avoidance of social situations in which the person affected could be exposed to interpersonal assessment. In addition, there is the fear of performance-related failure, social shame and humiliation. Common to the specific phobias is the irrational fear of certain situations or objects, which leads to avoidance behaviour and thus to an attempt to control the circumscribed fear. Frequently, phobic disorders occur in relation to animals, confined spaces, heights, airplanes, dangerous objects, blood, physical injuries, medical utensils or medical locations. Neurobiologically, hyperactivity of the central nucleus of the amygdala can be observed. The level of suffering associated with phobias can vary greatly depending on its severity and the situation that triggers it [Bandelow, 2001; Bandelow et al. 2015]. <\/p>

In psychological or psychotherapeutic practice, the focus is on exposure or confrontation therapy. This is considered to be the most effective method of gradually establishing a habit in response to the fear stimulus and thus enabling normal handling of these situations [Shiban, 2018]. <\/p>

For some years now, this form of therapy has also been explored with the help of virtual reality or virtual realities, and has been summarised as Virtual Reality Exposure Therapy (VRET). Computer-generated immersive 3D rooms or 360-degree videos are used in which patients are confronted with fear-inducing situations or objects. In some cases, patients can move virtually through these rooms and interact with the environment. The degree of confrontation can be controlled by patients and therapists. Accompanying interventions such as relaxation exercises or conversations complement VRET [Shiban, 2018; Boeldt et al., 2019]. <\/p>

In this presented paper, the studies regarding the effectiveness and acceptance of VRET is discussed. A VRET protocol based on two training courses is proposed, which to our knowledge also discusses the application of 360\u00b0 images for the first time. An outlook on the latest developments in VRET is given, with which Virtual Reality programmes can be used widely and cost-effectively. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Expositionstherapie als zentrale Behandlung bei Phobien<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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In der psychologischen bzw. psychotherapeutischen Praxis ist die Expositions- oder Konfrontationstherapie, wie sie auch in der Expositionstherapie mit VR<\/span><\/a> eingesetzt wird, im Vordergrund. Dies gilt als die effektivste Methode, um auf den Angstreiz eine schrittweise Habituierung zu erzielen und so einen normalen Umgang mit diesen Situationen zu erm\u00f6glichen [Shiban, 2018].<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Virtual Reality Exposure Therapy: Exposition in virtuellen Umgebungen<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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Seit einigen Jahren wird diese Therapieform auch unter Zuhilfenahme von Virtual Reality im Rahmen der VR Therapie<\/span><\/a> oder virtuellen Realit\u00e4ten untersucht, und als Virtual Reality Exposure Therapy (VRET) zusammengefasst. Dabei kommen computergenerierte immersive 3D-R\u00e4ume oder 360-Grad-Videos zum Einsatz, in denen Patienten mit angstausl\u00f6senden Situationen oder Objekte konfrontiert werden. Teilweise k\u00f6nnen sich Patienten durch diese R\u00e4ume virtuell bewegen und mit der Umgebung interagieren. Den Grad der Konfrontation k\u00f6nnen Patienten und Therapeuten dabei steuern. Begleitinterventionen wie Entspannungs\u00fcbungen oder Gespr\u00e4che erg\u00e4nzen die VRET [Shiban, 2018; Boeldt et al., 2019].<\/p>

In der vorliegenden Arbeit soll die Studienlage zur Effektivit\u00e4t und Akzeptanz von VRET diskutiert werden. Es wird ein VRET-Protokoll auf Basis zweier Ausbildungslehrg\u00e4nge vorgeschlagen, welches unseres Wissens nach erstmals auch die Anwendung von 360\u00b0-Aufnahmen diskutiert. Ein Ausblick auf die neuesten Entwicklungen in der VRET wird gegeben, mit der Virtual Reality Programme kosteng\u00fcnstig breiten Einsatz finden k\u00f6nnen.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Comparison of effectiveness and treatment adherence with VRET <\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Exposure therapy in relation to anxiety disorders is based on strong evidence from studies. It is also based on gradual and repeated exposure with the appropriate anxiety stimuli. In practice, it is often difficult to implement. With imagination techniques, the therapist cannot know precisely what the patient is imagining, nor can he or she control it exactly. The ability to create vivid mental images is not the same for everyone and also decreases with age. The in vivo exposure, on the other hand, is often difficult and can only be arranged with great effort, for example, if the fear of heights is to be habituated at actual heights under therapeutic guidance. In addition, the drop-out of patients is an issue for these approaches, as this type of intervention is experienced as stressful and unpleasant [Boeldt et al., 2019]. <\/p>

By means of VRET these barriers and problems can be avoided or at least reduced. On the one hand, VR can involve people mentally and emotionally, but it can also provide a controllable, repeatable and safe environment for therapy. Findings from neuroscience show that VR images strongly involve the primary visual cortex V1 and the visual working memory. Perception and imagination are based on comparable neural processes. The use of VR for specific phobias, such as those for heights or spiders has already been well researched in both random and controlled studies [Boeldt et al., 2019]. <\/p>

Carl et al. 2019 examined a total of 30 studies with 1057 participants, 14 of which dealt with specific phobias. The effect size for VRET versus the wait list control group was very high (g = 0.90), and medium to high for VRET versus psychological placebo control groups (g = 0.78). A comparison between VRET and in vivo therapies showed no significance in effect size. he findings were consistent for all forms of anxiety disorders studied and suggest that VRET is an effective intervention for anxiety disorders [Carl et al., 2019]. <\/p>

n 2018, Benbow and Anderson published a meta-analysis in which the probability of drop-outs by patients was determined [Benbow & Anderson, 2019]. More than 46 studies have shown a value of 84% for treatment compliance. The drop-out rate of 16% is slightly lower than the drop-out rates of 19.6% and 19.7% for in vivo interventions and cognitive behavioural therapy for anxiety disorders [Swift & Greenberg, 2012; Fernandez et al. 2015; Benbow & Anderson, 2019]. The reasons for discontinuing therapy were different in VR versus in vivo. In VR, the reasons were lack of immersiveness, cybersickness, viewing complications and discomfort in viewing and talking to the therapist simultaneously. The main reason for in vivo therapy was the fear of exposure to the actual anxiety-inducing stimulus [Swift & Greenberg, 2012; Fernandez et al. 2015; Benbow & Anderson, 2019]. <\/p>

The results of these two meta-analyses correspond to the studies of Fodor et al. 2018 on anxiety disorders and depression. The authors included 39 studies and were able to show a high effect strength of g = 0.79, 95% CI 0.57 to 1.07 in anxiety disorders. VR has a high efficacy compared to control groups, but due to pronounced heterogeneity, no clear effect on the drop-out rate was noticeable [Fodor et al., 2018]. <\/p>

Already in 2012, Opris et al. had already summarised the results of VRET studies on anxiety disorders and found that VRET had far better results than wait list control groups, the results show a similar effectiveness between behavioural and cognitive behavioural interventions, VRET has powerful real effects similar to classic evidence-based treatments, VRET has a good stability of results over time and thus a sustained effect, there is a dose-effect relation for VRET and therefore intensive programmes lead to faster results and there is no difference in the drop-out rate between virtual reality exposure and in vivo exposure [Opris et al. , 2012]. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Vorteile von VRET gegen\u00fcber Imagination und in vivo Exposition<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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Mittels VRET k\u00f6nnen diese Barrieren und Probleme vermieden oder zumindest reduziert werden. So kann VR einerseits stark mental und emotional involvieren, aber auch ein kontrollierbares, wiederholbares und sicheres Ambiente f\u00fcr die Therapie bieten. Erkenntnisse aus den Neurowissenschaften belegen, dass VR-Bilder den prim\u00e4ren visuellen Kortex V1 und das visuelle Arbeitsged\u00e4chtnis stark beteiligen. Wahrnehmung und Imagination beruhen auf vergleichbaren neuronalen Prozessen. Der Einsatz von VR bei spezifischen Phobien wie vor H\u00f6hen oder Spinnen wurde bereits gut in randomisierten und kontrollierten Studien erforscht [Boeldt et al., 2019].<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Studienlage zur Wirksamkeit von VRET<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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Carl et al. 2019 haben insgesamt 30 Studien mit 1057 Teilnehmern untersucht, wobei sich 14 mit spezifischen Phobien besch\u00e4ftigt haben. Die Effektst\u00e4rke f\u00fcr VRET versus Warteliste war sehr hoch (g = 0.90), sowie mittel bis hoch f\u00fcr VRET versus psychologischen Placebo-Kontrollgruppen (g = 0.78). Ein Vergleich zwischen VRET und in vivo Therapien zeigte keine Signifikanz in der Effektst\u00e4rke. Die Befunde waren konsistent f\u00fcr alle untersuchten Formen von Angstst\u00f6rungen und weisen darauf hin, dass VRET eine wirksame Intervention bei Angstst\u00f6rungen darstellt [Carl et al., 2019].<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Therapietreue und Drop-out-Raten bei VRET<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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Benbow und Anderson haben 2018 eine Metaanalyse publiziert, in der die Wahrscheinlichkeit f\u00fcr Drop outs durch Patienten ermittelt worden ist [Benbow & Anderson, 2019]. \u00dcber 46 untersuchte Studien ergaben einen Wert f\u00fcr die Therapietreue von 84%. Die Drop out Rate von 16% liegt leicht unter den Drop out Raten wie sie f\u00fcr in vivo Interventionen und kognitive Verhaltenstherapie bei Angstst\u00f6rungen mit 19.6% bzw. 19.7% ermittelt wurden [Swift & Greenberg, 2012; Fernandez et al. 2015; Benbow & Anderson, 2019]. Die Gr\u00fcnde f\u00fcr Therapieabbr\u00fcche waren in VR versus in vivo unterschiedlich. Bei VR waren es fehlende Immersivit\u00e4t, Cybersickness, Komplikationen beim Betrachten und Unbehagen gleichzeitig zu Betrachten und mit dem Therapeuten zu sprechen. Die in vivo Therapie hatte als haupts\u00e4chlichen Grund die Furcht vor der Exposition mit dem tats\u00e4chlich angstausl\u00f6senden Reiz [Swift & Greenberg, 2012; Fernandez et al. 2015; Benbow & Anderson, 2019].\u00a0 \u00a0<\/p>

