A Review of Virtual Reality and Serious Games within Cognitive Behavioral Therapy for Social Anxiety Disorder
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Abstract
This literature review discusses efforts to enhance cognitive behavioral therapy in addressing social phobia, such as social anxiety disorder, by utilizing serious games and virtual reality exposure therapy. In the worldwide context of the COVID-19 outbreak, conventional cognitive behavioral therapy faces significant challenges, prompting practitioners and researchers to seek innovative e solutions. During the conducted literature review, several research articles were identified that explore the utilization of virtual reality exposure therapy and serious games within the stages of cognitive behavioral therapy. Using the PICOC method and software such as Publish or Perish, Zotero, and VOSViewer, 30 journal articles have been obtained, indicating that virtual reality exposure therapy and serious games can enhance the effectiveness of cognitive behavioral therapy. However, there are clear signs suggesting that integrating virtual reality (VR) technology and serious games on smartphones into the cognitive behavioral therapy process could offer a promising avenue for new research. This approach may help address the challenges brought about by the effects of the COVID-19 pandemic on people with social anxiety disorder, particularly in Indonesia. Although further research and therapy adaptation according to the cultural context in Indonesia are needed, this development offers new research opportunities as an alternative therapeutic approach with significant advancements in addressing social anxiety disorder.
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References
Abd-Alrazaq, A., Alajlani, M., Alhuwail, D., Schneider, J., Akhu-Zaheya, L., Ahmed, A., & Househ, M. (2022). The Effectiveness of Serious Games in Alleviating Anxiety: Systematic Review and Meta-analysis. JMIR serious games, 10(1). e29137.
Almeqbaali, M., Ouhbi, S., Serhani, M. A., Amiri, L., Jan, R. K., Zaki, N., ... & Almheiri, E. (2022). A Biofeedback-Based Mobile App With Serious Games for Young Adults With Anxiety in the United Arab Emirates: Development and Usability Study. JMIR Serious Games, 10(3), e36936.
Arnfred, B., Bang, P., Hjorthøj, C., Christensen, C. W., Moeller, K. S., Hvenegaard, M., ... & Nordentoft, M. (2022). Group cognitive behavioural therapy with virtual reality exposure versus group cognitive behavioural therapy with in vivo exposure for social anxiety disorder and agoraphobia: a protocol for a randomised clinical trial. BMJ open, 12(2), e051147.
Báldy, I. D., Hansen, N., & Bjørner, T. (2021). An engaging serious game aiming at awareness of therapy skills associated with social anxiety disorder. Mobile Networks and Applications, 1-12.
Beidel, D. C., Tuerk, P. W., Spitalnick, J., Bowers, C. A., & Morrison, K. (2021). Treating childhood social anxiety disorder with virtual environments and serious games: a randomized trial. Behavior therapy, 52(6), 1351-1363.
Boeldt, D., McMahon, E., McFaul, M., & Greenleaf, W. (2019). Using Virtual Reality Exposure Therapy to Enhance Treatment of Anxiety Disorders: Identifying Areas of Clinical Adoption and Potential Obstacles. Frontiers in psychiatry, 10, 773. https://doi.org/10.3389/fpsyt.2019.00773.
Bossenbroek. R., Wols, A., Weerdmeester, J., Lichtwarck-Aschoff, A., Granic, I., van Rooij, M.M.J.W. (2020). Efficacy of a Virtual Reality Biofeedback Game (DEEP) to Reduce Anxiety and Disruptive Classroom Behavior: Single-Case Study. JMIR Ment Health, 7(3):e16066.
Carlier, S., Van der Paelt, S., Ongenae, F., De Backere, F., & De Turck, F. (2020). Empowering children with ASD and their parents: Design of a serious game for anxiety and stress reduction. Sensors, 20(4), 966.
Caserman, P., Hoffmann, K., Müller, P., Schaub, M., Straßburg, K., Wiemeyer, J., ... & Göbel, S. (2020). Quality criteria for serious games: serious part, game part, and balance. JMIR serious games, 8(3), e19037.
Chand, S.P., Kuckel D.P., Huecker, M.R. (2023). Cognitive Behavior Therapy. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, Available from: https://www.ncbi.nlm.nih.gov/books/NBK470241/
Chard, I., Van Zalk, N., & Picinali, L. (2023). Virtual reality exposure therapy for reducing social anxiety in stuttering: A randomized controlled pilot trial. Frontiers in Digital Health, 5, 1061323.
Christie, G. I., Shepherd, M., Merry, S. N., Hopkins, S., Knightly, S., & Stasiak, K. (2019). Gamifying CBT to deliver emotional health treatment to young people on smartphones. Internet interventions, 18, 100286.
Clemmensen, L., Bouchard, S., Rasmussen, J., Holmberg, T. T., Nielsen, J. H., Jepsen, J. R. M., & Lichtenstein, M. B. (2020). 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. BMC psychiatry, 20, 1-9.
