臺灣博碩士論文加值系統

背景：全球焦慮症患者增加了26%，台灣的就診人數也逐年上升，對個體和社會健康產生嚴重影響。虛擬現實暴露療法（VRET）已有臨床成效。過去因為相關的統合分析中包括未被診斷為焦慮或相關障礙症的參與者的研究，在過去VRET的整體效果不太清楚整。
目的：探討虛擬現實暴露療法對焦慮相關疾患及創傷後壓力症候群病人的焦慮、恐懼、行為、創傷後壓力症候群之成效。
方法：研究的目的是以系統性文獻回顧和統合分析，特別是在焦慮、恐懼、行為和創傷後壓力症候群症狀緩解方面，搜尋以VRET為介入措施的隨機臨床研究文獻，以考科藍文獻評讀工具第二版（Cochrane risk of bias tool 〔RoB〕2.0）評讀文獻，以CMA 3.0進行統合分析，森林圖來呈現合併結果，檢測樣本間的異質性，檢測敏感性分析，進而做次群組分析，最後由漏斗圖的對稱性評估是否有出版偏差。
結果：共納入24篇文章，結果顯示VRET對焦慮相關疾患及創傷後壓力症候群病人的焦慮、恐懼、行為、創傷後壓力症候群有顯著效果量。在主要結果指標為焦慮，焦慮效果量為-0.514（95% CI: -0.741~-0.287, p<0.001），次要結果指標為恐懼、行為、創傷後壓力症候群，恐懼效果量為-0.91（95% CI: -1.36~-0.47, p<0.001），趨近行為效果量為0.62（95% CI: 0.11~1.12, p=0.016），迴避行為效果量為-1.301（95% CI: -2.61~-0.00, p=0.049），創傷壓力症候群效果量為-0.46（95% CI: -0.63~-0.29, p<0.001），針對焦慮進行調節變相分析，發現每次介入時間小於等於50分鐘，效果量較大（p=0.015）。
結論：本研究結果顯示，虛擬現實暴露治療，減少焦慮症狀方面成效顯著，在減少恐懼、趨避行為效果更大。然而，由於設備性能的限制，治療效果隨時間可能會減弱，因此需要更多使用先進虛擬現實設備的隨機對照試驗來進一步驗證。未來研究建議包括：減少暈動症發生、增加樣本量、統一研究設計和多樣化參與者樣本，以提高研究結果的代表性和穩定性，並檢驗治療法在不同人群中的適用性和有效性。

Background: The global prevalence of anxiety disorders has increased by 26%, with a corresponding rise in treatment-seeking patients in Taiwan, significantly impacting individual and societal health. While Virtual Reality Exposure Therapy (VRET) has demonstrated clinical effectiveness, the overall efficacy remains unclear due to previous meta-analyses including participants without diagnosed anxiety or related disorders.
Objective: To investigate the effectiveness of Virtual Reality Exposure Therapy on anxiety, Phobia, behavior, and Post-Traumatic Stress Disorder (PTSD) symptoms in patients with anxiety-related disorders and PTSD.
Methods: The aim of this study was to conduct a systematic literature review and meta-analysis, particularly focusing on the relief of anxiety, Phobia, behavior, and PTSD symptoms. Randomized clinical trial literature using VRET as an intervention measure and assessing the aforementioned outcome indicators were searched. The Cochrane Risk of Bias Tool (RoB) 2.0 was used for literature assessment, and Comprehensive Meta-Analysis (CMA) 3.0 was used for meta-analysis. A forest plot was used to present the combined results, heterogeneity between samples was examined, sensitivity analysis was conducted, subgroup analysis was considered, and the symmetry of the funnel plot was used to assess publication bias.
Results: A total of 24 articles were included, and the results showed that VRET had significant effect sizes on anxiety, Phobia, behavior, and PTSD in patients with anxiety-related disorders and PTSD. The main outcome indicator was anxiety, with an effect size of -0.51 (95% CI: -0.74~-0.29, p<0.001). Secondary outcome indicators were phobia, behavior, and PTSD, with effect sizes of -0.91 (95% CI: -1.36~-0.47, p<0.001) for phobia, 0.62 (95% CI: 0.11~1.12, p=0.016) for approach behavior, -1.31 (95% CI: -2.61~ -0.00, p=0.049) for avoidance behavior, and -0.46 (95% CI: -0.63~-0.29, p<0.001) for PTSD. Moderation analysis for anxiety revealed that shorter intervention times (≤50 minutes) were associated with larger effect sizes (p=0.015).
