@article{quintana_engaging_2023,

title = {Engaging in Awkward Social Interactions in a Virtual Environment Designed for Exposure-Based Psychotherapy for People with Generalized Social Anxiety Disorder: An International Multisite Study},

author = {P. Quintana and S. Bouchard and C. Botella and G. Robillard and B. Serrano and A. Rodriguez-Ortega and M. Torp Ernst and B. Rey and M. Berthiaume and G. Corno},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85165033932&doi=10.3390%2fjcm12134525&partnerID=40&md5=7b0f59b46ff7680611d5a64e18909651},

doi = {10.3390/jcm12134525},

issn = {20770383 (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {Journal of Clinical Medicine},

volume = {12},

number = {13},

abstract = {The effectiveness of in virtuo exposure-based treatment of performance-only social anxiety disorder (SAD) has been demonstrated in several studies. However, few studies have validated virtual environments with participants suffering from generalized SAD. The goal of this study is to confirm the potential of a virtual environment in inducing anxiety in adults suffering from generalized SAD, compared to adults without SAD, when engaged in awkward social interactions. Differences between participants from two different countries were also explored. The sample consisted of 15 participants with SAD from Canada, 17 participants without SAD from Canada, 16 participants with SAD from Spain, and 21 participants without SAD from Spain. All participants were immersed in a control virtual environment and in an experimental virtual environment considered potentially anxiety-inducing for individuals with generalized SAD. As hypothesized, results showed that the experimental virtual environment induced a higher level of anxiety than the control environment among participants with SAD compared to those without SAD. The impact on anxiety of each socially threatening task performed during the experimental immersion was statistically significant. In terms of anxiety responses, no significant differences were found between participants from Canada and Spain. However, spatial presence and ecological validity were higher in Canadians than in Spaniards. Unwanted negative side effects induced by immersions in virtual reality were higher in the SAD group. This study highlights the importance for therapists to engage people with SAD in clinically relevant tasks while immersed in VR psychotherapeutic applications. © 2023 by the authors.},

note = {Publisher: Multidisciplinary Digital Publishing Institute (MDPI)},

keywords = {adult, anxiety assessment, article, Canada, clinical article, controlled study, cultural differences, ecological validity, exposure, female, generalized social anxiety, human, immersion, male, multicenter study, psychotherapy, self report, social anxiety, social interaction, social phobia, Spain, virtual reality, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{orskov_cognitive_2022,

title = {Cognitive behavioral therapy with adaptive virtual reality exposure vs. cognitive behavioral therapy with in vivo exposure in the treatment of social anxiety disorder: A study protocol for a randomized controlled trial},

author = {P. T. Ørskov and M. B. Lichtenstein and M. T. Ernst and I. Fasterholdt and A. F. Matthiesen and M. Scirea and S. Bouchard and T. E. Andersen},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85140322564&doi=10.3389%2ffpsyt.2022.991755&partnerID=40&md5=1dacd4e05081f4790ccd5e0d7224e0ca},

doi = {10.3389/fpsyt.2022.991755},

issn = {16640640 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {Frontiers in Psychiatry},

volume = {13},

abstract = {Background: Social anxiety disorder (SAD) has a high prevalence and an early onset with recovery taking decades to occur. Current evidence supports the efficacy of cognitive behavioral therapy (CBT) with virtual reality (VR) exposure. However, the evidence is based on a sparse number of studies with predominantly small sample sizes. There is a need for more trials investigating the optimal way of applying VR based exposure for SAD. In this trial, we will test the efficacy of CBT with adaptive VR exposure allowing adjustment of the exposure based on real-time monitoring of the participants's anxiety level. Methods: The trial is a randomized controlled, assessor-blinded, parallel-group superiority trail. The study has two arms: (1) CBT including exposure in vivo (CBT-Exp), (2) CBT including exposure therapy using individually tailored VR-content and a system to track anxiety levels (CBT-ExpVR). Treatment is individual, manual-based and consists of 10 weekly sessions with a duration of 60 min. The study includes 90 participants diagnosed with SAD. Assessments are carried out pre-treatment, mid-treatment and at follow-up (6 and 12 months). The primary outcome is the mean score on the Social Interaction Anxiety Scale (SIAS) with the primary endpoint being post-treatment. Discussion: The study adds to the existing knowledge by assessing the efficacy of CBT with adaptive VR exposure. The study has high methodological rigor using a randomized controlled trial with a large sample size that includes follow-up data and validated measures for social anxiety outcomes. Clinical trial registration: ClinicalTrials.gov, identifier: NCT05302518. Copyright © 2022 Ørskov, Lichtenstein, Ernst, Fasterholdt, Matthiesen, Scirea, Bouchard and Andersen.},