Die Ergebnisse dieser beiden Metaanalysen entsprechen den Untersuchungen von Fodor et al. 2018 bei Angstst\u00f6rungen und Depression. Die Autoren haben 39 Studien inkludiert, und konnten eine hohe Effektst\u00e4rke von g = 0.79, 95% CI 0.57 bis 1.07 bei Angstst\u00f6rungen zeigen. VR weist eine hohe Wirksamkeit im Vergleich zu Kontrollgruppen auf, aber aufgrund ausgepr\u00e4gter Heterogenit\u00e4t war kein klarer Effekt auf die Drop out Rate bemerkbar [Fodor et al., 2018].<\/p>

Bereits 2012 habe Opris et al. die Ergebnisse aus VRET-Studien zu Angstst\u00f6rungen zusammengefasst und dabei festgestellt, dass VRET weit bessere Ergebnisse als die Warteliste-Kontrolle hat, die Ergebnisse eine \u00e4hnliche Wirksamkeit zwischen der Verhaltens-und kognitiven verhaltenstherapeutischen Interventionen zeigen, VRET \u00fcber leistungsstarke realen Auswirkungen verf\u00fcgt \u00e4hnlich der klassischen evidenzbasierte Behandlungen, VRET eine gute Stabilit\u00e4t der Ergebnisse im Laufe der Zeit und somit eine nachhaltige Wirkung aufweist, es eine Dosis-Wirkungs-Beziehung f\u00fcr VRET gibt und daher intensive Programme zu schnelleren Ergebnissen f\u00fchren und es keinen Unterschied in der Dropout-Rate zwischen der virtuellen Realit\u00e4t Exposition und der in vivo Exposition gibt [Opris et al., 2012].<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Protocol for VRET <\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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We conducted two training courses in 2019 with clinical psychologists and psychotherapists in Graz and Vienna, among others, during which VR programmes were created using 8k recordings with an Insta 360\u00b0 Pro camera.<\/p>

Some of the participants of the training course treat patients with social phobia in their practice, who hardly dare to socialise with people. A programme in a park was developed for these clients. At first you are alone on a park bench. Gradually other people (the participants) join in and thus increase the perception of human closeness. By means of a controller, the patient can stop the steadily increasing challenge at any time. <\/p>

The topics of exam anxiety and speaking in front of an audience are also frequent reasons why a practice is visited by participants. For this reason, the group simulated a seminar audience or, subsequently, an examination board itself. <\/p>

All three scenarios, the park bench, the presentation and the examination are available to patients through an Oculus GO 32GB VR goggle. The graduates can learn to handle these situations confidently and safely in a realistic atmosphere created by the 360\u00b0 shots, however, this access does not offer any interactivity. <\/p>

Moreover, additional interventions are practised with which the VR programmes can be combined. For example, resources such as energy\/power providing locations that have been activated by a VR application can be tracked down and expanded again and again. Or relaxation scenes such as calming natural scenery can be used to support a client in the context of VRET. <\/p>

A special challenge in the application of such programmes is that some patients cannot even stand the realistic VR scenarios at the beginning. The great strength of VR is the realistic experience, but this can be a hurdle for people with a high level of suffering at first. If this experience is too stressful, it is necessary to rely on attenuated forms of perception in the beginning. <\/p>

Step 1: The client remains distant from the relevant situations, while still easily confronting them. This can be achieved, for example, by means of pictures or videos without fear stimuli. On search engines, pictures and videos can be found on practically any topic with just a few clicks. For this purpose, one can work with a laptop or a tablet. Pictures can also be prepared in printed form. The reaction of most clients will probably be that they have no problem with this light form of confrontation. <\/p>

Step 2: The client still remains distant from the relevant situations. But in this step the client, with eyes closed, tries to use his\/her imagination to visit certain places where the fear-inducing situations are not far away. For example, the building across the street where a test is being held or where there is a lift. Or a football field that you have to leave soon, where you have to walk through a narrow tunnel further ahead. Or a deserted park that you will soon have to leave towards the city centre. <\/p>

Step 3: Now, for the first time, the client tries an easier form of association with the fear-inducing situation through his imagination. He enters the building in his mind and gets into the lift. He enters the room and begins his lecture or welcomes the examination committee. Or imaginatively leaves an empty space and seeks the proximity of other people. <\/p>

Step 4: In the penultimate step, the client enters a strong form of associated perception through the VR scenario. Before step 4 is possible, some clients need several appointments to go through steps 1 – 3. <\/p>

Step 5: In reality, the client enters a (formerly) fear-triggering situation. Depending on the feedback, step 4 is repeated several times. <\/p>

Accompanying this slow increase in perception, a physical relaxation exercise can be supportive for the client as soon as the client reports symptoms of tension or if they become visible without any feedback. Initial application reports from participants with their patients indicate the effectiveness and acceptance of this strategy. This VRET protocol has been tested on 360\u00b0 videos, but can also be used for computer-generated spaces without adaptation. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Schrittweise Ann\u00e4herung an angstausl\u00f6sende Situationen<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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Schritt 1: Der Klient bleibt von den entsprechenden Situationen distanziert, w\u00e4hrend er sich trotzdem leicht damit konfrontiert. Das gelingt zum Beispiel durch Bilder oder Videos ohne Angstreize. Auf Suchmaschinen k\u00f6nnen praktisch zu jedem Thema durch wenige Klicks Bilder und Videos gefunden werden. Hierzu kann man mit einem Laptop oder einem Tablet arbeiten. Bilder k\u00f6nnen aber auch ausgedruckt vorbereitet werden. Die Reaktion der meisten Klienten wird vermutlich sein, kein Problem mit dieser leichten Form der Konfrontation zu haben.<\/p>

Schritt 2: Der Klient bleibt von den entsprechenden Situationen noch immer distanziert. Aber bei diesem Schritt versucht der Klient bei geschlossenen Augen in seiner Vorstellungskraft gewisse Orte aufzusuchen, bei denen die angstausl\u00f6senden Situationen nicht mehr weit weg sind. Zum Beispiel das Geb\u00e4ude auf der anderen Stra\u00dfenseite, in dem eine Pr\u00fcfung stattfindet oder sich ein Aufzug befindet. Oder ein Fu\u00dfballfeld, das man bald verlassen muss, in dem man durch einen engen Tunnel weiter vorne gehen muss. Oder ein menschenleerer Park, den man bald Richtung Stadtzentrum verlassen wird.<\/p>

Schritt 3: Jetzt versucht der Klient erstmals eine leichtere Form der Assoziierung mit der angstausl\u00f6senden Situation durch seine Vorstellungskraft. Er betritt in Gedanken das Geb\u00e4ude und steigt in den Aufzug ein. Er betritt den Raum und beginnt seinen Vortrag oder begr\u00fc\u00dft die Pr\u00fcfungskommission. \u00a0Oder verl\u00e4sst imaginativ einen leeren Platz und sucht die N\u00e4he anderer Menschen.\u00a0<\/p>

Schritt 4: Im vorletzten Schritt begibt sich der Klient in eine starke Form der assoziierten Wahrnehmung durch das VR-Szenario. Bevor Schritt 4 m\u00f6glich ist, bedarf es bei manchen Betroffenen mehrere Termine, in denen es um die Schritte 1 \u2013 3 geht.<\/p>

Schritt 5: Der Klient begibt sich in der Realit\u00e4t in eine (ehemals) angstausl\u00f6sende Situation. Je nach Feedback wird Schritt 4 mehrmals wiederholt.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Erg\u00e4nzende Entspannungsstrategien in der VR-Exposition<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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Begleitend zu dieser langsamen Wahrnehmungs-Steigerung kann eine physische Entspannungs\u00fcbung f\u00fcr den Klienten unterst\u00fctzend sein, sobald der Klient \u00fcber Anspannungs-Symptome berichtet oder diese auch ohne sein Feedback sichtbar werden. Erste Anwendungsberichte der Teilnehmer mit ihren Patienten weisen auf Wirksamkeit und Akzeptanz dieser Strategie hin. Dieses VRET-Protokoll wurde an 360\u00b0-Videos erprobt, ist aber ohne Adaption auch f\u00fcr Computer-generierte R\u00e4ume verwendbar.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Diskussion<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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Discussion <\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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The effect strength for VRET interventions compared to controls is very high. VR can therefore be classified as a very effective approach in the treatment of phobias. The drop-out rate is low at 16%, but no significance to in vivo therapies could be found. Since “real exposure” is associated with great fear on the part of patients and leads to therapy discontinuation in this case, VRET has great potential for even greater patient acceptance. <\/p>

The advantages of VRET are: It is low-threshold, cost-effective, can be performed as often as is required (e.g. take-off of an airplane) and the patient has full control over the scene. Lack of immersion, cybersickness, complications of viewing and discomfort of viewing and talking to the therapist at the same time are the most common limitations that lead to the intrinsically low rate of terminations. The drop-outs show that VRET benefits from VR programmes of correspondingly high quality, where the aforementioned advantages can actually be used accordingly. For the best possible immersion, computer-generated rooms with position tracking are advisable, as one moves interactively in these rooms. In order to prevent cybersickness as well as discomfort while viewing, the principle of minimising stimuli applies – i.e. scenarios designed as simply as possible. <\/p>

