35

Psicologia:TeoriaePesquisa
JanMar2010,Vol.26n.1,pp.3542
ExposioporRealidadeVirtualnoTratamentodoMedodeDirigir
1
RafaelThomazdaCosta
2
MarceleReginedeCarvalho
AntonioEgidioNardi
UniversidadeFederaldoRiodeJaneiro
InstitutoNacionaldeCinciaeTecnologiaTranslationalMedicine(CNPq)
RESUMOUmcrescentenmerodepesquisastmsurgidosobreaaplicaodaterapiadeexposioporrealidadevirtual
(VRET) para transtornos ansiosos. O obietivo deste estudo Ioi revisar as evidncias que apoiam a efcacia da VRET para tratar
Iobia de dirigir. Os estudos Ioram identifcados por meio de buscas computadorizadas (PubMed/Medline. Web oI Science e
Scielo databases) no periodo de 1984 a 2007. Alguns achados so promissores. Indices de ansiedade/evitaco cairam entre o
inicio e o fm do tratamento. VRET poderia ser um primeiro passo no tratamento da Iobia de dirigir. uma vez que pode Iacilitar
a exposico ao vivo. evitando-se os riscos e elevados custos dessa exposico. Entretanto. mais estudos clinicos randomizados/
controlados so necessarios para comprovar sua efcacia.
Palavraschave:revisorealidadevirtualfobiadedirigir.
VirtualRealityExposureTherapyintheTreatmentofDrivingPhobia
ABSTRACTAgrowingnumberofresearcheshasappearedonvirtualrealityexposuretherapy(VRET)totreatanxiety
disorders. The purpose oI this article was to review the evidences that support the VRET eIfcacy to treat driving phobia. The
studies were identifed through computerized search (PubMed/Medline. Web oI Science. and Scielo databases) Irom 1984 to
2007. Some fndings are promising. Anxiety/avoidance ratings declined Irom pre to post-treatment. VRET may be used as a
frst step in the treatment oI driving phobia. as long as it may Iacilitate the invivo exposure. thus reducing risks and high costs
oI such exposure. Notwithstanding. more randomized/controlled clinical trials are required to prove its eIfcacy.
Keywords:reviewvirtualrealitydrivingphobia.
1 Este trabalho recebeu o apoio do Conselho Brasileiro de Desenvolvi-
mento Cientifco e Tecnologico (CNPq). Processo: 554411/2005-9. e
do Instituto Nacional de Cincia e Tecnologia - Translational Medicine
- INCT-TM (CNPq).
2 Endereco para correspondncia: Instituto de Psiquiatria. Universidade
Federal do Rio de Janeiro. R. da Matriz. 336/201. Centro. So Joo
de Meriti. RJ. CEP 25520-640. Tel: (21) 2756-0965 / (21) 9509-4461.
Email:faelthomaz@ig.com.br.
Driving is a skill that Irequently Iacilitates the mainte-
nance oI independence and mobility. and enables contact
with a wide variety oI important activities (Taylor. Deane &
Podd. 2002).

Driving phobia is a serious social and personal

issue. This Iear-related avoidance has serious consequences
such a restriction oI Ireedom. career impairments and social
embarrassment (Ku. Jang. Lee. Lee. Kim & Kim. 2002).
Driving phobia is defned as a specifc phobia. situational
type. in the DSM-IV (APA. 1994). It is characterized by
intense. persistent Iear oI driving. which increases as the
individual anticipates. or is exposed to driving stimuli. People
withdrivingphobiarecognizethattheirfearsareexcessive
or unreasonable. However. they are either unable to drive or
tolerate driving with considerable distress (Wald & Taylor.
2000). Driving phobia does not typically decrease or beco-
messpontaneouslyasymptomaticwithouttreatmentandcan
become chronic (Mayou. Tyndel & Bryant. 1997; Taylor &
Deane. 1999; Wald & Taylor. 2003). This specifc phobia
typically occurs in young to middle adult Iemales (Ehlers.
HoImann. Herda & Roth. 1994; Taylor & Deane. 1999).
The maiority oI research points to post-traumatic stress
disorder (typically related to motor-vehicle accident invol-
vement). panic disorder. or agoraphobia as the psychiatric
disorders most commonly associated with driving phobia
(Taylor & Deane. 1999; Taylor & Deane. 2000). Ehlers et al.
(1994) and Herda. Ehlers and Roth (1993) add social phobia
asacontributingfactoroffearofdriving.
