运用虚拟现实暴露疗法治疗飞行恐惧症的研究述评

虚拟现实暴露疗法是治疗飞行恐惧症的新方法。与传统的暴露疗法相比,虚拟现实暴露疗法集合了实体暴露疗法和想象暴露疗法的优点。避免了二者的不足,具有灵活、高效、安全、可重复和易于操控的特点。研究者们利用数据头盔、双通道立体声耳机、追踪设备、感应器等设备给飞行恐惧症患者呈现实时的计算机动画、双通道立体声和触觉刺激,使之沉浸在虚拟的飞行情景中,从而激发出患者的恐惧情绪。在虚拟现实暴露治疗的过程中,治疗师根据患者的情况使之逐步暴露在不同等级的刺激性情景中,经反复练习逐渐耐受并适应这些情景,最终克服不合理的恐惧。近10年的大量研究表明:虚拟现实暴露疗法能有效地治愈飞行恐惧症,在临床上具有良好的应用前景。今后的研究将进一步比较虚拟现实暴露疗法与其他治疗方法的疗效,并开发出成本更低、临场感更好的虚拟现实设备以扩展虚拟现实暴露疗法在飞行恐惧症治疗中的应用。     

Telemental health: A status update

A rather large body of literature now exists on the use of telemental health services in the diagnosis and management of various psychiatric conditions. This review aims to provide an up‐to‐date assessment of telemental health, focusing on four main areas: computerized CBT (cCBT), Internet‐based CBT (iCBT), virtual reality exposure therapy (VRET), and mobile therapy (mTherapy). Four scientific databases were searched and, where possible, larger, better‐designed meta‐analyses and controlled trials were highlighted. Taken together, published studies support an expanded role for telepsychiatry tools, with advantages that include increased care access, enhanced efficiency, reduced stigma associated with visiting mental health clinics, and the ability to bypass diagnosis‐specific obstacles to treatment, such as when social anxiety prevents a patient from leaving the house. Of technology‐mediated therapies, cCBT and iCBT possess the most efficacy evidence, with VRET and mTherapy representing promising but less researched options that have grown in parallel with virtual reality and mobile technology advances. Nonetheless, telepsychiatry remains challenging because of the need for specific computer skills, the difficulty in providing patients with a deep understanding or support, concerns about the “therapeutic alliance”, privacy fears, and the well documented problem of patient attrition. Future studies should further test the efficacy, advantages and limitations of technology‐enabled CBT, as well as explore the online delivery of other psychotherapeutic and psychopharmacological modalities.     

Virtual Reality Cue Reactivity Assessment: A Case Study in a Teen Smoker

Cigarette smoking in adolescents is a major public health problem. To address the increasing need for efficacious assessment and treatment methods, we developed and tested a novel virtual reality cue reactivity assessment system. A case study of a controlled virtual reality cue reactivity trial with a 17-year-old adolescent cigarette smoker is presented. During the trial, the participant was exposed to virtual reality (VR) smoking cues and VR neutral cues and assessments of subjective craving and skin conductance response (SCR) were recorded. Upon exposure to VR smoking cues, craving increased. A novel methodology for collecting and analyzing SCR in VR was developed and explored to expand the role of physiological variables in VR research. SCR data indicated specific reactions to smoking cue stimuli, with the subject experiencing increased reactivity to smoking cues (i.e., cigarettes) compared to food or drinks. Based on this case study, further research using VR cue reactivity assessment in adolescent smokers is warranted. The impact of VR in drug research and future applications in research are also discussed.     