As part of two training courses, psychologists and psychotherapists have created VRET scenarios by means of video shooting, the degree of exposure to which is gradually increasing. The reports of the course participants with this protocol indicate that this procedure can be combined with satisfactory effectiveness with patient acceptance, with reductions in immersion. A clinical study could evaluate this experience more closely and increase the evidence base to use such videos in isolated cases as a cost-effective alternative to computer-generated rooms. <\/p>

It is also recommended to offer relaxation exercises during the phobia treatment. Relaxation programmes can be used via VR. The use of VR in relaxation could lead patients to associate VR not only with the negative stimulus, which could have a positive effect on acceptance. Furthermore, VR is a very effective tool for rapid physiological recovery from stress stimuli, as a measurement of heart rate variability and pulse at the University of Salzburg has shown (T\u00e4uber M. & Altenhofer M., manuscript in preparation). <\/p>

We recommend starting with one to three hours after the above five-step protocol and supplementing this with relaxation strategies. It is important to start by building up sufficient trust and rapport. Furthermore, we recommend using VRET of a correspondingly high quality, allowing patients to immerse themselves, step by step, in virtual realities. <\/p>

Addendum to this article, November 2023:<\/p>

In recent years, hardware and software have evolved significantly. In addition to phobias, VR exposure also plays an increasingly important role in addictions and depression. You will find further information on these pages. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Vorteile und Limitationen der VR-Expositionstherapie<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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Die Vorteile von VRET sind: Sie ist niedrigschwellig, kosteng\u00fcnstig, beliebig oft durchf\u00fchrbar (z.B. Start eines Flugzeugs) und der Patient hat volle Kontrolle \u00fcber die Szene. Fehlende Immersion, Cybersickness, Komplikationen beim Betrachten und Unbehagen gleichzeitig zu betrachten und mit dem Therapeuten zu sprechen sind die h\u00e4ufigsten Limitierungen, die zu der an sich niedrigen Rate an Abbr\u00fcchen f\u00fchren. Die Drop Outs zeigen, dass die VRET von VR-Programmen entsprechend hoher Qualit\u00e4t profitiert, wo die zuvor genannten Vorteile auch tats\u00e4chlich entsprechend genutzt werden k\u00f6nnen. F\u00fcr die bestm\u00f6gliche Immersion sind Computer-generierte R\u00e4ume mit Positionstracking anzuraten, da man sich dort interaktiv bewegt. Um Cybersickness wie auch Unwohlsein beim Betrachten zu verhindern, gilt der Grundsatz der Reizminimierung \u2013 also m\u00f6glichst einfach gestaltete Szenarien.\u00a0<\/p>

Im Rahmen zweier Ausbildungslehrg\u00e4nge haben Psychologinnen und Psychotherapeutinnen VRET-Szenarien mittels Videodrehs erstellt, deren Expositionsgrad sich sukzessive steigert. Die Berichte der Kursteilnehmer mit diesem Protokoll weisen darauf hin, dass sich mit diesem Vorgehen zufriedenstellende Wirksamkeit mit Patientenakzeptanz verbinden lassen, bei Abstrichen in der Immersion. Eine klinische Studie dazu k\u00f6nnte diese Erfahrung genauer evaluieren und den Evidenzgrad erh\u00f6hen, um solche Videos auch vereinzelt als kosteng\u00fcnstige Alternative zu Computer-generierten R\u00e4umen einzusetzen.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Entspannung und 360\u00b0-Naturkulissen als Erg\u00e4nzung<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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Es ist bei der Phobiebehandlung auch zu empfehlen, Entspannungs\u00fcbungen anzubieten. \u00dcber VR lassen sich Entspannungsprogramme einsetzen. Der Einsatz von VR in der Entspannung k\u00f6nnte dazu f\u00fchren, dass Patienten VR nicht nur mit dem negativen Reiz assoziieren, was sich positiv auf die Akzeptanz auswirken k\u00f6nnte. Au\u00dferdem ist VR ein sehr effektives Tool um rasch physiologische Erholung von Stressreizen zu erlangen, wie eine Messung an der Universit\u00e4t Salzburg von Herzratenvariabilit\u00e4t und Puls gezeigt hat (T\u00e4uber M. & Altenhofer M., Manuskript in Vorbereitung).<\/p>

Wir empfehlen mit ein bis drei Stunden nach obigen F\u00fcnf-Schritte-Protokoll zu starten, und diese mit Entspannungsstrategien zu erg\u00e4nzen. Wichtig ist zun\u00e4chst auf ausreichenden Aufbau von Vertrauen und Rapport zu achten. Weiters empfehlen wir VRET entsprechend hoher Qualit\u00e4t einzusetzen, und hier Patienten Schritt f\u00fcr Schritt in virtuelle Realit\u00e4ten eintauchen zu lassen.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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Update 2023: Neue Entwicklungen in der VR-Exposition<\/h3>\t\t\t\t<\/div>\n\t\t\t\t
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In den letzten Jahren haben sich Hardware und Software stark weiterentwickelt. Neben Phobien spielen VR-Expositionen auch bei S\u00fcchten<\/u><\/a> und Depressionen<\/span><\/a> eine immer gr\u00f6\u00dfer werdende Rolle. Auf diesen Seiten finden Sie n\u00e4here Informationen dazu.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Literature<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Bandelow B.: Panik und Agoraphobie. Diagnose, Ursachen, Behandlung. Springer, Wien, New York 2001.<\/p>

Bandelow B, Michaelis S: Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci 2015; 17:327\u201335. <\/p>

Benbow AA, Anderson PL: A meta-analytic examination of attrition in virtual reality exposure therapy for anxiety disorders. J Anxiety Disord 2019; 61:18\u201326. <\/p>

Boeldt D, McMahon E, McFaul M, Greenleaf W: Using Virtual Reality Exposure Therapy to Enhance Treatment of Anxiety Disorders: Identifying Areas of Clinical Adoption and Potential Obstacles. Front Psychiatry 2019; 10:773. <\/p>

Carl E, Stein AT, Levihn-Coon A, Pogue JR, Rothbaum B, Emmelkamp P, Asmundson GJG, Carlbring P, Powers MB: Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. J Anxiety Disord. 2019; 61:27-36. <\/p>

Fernandez E, Salem D, Swift J K, Ramtahal N: Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology 2015; 83:1108\u20131122. <\/p>

Fodor LA, Cote\u0163 CD, Cuijpers P, Szamoskozi \u0218, David D, Cristea IA: The effectiveness of virtual reality based interventions for symptoms of anxiety and depression: A meta-analysis. Sci Rep 2018; 8:10323. <\/p>

Opri\u015f D, Pintea S, Garc\u00eda-Palacios A, Botella C, Szamosk\u00f6zi \u015e, David D: Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis. Depress Anxiety 2012; 29:85-93. <\/p>

Shiban Y: Virtuelle Expositionstherapie bei Angstst\u00f6rungen. Der Nervenarzt 2018; 11. <\/p>

Swift JK, Greenberg RP: Premature discontinuation in adult psychotherapy: a meta-analysis. J Consult Clin Psychol. 2012; 80: 547\u2013559. <\/p>

T\u00e4uber M: Gedanken als Medizin. Goldegg, Berlin\/Wien, 2020. <\/p>

T\u00e4uber M & Altenhofer M: Rasche Erholung nach sozialem Stress durch Virtual-Reality-Naturkulissen. Manuskript in Vorbereitung. <\/p>

Wancata J, Freidl M, Fabrian F: Epidemiologie der Angstst\u00f6rungen. Journal f\u00fcr Neurologie, Neurochirurgie und Psychiatrie 2011; 12, 332-335. <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Authors<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Michael Altenhofer, VR Coach GmbH, E-mail: info@vr-coach.at<\/a>
Dr. Marcus T\u00e4uber, VR Coach GmbH, E-Mail: info@vr-coach.at<\/a><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t

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This article was published in 2020 in the German magazine \u201eBehavior Therapy & Behavior Medicine\u201c<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Dieser Beitrag gibt einen wissenschaftlichen \u00dcberblick zur VRET \u2014 eine thematische Zusammenfassung weiterer klinischer Einsatzbereiche finden Sie im Themenschwerpunkt VR-Therapie bei Angst<\/a><\/strong><\/span>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Virtual Reality Exposure Therapy in Ihrer Praxis<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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Sie m\u00f6chten VR Expositionstherapie in Ihrer Klinik oder Praxis einsetzen?\n

\nErfahren Sie, wie das VR Coach smartsystem in der Behandlung von Phobien, Angstst\u00f6rungen und weiteren Indikationen eingesetzt wird.<\/h3>\t\t\t\t<\/div>\n\t\t\t\t

\n\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t<\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\tJetzt Katalog anfordern<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\"Stehende\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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You might also be interested in that<\/h2>\t\t\t\t<\/div>\n\t\t\t\t
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\"Beitragsbild:<\/figure><\/a><\/div>

Overcoming Fear of Flying with modern VR-therapy<\/a><\/h3><\/div>\t\t\t<\/div>\n\t\t<\/article>\n\t\t\n\t\t
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\"PTSD<\/figure><\/a><\/div>

PTSD After War Experiences<\/a><\/h3><\/div>\t\t\t<\/div>\n\t\t<\/article>\n\t\t\n\t\t
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\"Beitragsbild,<\/figure><\/a><\/div>

How realistic is VR?<\/a><\/h3><\/div>\t\t\t<\/div>\n\t\t<\/article>\n\t\t\n\t\t
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\"Update<\/figure><\/a><\/div>

Update of the VR Therapy Software 2026<\/a><\/h3><\/div>\t\t\t<\/div>\n\t\t<\/article>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t
<\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