People with Iear oI driving oIten engage in maladaptive
safety behaviors in an attempt to protect themselves from
unpredicted dangers when driving (Antony. Craske & Bar-
low. 1995; Taylor. Deane & Podd. 2007).

About one-fIth oI
accidentsurvivorsdevelopacutestressreactionoutofthis
subgroup. 10 go on to develop a mood disorder. and 20
develop phobic travel anxiety. with 11 developing post-
traumatic stress disorder (Mayou et al.. 1997).
DrivingPhobia
Some controversies lie upon categorizing Iear oI driving.
and some diagnosis as panic disorder. agoraphobia. posttrau-
matic stress disorder. social phobia are considered to be part
oI the driving phobia (Lewis & Walshe. 2005). Although
driving phobia is defned as a specifc phobia in the DSM-
IV (APA. 1994). Blanchard and Hickling (1997) point out
some problems with classifcation: (a) anxiety may be better
accountedforbyanothermentaldisorder(b)anxietymay
not invariably provoke an immediate anxiety response; (c)
36 Psic.: Teor. e Pesq.. Brasilia. Jan-Mar 2010. Vol. 26 n. 1. pp. 35-42
R.T.Costa&Cols.
there may be times when driving does not evoke the parti-
culartriggersrequiredforaphobicresponseand(d)such
responsemaynotberegardedasfearasmuchasasituation
that elicits anxiety and uncomIortable aIIect (Blanchard &
Hickling. 1997; Taylor & Deane 2000).
Another point oI confict is whether or not Iear oI driving
isconsideredacomponentofwideragoraphobicavoidance.
Some authors show that situational panic attacks experienced
by those with specifc phobia are very similar to those with
agoraphobia (Taylor. Deane & Podd. 2000). Others indicate
that driving phobias can also develop after the individual
experiences an unexpected panic attack in the Ieared situation
(Taylor et al.. 2000). Curtis and Himle (citado por Taylor et
al.. 2000) distinguish specifc phobias and agoraphobia in
termsoffocusofapprehension.Individualswithagoraphobia
have avoidance behaviors because they fear panic and its
consequences (anxiety expectancy). whereas people with
specifc phobia Iear danger (danger expectancy) (Antony
Brown & Barlow. 1997; Taylor et al.. 2000).
The onset oI driving-related Iears is attributed to diIIe-
rent variables. Most Irequently. panic attacks are cited as
the onset oI driving Iears (Taylor et al.. 2000). Other cir-
cumstances correspond to traumatic experience (accidents.
dangerous traIfc situations. being assaulted while driving).
seeing someone else experiencing a traumatic event when
driving. being a generally anxious individual and being
generally aIraid oI high speed (Muniack. 1984; Ehlers et
al.. 1994). Other psychological problems reported in road
trauma include irritability. anger. insomnia. nightmares. and
headaches (Blaszczynski. Gordon. Silove. Sloane. Hilman
& Panasetis. 1998).
Interestingly. Taylor and Deane (2000) noticed that many
non-motor vehicle accidents (MVA)-onset driving-IearIuls
individuals have Iears oI similar severity as their MVA-onset
driving-IearIul counterparts. In their research. no signifcant
differenceswerefoundbetweenthesegroupsonmeasures
oI physiological and cognitive symptoms. state anxiety.
degree oI interIerence in daily Iunctioning. prior help Irom
a mental health proIessional. and avoidance oI obtaining a
driverslicense.
Themostfeareddrivingsituationcitedbydrivingpho-
bics is MVA (Blanchard. Hickling. Taylor. Loos & Gerardi.
1994; Blanchard. Hickling. Taylor & Loos. 1995). but they
also mention issues oI control (losing control oI the car. not
being in control oI the driving situation. being in control
oI a powerIul vehicle). specifc driving situations (driving
at high speed. at night. in unIamiliar areas. over bridges.
through tunnels. on steep roads. on open roads. merging. and
changing lanes). and the skills required Ior driving (reaction
time. iudgment errors. weather conditions. road conditions)
(Taylor & Deane. 2000; Taylor et al.. 2000; Taylor et al..
2007b). Concerns about anxiety symptoms while driving
may also be present (Wald & Taylor. 2003). Driving in the
companyofsomeonewhocriticizesonesdrivingwasrated
withthehighestscoreofanxietyandavoidanceinTaylorand
Deane`s study (2000). even though it was unclear whether
therespondentratedaperceivedorrealcriticism.