Development of a Data Management Tool for Investigating Multivariate Space and Free Will Experiences in Virtual Reality

Virtual reality (VR) has become mature enough to be successfully used in clinical applications such as exposure therapy, pain distraction, and neuropsychological assessment. However, we now need to go beyond the outcome data from this research and conduct the detailed scientific investigations required to better understand what factors influence why VR works (or doesn’t) in these types of clinical applications. This knowledge is required to guide the development of VR applications in the key areas of education, training, and rehabilitation and to further evolve existing VR approaches. One of the primary assets obtained with the use of VR is the ability to simulate the complexity of real world environments, within which human performance can be tested and trained. But this asset comes with a price in terms of the capture, quantification and analysis of large, multivariate and concurrent data sources that reflect the naturalistic behavioral interaction that is afforded in a virtual world. As well, while achieving realism has been a main goal in making convincing VR environments, just what constitutes realism and how much is needed is still an open question situated firmly in the research domain. Just as in real “reality,” such factors in virtual reality are complex and multivariate, and the understanding of this complexity presents exceptional challenges to the VR researcher. For certain research questions, good behavioral science often requires consistent delivery of stimuli within tightly controlled lab-based experimental conditions. However, for other important research questions we do not want to constrain naturalistic behavior and limit VR’s ability to replicate real world conditions, simply because it is easier to study human performance with traditional lab-based methodologies. By doing so we may compromise the very qualities that comprise VR’s unique capacity to mimic the experiences and challenges that exist in everyday life. What is really needed to address scientific questions that require natural exploration of a simulated environment are more usable and robust tools to instrument, organize, and visualize the complex data generated by measurements of participant behaviors within a virtual world. This paper briefly describes the rationale and methodology of an initial study in an ongoing research program that aims to investigate human performance within a virtual environment where unconstrained “free will” exploratory behavior is essential to research questions that involve the relationships between physiology, emotion, and memory. After a discussion of the research protocol and the types of data that were collected, we describe a novel tool that was borne from our need to more efficiently capture, manage, and explore the complex data that was generated in this research. An example of a research participant’s annotated display from this data management and visualization tool is then presented. It is our view that this tool provides the capacity to better visualize and understand the complex data relationships that may arise in VR research that investigates naturalistic free will behavior and its impact on other human performance variables.     

综述与专论: 认知行为疗法和虚拟现实疗法干预神经性疼痛的作用及机制

神经性疼痛（neuropathic pain，NP）是由外周或中枢躯体感觉系统的损伤或疾病导致的疼痛。药物治疗在镇痛中占据重要地位，但是过量药物治疗往往会引起严重的副作用，或在可耐受剂量下仅提供了部分的疼痛缓解。认知行为疗法（cognitive-behavioral therapy，CBT）和虚拟现实（virtual reality，VR）干预作为新的、非侵入性的，以及更为安全的疼痛替代治疗方法引起了广泛的关注。CBT和VR疗法可通过转移注意力、改变神经可塑性和神经环路，以及调节促炎和抗炎因子水平缓解神经性疼痛。本文旨在对神经性疼痛的发病机制以及CBT和VR疗法的镇痛效果和机制做出解析，从而为神经性疼痛的治疗干预提供重要的理论指导。     

Modulation of Visually Evoked Postural Responses by Contextual Visual,Haptic and Auditory Information: A ‘Virtual Reality Check’

Externally generated visual motion signals can cause the illusion of self-motion in space (vection) and corresponding visually evoked postural responses (VEPR). These VEPRs are not simple responses to optokinetic stimulation, but are modulated by the configuration of the environment. The aim of this paper is to explore what factors modulate VEPRs in a high quality virtual reality (VR) environment where real and virtual foreground objects served as static visual, auditory and haptic reference points. Data from four experiments on visually evoked postural responses show that: 1) visually evoked postural sway in the lateral direction is modulated by the presence of static anchor points that can be haptic, visual and auditory reference signals; 2) real objects and their matching virtual reality representations as visual anchors have different effects on postural sway; 3) visual motion in the anterior-posterior plane induces robust postural responses that are not modulated by the presence of reference signals or the reality of objects that can serve as visual anchors in the scene. We conclude that automatic postural responses for laterally moving visual stimuli are strongly influenced by the configuration and interpretation of the environment and draw on multisensory representations. Different postural responses were observed for real and virtual visual reference objects. On the basis that automatic visually evoked postural responses in high fidelity virtual environments should mimic those seen in real situations we propose to use the observed effect as a robust objective test for presence and fidelity in VR.     