Virtual reality exposure in the treatment of phobias Wirksamkeit, Protokoll und Einsatz in der Praxis Dr. Marcus T\u00e4uber & Michael AltenhoferVR Coach GmbH, Austria Summary Virtual Reality Exposure Therapy bei Phobien VRET is an effective approach in the treatment of phobia patients. The anxiety stimulus can be exposed under controlled conditions in a gradual and […]<\/p>\n","protected":false},"author":20,"featured_media":8167,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"elementor_header_footer","format":"standard","meta":{"_acf_changed":false,"_seopress_titles_title":"VR therapy works for phobias","_seopress_titles_desc":"Whether for specific phobias such as fear of heights, fear of flying, fear of spiders or social phobias in lectures or in everyday life: the use of VR glasses in therapy has now been well researched.","_seopress_robots_index":"","_seopress_robots_follow":"","_seopress_robots_imageindex":"","_seopress_robots_snippet":"","_seopress_robots_primary_cat":"206","_seopress_robots_breadcrumbs":"","_seopress_robots_freeze_modified_date":"","_seopress_robots_custom_modified_date":"","_seopress_robots_canonical":"","_seopress_social_fb_title":"","_seopress_social_fb_desc":"","_seopress_social_fb_img":"","_seopress_social_fb_img_attachment_id":0,"_seopress_social_fb_img_width":0,"_seopress_social_fb_img_height":0,"_seopress_social_twitter_title":"","_seopress_social_twitter_desc":"","_seopress_social_twitter_img":"","_seopress_social_twitter_img_attachment_id":0,"_seopress_social_twitter_img_width":0,"_seopress_social_twitter_img_height":0,"_seopress_redirections_value":"","_seopress_redirections_enabled":"","_seopress_redirections_enabled_regex":"","_seopress_redirections_logged_status":"both","_seopress_redirections_param":"","_seopress_redirections_type":301,"_seopress_analysis_target_kw":"","_angie_page":false,"page_builder":"","footnotes":"","_elementor_edit_mode":"builder","_elementor_template_type":"wp-post","_elementor_data":"[{\"id\":\"115a30b\",\"elType\":\"section\",\"settings\":{\"content_width\":{\"unit\":\"px\",\"size\":768,\"sizes\":[]},\"_ob_glider_nav_pos_y_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_x_prev_alt\":\"0%\",\"_ob_glider_nav_pos_x_next_alt\":\"0%\",\"margin\":{\"unit\":\"px\",\"top\":\"40\",\"right\":0,\"bottom\":\"0\",\"left\":0,\"isLinked\":false},\"_ob_glider_nav_pos_y_prev_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_y_next_alt\":\"50% - 25px\",\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"22d0d63\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"b7eb2d5\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"820c626\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"7b7886a\",\"elType\":\"column\",\"settings\":{\"_column_size\":100,\"_inline_size\":null,\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"279c749\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"b71d682\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"fb86932\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"9939efe\",\"elType\":\"widget\",\"settings\":{\"title\":\"Virtual reality exposure in the treatment of phobias \",\"header_size\":\"h1\",\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"64c4c01\",\"elType\":\"widget\",\"settings\":{\"title\":\"Wirksamkeit, Protokoll und Einsatz in der Praxis\",\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\",\"__globals__\":{\"typography_typography\":\"globals\\\/typography?id=secondary\"}},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"1e4bdff\",\"elType\":\"widget\",\"settings\":{\"title\":\"Dr. Marcus T\\u00e4uber & Michael Altenhofer<\\\/b>
VR Coach GmbH, Austria\",\"header_size\":\"div\",\"typography_typography\":\"custom\",\"typography_font_size\":{\"unit\":\"em\",\"size\":1,\"sizes\":[]},\"typography_font_weight\":\"normal\",\"typography_line_height\":{\"unit\":\"em\",\"size\":1.4,\"sizes\":[]},\"__globals__\":{\"title_color\":\"globals\\\/colors?id=text\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"heading\"}],\"isInner\":false}],\"isInner\":false},{\"id\":\"15c61a2\",\"elType\":\"section\",\"settings\":{\"content_width\":{\"unit\":\"px\",\"size\":768,\"sizes\":[]},\"_ob_glider_nav_pos_y_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_x_prev_alt\":\"0%\",\"_ob_glider_nav_pos_x_next_alt\":\"0%\",\"_ob_glider_nav_pos_y_prev_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_y_next_alt\":\"50% - 25px\",\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"44bf44e\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"9acb2b9\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"764b703\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"72fd6cf\",\"elType\":\"column\",\"settings\":{\"_column_size\":100,\"_inline_size\":null,\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"664062b\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"a504f27\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"755d4e6\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"6899881\",\"elType\":\"widget\",\"settings\":{\"title\":\"Summary\",\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\",\"header_size\":\"h3\",\"_margin\":{\"unit\":\"px\",\"top\":\"0\",\"right\":\"0\",\"bottom\":\"-15\",\"left\":\"0\",\"isLinked\":false},\"__globals__\":{\"typography_typography\":\"globals\\\/typography?id=548eae5\"}},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"129ef03\",\"elType\":\"widget\",\"settings\":{\"title\":\"Virtual Reality Exposure Therapy bei Phobien\",\"typography_typography\":\"custom\",\"typography_font_size\":{\"unit\":\"em\",\"size\":1.8,\"sizes\":[]},\"typography_font_weight\":\"900\",\"typography_line_height\":{\"unit\":\"em\",\"size\":1.4,\"sizes\":[]},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"707e1cd\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

VRET is an effective approach in the treatment of phobia patients. The anxiety stimulus can be exposed under controlled conditions in a gradual and repeated manner and thereby habituated. VR-programmes with sufficient quality and thus sufficient patient acceptance have been limited to clinics and centers due to high developmental costs. <\\\/p>

In this work we show, how sophisticated VR-solutions can be made accessable to all psychologists and psychotherapists, and we propose a five-steps-protocol to be used in phobia patients. We see computer-generated images as a prospective gold standard for phobia treatment and 360\\u00b0 videos as a meaningful supplement of VRET for relaxation response. <\\\/p>\",\"typography_typography\":\"custom\",\"typography_font_size\":{\"unit\":\"em\",\"size\":1,\"sizes\":[]},\"typography_font_weight\":\"700\",\"typography_line_height\":{\"unit\":\"em\",\"size\":1.4,\"sizes\":[]},\"__globals__\":{\"text_color\":\"globals\\\/colors?id=primary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"}],\"isInner\":false}],\"isInner\":false},{\"id\":\"9dd281a\",\"elType\":\"section\",\"settings\":{\"content_width\":{\"unit\":\"px\",\"size\":768,\"sizes\":[]},\"_ob_glider_nav_pos_y_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_x_prev_alt\":\"0%\",\"_ob_glider_nav_pos_x_next_alt\":\"0%\",\"_ob_glider_nav_pos_y_prev_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_y_next_alt\":\"50% - 25px\",\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"ed0cca1\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"4af0d50\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"09c38f9\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"25acc50\",\"elType\":\"column\",\"settings\":{\"_column_size\":100,\"_inline_size\":null,\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"eae8ba1\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"3dd4195\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"22057d5\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"885abf8\",\"elType\":\"widget\",\"settings\":{\"title\":\"Einf\\u00fchrung\",\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\",\"header_size\":\"h3\",\"_margin\":{\"unit\":\"px\",\"top\":\"0\",\"right\":\"0\",\"bottom\":\"-15\",\"left\":\"0\",\"isLinked\":false},\"__globals__\":{\"typography_typography\":\"globals\\\/typography?id=67e91fa\"}},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"8e16486\",\"elType\":\"widget\",\"settings\":{\"title\":\"Introduction\",\"typography_typography\":\"custom\",\"typography_font_size\":{\"unit\":\"em\",\"size\":1.8,\"sizes\":[]},\"typography_font_weight\":\"900\",\"typography_line_height\":{\"unit\":\"em\",\"size\":1.4,\"sizes\":[]},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"560df9f\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

Anxiety disorders are among the most common mental disorders. A meta-analysis of the worldwide prevalence and incidence of anxiety disorders comes to a mean 1-year prevalence of 10.6% for all anxiety disorders. Social phobia (4.5%) and specific phobias (3.0%) are the dominant forms [Bandelow, 2001; Wancata et al., 2011; Bandelow et al. 2015; Boeldt et al. 2019]. Social phobia is characterised by inappropriate, often chronic fear and avoidance of social situations in which the person affected could be exposed to interpersonal assessment. In addition, there is the fear of performance-related failure, social shame and humiliation. Common to the specific phobias is the irrational fear of certain situations or objects, which leads to avoidance behaviour and thus to an attempt to control the circumscribed fear. Frequently, phobic disorders occur in relation to animals, confined spaces, heights, airplanes, dangerous objects, blood, physical injuries, medical utensils or medical locations. Neurobiologically, hyperactivity of the central nucleus of the amygdala can be observed. The level of suffering associated with phobias can vary greatly depending on its severity and the situation that triggers it [Bandelow, 2001; Bandelow et al. 2015]. <\\\/p>

In psychological or psychotherapeutic practice, the focus is on exposure or confrontation therapy. This is considered to be the most effective method of gradually establishing a habit in response to the fear stimulus and thus enabling normal handling of these situations [Shiban, 2018]. <\\\/p>

For some years now, this form of therapy has also been explored with the help of virtual reality or virtual realities, and has been summarised as Virtual Reality Exposure Therapy (VRET). Computer-generated immersive 3D rooms or 360-degree videos are used in which patients are confronted with fear-inducing situations or objects. In some cases, patients can move virtually through these rooms and interact with the environment. The degree of confrontation can be controlled by patients and therapists. Accompanying interventions such as relaxation exercises or conversations complement VRET [Shiban, 2018; Boeldt et al., 2019]. <\\\/p>

