A Meta-Analysis on the Relationship between Self-Reported Presence and Anxiety in Virtual Reality Exposure Therapy for Anxiety Disorders

In virtual reality exposure therapy (VRET) for anxiety disorders, sense of presence in the virtual environment is considered the principal mechanism that enables anxiety to be felt. Existing studies on the relation between sense of presence and level of anxiety, however, have yielded mixed results on the correlation between the two. In this meta-analysis, we reviewed publications on VRET for anxiety that included self-reported presence and anxiety. The comprehensive search of the literature identified 33 publications with a total of 1196 participants. The correlation between self-reported sense of presence and anxiety was extracted and meta-analyzed. Potential moderators such as technology characteristics, sample characteristics including age, gender and clinical status, disorder characteristics and study design characteristics such as measurements were also examined. The random effects analysis showed a medium effect size for the correlation between sense of presence and anxiety (r = .28; 95% CI: 0.18–0.38). Moderation analyses revealed that the effect size of the correlation differed across different anxiety disorders, with a large effect size for fear of animals (r = .50; 95% CI: 0.30–0.66) and a no to small effect size for social anxiety disorder (r = .001; 95% CI: −0.19–0.19). Further, the correlation between anxiety and presence was stronger in studies with participants who met criteria for an anxiety disorder than in studies with a non-clinical population. Trackers with six degrees of freedom and displays with a larger field of view resulted in higher effect sizes, compared to trackers with three degrees of freedom and displays with a smaller field of view. In addition, no difference in effect size was found for the type of presence measurement and the type of anxiety measurement. This meta-analysis confirms the positive relation between sense of presence and anxiety and demonstrates that this relation can be affected by various moderating factors.

在针对焦虑障碍的虚拟现实暴露疗法（Virtual Reality Exposure Therapy, VRET）中，个体在虚拟环境中的临场感（sense of presence）被视为引发焦虑体验的核心机制。然而，现有关于临场感与焦虑水平之间关联的研究，在二者相关性的结论上莫衷一是。
本荟萃分析共梳理了针对焦虑障碍的VRET相关研究文献，这些文献均纳入了自我报告的临场感与焦虑数据。通过全面的文献检索，最终纳入33项研究，共计1196名被试。研究人员提取了自我报告临场感与焦虑间的相关系数，并开展荟萃分析。
本研究同时考察了多项潜在调节变量，包括技术特征、被试特征（年龄、性别与临床状态）、障碍类型特征，以及研究设计特征（如测评工具类型）等。随机效应模型分析结果显示，临场感与焦虑间的相关系数具有中等效应量（r=0.28；95%置信区间：0.18~0.38）。
调节效应分析结果表明，不同焦虑障碍类型下的相关效应量存在显著差异：针对动物恐惧症的效应量为大（r=0.50；95%置信区间：0.30~0.66），而社交焦虑障碍的效应量则为接近无效应的小效应量（r=0.001；95%置信区间：-0.19~0.19）。此外，纳入符合焦虑障碍诊断标准被试的研究中，焦虑与临场感的相关性要强于非临床人群被试的研究。
相较于三自由度追踪设备与小视场角显示设备，配备六自由度追踪设备与大视场角显示设备的研究，其效应量更高。此外，临场感测评工具类型与焦虑测评工具类型并未对效应量产生显著影响。
本荟萃分析证实了临场感与焦虑间存在正向关联，并表明该关联可受多种调节变量的影响。