Preventing post-traumatic stress disorder after mass exposure to violence

Bioterrorism preparedness plans must take into account the psychosocial consequences of exposure to mass violence. If possible, post-traumatic stress disorder (PTSD), which is associated with significant morbidity and cost, should be prevented. There are, however, no effective interventions that have been scaled up to prevent PTSD following mass exposure to violence. In fact, randomized controlled trials of the most commonly used preventive intervention, psychological debriefing, suggest no efficacy, or even potential harm. Fortunately, randomized controlled trials of cognitive behavioral therapy--that is, targeting individuals who are symptomatic in the weeks after trauma--reveal significant efficacy. Given the potential for repeated mass violence exposure, public health professionals need to refine methods for screening and tracking large numbers of casualties. At the same time, the use of telephone and internet-based cognitive behavioral therapy protocols should be further tested as strategies for bringing the only effective early intervention for PTSD to scale. Research on preventive pharmacotherapy for PTSD and on the effects of media exposure on PTSD severity is also a priority.     

Developing a Novel Measure of Body Satisfaction Using Virtual Reality

Body image disturbance (BID), considered a key feature in eating disorders, is a pervasive issue among young women. Accurate assessment of BID is critical, but the field is currently limited to self-report assessment methods. In the present study, we build upon existing research, and explore the utility of virtual reality (VR) to elicit and detect changes in BID across various immersive virtual environments. College-aged women with elevated weight and shape concerns (n = 38) and a non-weight and shape concerned control group (n = 40) were randomly exposed to four distinct virtual environments with high or low levels of body salience and social presence (i.e., presence of virtual others). Participants interacted with avatars of thin, normal weight, and overweight body size (BMI of approximately 18, 22, and 27 respectively) in virtual social settings (i.e., beach, party). We measured state-level body satisfaction (state BD) immediately after exposure to each environment. In addition, we measured participants’ minimum interpersonal distance, visual attention, and approach preference toward avatars of each size. Women with higher baseline BID reported significantly higher state BD in all settings compared to controls. Both groups reported significantly higher state BD in a beach with avatars as compared to other environments. In addition, women with elevated BID approached closer to normal weight avatars and looked longer at thin avatars compared to women in the control group. Our findings indicate that VR may serve as a novel tool for measuring state-level BID, with applications for measuring treatment outcomes. Implications for future research and clinical interventions are discussed.     

Heart Rate Variability (HRV) and Posttraumatic Stress Disorder (PTSD): A Pilot Study

Exposure to combat experiences is associated with increased risk of developing Post Traumatic Stress Disorder. Prolonged exposure therapy and cognitive processing therapy have garnered a significant amount of empirical support for PTSD treatment; however, they are not universally effective with some patients continuing to struggle with residual PTSD symptoms. Heart rate variability (HRV) is a measure of the autonomic nervous system functioning and reflects an individual’s ability to adaptively cope with stress. A pilot study was undertaken to determine if veterans with PTSD (as measured by the Clinician-Administered PTSD Scale and the PTSD Checklist) would show significantly different HRV prior to an intervention at baseline compared to controls; specifically, to determine whether the HRV among veterans with PTSD is more depressed than that among veterans without PTSD. The study also aimed at assessing the feasibility, acceptability, and potential efficacy of providing HRV biofeedback as a treatment for PTSD. The findings suggest that implementing an HRV biofeedback as a treatment for PTSD is effective, feasible, and acceptable for veterans. Veterans with combat-related PTSD displayed significantly depressed HRV as compared to subjects without PTSD. When the veterans with PTSD were randomly assigned to receive either HRV biofeedback plus treatment as usual (TAU) or just TAU, the results indicated that HRV biofeedback significantly increased the HRV while reducing symptoms of PTSD. However, the TAU had no significant effect on either HRV or symptom reduction. A larger randomized control trial to validate these findings appears warranted.     