note = {Publisher: Frontiers Media S.A.},

keywords = {adult, aged, Alcohol Use Disorders Identification Test, anxiety assessment, Anxiety disorder, article, behavior disorder assessment, cognitive behavioral therapy, comparative effectiveness, controlled study, Depression, Drug Use Disorders Identification Test, electrodermal activity, exposure, Fear of Negative Evaluation, follow up, health economics, Heart Rate, human, Leibowitz Anxiety Scale, Machine learning, major clinical study, psychological distress assessment, psychophysiological measurements, randomized controlled trial, Simulator Sickness Questionnaire, social anxiety, Social Interaction Anxiety Scale, social phobia, Subjective Units of Distress Scale, therapy effect, treatment duration, treatment outcome, virtual reality, virtual reality exposure therapy, Working Alliance Inventory},

pubstate = {published},

tppubtype = {article}

}

@article{lafortune_virtual_2020,

title = {Virtual Reality and Sex Therapy: Future Directions for Clinical Research},

author = {D. Lafortune and L. Dion and P. Renaud},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85075661234&doi=10.1080%2f0092623X.2019.1623357&partnerID=40&md5=217b4082644658823a6c8dd10fea1b7b},

doi = {10.1080/0092623X.2019.1623357},

issn = {0092623X},

year  = {2020},

date = {2020-01-01},

journal = {Journal of Sex and Marital Therapy},

volume = {46},

number = {1},

pages = {1–17},

abstract = {Rapidly growing new technologies are revolutionizing the field of mental health, in terms of both understanding and treating mental disorders. Among these, virtual reality (VR) is a powerful tool providing clients with new learning experiences benefiting their psychological well-being. This article offers an overview of the current literature on VR in psychotherapy, highlighting its relevance to sexual dysfunction (SD) treatment. A literature review of PubMed and Google Scholar databases was used to provide a description of the theoretical frameworks and clinical indications associated with VR use in psychotherapy and SD treatment. The effectiveness of VR exposure-based therapy has been empirically validated for several mental disorders, notably anxiety disorders. The emerging combined use of VR and mindfulness tends to focus on chronic pain treatment. Experimental research examining the use of immersive technologies in the treatment of SDs is lacking. Given the shortcomings of conventional SD treatments, exploring and developing specialized VR interventions may prove beneficial. VR offers promising avenues in sex therapy, particularly for the treatment of genital pain disorders or SDs in which anxiety plays a significant etiological role. © 2019, © 2019 Taylor & Francis Group, LLC.},

note = {Publisher: Routledge},

keywords = {human, Humans, Mental health, Physiological, procedures, Psychological, psychosexual disorder, Sexual Dysfunction, Sexual Dysfunctions, virtual reality, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{clemmensen_study_2020,

title = {Study protocol: Exposure in virtual reality for social anxiety disorder-a randomized controlled superiority trial comparing cognitive behavioral therapy with virtual reality based exposure to cognitive behavioral therapy with in vivo exposure},

author = {L. Clemmensen and S. Bouchard and J. Rasmussen and T. T. Holmberg and J. H. Nielsen and J. R. Mø. Jepsen and M. B. Lichtenstein},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85078711155&doi=10.1186%2fs12888-020-2453-4&partnerID=40&md5=28b076f10bf189f7c90b8bed4c719200},