Conclusion: The study demonstrates that Virtual Reality Exposure Therapy (VRET) effectively reduces anxiety symptoms and is particularly effective for phobias and approach-avoidance behaviors. However, equipment performance limitations may reduce therapeutic effects over time. Therefore, advanced virtual reality equipment should be used in further randomized controlled trials to validate these findings. Future research should focus on minimizing motion sickness, increasing sample sizes, standardizing study designs, and diversifying participant samples to enhance the representativeness and stability of results and to assess the therapy's applicability across different populations.

致謝Ⅰ
中文摘要ⅡI
英文摘要V
目錄VII
圖表目次
圖目次IX
表目次X
第一章緒論
第一節研究動機及重要性1
第二節過去研究的缺口2
第三節研究目的2
第四節研究問題2
第二章文獻查證
第一節焦慮相關疾患及創傷後壓力症候群之盛行率、診斷及症狀3
第二節焦慮相關疾患及創傷後壓力症候群之相關理論7
第三節焦慮相關疾患及創傷後壓力症候群之治療11
第四節虛擬現實暴露療法14
第五節虛擬現實暴露療法改善焦慮相關疾患及創傷後壓力症候群之相關研究分析23
第三章 研究方法
第一節名詞界定25
第二節研究設計29
第三節文獻之納入條件與排除條件29
第四節文獻檢索30
第五節文獻選擇與資料蒐集33
第六節文獻品質評讀33
第七節統計分析34
第四章研究結果
第一節資料檢索36
第二節基本特性36
第三節文章品質評析37
第四節統合分析結果51
第五章討論
第一節虛擬現實暴露治療法在焦慮之成效62
第二節虛擬現實暴露治療法在恐懼之成效64
第三節虛擬現實暴露治療法在趨近行為之成效65
第四節虛擬現實暴露治療法在迴避行為之成效66
第五節虛擬現實暴露治療法在創傷壓力症候群之成效68
第六章結論69
參考資料70
表目次
表4.1納入文獻特性38
表4.2納入隨機臨床試驗文章之試驗品質評估（偏誤風險評估）（N=24）50
表4.3出版偏差58
表4.4焦慮之次群組分析及Meta regression59
表4.5恐懼之次群組分析及Meta regression60
圖目次
圖 4.1統合分析納入文章流程圖37
圖 4.2虛擬現實暴露治療法對焦慮之森林圖52
圖 4.3虛擬現實暴露治療法對焦慮之出版偏差圖52
圖 4.4虛擬現實暴露治療法對恐懼之森林圖53
圖 4.5虛擬現實暴露治療法對恐懼之出版偏差圖53
圖 4.6虛擬現實暴露治療法對趨近行為之森林圖54
圖 4.7虛擬現實暴露治療法對趨近行為之出版偏差圖54
圖 4.8虛擬現實暴露治療法對迴避行為之森林圖55
圖 4.9虛擬現實暴露治療法對迴避行為之出版偏差圖55
圖 4.10虛擬現實暴露治療法對創傷壓力症候群之森林圖56
圖 4.11虛擬現實暴露治療法對創傷壓力症候群之出版偏差圖56

衛生福利部（2024）．衛生類性別統計指標，每千人精神疾病門診件數-按縣市別、疾病別(第10版)。https://www.gender.ey.gov.tw/gecdb/Stat_Statistics_DetailData.aspx?sn=nEjQfb3jDFmLyLwlriuA6Q%40%40&d=194q2o4!otzoYO!8OAMYew%40%40
Anderson, P. L., Price, M., Edwards, S. M., Obasaju, M. A., Schmertz, S. K., Zimand, E., & Calamaras, M. R. (2013). Virtual reality exposure therapy for social anxiety disorder: a randomized controlled trial. Journal of consulting and clinical psychology, 81(5), 751. https://doi.org/10.1037/a0033559
American Psychiatric Association. (2013). American Psychiatric Association: Diagnosti c and Statistical Manual of Mental Disorders, Arlington.