Cumpston, M. S., McKenzie, J. E., Thomas, J., & Brennan, S. E. (2021). The use of ‘PICO for synthesis’ and methods for synthesis without meta-analysis: protocol for a survey of current practice in systematic reviews of health interventions. F1000Research, 9, 678.
Curtiss, J. E., Levine, D. S., Ander, I., & Baker, A. W. (2021). Cognitive-behavioral treatments for anxiety and stress-related disorders. Focus, 19(2), 184-189.
Damaševičius, R., Maskeliūnas, R., & Blažauskas, T. (2023). Serious games and gamification in healthcare: a meta-review. Information, 14(2), 105.
Emmelkamp, P.M.G., & Meyerbröker, K., Morina, N. (2020). Virtual Reality Therapy in Social Anxiety Disorder. Curr Psychiatry Rep, 22(7). 32.
Emmelkamp, P.M.G., & Meyerbröker, K. (2021). Virtual Reality Therapy in Mental Health. Annual Review of Clinical Psychology, 17, 495-519.
Fan, J. (2022). The Effectiveness of Cognitive Behavioral Therapy on Social Anxiety in China. Journal of Education, Humanities and Social Sciences, 1, 404-409.
Farrer, L. M., Gulliver, A., Katruss, N., Fassnacht, D. B., Kyrios, M., & Batterham, P. J. (2019). A novel multi-component online intervention to improve the mental health of university students: Randomised controlled trial of the Uni Virtual Clinic. Internet interventions, 18, 100276.
Geraets, C. N., Veling, W., Witlox, M., Staring, A. B., Matthijssen, S. J., & Cath, D. (2019). Virtual reality-based cognitive behavioural therapy for patients with generalized social anxiety disorder: a pilot study. Behavioural and cognitive psychotherapy, 47(6), 745-750.
Gómez-Cambronero, Á., Casteleyn, S., Bretón-López, J., García-Palacios, A., & Mira, A. (2023). A smartphone-based serious game for depressive symptoms: Protocol for a pilot randomized controlled trial. Internet Interventions, 32, 100624.
Hawajri, O., Lindberg, J., Suominen, S. (2023) Virtual Reality Exposure Therapy as a Treatment Method Against Anxiety Disorders and Depression-A Structured Literature Review, Issues in Mental Health Nursing. 44:4, 245-269.
Harzing, A. W., & Adler, N. J. (2016). Disseminating knowledge: From potential to reality—new open-access journals collide with convention. Academy of management learning & education, 15(1), 140-156.
Heng, Y. K., Liew, J. S. Y., Abdullah, M. F. I. L., Tang, Y., & Prestopnik, N. (2023). ReWIND: A CBT-Based Serious Game to Improve Cognitive Emotion Regulation and Anxiety Disorder. International Journal of Serious Games, 10(3), 43-65.
Hernandez, M. E. H., Michalak, E., Choudhury, N., Hewko, M., Torres, I., Menon, M., ... & Chakrabarty, T. (2023). Co-design of a Virtual Reality Cognitive Remediation Program for Depression (bWell-D) With Patient End Users and Clinicians: Qualitative Interview Study Among Patients and Clinicians. JMIR Serious Games, 11(1), e43904.
Heinen, A., Varghese, S., Krayem, A., & Molodynski, A. (2022). Understanding health anxiety in the COVID-19 pandemic. International Journal of Social Psychiatry, 68. 1756-1763.
Hur, J. W., Shin, H., Jung, D., Lee, H. J., Lee, S., Kim, G. J., ... & Cho, C. H. (2021). Virtual reality–based psychotherapy in social anxiety disorder: fMRI study using a self-referential task. JMIR mental health, 8(4), e25731.
Jeong, H. S., Lee, J. H., Kim, H. E., & Kim, J. J. (2021). Appropriate number of treatment sessions in virtual reality-based individual cognitive behavioral therapy for social anxiety disorder. Journal of Clinical Medicine, 10(5), 915.
Kahlon, S., Lindner, P., Nordgreen, T. (2023). Gamified virtual reality exposure therapy for adolescents with public speaking anxiety: a four-armed randomized controlled trial. Frontiers in Virtual Reality. 4. 10.3389/frvir.2023.1240778.
Kindred, R., & Bates, G. W. (2023). The Influence of the COVID-19 Pandemic on Social Anxiety: A Systematic Review. International journal of environmental research and public health, 20(3), 2362.
Kitchenham, B., Pretorius, R., Budgen, D., Brereton, O. P., Turner, M., Niazi, M., & Linkman, S. (2010). Systematic literature reviews in software engineering–a tertiary study. Information and software technology, 52(8), 792-805.