doi = {10.1186/s12888-020-2453-4},

issn = {1471244X},

year  = {2020},

date = {2020-01-01},

journal = {BMC Psychiatry},

volume = {20},

number = {1},

abstract = {Background: Social Anxiety Disorder (SAD) is characterized by an intense fear of negative judgement by others. Cognitive Behavioral Therapy (CBT) is recommended for treatment, but a substantial part of individuals with SAD either do not seek treatment or drop-out. CBT with Virtual Reality (VR)-based exposure has several advantages compared to traditional exposure methods, mainly due to increased control of situational elements. The aim of the current study is to develop a CBT program containing VR-based exposure. The intervention is targeted to adult patients suffering from SAD and treatment effect will be assessed by changes in SAD symptoms. Methods: This article describes the study protocol of a Randomized Controlled Trial with three arms: 1) CBT with VR exposure based on 360° videos 2) CBT with in vivo exposure and 3) VR relaxation therapy. There will be 30 participants in each arm with a crossover at the end of the treatment period during which the participants in the third group will be randomly re-Allocated to one of the two former groups. The treatment program consists of 10 weekly individual sessions with a psychologist, and a six month follow-up consisting of a questionnaire. The primary outcome measure is reduction in SAD symptoms which will be assessed with the Social Interaction Anxiety Scale (SIAS). Discussion: There are currently no published studies on CBT with VR exposure based on 360° videos for SAD treatment. Furthermore, the current study will be the first Danish SAD treatment program that includes VR technology. Trial registration: clinicaltrials.gov (NCT03973541) June 3rd 2019. © 2020 The Author(s).},

note = {Publisher: BioMed Central},

keywords = {adult, Anxiety, article, clinical effectiveness, cognitive behavioral therapy, controlled study, exposure, follow up, health program, human, Humans, in vivo study, outcome assessment, phobia, psychologist, questionnaire, randomized controlled trial, relaxation training, Social, Social Interaction Anxiety Scale, social phobia, treatment outcome, virtual reality, virtual reality exposure therapy, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{nolet_adoption_2020,

title = {The Adoption of New Treatment Modalities by Health Professionals and the Relative Weight of Empirical Evidence in Favor of Virtual Reality Exposure Versus Mindfulness in the Treatment of Anxiety Disorders},

author = {K. Nolet and G. Corno and S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85083108852&doi=10.3389%2ffnhum.2020.00086&partnerID=40&md5=e72f1ece3a23c5283e1c9cc954c090bb},

doi = {10.3389/fnhum.2020.00086},

issn = {16625161},

year  = {2020},

date = {2020-01-01},

journal = {Frontiers in Human Neuroscience},

volume = {14},

abstract = {Anxiety disorders are among the most prevalent mental disorders, and cognitive-behavioral therapy (CBT) with exposure exercises is considered as the gold-standard psychological intervention. New psychotherapeutic modalities have emerged in the last decade and, among them, mindfulness has been rapidly adopted by therapists. The adoption rate is slower for the use of virtual reality (VR) to conduct exposure. The goal of the present position paper is to contrast, for the treatment of anxiety disorders, the weight of empirical evidences supporting the use of exposure in VR with the use of mindfulness-based therapy (MBT). Based on the most recent meta-analyses, we found that CBT with exposure conducted in VR was more thoroughly researched and supported than MBT, receiving validation from roughly twice as many studies with high control (i.e., randomized, active controls with clinical samples). However, this conclusion is nuanced by reviewing gaps in the literature for both therapies. Potential factors influencing clinicians’ choice of treatment and suggestions for future research directions are proposed. © Copyright © 2020 Nolet, Corno and Bouchard.},

note = {Publisher: Frontiers Media S.A.},

keywords = {Anxiety disorder, clinical decision making, cognitive behavioral therapy, comparative effectiveness, controlled study, evidence based medicine, human, intermethod comparison, mental health care personnel, mindfulness, randomized controlled trial (topic), review, therapy effect, validation study, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{tardif_re-examining_2019,