Botella, C., Pérez-Ara, M. Á., Bretón-López, J., Quero, S., García-Palacios, A., & Baños, R. M. (2016). In vivo versus augmented reality exposure in the treatment of small animal phobia: a randomized controlled trial. PloS one, 11(2), e0148237. https://doi.org/10.1371/journal.pone.0148237
Bouchard, S., Robillard, G., Larouche, S., & Loranger, C. (2012). Description of a treatment manual for in virtuo exposure with specific phobia. Virtual reality in psychological, medical and pedagogical applications, 82-108. https://doi.org/10.5772/46417
Bourassa, K. J., Smolenski, D. J., Edwards-Stewart, A., Campbell, S. B., Reger, G. M., & Norr, A. M. (2020). The impact of prolonged exposure therapy on social support and PTSD symptoms. Journal of affective disorders, 260, 410-417. https://doi.org/10.1016/j.jad.2019.09.036
Carl, E., Stein, A. T., Levihn-Coon, A., Pogue, J. R., Rothbaum, B., Emmelkamp, P., ... & Powers, M. B. (2019). Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials. Journal of anxiety disorders, 61, 27-36. https://doi.org/10.1016/j.janxdis.2018.08.003
Craske, M. G., Stein, M. B. (2016). Anxiety. The Lancet, 388(10063), 3048-3059. https://doi.org/10.1016/S0140-6736(16)30381-6
Deng, W., Hu, D., Xu, S., Liu, X., Zhao, J., Chen, Q., ... & Li, X. (2019). The efficacy of virtual reality exposure therapy for PTSD symptoms: A systematic review and meta-analysis. Journal of affective disorders, 257, 698-709. https://doi.org/10.1016/j.jad.2019.07.086
Eaton, W. W., Bienvenu, O. J., & Miloyan, B. (2018). Specific phobias. The Lancet Psychiatry, 5(8), 678-686. https://doi.org/10.1016/S2215-0366(18)30169-X
Emmelkamp, P. M., Krijn, M., Hulsbosch, A. M., De Vries, S., Schuemie, M. J., & van der Mast, C. A. (2002). Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia. Behaviour research and therapy, 40(5), 509-516. https://doi.org/10.1016/S0005-7967(01)00023-7
Freeman, D., Haselton, P., Freeman, J., Spanlang, B., Kishore, S., Albery, E., ... & Nickless, A. (2018). Automated psychological therapy using immersive virtual reality for treatment of fear of heights: a single-blind, parallel-group, randomised controlled trial. The Lancet Psychiatry, 5(8), 625-632. http://dx.doi.org/10.1016/S2215-0366(18)30226-8
Freitas, J. R. S., Velosa, V. H. S., Abreu, L. T. N., Jardim, R. L., Santos, J. A. V., Peres, B., & Campos, P. F. (2021). Virtual reality exposure treatment in phobias: a systematic review. Psychiatric Quarterly, 92(4), 1685-1710. https://doi.org/10.1007/s11126-021-09935-6
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: exposure to corrective information. Psychological bulletin, 99(1), 20. https://doi.org/10.1037/0033-2909.99.1.20
Gamito, P., Oliveira, J., Rosa, P., Morais, D., Duarte, N., Oliveira, S., & Saraiva, T. (2010). PTSD elderly war veterans: A clinical controlled pilot study. Cyberpsychology, Behavior, and Social Networking, 13(1), 43-48. https://doi.org/10.1089/cyber.2009.0237
Garcia-Palacios, A., Hoffman, H., Carlin, A., Furness III, T. A., & Botella, C. (2002). Virtual reality in the treatment of spider phobia: a controlled study. Behaviour research and therapy, 40(9), 983-993. https://doi.org/10.1016/S0005-7967(01)00068-7
Gujjar, K. R., van Wijk, A., Kumar, R., & de Jongh, A. (2019). Efficacy of virtual reality exposure therapy for the treatment of dental phobia in adults: A randomized controlled trial. Journal of anxiety disorders, 62, 100-108. https://doi.org/10.1016/j.janxdis.2018.12.001
Hall, R. J., Miller, J. W. ,. (1963). Head mounted electrocular display: a new display concept for specialized environments. Aerospace Medicine, 34, 316-318.