In this presented paper, the studies regarding the effectiveness and acceptance of VRET is discussed. A VRET protocol based on two training courses is proposed, which to our knowledge also discusses the application of 360\\u00b0 images for the first time. An outlook on the latest developments in VRET is given, with which Virtual Reality programmes can be used widely and cost-effectively. <\\\/p>\",\"__globals__\":{\"text_color\":\"globals\\\/colors?id=secondary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"},{\"id\":\"75184e7\",\"elType\":\"widget\",\"settings\":{\"title\":\"Expositionstherapie als zentrale Behandlung bei Phobien\",\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\",\"header_size\":\"h3\",\"_margin\":{\"unit\":\"px\",\"top\":\"0\",\"right\":\"0\",\"bottom\":\"0\",\"left\":\"0\",\"isLinked\":false},\"__globals__\":{\"typography_typography\":\"globals\\\/typography?id=67e91fa\"}},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"0cdaab8\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

In der psychologischen bzw. psychotherapeutischen Praxis ist die Expositions- oder Konfrontationstherapie, wie sie auch in der Expositionstherapie mit VR<\\\/span><\\\/a> eingesetzt wird, im Vordergrund. Dies gilt als die effektivste Methode, um auf den Angstreiz eine schrittweise Habituierung zu erzielen und so einen normalen Umgang mit diesen Situationen zu erm\\u00f6glichen [Shiban, 2018].<\\\/p>\",\"__globals__\":{\"text_color\":\"globals\\\/colors?id=secondary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"},{\"id\":\"4bdd737\",\"elType\":\"widget\",\"settings\":{\"title\":\"Virtual Reality Exposure Therapy: Exposition in virtuellen Umgebungen\",\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\",\"header_size\":\"h3\",\"_margin\":{\"unit\":\"px\",\"top\":\"0\",\"right\":\"0\",\"bottom\":\"0\",\"left\":\"0\",\"isLinked\":false},\"__globals__\":{\"typography_typography\":\"globals\\\/typography?id=67e91fa\"}},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"bcd0c12\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

Seit einigen Jahren wird diese Therapieform auch unter Zuhilfenahme von Virtual Reality im Rahmen der VR Therapie<\\\/span><\\\/a> oder virtuellen Realit\\u00e4ten untersucht, und als Virtual Reality Exposure Therapy (VRET) zusammengefasst. Dabei kommen computergenerierte immersive 3D-R\\u00e4ume oder 360-Grad-Videos zum Einsatz, in denen Patienten mit angstausl\\u00f6senden Situationen oder Objekte konfrontiert werden. Teilweise k\\u00f6nnen sich Patienten durch diese R\\u00e4ume virtuell bewegen und mit der Umgebung interagieren. Den Grad der Konfrontation k\\u00f6nnen Patienten und Therapeuten dabei steuern. Begleitinterventionen wie Entspannungs\\u00fcbungen oder Gespr\\u00e4che erg\\u00e4nzen die VRET [Shiban, 2018; Boeldt et al., 2019].<\\\/p>

In der vorliegenden Arbeit soll die Studienlage zur Effektivit\\u00e4t und Akzeptanz von VRET diskutiert werden. Es wird ein VRET-Protokoll auf Basis zweier Ausbildungslehrg\\u00e4nge vorgeschlagen, welches unseres Wissens nach erstmals auch die Anwendung von 360\\u00b0-Aufnahmen diskutiert. Ein Ausblick auf die neuesten Entwicklungen in der VRET wird gegeben, mit der Virtual Reality Programme kosteng\\u00fcnstig breiten Einsatz finden k\\u00f6nnen.<\\\/p>\",\"__globals__\":{\"text_color\":\"globals\\\/colors?id=secondary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"}],\"isInner\":false}],\"isInner\":false},{\"id\":\"80be62c\",\"elType\":\"section\",\"settings\":{\"content_width\":{\"unit\":\"px\",\"size\":768,\"sizes\":[]},\"_ob_glider_nav_pos_y_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_x_prev_alt\":\"0%\",\"_ob_glider_nav_pos_x_next_alt\":\"0%\",\"_ob_glider_nav_pos_y_prev_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_y_next_alt\":\"50% - 25px\",\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"3a32e07\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"8e76efd\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"1caf80b\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"f384018\",\"elType\":\"column\",\"settings\":{\"_column_size\":100,\"_inline_size\":null,\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"39dd1f2\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"c08d291\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"b946809\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"d2ebb34\",\"elType\":\"widget\",\"settings\":{\"title\":\"Comparison of effectiveness and treatment adherence with VRET \",\"typography_typography\":\"custom\",\"typography_font_size\":{\"unit\":\"em\",\"size\":1.8,\"sizes\":[]},\"typography_font_weight\":\"900\",\"typography_line_height\":{\"unit\":\"em\",\"size\":1.4,\"sizes\":[]},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"c733a7c\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

Exposure therapy in relation to anxiety disorders is based on strong evidence from studies. It is also based on gradual and repeated exposure with the appropriate anxiety stimuli. In practice, it is often difficult to implement. With imagination techniques, the therapist cannot know precisely what the patient is imagining, nor can he or she control it exactly. The ability to create vivid mental images is not the same for everyone and also decreases with age. The in vivo exposure, on the other hand, is often difficult and can only be arranged with great effort, for example, if the fear of heights is to be habituated at actual heights under therapeutic guidance. In addition, the drop-out of patients is an issue for these approaches, as this type of intervention is experienced as stressful and unpleasant [Boeldt et al., 2019]. <\\\/p>

By means of VRET these barriers and problems can be avoided or at least reduced. On the one hand, VR can involve people mentally and emotionally, but it can also provide a controllable, repeatable and safe environment for therapy. Findings from neuroscience show that VR images strongly involve the primary visual cortex V1 and the visual working memory. Perception and imagination are based on comparable neural processes. The use of VR for specific phobias, such as those for heights or spiders has already been well researched in both random and controlled studies [Boeldt et al., 2019]. <\\\/p>

Carl et al. 2019 examined a total of 30 studies with 1057 participants, 14 of which dealt with specific phobias. The effect size for VRET versus the wait list control group was very high (g = 0.90), and medium to high for VRET versus psychological placebo control groups (g = 0.78). A comparison between VRET and in vivo therapies showed no significance in effect size. he findings were consistent for all forms of anxiety disorders studied and suggest that VRET is an effective intervention for anxiety disorders [Carl et al., 2019]. <\\\/p>

n 2018, Benbow and Anderson published a meta-analysis in which the probability of drop-outs by patients was determined [Benbow & Anderson, 2019]. More than 46 studies have shown a value of 84% for treatment compliance. The drop-out rate of 16% is slightly lower than the drop-out rates of 19.6% and 19.7% for in vivo interventions and cognitive behavioural therapy for anxiety disorders [Swift & Greenberg, 2012; Fernandez et al. 2015; Benbow & Anderson, 2019]. The reasons for discontinuing therapy were different in VR versus in vivo. In VR, the reasons were lack of immersiveness, cybersickness, viewing complications and discomfort in viewing and talking to the therapist simultaneously. The main reason for in vivo therapy was the fear of exposure to the actual anxiety-inducing stimulus [Swift & Greenberg, 2012; Fernandez et al. 2015; Benbow & Anderson, 2019]. <\\\/p>

The results of these two meta-analyses correspond to the studies of Fodor et al. 2018 on anxiety disorders and depression. The authors included 39 studies and were able to show a high effect strength of g = 0.79, 95% CI 0.57 to 1.07 in anxiety disorders. VR has a high efficacy compared to control groups, but due to pronounced heterogeneity, no clear effect on the drop-out rate was noticeable [Fodor et al., 2018]. <\\\/p>

Already in 2012, Opris et al. had already summarised the results of VRET studies on anxiety disorders and found that VRET had far better results than wait list control groups, the results show a similar effectiveness between behavioural and cognitive behavioural interventions, VRET has powerful real effects similar to classic evidence-based treatments, VRET has a good stability of results over time and thus a sustained effect, there is a dose-effect relation for VRET and therefore intensive programmes lead to faster results and there is no difference in the drop-out rate between virtual reality exposure and in vivo exposure [Opris et al. , 2012]. <\\\/p>\",\"__globals__\":{\"text_color\":\"globals\\\/colors?id=secondary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"},{\"id\":\"954c833\",\"elType\":\"widget\",\"settings\":{\"title\":\"Vorteile von VRET gegen\\u00fcber Imagination und in vivo Exposition\",\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\",\"header_size\":\"h3\",\"_margin\":{\"unit\":\"px\",\"top\":\"0\",\"right\":\"0\",\"bottom\":\"0\",\"left\":\"0\",\"isLinked\":false},\"__globals__\":{\"typography_typography\":\"globals\\\/typography?id=67e91fa\"}},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"fb41a5c\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

Mittels VRET k\\u00f6nnen diese Barrieren und Probleme vermieden oder zumindest reduziert werden. So kann VR einerseits stark mental und emotional involvieren, aber auch ein kontrollierbares, wiederholbares und sicheres Ambiente f\\u00fcr die Therapie bieten. Erkenntnisse aus den Neurowissenschaften belegen, dass VR-Bilder den prim\\u00e4ren visuellen Kortex V1 und das visuelle Arbeitsged\\u00e4chtnis stark beteiligen. Wahrnehmung und Imagination beruhen auf vergleichbaren neuronalen Prozessen. Der Einsatz von VR bei spezifischen Phobien wie vor H\\u00f6hen oder Spinnen wurde bereits gut in randomisierten und kontrollierten Studien erforscht [Boeldt et al., 2019].<\\\/p>\",\"__globals__\":{\"text_color\":\"globals\\\/colors?id=secondary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"},{\"id\":\"6965f37\",\"elType\":\"widget\",\"settings\":{\"title\":\"Studienlage zur Wirksamkeit von VRET\",\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\",\"header_size\":\"h3\",\"_margin\":{\"unit\":\"px\",\"top\":\"0\",\"right\":\"0\",\"bottom\":\"0\",\"left\":\"0\",\"isLinked\":false},\"__globals__\":{\"typography_typography\":\"globals\\\/typography?id=67e91fa\"}},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"dbac835\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