title = {Re-Examining Psychological Mechanisms Underlying Virtual Reality-Based Exposure for Spider Phobia},

author = {N. Tardif and C. -E. Therrien and S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85060171246&doi=10.1089%2fcyber.2017.0711&partnerID=40&md5=43737ac357efea6e35bd5668eb17e040},

doi = {10.1089/cyber.2017.0711},

issn = {21522715},

year  = {2019},

date = {2019-01-01},

journal = {Cyberpsychology, Behavior, and Social Networking},

volume = {22},

number = {1},

pages = {39–45},

abstract = {The proposed study aims at expanding results from a previous study on mechanisms of change after exposure in virtual reality (VR) and documenting the impact of adding tactile and haptic feedback. It was predicted that change in the severity of spider phobia according to the Fear of Spiders Questionnaire (FSQ) would be significantly predicted by change in dysfunctional beliefs toward spiders and self-efficacy, over and above the variance explained by a physiological measure of fear during exposure (heart rate) and presence during the immersion. Participants (N = 59) were randomly assigned to the presentation of visual stimuli only, visual plus tactile stimuli, or visual, tactile plus haptic feedback stimuli. A standard multiple regression was conducted to predict change on the FSQ using the following predictors: beliefs about spiders, beliefs about one's own behavior when facing spiders, perceived self-efficacy, disgust, presence, and heart rate. Only changes in beliefs about spiders and in perceived self-efficacy significantly predicted the reduction in fear of spiders. This result enhances our understanding of the mechanisms involved in exposure conducted in VR. Analyses of variance also show that participants reported statistically significant changes in their clinical condition, with little added value to the addition of tactile and haptic feedback. The advantages of tactile and haptic stimulation are questioned, at least in the context of only one brief exposure session and the equipment used. © 2019, Mary Ann Liebert, Inc.},

note = {Publisher: Mary Ann Liebert Inc.},

keywords = {animal, Animals, Fear, Heart Rate, human, Humans, phobia, Phobic Disorders, physiology, psychology, questionnaire, spider, Spiders, Surveys and Questionnaires, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{fernandez-alvarez_deterioration_2019,

title = {Deterioration rates in Virtual Reality Therapy: An individual patient data level meta-analysis},

author = {J. Fernández-Álvarez and A. Rozental and P. Carlbring and D. Colombo and G. Riva and P. L. Anderson and R. M. Baños and A. A. Benbow and S. Bouchard and J. M. Bretón-López and G. Cárdenas and J. Difede and P. Emmelkamp and A. García-Palacios and V. Guillén and H. Hoffman and I. Kampann and R. Moldovan and A. Mühlberger and M. North and P. Pauli and W. Peñate Castro and S. Quero and M. Tortella-Feliu and K. Wyka and C. Botella},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85050381788&doi=10.1016%2fj.janxdis.2018.06.005&partnerID=40&md5=012fdcaa9b8676314cbf22c52c91135b},

doi = {10.1016/j.janxdis.2018.06.005},

issn = {08876185 (ISSN)},

year  = {2019},

date = {2019-01-01},

journal = {Journal of Anxiety Disorders},

volume = {61},

pages = {3–17},

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. © 2018 Elsevier Ltd},

note = {Publisher: Elsevier Ltd},

keywords = {Adolescent, adult, aged, Anxiety disorder, Anxiety Disorders, article, demography, deterioration, Deterioration rates, disease association, female, human, Humans, Individual patient data analysis, male, marriage, meta analysis, Middle Aged, Odds Ratio, outcome assessment, Probability, psychology, randomized controlled trial (topic), social status, virtual reality, virtual reality exposure therapy, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{du_sert_virtual_2018,

title = {Virtual reality therapy for refractory auditory verbal hallucinations in schizophrenia: A pilot clinical trial},

author = {O. P. Sert and S. Potvin and O. Lipp and L. Dellazizzo and M. Laurelli and R. Breton and P. Lalonde and K. Phraxayavong and K. O'Connor and J. -F. Pelletier and T. Boukhalfi and P. Renaud and A. Dumais},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85042420594&doi=10.1016%2fj.schres.2018.02.031&partnerID=40&md5=fe98669ecfdfb69d05cc9ebb58fecdcc},