Krzystanek, M., Surma, S., Stokrocka, M., Romańczyk, M., Przybyło, J., Krzystanek, N., & Borkowski, M. (2021). Tips for Effective Implementation of Virtual Reality Exposure Therapy in Phobias-A Systematic Review. Frontiers in psychiatry, 12. 737351. https://doi.org/10.3389/fpsyt.2021.737351.
Nandiyanto, A. B. D., & Al Husaeni, D. F. (2022). Bibliometric analysis of engineering research using vosviewer indexed by google scholar. Journal of Engineering Science and Technology, 17(2), 883-894.
Ørskov, P. T., Lichtenstein, M. B., Ernst, M. T., Fasterholdt, I., Matthiesen, A. F., Scirea, M., ... & Andersen, T. E. (2022). 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. Frontiers in Psychiatry, 13, 991755.
Pan, J. Y. (2023). Internet-Based Cognitive Behavioral Therapy and Virtual Reality Exposure Therapy for Social Anxiety Disorder: Protocol for a Randomized Controlled Trial in Hong Kong. JMIR Research Protocols, 12(1), e48437.
Saleh, N. M. M., Sarim, H. M., & Noor, S. F. M. (2023). Game based implementation of Cognitive Behavioral Therapy for introspective treatment of Social Anxiety Disorder. Geografia-Malaysian Journal of Society and Space, 19(2), 102-118.
Sanderson, W. C., Arunagiri, V., Funk, A. P., Ginsburg, K. L., Krychiw, J. K., Limowski, A. R., Olesnycky, O. S., & Stout, Z. (2020). The Nature and Treatment of Pandemic-Related Psychological Distress. Journal of contemporary psychotherapy, 50(4), 251–263.
Schittenhelm, J. M., von Borell, C., Clément, C., Schüller, J., Stangier, U., & Hoyer, J. (2023). Evaluation of a smartphone application for self-help for patients with social anxiety disorder: a randomized controlled study—SMASH. Trials, 24(1), 154.
Shin, B., Oh, J., Kim, B. H., Kim, H. E., Kim, H., Kim, S., & Kim, J. J. (2021). Effectiveness of self-guided virtual reality–based cognitive behavioral therapy for panic disorder: randomized controlled trial. JMIR Mental Health, 8(11), e30590.
Silk, J. S., Pramana, G., Sequeira, S. L., Lindhiem, O., Kendall, P. C., Rosen, D., & Parmanto, B. (2020). Using a smartphone app and clinician portal to enhance brief cognitive behavioral therapy for childhood anxiety disorders. Behavior therapy, 51(1), 69-84.
Sriwatanathamma, P., Sirivesmas, V., Simatrang, S., & Bhowmik, N. H. (2023). Gamifying Cognitive Behavioral Therapy Techniques on Smartphones for Bangkok’s Millennials With Depressive Symptoms: Interdisciplinary Game Development. JMIR Serious Games, 11(1), e41638.
Stefaniak, I., Hanusz, K., Mierzejewski, P., Bieńkowski, P., Parnowski, T., & Murawiec, S. (2022). Preliminary study of efficacy and safety of self-administered virtual exposure therapy for social anxiety disorder vs. cognitive-behavioral therapy. Brain Sciences, 12(9), 1236.
Thabrew, H., Stasiak, K., Kumar, H., Naseem, T., Frampton, C., & Merry, S. (2021). A cognitive behavioral Therapy–, Biofeedback-, and game-based eHealth intervention to treat anxiety in children and Young People with Long-Term Physical Conditions (Starship Rescue): Co-design and Open Trial. JMIR Serious Games. 9(3), e26084.
Thew, G. R., Kwok, A. P., Chan, M. H. L., Powell, C. L., Wild, J., Leung, P. W., & Clark, D. M. (2022). Internet-delivered cognitive therapy for social anxiety disorder in Hong Kong: A randomized controlled trial. Internet Interventions, 28, 100539.
Valls-Ratés, Ï., Niebuhr, O., & Prieto, P. (2023). Encouraging participant embodiment during VR-assisted public speaking training improves persuasiveness and charisma and reduces anxiety in secondary school students. Frontiers in Virtual Reality, 2023(4), 1-18.
Zainal, N. H., Chan, W. W., Saxena, A. P., Taylor, C. B., & Newman, M. G. (2021). Pilot randomized trial of self-guided virtual reality exposure therapy for social anxiety disorder. Behaviour research and therapy, 147, 103984.
Zhang, W., Paudel, D., Shi, R., Liang, J., Liu, J., Zeng, X., Zhou, Y., & Zhang, B. (2020). Virtual Reality Exposure Therapy (VRET) for Anxiety Due to Fear of COVID-19 Infection: A Case Series. Neuropsychiatric disease and treatment. 16. 2669–2675. https://doi.org/10.2147/NDT.S276203.