Documenting the Efficacy of Virtual RealityExposure with Psychophysiological andInformation Processing Measures

Many outcome studies have been conducted to assess the efficacy of virtual reality in the treatment of specific phobias. However, most studies used self-report data. The addition of objective measures of arousal and information processing mechanisms would be a valuable contribution in order to validate the usefulness of virtual reality in the treatment of anxiety disorders. The goal of this study was to document the impact of virtual reality exposure (VRE) on cardiac response and automatic processing of threatening stimuli. Twenty-eight adults suffering from arachnophobia were assessed and received an exposure-based treatment using virtual reality. General outcome and specific processes measures included a battery of standardized questionnaires, a pictorial emotional Stroop task, a behavioral avoidance test and a measure of participants’ inter-beat intervals (IBI) while they were looking at a live tarantula. Assessment was conducted before and after treatment. Repeated measures ANOVAs revealed that therapy had a positive impact on questionnaire data, as well as on the behavioral avoidance test. Analyses made on the pictorial Stroop task showed that information processing of spider-related stimuli changed after treatment, which also indicates therapeutic success. Psychophysiological data also showed a positive change after treatment, suggesting a decrease in anxiety. In sum, VRE led to significant therapeutic improvements on objective measures as well as on self-report instruments.     

Multisensory stimulation can induce an illusion of larger belly size in immersive virtual reality

Background

Body change illusions have been of great interest in recent years for the understanding of how the brain represents the body. Appropriate multisensory stimulation can induce an illusion of ownership over a rubber or virtual arm, simple types of out-of-the-body experiences, and even ownership with respect to an alternate whole body. Here we use immersive virtual reality to investigate whether the illusion of a dramatic increase in belly size can be induced in males through (a) first person perspective position (b) synchronous visual-motor correlation between real and virtual arm movements, and (c) self-induced synchronous visual-tactile stimulation in the stomach area.

Methodology

Twenty two participants entered into a virtual reality (VR) delivered through a stereo head-tracked wide field-of-view head-mounted display. They saw from a first person perspective a virtual body substituting their own that had an inflated belly. For four minutes they repeatedly prodded their real belly with a rod that had a virtual counterpart that they saw in the VR. There was a synchronous condition where their prodding movements were synchronous with what they felt and saw and an asynchronous condition where this was not the case. The experiment was repeated twice for each participant in counter-balanced order. Responses were measured by questionnaire, and also a comparison of before and after self-estimates of belly size produced by direct visual manipulation of the virtual body seen from the first person perspective.

Conclusions

The results show that first person perspective of a virtual body that substitutes for the own body in virtual reality, together with synchronous multisensory stimulation can temporarily produce changes in body representation towards the larger belly size. This was demonstrated by (a) questionnaire results, (b) the difference between the self-estimated belly size, judged from a first person perspective, after and before the experimental manipulation, and (c) significant positive correlations between these two measures. We discuss this result in the general context of body ownership illusions, and suggest applications including treatment for body size distortion illnesses.     

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.     

KinImmerse: Macromolecular VR for NMR ensembles

Background  

In molecular applications, virtual reality (VR) and immersive virtual environments have generally been used and valued for the visual and interactive experience – to enhance intuition and communicate excitement – rather than as part of the actual research process. In contrast, this work develops a software infrastructure for research use and illustrates such use on a specific case.     

Mobile learning applications to improve invertebrate zoology online teaching

The use of new technologies including personal mobile devices has become an indispensable tool in our daily lives, and thus its presence in education is becoming ever more ubiquitous. In the current scenario imposed by the COVID‐19 pandemic, in which in‐person presence in classrooms has been enormously reduced at all educational levels, the use of mobile learning and cutting‐edge methods can greatly improve the way students learn and enhance their online‐learning experience. Mobile applications, combined with extended reality technologies such as virtual reality (VR) and augmented reality (AR), are powerful tools that connect real and virtual environments and allow higher interaction for the user. We have leveraged the advantages of mobile learning and extended reality technologies to develop a series of mobile applications and associated educational activities for university‐level courses involving invertebrate zoology field work. In particular, we have developed (a) a VR SCUBA diving video to explore the diversity of a marine protected area; (b) an AR mobile app to visualize 3D models of marine invertebrates; and (c) a mobile‐based catalogue to explore the terrestrial biodiversity of one of the most diverse regions of Spain. Here we provide detailed information describing the design and creation of these tools, as well as their application in class, to facilitate and encourage their use in higher education. Despite the relatively recent application of these technologies in education, they have an enormous potential: they improve student motivation and learning, can be adapted to different learning styles, reduce social inequalities, and facilitate inclusiveness and diversity practices in the classroom.     