Cognitive errors are likely to increase Ieelings oI vulne-
rability and maintain anxiety and Iear reactions (Taylor et al..
2007). It is suggested that cognitive errors oI driving phobia
mayinvolvethetendencytooverestimatetheamountoffear
thatwillbeenduredinasubjectivelythreateningsituation
(Rachman & Bichard. 1998). In addiction. people with dri-
ving phobia underestimate their own skills and abilities and
those oI other drivers. As a result. they experience increased
anticipatory anxiety beIore attempting to drive. as well as
avoidance behavior (Koch & Taylor. 1995; Taylor & Deane.
2000). Avoidance behavior may range Irom an occasional
reluctance to drive in particular situations (e.g. heavy traIfc
orbadweather)toaglobalavoidanceofvehiculartravelal-
together.Itcanmaintainphobiasymptomstotheextentthat
it prevents exposure to the Iear stimuli (Taylor et al.. 2007).
Taylor et al. (2007b) used the Driving Cognitions Ques-
tionnaire (DCQ) to detect the most Irequent cognitions oI
fearfulparticipantswhiledriving.Themostrateditemswere
reacting too slowly. being perceived as a bad driver. holding
up traIfc and making people angry. In the same study. so-
cial concerns were evident on the Fear Questionnaire (FQ).
Taylor and Deane (2000) have already mentioned evidence
oI the infuence oI social Iactors in driving Iear. emphasizing
feelingsofhumiliationorembarrassmentasaconsequence
ofperceivednegativeperformanceevaluationbyothers.
VirtualRealityExposureTherapyinthe
TreatmentofDrivingPhobia
According to the emotional processing theory. success-
fulexposuretherapyleadstonewandmoreneutralmemory
structures that overrule the old anxiety-provoking ones
(Foa & Kozak. 1986). II a virtual environment can elicit
Iear responses and activate the anxiety-provoking mecha-
nism. it might be eIIective as an alternative technique to
address exposure interventions. In this sense. VRET can
be a viable alternative to in vivo exposure therapy (Foa &
Kozak. 1986).
Virtual reality exposure integrates real-time computer
graphics. sounds and other sensory inputs to create a com-
puter-generated world with which the individual can interact
(Anderson. Jacobs & Rothbaum.. 2004; Riva. 2002; Riva &
Wiederhold. 2002; Rothbaum & Hodges. 1999; Wiederhold
& Rizzo. 2005). A successIul virtual experience provides
users with a sense oI presence. as though they were physically
immersed in the virtual environment (Gregg & Tarrier. 2007;
Kriin et al.. 2004; Kriin. Emmelkamp. OlaIsson & Biemond.
2004). This sensation is achieved by shutting out 'real world
stimuli so that only computer-generated stimuli can be seen
and heard. Some sensory virtual reality modalities also in-
cludetactileandolfactorysensorystimulationaselementsof
reality (Gregg & Tarrier. 2007; Kriin et al.. 2004b). It has been
observed that. Ior phobic subiects. an increase in the sense oI
presence consequently increases anxiety. On the other hand.
ithasalsobeennoticedthatincreasingstresslevelsincrease
the sense oI presence (Walshe. Lewis & Kim. 2004; Walshe.
Lewis. O`Sullivan & Kim. 2005).
Little controlled treatment research on driving phobia
has been Iound. although some case reports oI accident and
nonaccident-related driving Iear point out that desensitiza-
37 Psic.: Teor. e Pesq.. Brasilia. Jan-Mar 2010. Vol. 26 n. 1. pp. 35-42
RVMedodedirigir
tion can be an eIIective treatment. whereas other studies show
thatvariouscombinationsofinvivoandimaginaryexposure
were successIul (Wald & Taylor. 2003; Taylor et al.. 2007;
Walshe et al.. 2005).

ResultsfromrecentstudiesusingVRET
suggestthatthiswayoftreatmentmightbeappropriatefor
driving phobia (Wald & Taylor. 2000; Wald & Taylor. 2003).
VREThassomepotentialadvantagesoverinvivoand
imaginary exposure. According to Wald and Taylor (2000).
individualswithintensedrivingfearsmayrefusetopartici-
pateininvivoexposureordropoutoftreatmentearly.For
these authors. in vivo exposure has a number oI limitations
and risks because exposure occurs on public roadways. whe-
reas driving situations are oIten unpredictable. time limited.
and diIfcult to control. The authors also assert that in vivo
exposureraisesspecialsafetyandethicalconcernsbecause
highly anxious patients may be at an increased risk oI making
drivingerrorsandbeinginvolvedinaMVAasaconsequence
ofreducedattentionandinformationprocessingcapacities
(Wald & Taylor. 2000).