Carl et al. 2019 haben insgesamt 30 Studien mit 1057 Teilnehmern untersucht, wobei sich 14 mit spezifischen Phobien besch\\u00e4ftigt haben. Die Effektst\\u00e4rke f\\u00fcr VRET versus Warteliste war sehr hoch (g = 0.90), sowie mittel bis hoch f\\u00fcr VRET versus psychologischen Placebo-Kontrollgruppen (g = 0.78). Ein Vergleich zwischen VRET und in vivo Therapien zeigte keine Signifikanz in der Effektst\\u00e4rke. Die Befunde waren konsistent f\\u00fcr alle untersuchten Formen von Angstst\\u00f6rungen und weisen darauf hin, dass VRET eine wirksame Intervention bei Angstst\\u00f6rungen darstellt [Carl et al., 2019].<\\\/p>\",\"__globals__\":{\"text_color\":\"globals\\\/colors?id=secondary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"},{\"id\":\"3179592\",\"elType\":\"widget\",\"settings\":{\"title\":\"Therapietreue und Drop-out-Raten bei VRET\",\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\",\"header_size\":\"h3\",\"_margin\":{\"unit\":\"px\",\"top\":\"0\",\"right\":\"0\",\"bottom\":\"0\",\"left\":\"0\",\"isLinked\":false},\"__globals__\":{\"typography_typography\":\"globals\\\/typography?id=67e91fa\"}},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"1e5ead9\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

Benbow und Anderson haben 2018 eine Metaanalyse publiziert, in der die Wahrscheinlichkeit f\\u00fcr Drop outs durch Patienten ermittelt worden ist [Benbow & Anderson, 2019]. \\u00dcber 46 untersuchte Studien ergaben einen Wert f\\u00fcr die Therapietreue von 84%. Die Drop out Rate von 16% liegt leicht unter den Drop out Raten wie sie f\\u00fcr in vivo Interventionen und kognitive Verhaltenstherapie bei Angstst\\u00f6rungen mit 19.6% bzw. 19.7% ermittelt wurden [Swift & Greenberg, 2012; Fernandez et al. 2015; Benbow & Anderson, 2019]. Die Gr\\u00fcnde f\\u00fcr Therapieabbr\\u00fcche waren in VR versus in vivo unterschiedlich. Bei VR waren es fehlende Immersivit\\u00e4t, Cybersickness, Komplikationen beim Betrachten und Unbehagen gleichzeitig zu Betrachten und mit dem Therapeuten zu sprechen. Die in vivo Therapie hatte als haupts\\u00e4chlichen Grund die Furcht vor der Exposition mit dem tats\\u00e4chlich angstausl\\u00f6senden Reiz [Swift & Greenberg, 2012; Fernandez et al. 2015; Benbow & Anderson, 2019].\\u00a0 \\u00a0<\\\/p>

Die Ergebnisse dieser beiden Metaanalysen entsprechen den Untersuchungen von Fodor et al. 2018 bei Angstst\\u00f6rungen und Depression. Die Autoren haben 39 Studien inkludiert, und konnten eine hohe Effektst\\u00e4rke von g = 0.79, 95% CI 0.57 bis 1.07 bei Angstst\\u00f6rungen zeigen. VR weist eine hohe Wirksamkeit im Vergleich zu Kontrollgruppen auf, aber aufgrund ausgepr\\u00e4gter Heterogenit\\u00e4t war kein klarer Effekt auf die Drop out Rate bemerkbar [Fodor et al., 2018].<\\\/p>

Bereits 2012 habe Opris et al. die Ergebnisse aus VRET-Studien zu Angstst\\u00f6rungen zusammengefasst und dabei festgestellt, dass VRET weit bessere Ergebnisse als die Warteliste-Kontrolle hat, die Ergebnisse eine \\u00e4hnliche Wirksamkeit zwischen der Verhaltens-und kognitiven verhaltenstherapeutischen Interventionen zeigen, VRET \\u00fcber leistungsstarke realen Auswirkungen verf\\u00fcgt \\u00e4hnlich der klassischen evidenzbasierte Behandlungen, VRET eine gute Stabilit\\u00e4t der Ergebnisse im Laufe der Zeit und somit eine nachhaltige Wirkung aufweist, es eine Dosis-Wirkungs-Beziehung f\\u00fcr VRET gibt und daher intensive Programme zu schnelleren Ergebnissen f\\u00fchren und es keinen Unterschied in der Dropout-Rate zwischen der virtuellen Realit\\u00e4t Exposition und der in vivo Exposition gibt [Opris et al., 2012].<\\\/p>\",\"__globals__\":{\"text_color\":\"globals\\\/colors?id=secondary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"}],\"isInner\":false}],\"isInner\":false},{\"id\":\"ed0c184\",\"elType\":\"section\",\"settings\":{\"content_width\":{\"unit\":\"px\",\"size\":768,\"sizes\":[]},\"_ob_glider_nav_pos_y_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_x_prev_alt\":\"0%\",\"_ob_glider_nav_pos_x_next_alt\":\"0%\",\"_ob_glider_nav_pos_y_prev_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_y_next_alt\":\"50% - 25px\",\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"eb35067\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"157dbe2\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"806ab4c\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"22f97f8\",\"elType\":\"column\",\"settings\":{\"_column_size\":100,\"_inline_size\":null,\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"a8aed64\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"00c2c8c\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"ad55212\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"add22cc\",\"elType\":\"widget\",\"settings\":{\"title\":\"Protocol for VRET \",\"typography_typography\":\"custom\",\"typography_font_size\":{\"unit\":\"em\",\"size\":1.8,\"sizes\":[]},\"typography_font_weight\":\"900\",\"typography_line_height\":{\"unit\":\"em\",\"size\":1.4,\"sizes\":[]},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"4ac9c78\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

We conducted two training courses in 2019 with clinical psychologists and psychotherapists in Graz and Vienna, among others, during which VR programmes were created using 8k recordings with an Insta 360\\u00b0 Pro camera.<\\\/p>

Some of the participants of the training course treat patients with social phobia in their practice, who hardly dare to socialise with people. A programme in a park was developed for these clients. At first you are alone on a park bench. Gradually other people (the participants) join in and thus increase the perception of human closeness. By means of a controller, the patient can stop the steadily increasing challenge at any time. <\\\/p>

The topics of exam anxiety and speaking in front of an audience are also frequent reasons why a practice is visited by participants. For this reason, the group simulated a seminar audience or, subsequently, an examination board itself. <\\\/p>

All three scenarios, the park bench, the presentation and the examination are available to patients through an Oculus GO 32GB VR goggle. The graduates can learn to handle these situations confidently and safely in a realistic atmosphere created by the 360\\u00b0 shots, however, this access does not offer any interactivity. <\\\/p>

Moreover, additional interventions are practised with which the VR programmes can be combined. For example, resources such as energy\\\/power providing locations that have been activated by a VR application can be tracked down and expanded again and again. Or relaxation scenes such as calming natural scenery can be used to support a client in the context of VRET. <\\\/p>

A special challenge in the application of such programmes is that some patients cannot even stand the realistic VR scenarios at the beginning. The great strength of VR is the realistic experience, but this can be a hurdle for people with a high level of suffering at first. If this experience is too stressful, it is necessary to rely on attenuated forms of perception in the beginning. <\\\/p>

Step 1: The client remains distant from the relevant situations, while still easily confronting them. This can be achieved, for example, by means of pictures or videos without fear stimuli. On search engines, pictures and videos can be found on practically any topic with just a few clicks. For this purpose, one can work with a laptop or a tablet. Pictures can also be prepared in printed form. The reaction of most clients will probably be that they have no problem with this light form of confrontation. <\\\/p>

Step 2: The client still remains distant from the relevant situations. But in this step the client, with eyes closed, tries to use his\\\/her imagination to visit certain places where the fear-inducing situations are not far away. For example, the building across the street where a test is being held or where there is a lift. Or a football field that you have to leave soon, where you have to walk through a narrow tunnel further ahead. Or a deserted park that you will soon have to leave towards the city centre. <\\\/p>

Step 3: Now, for the first time, the client tries an easier form of association with the fear-inducing situation through his imagination. He enters the building in his mind and gets into the lift. He enters the room and begins his lecture or welcomes the examination committee. Or imaginatively leaves an empty space and seeks the proximity of other people. <\\\/p>

Step 4: In the penultimate step, the client enters a strong form of associated perception through the VR scenario. Before step 4 is possible, some clients need several appointments to go through steps 1 - 3. <\\\/p>

Step 5: In reality, the client enters a (formerly) fear-triggering situation. Depending on the feedback, step 4 is repeated several times. <\\\/p>

Accompanying this slow increase in perception, a physical relaxation exercise can be supportive for the client as soon as the client reports symptoms of tension or if they become visible without any feedback. Initial application reports from participants with their patients indicate the effectiveness and acceptance of this strategy. This VRET protocol has been tested on 360\\u00b0 videos, but can also be used for computer-generated spaces without adaptation. <\\\/p>\",\"__globals__\":{\"text_color\":\"globals\\\/colors?id=secondary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"},{\"id\":\"0e69e21\",\"elType\":\"widget\",\"settings\":{\"title\":\"Schrittweise Ann\\u00e4herung an angstausl\\u00f6sende Situationen\",\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\",\"header_size\":\"h3\",\"_margin\":{\"unit\":\"px\",\"top\":\"0\",\"right\":\"0\",\"bottom\":\"0\",\"left\":\"0\",\"isLinked\":false},\"__globals__\":{\"typography_typography\":\"globals\\\/typography?id=67e91fa\"}},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"31f375d\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