Heo, S., & Park, J. H. (2022). Effects of virtual reality-based graded exposure therapy on PTSD symptoms: a systematic review and meta-analysis. International journal of environmental research and public health, 19(23), 15911. https://doi.org/10.3390/ijerph192315911
Hao, J., Xie, H., Harp, K., Chen, Z., & Siu, K. C. (2022). Effects of virtual reality intervention on neural plasticity in stroke rehabilitation: a systematic review. Archives of Physical Medicine and Rehabilitation, 103(3), 523-541. https://doi.org/10.1016/j.apmr.2021.06.024
Jiang, M. Y., Upton, E., & Newby, J. M. (2020). A randomised wait-list controlled pilot trial of one-session virtual reality exposure therapy for blood-injection-injury phobias. Journal of Affective Disorders, 276, 636-645. https://doi.org/10.1016/j.jad.2020.07.076
Kampmann, I. L., Emmelkamp, P. M., Hartanto, D., Brinkman, W. P., Zijlstra, B. J., & Morina, N. (2016). Exposure to virtual social interactions in the treatment of social anxiety disorder: A randomized controlled trial. Behaviour research and therapy, 77, 147-156. http://dx.doi.org/10.1016/j.brat.2015.12.016
Katz, A. C., Norr, A. M., Buck, B., Fantelli, E., Edwards-Stewart, A., Koenen-Woods, P., ... & Andrasik, F. (2020). Changes in physiological reactivity in response to the trauma memory during prolonged exposure and virtual reality exposure therapy for posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 12(7), 756. https://doi.org/10.1037/tra0000567
Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., Van Ameringen, M., & Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and McGill University. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC psychiatry, 14, 1-83. https://doi.org/10.1186/1471-244X-14-S1-S1
Knaust, T., Felnhofer, A., Kothgassner, O. D., Höllmer, H., Gorzka, R. J., & Schulz, H. (2020). Virtual trauma interventions for the treatment of post-traumatic stress disorders: a scoping review. Frontiers in Psychology, 11, 2877. https://doi.org/10.3389/fpsyg.2020.562506
Kourtesis, P., Papadopoulou, A., & Roussos, P. (2023). Cybersickness in Virtual Reality: The Role of Individual Differences, Effects on Cognitive Functions &Amp; Motor Skills, and Intensity Differences during and after Immersion. https://doi.org/10.3390/virtualworlds3010004
Lang, P. J., & Lazovik, A. D. (1963). Experimental desensitization of phobia. The Journal of Abnormal and Social Psychology, 66(6), 519-525. https://doi.org/10.1037/h0039828
Leppink, J., O’Sullivan, P., & Winston, K. (2016). Effect size–large, medium, and small. Perspectives on medical education, 5, 347-349. https://doi.org/10.1007/s40037-016-0308-y
Maltby, N., Kirsch, I., Mayers, M., & Allen, G. J. (2002). Virtual reality exposure therapy for the treatment of fear of flying: a controlled investigation. Journal of consulting and clinical psychology, 70(5), 1112. https://doi.org/10.1037//0022-006X.70.5.1112
McGlynn, F. D., Mealiea Jr, W. L., & Landau, D. L. (1981). The current status of systematic desensitization. Clinical Psychology Review, 1(2), 149-179. https://doi.org/10.1016/0272-7358(81)90001-5
McLay, R. N., Baird, A., Webb-Murphy, J., Deal, W., Tran, L., Anson, H., ... & Johnston, S. (2017). A randomized, head-to-head study of virtual reality exposure therapy for posttraumatic stress disorder. Cyberpsychology, Behavior, and Social Networking, 20(4), 218-224. https://doi.org/10.1089/cyber.2016.0554
McLay, R. N., Wood, D. P., Webb-Murphy, J. A., Spira, J. L., Wiederhold, M. D., Pyne, J. M., & Wiederhold, B. K. (2011). A randomized, controlled trial of virtual reality-graded exposure therapy for post-traumatic stress disorder in active duty service members with combat-related post-traumatic stress disorder. Cyberpsychology, behavior, and social networking, 14(4), 223-229. https://doi.org/10.1089/cyber.2011.0003
McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. Journal of psychiatric research, 45(8), 1027-1035 https://doi.org/10.1016/j.jpsychires.2011.03.006
Michaliszyn, D., Marchand, A., Bouchard, S., Martel, M. O., & Poirier-Bisson, J. (2010). A randomized, controlled clinical trial of in virtuo and in vivo exposure for spider phobia. Cyberpsychology, Behavior, and Social Networking, 13(6), 689-695. https://doi.org/10.1089/cyber.2009.0277
Miloff, A., Lindner, P., Dafgard, P., Deak, S., Garke, M., Hamilton, W., ... & Carlbring, P. (2019). Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: A randomized non-inferiority trial. Behaviour research and therapy, 118, 130-140. https://doi.org/10.1016/j.brat.2019.04.004
Morina, N., Kampmann, I., Emmelkamp, P., Barbui, C., & Hoppen, T. H. (2023). Meta-analysis of virtual reality exposure therapy for social anxiety disorder. Psychological Medicine, 53(5), 2176-2178. https://doi.org/10.1017/S0033291721001690
Mowrer, O. (1947). On the dual nature of learning—a reinterpretation of" conditioning" and" problem-solving.". Harvard educational review. 17(2), 102-148.