VRET. on the other hand. occurs in a clinician`s oIfce
sotheconsequencesofdrivingerrorsorunsafeavoidance
behaviors are minimized as well as the risk oI a real motor
vehicle accident. It also reduces potential embarrassment
thatcanbeassociatedwithinitialinvivodrivingexposure.
Otheradvantageisthatfeareddrivingsituationsareableto
be controlled by the clinician. and adiusted. repeated. and
prolonged according to the client`s needs (Wald & Taylor.
2000).
Sometimes. in imaginary exposure. it is diIfcult Ior pho-
bic subiects to imagine a Ieared stimulus. so it is harder to
induce anxiety (Wald & Taylor. 2000). For most individuals.
virtual reality stimuli are more concrete and realistic than
imaginary exposure. reducing the possibility oI avoidan-
ce behaviors. Thus. VRET is mentioned as an alternative
treatment to be used beIore the in vivo exposure (Wald &
Taylor. 2000).
Some limitations are presented in VRET. In some cases.
similar diIfculties as those experienced in imaginary expo-
sure can arise in virtual environments. For some individuals.
Ior example. it might not be suIfciently realistic. so it is
more diIfcult to Ieel the sense oI presence; as a result. the
experience is not real enough to induce anxiety (Walshe et
al.. 2005). According to Wald and Taylor (2003). VRET
has other limitations: it may not be cost-eIIective given the
current cost oI virtual reality technology. it is not widely
accessible to therapists and clients. and sometimes it is not
able to suIfciently target the client`s idiosyncratic driving
Iears (Wald & Taylor. 2003).
Recently. the literature shows a considerable number oI
publications on various aspects of virtual reality exposure
therapy (VRET). which has been applied to the treatment
oI anxiety disorders. especially phobias (Cte & Bouchard.
2005; Jang. Kim. Nam. Wiederhold. Wiederhold & Kim.
2002; Pull. 2005; Rothbaum & Hodges. 1999; Rothbaum.
Hodges & Kooper. 1997; Rothbaum. Hodges & Smith. 1999;
Wilhelm et al.. 2005). The purpose oI this article is to review.
by means oI a systematic methodology. the literature that
supportsthepotentialeffectivenessofVRETinthetreatment
ofdrivingphobia.
Method
A systematic on-line search was perIormed on the
PubMed/Medline and Web oI Science (ISI) databases. The
keywords used in the search were: 'virtual reality and
'Iear oI driving; 'virtual reality and 'driving phobia.
We reviewed articles published between 1984 and 2007.
Among the articles we selected those approaching virtual
reality applied to driving phobia treatment and trials with
VRETforanxietydisorders.Anothersearchwasmadefor
the relevant reIerences cited in these papers. We included
papers in English. Portuguese. French. German and Spanish.
Results
Forty-seven articles were selected and reviewed. oI which
34 dated Irom the last 10 years. Twenty-Iour studies citing
VRET Ior the treatment oI driving phobia were identifed.
Tenstudiestestedthesenseofpresenceinthevirtualenvi-
ronmentsorusedvirtualrealitytechnologiesforthetreatment
oI this Iear. with or without the development and validation
ofanyinstrumentfordrivingfearevaluation.Tenliterature
reviewswereincluded:twoonVRETfordrivingphobiaand
eight on VRET Ior anxiety disorders. UnIortunately. there
arefewsystematicstudiespublishedontheeffectivenessof
VRET in the treatment oI driving phobia. In Iact. only three
papersrepresentedsystematicstudiesonVRETofdriving
phobia (one oI them was a case study). and cause oI that they
were selected to be described here (see Table 1).
Jang et al. (2002) analyzed non-phobic participants`
physiological reactions to driving and fying virtual envi-
ronments.Elevenparticipantswereexposedtoeachvirtual
environment Ior 15 min. Physiological measures consisted in
heart rate. skin resistance. and skin temperature monitoring.
AIter each exposure. participants were evaluated by means oI
the Presence & Realism Questionnaire (PRQ) and Simulator
Sickness Questionnaire (SSQ). Results demonstrated that
skin resistance and heart rate variability can be used to show
arousal in participants exposed to virtual environments. and.
thereIore. can be used as obiective measures in monitoring
the reaction oI non-phobic participants to these environments.