Schritt 1: Der Klient bleibt von den entsprechenden Situationen distanziert, w\\u00e4hrend er sich trotzdem leicht damit konfrontiert. Das gelingt zum Beispiel durch Bilder oder Videos ohne Angstreize. Auf Suchmaschinen k\\u00f6nnen praktisch zu jedem Thema durch wenige Klicks Bilder und Videos gefunden werden. Hierzu kann man mit einem Laptop oder einem Tablet arbeiten. Bilder k\\u00f6nnen aber auch ausgedruckt vorbereitet werden. Die Reaktion der meisten Klienten wird vermutlich sein, kein Problem mit dieser leichten Form der Konfrontation zu haben.<\\\/p>

Schritt 2: Der Klient bleibt von den entsprechenden Situationen noch immer distanziert. Aber bei diesem Schritt versucht der Klient bei geschlossenen Augen in seiner Vorstellungskraft gewisse Orte aufzusuchen, bei denen die angstausl\\u00f6senden Situationen nicht mehr weit weg sind. Zum Beispiel das Geb\\u00e4ude auf der anderen Stra\\u00dfenseite, in dem eine Pr\\u00fcfung stattfindet oder sich ein Aufzug befindet. Oder ein Fu\\u00dfballfeld, das man bald verlassen muss, in dem man durch einen engen Tunnel weiter vorne gehen muss. Oder ein menschenleerer Park, den man bald Richtung Stadtzentrum verlassen wird.<\\\/p>

Schritt 3: Jetzt versucht der Klient erstmals eine leichtere Form der Assoziierung mit der angstausl\\u00f6senden Situation durch seine Vorstellungskraft. Er betritt in Gedanken das Geb\\u00e4ude und steigt in den Aufzug ein. Er betritt den Raum und beginnt seinen Vortrag oder begr\\u00fc\\u00dft die Pr\\u00fcfungskommission. \\u00a0Oder verl\\u00e4sst imaginativ einen leeren Platz und sucht die N\\u00e4he anderer Menschen.\\u00a0<\\\/p>

Schritt 4: Im vorletzten Schritt begibt sich der Klient in eine starke Form der assoziierten Wahrnehmung durch das VR-Szenario. Bevor Schritt 4 m\\u00f6glich ist, bedarf es bei manchen Betroffenen mehrere Termine, in denen es um die Schritte 1 \\u2013 3 geht.<\\\/p>

Schritt 5: Der Klient begibt sich in der Realit\\u00e4t in eine (ehemals) angstausl\\u00f6sende Situation. Je nach Feedback wird Schritt 4 mehrmals wiederholt.<\\\/p>\",\"__globals__\":{\"text_color\":\"globals\\\/colors?id=secondary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"},{\"id\":\"e3a1028\",\"elType\":\"widget\",\"settings\":{\"title\":\"Erg\\u00e4nzende Entspannungsstrategien in der VR-Exposition\",\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\",\"header_size\":\"h3\",\"_margin\":{\"unit\":\"px\",\"top\":\"0\",\"right\":\"0\",\"bottom\":\"0\",\"left\":\"0\",\"isLinked\":false},\"__globals__\":{\"typography_typography\":\"globals\\\/typography?id=67e91fa\"}},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"f2a0a23\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

Begleitend zu dieser langsamen Wahrnehmungs-Steigerung kann eine physische Entspannungs\\u00fcbung f\\u00fcr den Klienten unterst\\u00fctzend sein, sobald der Klient \\u00fcber Anspannungs-Symptome berichtet oder diese auch ohne sein Feedback sichtbar werden. Erste Anwendungsberichte der Teilnehmer mit ihren Patienten weisen auf Wirksamkeit und Akzeptanz dieser Strategie hin. Dieses VRET-Protokoll wurde an 360\\u00b0-Videos erprobt, ist aber ohne Adaption auch f\\u00fcr Computer-generierte R\\u00e4ume verwendbar.<\\\/p>\",\"__globals__\":{\"text_color\":\"globals\\\/colors?id=secondary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"}],\"isInner\":false}],\"isInner\":false},{\"id\":\"8b9c77d\",\"elType\":\"section\",\"settings\":{\"content_width\":{\"unit\":\"px\",\"size\":768,\"sizes\":[]},\"_ob_glider_nav_pos_y_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_x_prev_alt\":\"0%\",\"_ob_glider_nav_pos_x_next_alt\":\"0%\",\"_ob_glider_nav_pos_y_prev_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_y_next_alt\":\"50% - 25px\",\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"4657556\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"58822c8\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"0bca9ff\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"6e871b9\",\"elType\":\"column\",\"settings\":{\"_column_size\":100,\"_inline_size\":null,\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"ce31db3\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"17e1837\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"2d27b65\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"72b4a64\",\"elType\":\"widget\",\"settings\":{\"title\":\"Diskussion\",\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\",\"header_size\":\"h3\",\"_margin\":{\"unit\":\"px\",\"top\":\"0\",\"right\":\"0\",\"bottom\":\"-15\",\"left\":\"0\",\"isLinked\":false},\"__globals__\":{\"typography_typography\":\"globals\\\/typography?id=67e91fa\"}},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"ad2c369\",\"elType\":\"widget\",\"settings\":{\"title\":\"Discussion \",\"typography_typography\":\"custom\",\"typography_font_size\":{\"unit\":\"em\",\"size\":1.8,\"sizes\":[]},\"typography_font_weight\":\"900\",\"typography_line_height\":{\"unit\":\"em\",\"size\":1.4,\"sizes\":[]},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"7c1d497\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

The effect strength for VRET interventions compared to controls is very high. VR can therefore be classified as a very effective approach in the treatment of phobias. The drop-out rate is low at 16%, but no significance to in vivo therapies could be found. Since \\\"real exposure\\\" is associated with great fear on the part of patients and leads to therapy discontinuation in this case, VRET has great potential for even greater patient acceptance. <\\\/p>

The advantages of VRET are: It is low-threshold, cost-effective, can be performed as often as is required (e.g. take-off of an airplane) and the patient has full control over the scene. Lack of immersion, cybersickness, complications of viewing and discomfort of viewing and talking to the therapist at the same time are the most common limitations that lead to the intrinsically low rate of terminations. The drop-outs show that VRET benefits from VR programmes of correspondingly high quality, where the aforementioned advantages can actually be used accordingly. For the best possible immersion, computer-generated rooms with position tracking are advisable, as one moves interactively in these rooms. In order to prevent cybersickness as well as discomfort while viewing, the principle of minimising stimuli applies - i.e. scenarios designed as simply as possible. <\\\/p>

As part of two training courses, psychologists and psychotherapists have created VRET scenarios by means of video shooting, the degree of exposure to which is gradually increasing. The reports of the course participants with this protocol indicate that this procedure can be combined with satisfactory effectiveness with patient acceptance, with reductions in immersion. A clinical study could evaluate this experience more closely and increase the evidence base to use such videos in isolated cases as a cost-effective alternative to computer-generated rooms. <\\\/p>

It is also recommended to offer relaxation exercises during the phobia treatment. Relaxation programmes can be used via VR. The use of VR in relaxation could lead patients to associate VR not only with the negative stimulus, which could have a positive effect on acceptance. Furthermore, VR is a very effective tool for rapid physiological recovery from stress stimuli, as a measurement of heart rate variability and pulse at the University of Salzburg has shown (T\\u00e4uber M. & Altenhofer M., manuscript in preparation). <\\\/p>

We recommend starting with one to three hours after the above five-step protocol and supplementing this with relaxation strategies. It is important to start by building up sufficient trust and rapport. Furthermore, we recommend using VRET of a correspondingly high quality, allowing patients to immerse themselves, step by step, in virtual realities. <\\\/p>

Addendum to this article, November 2023:<\\\/p>

In recent years, hardware and software have evolved significantly. In addition to phobias, VR exposure also plays an increasingly important role in addictions and depression. You will find further information on these pages. <\\\/p>\",\"__globals__\":{\"text_color\":\"globals\\\/colors?id=secondary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"},{\"id\":\"14d489d\",\"elType\":\"widget\",\"settings\":{\"title\":\"Vorteile und Limitationen der VR-Expositionstherapie\",\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\",\"header_size\":\"h3\",\"_margin\":{\"unit\":\"px\",\"top\":\"0\",\"right\":\"0\",\"bottom\":\"0\",\"left\":\"0\",\"isLinked\":false},\"__globals__\":{\"typography_typography\":\"globals\\\/typography?id=67e91fa\"}},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"4f865a4\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

Die Vorteile von VRET sind: Sie ist niedrigschwellig, kosteng\\u00fcnstig, beliebig oft durchf\\u00fchrbar (z.B. Start eines Flugzeugs) und der Patient hat volle Kontrolle \\u00fcber die Szene. Fehlende Immersion, Cybersickness, Komplikationen beim Betrachten und Unbehagen gleichzeitig zu betrachten und mit dem Therapeuten zu sprechen sind die h\\u00e4ufigsten Limitierungen, die zu der an sich niedrigen Rate an Abbr\\u00fcchen f\\u00fchren. Die Drop Outs zeigen, dass die VRET von VR-Programmen entsprechend hoher Qualit\\u00e4t profitiert, wo die zuvor genannten Vorteile auch tats\\u00e4chlich entsprechend genutzt werden k\\u00f6nnen. F\\u00fcr die bestm\\u00f6gliche Immersion sind Computer-generierte R\\u00e4ume mit Positionstracking anzuraten, da man sich dort interaktiv bewegt. Um Cybersickness wie auch Unwohlsein beim Betrachten zu verhindern, gilt der Grundsatz der Reizminimierung \\u2013 also m\\u00f6glichst einfach gestaltete Szenarien.\\u00a0<\\\/p>