National Institute of Mental Health. (2024). Agoraphobia (Touchpoints OMB Approval #0925-0648). https://www.nimh.nih.gov/health/statistics/agoraphobia
National Institute of Mental Health. (2024). Social Anxiety Disorder (Touchpoints OMB Approval #0925-0648). https://www.nimh.nih.gov/health/statistics/social-anxiety-disorder
National Institute of Mental Health. (2024). Specific Phobia (Touchpoints OMB Approval #0925-0648). https://www.nimh.nih.gov/health/statistics/specific-phobia#part_2636
North, M. M., North, S. M., & Coble, J. R. (1997). Virtual reality therapy: an effective treatment for psychological disorders. Virtual reality in neuro-psycho-physiology, 59-70 https://doi.org/10.3233/978-1-60750-888-5-59
Pelissolo, A., Zaoui, M., Aguayo, G., Yao, S. N., Roche, S., Ecochard, R., ... & Cottraux, J. (2012). Virtual reality exposure therapy versus cognitive behavior therapy for panic disorder with agoraphobia: a randomized comparison study. J Cyber Ther Rehabil, 5(1), 35-43. https://doi.org/10.3389/conf.neuro.14.2009.06.082
Powers, M. B., & Emmelkamp, P. M. (2008). Virtual reality exposure therapy for anxiety disorders: A meta-analysis. Journal of anxiety disorders, 22(3), 561-569. https://doi.org/10.1016/j.janxdis.2007.04.006
Ramaseri Chandra, A. N., El Jamiy, F., & Reza, H. (2022). A systematic survey on cybersickness in virtual environments. Computers, 11(4), 51. https://doi.org/10.3390/computers11040051
Ready, D. J., Gerardi, R. J., Backscheider, A. G., Mascaro, N., & Rothbaum, B. O. (2010). Comparing virtual reality exposure therapy to present-centered therapy with 11 US Vietnam veterans with PTSD. Cyberpsychology, Behavior, and Social Networking, 13(1), 49-54. https://doi.org/10.1089/cyber.2009.0239
Reeves, R., Elliott, A., Curran, D., Dyer, K., & Hanna, D. (2021). 360 Video virtual reality exposure therapy for public speaking anxiety: A randomized controlled trial. Journal of Anxiety Disorders, 83, 102451. https://doi.org/10.1016/j.janxdis.2021.102451
Reger, G. M., Koenen-Woods, P., Zetocha, K., Smolenski, D. J., Holloway, K. M., Rothbaum, B. O., ... & Gahm, G. A. (2016). Randomized controlled trial of prolonged exposure using imaginal exposure vs. virtual reality exposure in active duty soldiers with deployment-related posttraumatic stress disorder (PTSD). Journal of consulting and clinical psychology, 84(11), 946. https://doi.org/10.1037/ccp0000134
Repetto, C., Gaggioli, A., Pallavicini, F., Cipresso, P., Raspelli, S., & Riva, G. (2013). Virtual reality and mobile phones in the treatment of generalized anxiety disorders: a phase-2 clinical trial. Personal and Ubiquitous Computing, 17, 253-260. https://doi.org/10.1007/s00779-011-0467-0
Rothbaum, B. O., Hodges, L. F., Kooper, R., Opdyke, D., Williford, J. S., & North, M. (1995). Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia. The American journal of psychiatry, 152(4), 626-628. https://doi.org/10.1176/ajp.152.4.626
Rothbaum, B. O., Anderson, P., Zimand, E., Hodges, L., Lang, D., & Wilson, J. (2006). Virtual reality exposure therapy and standard (in vivo) exposure therapy in the treatment of fear of flying. Behavior therapy, 37(1), 80-90. https://doi.org/10.1016/j.beth.2005.04.004
Rus-Calafell, M., Gutiérrez-Maldonado, J., Botella, C., & Baños, R. M. (2013). Virtual reality exposure and imaginal exposure in the treatment of fear of flying: a pilot study. Behavior modification, 37(4), 568-590. https://doi.org/10.1177/0145445513482969
Schröder, D., Wrona, K. J., Müller, F., Heinemann, S., Fischer, F., & Dockweiler, C. (2023). Impact of virtual reality applications in the treatment of anxiety disorders: A systematic review and meta-analysis of randomized-controlled trials. Journal of Behavior Therapy and Experimental Psychiatry, 101893. https://doi.org/10.1016/j.jbtep.2023.101893