Theauthorsalsoconcludedthatheartratevariabilitycould
beusefulforassessingtheemotionalstateofparticipants.
One study by Wald and Taylor (2003) examined the eIf-
cacyofVRETfordrivingphobiawithamultiplebaseline
across-subiects experimental design. This design included an
intervention phase consisting oI eight weekly treatment ses-
sions and Iollow-up assessments. Seven adults with a specifc
phobiadiagnosiswererecruitedfromthecommunitybyme-
ansofmediaadvertisements.Fiveparticipantscompletedthe
treatment with 1- and 3-month Iollow-up assessments. From
those fve participants. three showed a decrease in scores on
many oI the outcome measures (see Table 1). and hence. no
longer met the criteria Ior driving phobia at post-treatment.
Thosethreepatientspresentedlossoftreatmentgainsinthe
frst and second Iollow-up assessments. and improvement
in driving Irequency in the last Iollow-up assessment. One
patient showed marginal improvement and another one
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39 Psic.: Teor. e Pesq.. Brasilia. Jan-Mar 2010. Vol. 26 n. 1. pp. 35-42
RVMedodedirigir
showed no treatment gains. According to the authors. these
resultssuggestthatVRETisapromisingtreatmentfordriving
phobia. although it may not be suIfcient Ior some patients.
Walshe. Lewis. Kim. O`Sullivan and Wiederhold (2003)
investigatedtheeffectivenessofthecombineduseofcom-
putergeneratedenvironmentsinvolvingdrivinggamesand
avirtualrealitydrivingenvironmentasanexposuretherapy
forthetreatmentofdrivingphobiafollowingamotorvehicle
accident program. Seven subiects. who met the DSM-IV
criteria Ior Simple Phobia/Accident Phobia. experienced
immersionwhenexposedtoavirtualdrivingenvironment
and computer driving games. and they were selected to par-
ticipate in a cognitive behavioral treatment. AIter treatment.
signifcant reductions were Iound in measures oI subiective
distress. driving anxiety. post-traumatic stress disorder rating.
heart rate rise. and depression ratings. The Fear oI Driving
Inventory (FDI) fndings were consistent with clinical reports
inwhitchwhereparticipantswereexpandingtheirdriving
practicesandtravelingbyvehiclewithlessanxiety.Accor-
ding to the authors. Ior some phobic drivers. computer game
realityinducedastrongsenseofpresencesometimestothe
pointofinducingpanic.
Only one case study using virtual reality applications
Ior driving phobia has been reported. Wald and Taylor
(2000) described a case oI a patient who completed three
sessions oI VRET (one hour each). The peak oI anxiety
decreased within and across sessions. In the post-treatment
assessment. her phobic symptoms had diminished and she
no longer met the diagnostic criteria for driving phobia.
Also. the clinical improvement was maintained at 1-. 3-. and
7-month Iollow-up. Evaluation was made by the Structured
Clinical Interview (First. Spitzer. Gibbon & Williams..
1996). the Driving Anxiety Test (an in vivo behavioral
measure). and a driving diary (minutes oI driving per day).
Thiscasestudyreportedsubstantialresults.VRETwassuc-
cessfulinreducingfearofdriving.Ratingsofanxietyand
avoidance declined Irom pre-treatment to post-treatment.
Phobia-related interIerence in daily Iunctioning similarly
decreased. However. more case studies are necessary to
corroborate these fndings.
Discussion
Itwasobservedthatthenumberofsessionsoftreatment
and Iollow up. and the number oI sessions spent on VRET
interventions differed immensely among the described
studies.Componentsofthetreatmentprotocolsalsovaried
among studies. As a consequence. comparing research results
wasimpossible.
Comorbiditieswerenotmentionedinanystudy.Comor-
biditiesareimportantconfoundingfactorsintheevaluation
oI treatment plans and their results. Besides. the studies did
notspecifythenumberofsubjectsonmedicationorthathad
previously attempted any treatmeThe assessment oI specifc
driving variables (e.g.. number oI accidents. years oI driving)
has been rarely reported in the literature. despite the obvious
clinicalrelevanceofthisinformationforconductingacom-
prehensiveassessmentandplanningappropriateintervention
targets. For example. the treatment Ior someone whose
driving fear developed subsequently to the onset of panic
disorder and agoraphobia is likely to be diIIerent Irom the
treatment Ior someone who has always had a specifc phobia
ofdriving.Relevantvariablesofinterestheremayrelateto
the individual`s history as a driver. such as circumstances
surrounding learning to drive. obtaining a driver`s license.
andaccidenthistory.Theindividualsexperienceintheseand
otherareascreatesacomplexsetofconditionsthatneedto
beconsideredindevelopinganinterventionthatistailored
to each client (Taylor et al.. 2007).