Im Rahmen zweier Ausbildungslehrg\\u00e4nge haben Psychologinnen und Psychotherapeutinnen VRET-Szenarien mittels Videodrehs erstellt, deren Expositionsgrad sich sukzessive steigert. Die Berichte der Kursteilnehmer mit diesem Protokoll weisen darauf hin, dass sich mit diesem Vorgehen zufriedenstellende Wirksamkeit mit Patientenakzeptanz verbinden lassen, bei Abstrichen in der Immersion. Eine klinische Studie dazu k\\u00f6nnte diese Erfahrung genauer evaluieren und den Evidenzgrad erh\\u00f6hen, um solche Videos auch vereinzelt als kosteng\\u00fcnstige Alternative zu Computer-generierten R\\u00e4umen einzusetzen.<\\\/p>\",\"__globals__\":{\"text_color\":\"globals\\\/colors?id=secondary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"},{\"id\":\"6fba09c\",\"elType\":\"widget\",\"settings\":{\"title\":\"Entspannung und 360\\u00b0-Naturkulissen als Erg\\u00e4nzung\",\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\",\"header_size\":\"h3\",\"_margin\":{\"unit\":\"px\",\"top\":\"0\",\"right\":\"0\",\"bottom\":\"0\",\"left\":\"0\",\"isLinked\":false},\"__globals__\":{\"typography_typography\":\"globals\\\/typography?id=67e91fa\"}},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"f7a261d\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

Es ist bei der Phobiebehandlung auch zu empfehlen, Entspannungs\\u00fcbungen anzubieten. \\u00dcber VR lassen sich Entspannungsprogramme einsetzen. Der Einsatz von VR in der Entspannung k\\u00f6nnte dazu f\\u00fchren, dass Patienten VR nicht nur mit dem negativen Reiz assoziieren, was sich positiv auf die Akzeptanz auswirken k\\u00f6nnte. Au\\u00dferdem ist VR ein sehr effektives Tool um rasch physiologische Erholung von Stressreizen zu erlangen, wie eine Messung an der Universit\\u00e4t Salzburg von Herzratenvariabilit\\u00e4t und Puls gezeigt hat (T\\u00e4uber M. & Altenhofer M., Manuskript in Vorbereitung).<\\\/p>

Wir empfehlen mit ein bis drei Stunden nach obigen F\\u00fcnf-Schritte-Protokoll zu starten, und diese mit Entspannungsstrategien zu erg\\u00e4nzen. Wichtig ist zun\\u00e4chst auf ausreichenden Aufbau von Vertrauen und Rapport zu achten. Weiters empfehlen wir VRET entsprechend hoher Qualit\\u00e4t einzusetzen, und hier Patienten Schritt f\\u00fcr Schritt in virtuelle Realit\\u00e4ten eintauchen zu lassen.<\\\/p>\",\"__globals__\":{\"text_color\":\"globals\\\/colors?id=secondary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"},{\"id\":\"34f4bc7\",\"elType\":\"widget\",\"settings\":{\"title\":\"Update 2023: Neue Entwicklungen in der VR-Exposition\",\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\",\"header_size\":\"h3\",\"_margin\":{\"unit\":\"px\",\"top\":\"0\",\"right\":\"0\",\"bottom\":\"0\",\"left\":\"0\",\"isLinked\":false},\"__globals__\":{\"typography_typography\":\"globals\\\/typography?id=67e91fa\"}},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"fbd18da\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

In den letzten Jahren haben sich Hardware und Software stark weiterentwickelt. Neben Phobien spielen VR-Expositionen auch bei S\\u00fcchten<\\\/u><\\\/a> und Depressionen<\\\/span><\\\/a> eine immer gr\\u00f6\\u00dfer werdende Rolle. Auf diesen Seiten finden Sie n\\u00e4here Informationen dazu.<\\\/p>\",\"__globals__\":{\"text_color\":\"globals\\\/colors?id=secondary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"}],\"isInner\":false}],\"isInner\":false},{\"id\":\"042181c\",\"elType\":\"section\",\"settings\":{\"content_width\":{\"unit\":\"px\",\"size\":768,\"sizes\":[]},\"_ob_glider_nav_pos_y_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_x_prev_alt\":\"0%\",\"_ob_glider_nav_pos_x_next_alt\":\"0%\",\"_ob_glider_nav_pos_y_prev_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_y_next_alt\":\"50% - 25px\",\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"d87bec5\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"460dace\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"9b6366a\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"77ea875\",\"elType\":\"column\",\"settings\":{\"_column_size\":100,\"_inline_size\":null,\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"23da64e\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"ff5d9e3\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"fdd255b\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"0d5f0cf\",\"elType\":\"widget\",\"settings\":{\"title\":\"Literature\",\"typography_typography\":\"custom\",\"typography_font_size\":{\"unit\":\"em\",\"size\":1.8,\"sizes\":[]},\"typography_font_weight\":\"900\",\"typography_line_height\":{\"unit\":\"em\",\"size\":1.4,\"sizes\":[]},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"2857c2a\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

Bandelow B.: Panik und Agoraphobie. Diagnose, Ursachen, Behandlung. Springer, Wien, New York 2001.<\\\/p>

Bandelow B, Michaelis S: Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci 2015; 17:327\\u201335. <\\\/p>

Benbow AA, Anderson PL: A meta-analytic examination of attrition in virtual reality exposure therapy for anxiety disorders. J Anxiety Disord 2019; 61:18\\u201326. <\\\/p>

Boeldt D, McMahon E, McFaul M, Greenleaf W: Using Virtual Reality Exposure Therapy to Enhance Treatment of Anxiety Disorders: Identifying Areas of Clinical Adoption and Potential Obstacles. Front Psychiatry 2019; 10:773. <\\\/p>

Carl E, Stein AT, Levihn-Coon A, Pogue JR, Rothbaum B, Emmelkamp P, Asmundson GJG, Carlbring P, Powers MB: Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. J Anxiety Disord. 2019; 61:27-36. <\\\/p>

Fernandez E, Salem D, Swift J K, Ramtahal N: Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology 2015; 83:1108\\u20131122. <\\\/p>

Fodor LA, Cote\\u0163 CD, Cuijpers P, Szamoskozi \\u0218, David D, Cristea IA: The effectiveness of virtual reality based interventions for symptoms of anxiety and depression: A meta-analysis. Sci Rep 2018; 8:10323. <\\\/p>

Opri\\u015f D, Pintea S, Garc\\u00eda-Palacios A, Botella C, Szamosk\\u00f6zi \\u015e, David D: Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis. Depress Anxiety 2012; 29:85-93. <\\\/p>

Shiban Y: Virtuelle Expositionstherapie bei Angstst\\u00f6rungen. Der Nervenarzt 2018; 11. <\\\/p>

Swift JK, Greenberg RP: Premature discontinuation in adult psychotherapy: a meta-analysis. J Consult Clin Psychol. 2012; 80: 547\\u2013559. <\\\/p>

T\\u00e4uber M: Gedanken als Medizin. Goldegg, Berlin\\\/Wien, 2020. <\\\/p>

T\\u00e4uber M & Altenhofer M: Rasche Erholung nach sozialem Stress durch Virtual-Reality-Naturkulissen. Manuskript in Vorbereitung. <\\\/p>

Wancata J, Freidl M, Fabrian F: Epidemiologie der Angstst\\u00f6rungen. Journal f\\u00fcr Neurologie, Neurochirurgie und Psychiatrie 2011; 12, 332-335. <\\\/p>\",\"__globals__\":{\"text_color\":\"globals\\\/colors?id=secondary\"},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"text-editor\"}],\"isInner\":false}],\"isInner\":false},{\"id\":\"4e3f506\",\"elType\":\"section\",\"settings\":{\"content_width\":{\"unit\":\"px\",\"size\":768,\"sizes\":[]},\"_ob_glider_nav_pos_y_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_x_prev_alt\":\"0%\",\"_ob_glider_nav_pos_x_next_alt\":\"0%\",\"color_link\":\"#838383\",\"_ob_glider_nav_pos_y_prev_alt\":\"50% - 25px\",\"_ob_glider_nav_pos_y_next_alt\":\"50% - 25px\",\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"1aefc97\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"313ba4a\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"5211904\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"ecead3e\",\"elType\":\"column\",\"settings\":{\"_column_size\":100,\"_inline_size\":null,\"eae_slider_delay\":\"5000\",\"gradient_color_list\":[{\"eae_animated_gradient_color\":\"#00a6d8\",\"_id\":\"f131dcd\"},{\"eae_animated_gradient_color\":\"#b800c9\",\"_id\":\"da747cf\"},{\"eae_animated_gradient_color\":\"#e57600\",\"_id\":\"b9a9c59\"}],\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[{\"id\":\"d9379cf\",\"elType\":\"widget\",\"settings\":{\"title\":\"Authors\",\"typography_typography\":\"custom\",\"typography_font_size\":{\"unit\":\"em\",\"size\":1.8,\"sizes\":[]},\"typography_font_weight\":\"900\",\"typography_line_height\":{\"unit\":\"em\",\"size\":1.4,\"sizes\":[]},\"wcm_element_visibility_content_restricted_message\":\"You are not authorized to view this content.\",\"dce_tooltip_content\":\"I'm a tooltip\",\"dce_visibility_favorites_key\":\"my_favorites\"},\"elements\":[],\"widgetType\":\"heading\"},{\"id\":\"6ee640b\",\"elType\":\"widget\",\"settings\":{\"editor\":\"

Michael Altenhofer, VR Coach GmbH, E-mail: info@vr-coach.at<\\\/a>
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