Shalev, A., Liberzon, I., & Marmar, C. (2017). Post-traumatic stress disorder. New England journal of medicine, 376(25), 2459-2469. https://doi.org/10.1056/NEJMra1612499
Stein, B. M., Goin, K. M, Pollack, H. M, et al. (2009). Practice Guideline for the Treatment of Patients with Panic Disorder (2nd ed.). American Psychiatric Association (APA) https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/panicdisorder.pdf
Slavin-Mulford, J., & Hilsenroth, M. J. (2012). Evidence-based psychodynamic treatments for anxiety disorders: A review. Psychodynamic psychotherapy research: Evidence-based practice and practice-based evidence, 117-137. https://doi.org/10.1007/978-1-60761-792-1_7
Szuhany, K. L., & Simon, N. M. (2022). Anxiety disorders: a review. Jama, 328(24), 2431-2445. https://doi.org/ 10.1001/jama.2022.22744
Takac, M., Collett, J., Conduit, R., & De Foe, A. (2023). A cognitive model for emotional regulation in virtual reality exposure. Virtual Reality, 27(1), 159-172. https://doi.org/10.1007/s10055-021-00531-4
Treanor, M., Staples-Bradley, L. K., & Craske, M. G. (2015). Learning Theory and Cognitive Behavioral Therapy. Primer on anxiety disorders: Translational perspectives on diagnosis and treatment, 355-366. https://doi.org/10.1093/med/9780199395125.003.0025
Turner, S. M. (Ed.). (2012). Behavioral theories and treatment of anxiety. Springer Science & Business Media.
van den Berg, D. P., de Bont, P. A., van der Vleugel, B. M., de Roos, C., de Jongh, A., Van Minnen, A., & van der Gaag, M. (2015). Prolonged exposure vs eye movement desensitization and reprocessing vs waiting list for posttraumatic stress disorder in patients with a psychotic disorder: a randomized clinical trial. JAMA psychiatry, 72(3), 259-267. https://doi.org/10.1001/jamapsychiatry.2014.2637
van Gelderen, M. J., Nijdam, M. J., Haagen, J. F., & Vermetten, E. (2020). Interactive motion-assisted exposure therapy for veterans with treatment-resistant posttraumatic stress disorder: a randomized controlled trial. Psychotherapy and psychosomatics, 89(4), 215-227. https://doi.org/10.1159/000505977
Warner, C. H., Warner, C. M., Appenzeller, G. N., & Hoge, C. W. (2013). Identifying and managing posttraumatic stress disorder. American family physician, 88(12), 827-834.
Wolpe, J. (1954). Reciprocal inhibition as the main basis of psychotherapeutic effects. AMA Archives of Neurology & Psychiatry, 72(2), 205-226. https://doi.org/10.1001/archneurpsyc.1954.02330020073007
World Health Organization. (2022). Director-General's report to Member States at the 75th World Health Assembly – 23 May 2022. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-address-at-the-75th-world-health-assembly---23-may-2022
World Health Organization. (2023). Anxiety disorders [Fact sheet]. Retrieved from https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders
Wong, K. P., Lai, C. Y. Y., & Qin, J. (2023). Systematic review and meta-analysis of randomised controlled trials for evaluating the effectiveness of virtual reality therapy for social anxiety disorder. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2023.04.043
Yang, X., Fang, Y., Chen, H., Zhang, T., Yin, X., Man, J., ... & Lu, M. (2021). Global, regional and national burden of anxiety disorders from 1990 to 2019: results from the Global Burden of Disease Study 2019. Epidemiology and psychiatric sciences, 30, e36. https://doi.org/10.1017/S2045796021000275
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. https://doi.org/10.1016/j.brat.2021.103984
Zimmer, A., Wang, N., Ibach, M. K., Fehlmann, B., Schicktanz, N. S., Bentz, D., ... & de Quervain, D. J. (2021). Effectiveness of a smartphone-based, augmented reality exposure app to reduce fear of spiders in real-life: A randomized controlled trial. Journal of anxiety disorders, 82, 102442. https://doi.org/10.1016/j.janxdis.2021.102442