Although the data are promising. they suggest that VRET
alone may not be suIfcient in the treatment oI driving phobia
Ior some individuals. VRET may be used as a frst step in the
treatmentforreducingdrivingfeartoadegreeappropriate
forasubsequentinvivoexposuretherapy.
Fearoranxietysymptomscanbeassessedbyobjective
measures: heart rate. peripheral skin temperature. skin
resistance (Jang et al.. 2002). body posture. respiration
rate. brain wave activity (Kriin et al.. 2004b; Wiederhold
& Wiederhold. 1999). or subiective measures. usually the
Subiective Units oI DiscomIort Scale (SUDS) (Kriin et al..
2004b; Wiederhold & Wiederhold. 1999). Generally. VRET
researchers administer a wide range of questionnaires to
evaluate the sense oI presence (Jang et al.. 2002) or driving
cognitions (Ehlers et al.. 2007). Both Iorms oI evaluation
were Iound in these studies. not necessarily administered
together.
Roth (2005) demonstrated that the anxiety oI patients
with situational phobias is accompanied by autonomic.
respiratory. and hormonal changes in the Ieared in vivo
situation. According to Roth (2005) and Alpers. Wilhelm
and Roth (2005). phobics diIIered Irom controls both in
terms oI physiologically and selI-report measures beIore.
during. and aIter in vivo exposure. The physiological
scores were highly congruent with selI-report measures
oI anxiety and decreased over sessions in phobics. what
isinaccordancewiththeexpectedtherapeuticeffectsof
repeated exposure. although the exposures were too Iew to
resultincompleteremission.Theseauthorsshowedsubs-
tantial respiratory disturbances along with the expected
elevations in heart rate and in the Irequency oI non-specifc
skin conductance fuctuations (a variable controlled by the
sympathetic system). In addition. a measure oI respiratory
variability was higher. with hyperventilation. In the study
oI Alpers et al.. salivary cortisol beIore and aIter driving
was greater than that oI control levels. particularly in
the frst exposure session. Also. multiple physiological
measuresofphobicparticipantsandcontrolscontributed
with no redundant inIormation. thus making it possible
an accurate classifcation oI 95 oI phobic and control
participants.
The data mentioned above illustrate the importance of
physiological monitoring. However. none oI the studies used
multiplephysiologicalmeasureswithphobics.Respiratory
variation or salivary cortisol level were not considered in
the analysis oI the eIfcacy oI VRET in Jang et al. (2002).
nevertheless they are effective physiological measures to
assessanxietyandsenseofpresenceinstandardexposure.No
electroencephalographicorneuroimagingdatawerefound
infearofdrivingVRETstudies.
40 Psic.: Teor. e Pesq.. Brasilia. Jan-Mar 2010. Vol. 26 n. 1. pp. 35-42
R.T.Costa&Cols.
FinalConsiderations
Driving phobia is a serious personal and social problem
with several consequences. including career repercussions.
social embarrassment and restrictions. In the treatment of
this disorder. there are some evidences oI the advantages oI
VRETbeforeapplyinginvivoexposuretherapybecauseit
canfunctionasanalternativewaytoinduceexposure.This
idea is supported by some studies in which physiological
measureswereusedtoassesstheeffectivenessofthesense
oI presence (Jang et al.. 2002; Walshe et al.. 2003; Alpers
et al.. 2005). In those studies. the post-treatment showed
reductions in such measures. thus suggesting that VRET has
adirecteffectofhabituation.
Virtual reality oIIers many possibilities Ior psychology.
including assessment. treatment. and research. In the clinical
psychology feld. virtual reality is a saIe. inexpensive. accep-
ted. and probably soon a widespread tool used in exposure
treatments oI phobic disorders. However. more randomized
clinical trials. in which VRET could be compared to standard
exposure. with more obiective measures. are required. We
suggest that Iurther studies should be made. using eIIective
physiological measures in vivo exposure to evaluate the
eIfcacy oI the VRET and the sense oI presence.
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