doi = {10.1016/j.schres.2018.02.031},

issn = {09209964},

year  = {2018},

date = {2018-01-01},

journal = {Schizophrenia Research},

volume = {197},

pages = {176–181},

abstract = {Schizophrenia is a chronic and severe mental illness that poses significant challenges. While many pharmacological and psychosocial interventions are available, many treatment-resistant schizophrenia patients continue to suffer from persistent psychotic symptoms, notably auditory verbal hallucinations (AVH), which are highly disabling. This unmet clinical need requires new innovative treatment options. Recently, a psychological therapy using computerized technology has shown large therapeutic effects on AVH severity by enabling patients to engage in a dialogue with a computerized representation of their voices. These very promising results have been extended by our team using immersive virtual reality (VR). Our study was a 7-week phase-II, randomized, partial cross-over trial. Nineteen schizophrenia patients with refractory AVH were recruited and randomly allocated to either VR-assisted therapy (VRT) or treatment-as-usual (TAU). The group allocated to TAU consisted of antipsychotic treatment and usual meetings with clinicians. The TAU group then received a delayed 7 weeks of VRT. A follow-up was ensured 3 months after the last VRT therapy session. Changes in psychiatric symptoms, before and after TAU or VRT, were assessed using a linear mixed-effects model. Our findings showed that VRT produced significant improvements in AVH severity, depressive symptoms and quality of life that lasted at the 3-month follow-up period. Consistent with previous research, our results suggest that VRT might be efficacious in reducing AVH related distress. The therapeutic effects of VRT on the distress associated with the voices were particularly prominent (d = 1.2). VRT is a highly novel and promising intervention for refractory AVH in schizophrenia. © 2018},

note = {Publisher: Elsevier B.V.},

keywords = {adult, article, auditory hallucination, auditory verbal hallucination, clinical article, clinical effectiveness, computer assisted therapy, Computer-Assisted, controlled study, Cross-Over Studies, crossover procedure, disease severity, distress syndrome, female, follow up, Follow-Up Studies, hallucination, Hallucinations, human, Humans, male, Middle Aged, neuroleptic agent, outcome assessment, Outcome Assessment (Health Care), phase 2 clinical trial, physiology, Pilot Projects, pilot study, priority journal, procedures, psychotherapy, quality of life, randomized controlled trial, schizophrenia, Speech Perception, symptom, Therapy, therapy delay, therapy effect, treatment duration, treatment response, virtual reality, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{bouchard_using_2017,

title = {Using virtual reality in the treatment of gambling disorder: The development of a new tool for cognitive behavior therapy},

author = {S. Bouchard and G. Robillard and I. Giroux and C. Jacques and C. Loranger and M. St-Pierre and M. Chrétien and A. Goulet},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85014229849&doi=10.3389%2ffpsyt.2017.00027&partnerID=40&md5=27df5ef448fec9e2ac3498cd76632899},

