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Am Fam Physician. 2021;104(6):638-640

Author disclosure: No relevant financial affiliations.

Clinical Question

Does therapy with virtual reality decrease generalized anxiety in adults?

Evidence-Based Answer

Virtual reality does not appear to be effective and should not be used in the treatment of generalized anxiety disorder (GAD). (Strength of Recommendation [SOR]: B, based on randomized controlled trials [RCTs].) In trials including anxiety disorders such as phobias and fear of flying, virtual reality may be better than no treatment, but it is not superior to traditional behavioral therapy or cognitive behavior therapy (CBT). (SOR: B, based on meta-analysis of RCTs.)

Evidence Summary

A 2019 meta-analysis of nine RCTs (N = 371) analyzed the treatment of specific phobias, social phobias, and agoraphobia when using virtual reality exposure therapy (VRET) compared with in vivo exposure therapy.1 VRET included a computer-generated presentation that provided input to the user's sensory system via specific glasses with a head-mounted display or through a projection system in an enclosed room. In vivo exposure involves the patient being exposed to their phobia in real live exposures that gradually increase in intensity each time the person has a lessened reaction to the previous exposure. When comparing these treatments for a specific phobia, there was no difference in symptom improvement between VRET and in vivo exposure therapy (four trials; n = 153; effect size [ES] = −0.15; 95% CI, −0.47 to 0.16). When examining trials treating social phobia, there was a small ES favoring in vivo exposure (three trials; n = 148; ES = −0.50; 95% CI, −0.83 to −0.16). Examining agoraphobia specifically, the result was also nonsignificant (two trials; n = 70; ES = −0.01; 95% CI, −0.47 to 0.45).

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Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (

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