Extended reality-based therapies for the treatment of anxiety disorders: clinical impact, perceptions of patients and healthcare professionals, and comparison of modalities - a systematic review

Abstract

Abstract Background: Anxiety disorders are among the most common psychiatric conditions and have a rising prevalence. Patients with anxiety disorders can however be deterred from seeking treatment due to associated stigma and medication side effects. Evidence indicates that promising digital health solutions to address those concerns reside in the growing field of extended reality (XR). However, the literature is lacking in investigating how patients and healthcare professionals (HCPs) experience and perceive XR therapies as well as in direct comparisons between XR modalities for anxiety disorder treatment. Objectives: This systematic review sought to: a) review how XR-based therapies are utilised in clinical practice for anxiety disorder patients; b) investigate the perceptions and experiences of patients and HCPs employing XR-based anxiety disorders therapies; and c) compare the effectiveness of different XR approaches in anxiety disorder treatment. Methods: A systematic search of the literature was conducted using three databases (CINAHL, APA PsycNet and PubMed). Studies were screened and filtered based on a predetermined inclusion and exclusion criteria. Included studies were appraised for their quality and risk of bias as appropriate. Results: Four studies fulfilled the inclusion requirements. The majority investigated the use of XR tools for individual therapy and indicated that they can be as effective as traditional methods and assist HCPs in therapeutic tasks. Patients generally experience these modalities as immersive with minimal side effects. It remains unclear whether XR is appropriate in group therapy settings. Conclusion: XR-based therapies have the potential to positively impact anxiety disorder treatment as potent drug-free alternatives or supplements to traditional therapy and could be considered for remote, individual care. While the XR setup for HCPs require improvement, these tools can be practical and assistive for them. The generalisability of the findings require further research into more conditions within the anxiety disorders group, as well as larger and more representative sample sizes. A potential gap has also been identified in the direct comparison of different XR modalities within the same study.