Alteration of resting-state functional connectivity network properties in patients with social anxiety disorder after virtual reality-based self-training

The Effectiveness of Immersive Virtual Reality-Based Treatment for Mental Disorders: A Systematic Review With Meta-Analysis

BACKGROUND

The increasing number of studies of immersive virtual reality (VR) interventions for mental disorders call for an examination of the current level of evidence on their effectiveness. The findings may guide scalability and contribute to the advancement and optimization of immersive VR-based interventions for mental disorders.

METHODS

A systematic literature search across four databases screened 2443 studies. Outcomes were disorder-specific symptoms, cognition, function, and quality of life. The study is registered on PROSPERO (CRD42023465845) and follows the reporting standards outlined in the PRISMA guidelines.

RESULTS

Fifty-five studies involving a total of 3031 participants covering 10 mental disorders were included in the analysis. VR interventions demonstrated statistically significant effects of post-treatment compared to active control conditions for alcohol use disorder (reduced state anxiety, g = 0.89, 95% CI[0.24, 1.55]) and schizophrenia spectrum disorders (reduced psychotic symptoms, g = 0.37, 95% CI[0.04, 0.70]). Compared to passive control conditions, statistically significant effects of VR interventions were observed for panic and agoraphobia (g = 1.28, 95% CI [0.47, 2.10]), social anxiety disorder (g = 0.83, 95% CI [0.49, 1.17]), specific phobias (g = 1.07, 95% CI[0.22, 1.92]), depression symptoms in PTSD (g = 0.67, 95% CI [0.22;1.13]). In contrast, no significant differences were found between VR interventions and active control conditions for functioning and quality of life in schizophrenia spectrum disorder and panic or agoraphobia. No meta-analyses were conducted on cognition due to insufficient data. Over 50% of the included studies were assessed as having a high risk of bias. According to the GRADE assessment, evidence for VR-based interventions across various mental disorders was generally of low to very low certainty, with a few exceptions rated as moderate certainty.

CONCLUSION

VR interventions may potentially have benefits, particularly when compared to passive control conditions, however, the evidence remains uncertain necessitating more large-scale, methodologically robust studies. Current findings can thus only be considered indicative. Recommendations on future directions of the VR field are discussed.

The efficacy of psychotherapy for social anxiety disorder, a systematic review and meta-analysis

BACKGROUND

Given the growth in research examining the effects of psychotherapy on social anxiety disorder (SAD), an up-to-date comprehensive meta-analysis in this field is needed.

METHODS

We selected studies from a database of randomized trials (RCTs) on psychotherapies for anxiety disorders (last updated search of PubMed, PsycINFO, Embase, and Cochrane (CENTRAL): 1 January 2024) We included RCTs comparing psychotherapy to a control condition for adults with SAD and conducted random effects meta-analyses to examine the efficacy of psychotherapy compared to control conditions at post-treatment.

RESULTS

Sixty-six RCTs were included with 5560 participants and 98 comparisons between psychotherapy and control groups. Psychotherapy was effective in reducing SAD symptoms, with a large effect size (g = 0.88; 95 % CI: 0.76 to 1.0; I2 = 74 %; 95 % CI: 69 to 79, NNT = 3.8). Effects remained robust across sensitivity analyses. However, there was evidence for significant risk of bias in the included trials. The multivariable meta-regression indicated significant differences in treatment delivery formats, type of recruitment strategy, target group, and number of sessions.

CONCLUSION

Psychotherapy is an effective treatment for SAD, with moderate to large effect sizes across all treatment types and formats. Future research is needed to determine the long-term effects.

Individual cognitive therapy reduces frontal-thalamic resting-state functional connectivity in social anxiety disorder

Introduction

Previous neuroimaging studies in social anxiety disorders (SAD) have reported potential neural predictors of cognitive behavioral therapy (CBT)-related brain changes. However, several meta-analyses have demonstrated that cognitive therapy (CT) was superior to traditional exposure-based CBT for SAD.

Objective

To explore resting-state functional connectivity (rsFC) to evaluate the response to individual CT for SAD patients.

Methods

Twenty SAD patients who attended 16-week individual CT were scanned pre- and post-therapy along with twenty healthy controls (HCs). The severity of social anxiety was assessed with the Liebowitz Social Anxiety Scale (LSAS). Multi-voxel pattern analysis (MVPA) was performed on the pre-CT data to extract regions associated with a change in LSAS (∆LSAS). Group comparisons of the seed-based rsFC analysis were performed between the HCs and pre-CT patients and between the pre-and post-CT patients.

Results

MVPA-based regression analysis revealed that rsFC between the left thalamus and the frontal pole/inferior frontal gyrus was significantly correlated with ∆LSAS (adjusted R2 = 0.65; p = 0.00002). Compared with HCs, the pre-CT patients had higher rsFCs between the thalamus and temporal pole and between the thalamus and superior/middle temporal gyrus/planum temporale (p < 0.05). The rsFC between the thalamus and the frontal pole decreased post-CT (p < 0.05).

Conclusion

SAD patients had significant rsFC between the thalamus and temporal pole, superior/middle temporal gyrus, and planum temporale, which may be indicators of extreme anxiety in social situations. In addition, rsFC between the thalamus and the frontal pole may be a neuromarker for the effectiveness of individual CT.

A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression

This systematic review aims to assess the effectiveness of virtual reality (VR) and gamification interventions in addressing anxiety and depression. The review also seeks to identify gaps in the current VR treatment landscape and provide guidelines for future research and development. A systematic literature search was conducted using Scopus, Web of Science, and PubMed databases, focusing on studies that utilized VR and gamification technology to address anxiety and depression disorders. A total of 2,664 studies were initially identified, 15 of those studies fulfilled the inclusion criteria for this systematic review. The efficacy of VR in addressing anxiety and depression was evident across all included studies. However, the diversity among VR interventions highlights the need for further investigation. It is advised to incorporate more diverse participant samples and larger cohorts and explore a broader spectrum of therapeutic approaches within VR interventions for addressing anxiety and depression to enhance the credibility of future research. Additionally, conducting studies in varying socioeconomic contexts would contribute to a more comprehensive understanding of their real-world applicability.