doi = {10.3389/fpsyt.2017.00027},

issn = {16640640},

year  = {2017},

date = {2017-01-01},

journal = {Frontiers in Psychiatry},

volume = {8},

number = {FEB},

abstract = {Virtual reality (VR) can be used in the treatment of gambling disorder to provide emotionally charged contexts (e.g., induce cravings) where patients can practice cognitive behavior therapy (CBT) techniques in the safety of the therapist's office. This raises practical questions, such as whether the cravings are sufficient to be clinically useful but also manageable enough to remain clinically safe. Pilot data are also needed to test the development of a treatment manual and prepare large randomized control trials. This paper reports on three studies describing (a) cravings induced in VR compared to real gambling and a control game of skill with no money involved (N = 28 frequent gamblers and 36 infrequent gamblers); (b) the usefulness of a treatment protocol with only two CBT sessions using VR (N = 34 pathological gamblers); and (c) the safety of a four-session treatment program of CBT in VR (N = 25 pathological gamblers). Study 1 reveals that immersions in VR can elicit desire and a positive anticipation to gamble in frequent gamblers that are (a) significantly stronger than for infrequent gamblers and for playing a control game of skill and (b) as strong as for gambling on a real video lottery terminal. Study 2 documents the feasibility of integrating VR in CBT, its usefulness in identifying more high-risk situations and dysfunctional thoughts, how inducing cravings during relapse prevention exercises significantly relates to treatment outcome, and the safety of the procedure in terms of cybersickness. Results from Study 3 confirm that, compared to inducing urges to gamble in imagination, using VR does not lead to urges that are stronger, last longer, or feel more out of control. Outcome data and effect sizes are reported for both randomized control pilot trials conducted in inpatient settings. Suggestions for future research are provided, including on increasing the number of VR sessions in the treatment program. © 2017 Bouchard, Robillard, Giroux, Jacques, Loranger, St-Pierre, Chrétien and Goulet.},

note = {Publisher: Frontiers Research Foundation},

keywords = {adult, age distribution, article, clinical effectiveness, cognitive behavioral therapy, controlled study, craving, DSM-5, ethnic difference, female, high risk population, human, major clinical study, male, outcome assessment, pathological gambling, pilot study, program feasibility, safety, sex difference, treatment duration, treatment outcome, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{bouchard_virtual_2017,

title = {Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial},

author = {S. Bouchard and S. Dumoulin and G. Robillard and T. Guitard and E. Klinger and H. Forget and C. Loranger and F. X. Roucaut},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85018214603&doi=10.1192%2fbjp.bp.116.184234&partnerID=40&md5=245751bf4ef3f8ae014a9c5816a585c3},

doi = {10.1192/bjp.bp.116.184234},

issn = {00071250},

year  = {2017},

date = {2017-01-01},

journal = {British Journal of Psychiatry},

volume = {210},

number = {4},

pages = {276–283},

abstract = {Background: People with social anxiety disorder (SAD) fear social interactions and may be reluctant to seek treatments involving exposure to social situations. Social exposure conducted in virtual reality (VR), embedded in individual cognitive-behavioural therapy (CBT), could be an answer. Aims: To show that conducting VR exposure in CBT for SAD is effective and is more practical for therapists than conducting exposure in vivo. Method: Participants were randomly assigned to either VR exposure (n =17), in vivo exposure (n=22) or waiting list (n= 20). Participants in the active arms received individual CBT for 14 weekly sessions and outcome was assessed with questionnaires and a behaviour avoidance test. (Trial registration number ISRCTN99747069.) Results: Improvements were found on the primary (Liebowitz Social Anxiety Scale) and all five secondary outcome measures in both CBT groups compared with the waiting list. Conducting exposure in VR was more effective at post-treatment than in vivo on the primary outcome measure and on one secondary measure. Improvements were maintained at the 6-month follow-up. VR was significantly more practical for therapists than in vivo exposure. Conclusions: Using VR can be advantageous over standard CBT as a potential solution for treatment avoidance and as an efficient, cost-effective and practical medium of exposure. Declaration of interest S.B. and G.R. are consultants to and own equity in Cliniques et Développement In Virtuo, which develops virtual environments; however, Cliniques et Développement In Virtuo did not create the virtual environments used in this study. The terms of these arrangements were reviewed and approved by Universitédu Québec en Outaouais, in accordance with its policy on conflicts of interest. © The Royal College of Psychiatrists 2017.},

note = {Publisher: Royal College of Psychiatrists},

keywords = {adult, article, avoidance behavior, clinical outcome, cognitive therapy, comparative effectiveness, comparative study, computer interface, controlled study, cost, devices, female, hospital admission, human, Humans, Implosive Therapy, in vivo study, major clinical study, male, Middle Aged, outcome assessment, Outcome Assessment (Health Care), phobia, procedures, randomized controlled trial, Social, social phobia, User-Computer Interface, virtual reality, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}