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首页> 外文期刊>Frontiers in Psychology >Inferiority or Even Superiority of Virtual Reality Exposure Therapy in Phobias?—A Systematic Review and Quantitative Meta-Analysis on Randomized Controlled Trials Specifically Comparing the Efficacy of Virtual Reality Exposure to Gold Standard in vivo Exposure in Agoraphobia, Specific Phobia, and Social Phobia
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Inferiority or Even Superiority of Virtual Reality Exposure Therapy in Phobias?—A Systematic Review and Quantitative Meta-Analysis on Randomized Controlled Trials Specifically Comparing the Efficacy of Virtual Reality Exposure to Gold Standard in vivo Exposure in Agoraphobia, Specific Phobia, and Social Phobia

机译：虚拟现实暴露治疗的较低或甚至优越性在恐惧症中的疗法？-A系统审查和定量荟萃分析对随机对照试验的分析，具体比较了虚拟现实暴露于广播恐惧症，特异性恐惧症和社会恐惧症的体内暴露于金标准的效果

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Background: Convincing evidence on Virtual Reality (VR) exposure for phobic anxiety disorders has been reported, however, the benchmark and golden standard for phobia treatment is in vivo exposure. For direct treatment comparisons, the control of confounding variables is essential. Therefore, the comparison of VR and in vivo exposure in studies applying an equivalent amount of exposure in both treatments is necessary. Methods: We conducted a systematic search of reports published until June 2019. Inclusion criteria covered the diagnosis of Specific Phobia, Social Phobia, or Agoraphobia, and a randomized-controlled design with an equivalent amount of exposure in VR and in vivo . We qualitatively reviewed participants' characteristics, materials, and the treatment procedures of all included studies. For quantitative synthesis, we calculated Hedges' g effect sizes for the treatment effects of VR exposure, in vivo exposure, and the comparison of VR to in vivo exposure in all studies and separately for studies on each diagnosis. Results: Nine studies ( n = 371) were included, four on Specific Phobia, three on Social Phobia, and two on Agoraphobia. VR and in vivo exposure both showed large, significant effect sizes. The comparison of VR to in vivo exposure revealed a small, but non-significant effect size favoring in vivo ( g = ?0.20). Specifically, effect sizes for Specific Phobia ( g = ?0.15) and Agoraphobia ( g = ?0.01) were non-significant, only for Social Phobia we found a significant effect size favoring in vivo ( g = ? 0.50 ). Except for Agoraphobia, effect sizes varied across studies from favoring VR to favoring in vivo exposure. Conclusions: We found no evidence that VR exposure is significantly less efficacious than in vivo exposure in Specific Phobia and Agoraphobia. The wide range of study specific effect sizes, especially in Social Phobia, indicates a high potential of VR, but also points to the need for a deeper investigation and empirical examination of relevant working mechanisms. In Social Phobia, a combination of VR exposure with cognitive interventions and the realization of virtual social interactions targeting central fears might be advantageous. Considering the advantages of VR exposure, its dissemination should be emphasized. Improvements in technology and procedures might even yield superior effects in the future.
机译：背景：据报道，令人信服的关于虚拟现实（VR）暴露的证据，但据报道，恐惧症治疗的基准和黄金标准是体内暴露。对于直接治疗比较，对混淆变量的控制是必不可少的。因此，需要比较VR和体内暴露在两种治疗中应用当量的暴露量的研究中。方法：我们对发表的报告进行了系统搜索，直到2019年6月。纳入标准涵盖了特定恐惧症，社交恐惧症或广视性的诊断，以及随机对照设计，在VR和体内具有相当数量的暴露。我们定性地审查了所有包括研究的参与者的特征，材料和治疗程序。对于定量合成，我们计算了VR暴露的治疗效果的Hedges的G效应大小，体内暴露和VR在所有研究中的体内暴露中的比较，并分别用于对每个诊断进行研究。结果：包括九项研究（n = 371），在特定的恐惧症，社会恐惧症三个上有四个，以及两个关于广播恐惧症。 VR和体内曝光都显示出大量显着的效果尺寸。 VR在体内暴露中的比较揭示了体内的小而非显着的效果大小（g =Δ0.20）。具体而言，特异性恐惧症（G = 0.15）和Agoraphobia（G =Δ01）的效果大小是非显着的，仅用于社交恐惧症，我们发现在体内有利的显着效果大小（G = 0.50）。除了广播恐惧症外，跨越VR在体内暴露中的研究中，效果大小不同。结论：我们发现没有证据表明VR暴露的效率明显不如在特定的恐惧症和广播恐惧症中的体内暴露中的效力。各种研究特定效果大小，特别是在社交恐惧症中，表明VR的高潜力，也是需要更深入的调查和对相关工作机制的实证检查。在社交恐惧症中，VR暴露与认知干预措施的结合和针对中央恐惧的虚拟社会互动的实现可能是有利的。考虑到VR暴露的优点，应强调其传播。技术和程序的改进甚至可能在未来产生卓越的效果。

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