Deterioration rates in Virtual Reality Therapy: An individual patient data level meta-analysis.

Azucena García-Palacios, Cristina Botella, Kataryzna Wyka, Miquel Tortella-Feliu, Soledad Quero, Wenceslao Peñate Castro, Paul Pauli, Max North, Andreas Mühlberger, Ramona Moldovan, Isabel Kampann, Hunter Hoffman, Verónica Guillén, Javier Fernández-Álvarez, Paul Emmelkamp, JoAnn Difede, Georgina Cárdenas, Juana María Bretón-López, Stéphane Bouchard, Amanda A Benbow, Rosa María Baños, Page L Anderson, Giuseppe Riva, Desirée Colombo, Per Carlbring, Alexander Rozental

Journal: Journal of anxiety disorders 2020;61():3-17

PMID: 30057346

Full Text on Elsevier Science View on PubMed

Abstract

Ample evidence supports the use of Virtual Reality (VR) for anxiety disorders. Nonetheless, currently there is no evidence about moderators or potential negative effects of VR treatment strategies. An Individual Patient Data (IPD) approach was employed with 15 retrieved datasets. The current study sample was composed of 810 patients. Randomized control trials (RCTs) for each primary outcome measure were performed, in addition to moderator analyses of the socio-demographic variables. Deterioration rates were 14 patients (4.0%) in VR, 8 (2.8%) in active control conditions, and 27 (15%) in the WL condition. With regard to receiving treatment, patients in a waiting list control condition had greater odds of deteriorating than in the two active conditions, odds ratios (ORs) 4.87, 95% confidence interval (CI) [0.05, 0.67]. In the case of the socio-demographic variables, none of them were associated with higher or lower odds of deterioration, with the exception of marital status in the WL condition; married people presented a significantly lower probability of deterioration, OR 0.19, 95% CI [0.05, 0.67]. Finally, when comparing pooled effects of VR versus all control conditions, the OR was 0.61 (95% CI 0.31-1.23) in favor of VR, although this result was not statistically significant. This study provides evidence about the deterioration rates of a therapeutic VR approach, showing that the number of deteriorated patients coincides with other therapeutic approaches, and that deterioration is less likely to occur, compared to patients in WL control groups.

Address: Università Cattolica del Sacro Cuore, Milan, Italy. Electronic address: [email protected].; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Institute of Child Health, University College London, London, United Kingdom.; Division of Clinical Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.; Department of Basic and Clinical Psychology and Psychobiology, Jaume I University. Castellon, Spain.; Università Cattolica del Sacro Cuore, Milan, Italy; Applied Technology for Neuro-Psychology Laboratory, Instituto Auxologico Italiano, Milan, Italy.; Department of Psychology, Georgia State University, Atlanta, United States.; Department of Personality, Assessment, and Psychological Treatments, Valencia University, Valencia, Spain; CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03 Instituto de Salud Carlos III, Spain.; Département de psychoéducation et de psychologie, Université du Québec en Outaouais, & Centre Intégré de Santé et de Services Sociaux de l'Outaouais, Gatineau, Québec, Canada.; Department of Basic and Clinical Psychology and Psychobiology, Jaume I University. Castellon, Spain; CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03 Instituto de Salud Carlos III, Spain.; School of Psychology, National Autonomous University of Mexico, Mexico City, Mexico.; Department of Psychiatry, Weill Medical College of Cornell University, New York, United States.; Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.; Virtual Reality Research Center at the Human Photonics Lab, Mechanical Engineering, University of Washington, Seattle, United States.; Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania.; Department of Psychology, University of Regensburg, Regensburg, Germany.; Visualization and Simulation Research Cluster, Information Systems Department, Kennesaw State University, Georgia, United States.; Center of Mental Health, Department of Biological Psychology, Clinical Psychology, and Psychotherapy, Julius-Maximilians-Universität Würzburg, Würzburg, Germany.; Facultad de Ciencias de la Salud - Sección Psicología, Universidad de La Laguna, Tenerife, Spain.; University Research Institute on Health Sciences - IUNICS, University of the Balearic Islands, Palma (Mallorca), Spain.

DOI: 10.1016/j.janxdis.2018.06.005

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MeSH Terms: Adolescent, Adult, Aged, Anxiety Disorders, Female, Humans, Male, Middle Aged, Odds Ratio, Virtual Reality Exposure Therapy, Young Adult