Virtual reality and music therapy as distraction interventions to alleviate anxiety and improve mood states in breast cancer patients during chemotherapy

Psychological distress is a common consequence of breast cancer diagnosis and treatment and could further exacerbate therapy side effects. Interventions increasing treatment tolerance are crucial to improve both patients' quality of life and adherence to therapies. Virtual reality (VR) has emerged as an effective distraction tool for different medical procedures. Here, we assessed the efficacy of immersive and interactive VR in alleviating chemotherapy-related psychological distress in a cohort of Italian breast cancer patients, also comparing its effects with those of music therapy (MT). Thirty patients were included in the VR group, 30 in the MT group, and 34 in the control group, consisting of patients receiving standard care during chemotherapy. Our data suggest that both VR and MT are useful interventions for alleviating anxiety and for improving mood states in breast cancer patients during chemotherapy. Moreover, VR seems more effective than MT in relieving anxiety, depression, and fatigue.     

Cardiovascular Correlates of Motor Vehicle Accident Related Posttraumatic Stress Disorder and its Successful Treatment

Persons with posttraumatic stress disorder (PTSD) have been shown to display elevated baseline cardiovascular activity and a heightened physiological reactivity to trauma-related stimuli. Study 1 examined differences in baseline heart rate (HR) and HR reactivity in 68 survivors of motor vehicle accidents (MVAs) and healthy controls without MVA. MVA survivors with PTSD (n=26), subsyndromal PTSD (n=22), traumatized controls without PTSD (non-PTSD with MVA, n=20) and healthy controls without MVA (HC, n=27) underwent measurement of HR during baseline and exposure to a neutral, positive, negative, and trauma-related picture. PTSD patients showed elevated baseline HR and increased HR reactivity only during exposure to the trauma-related picture. Study 2 investigated whether the elevated physiological responses observed in Study 1 normalized after cognitive behavioral therapy (CBT). We conducted a randomized, controlled treatment trial comparing CBT (n=17) to a Wait-list condition (WLC, n=18). Results showed a greater decrease in HR reactivity for CBT than for WLC. The change in HR reactivity was associated with clinical improvement.     

Effects of Kinect-based virtual reality game training on upper extremity motor recovery in chronic stroke

Background: Therapeutic benefits of Kinect-based virtual reality (VR) game training in rehabilitation encourage its use to improve motor function.

Objective: To assess the effects of Kinect-based VR training on motor recovery of the upper extremity and functional outcomes in patients with chronic stroke.

Methods: In this randomized controlled trial, group A received 20 sessions of physical therapy (PT)?+?20 sessions of Kinect-based VR training and group B received only 20 sessions of PT. Clinical outcome measures were assessed at baseline and at the end of the treatments. Primary outcome measures that assess stroke patients’ motor function included upper extremity (UE) Fugl-Meyer Assessment (FMA). Secondary outcome measures were Brunnstrom Recovery Stages (BRS), Modified Ashworth Scale (MAS), Box and Block test (BBT), Motricity index (MI), and active range of motion (AROM) measurement.

Results: Statistically significant improvements in game scores (p?p?Conclusions: To conclude, our results suggest that the adjunct use of Kinect-based VR training may contribute to the improvement of UE motor function and AROM in chronic stroke patients. Further studies with a larger number of subjects with longer follow-up periods are needed to establish its effectiveness in neurorehabilitation.     

A randomized controlled effectiveness trial of cognitive behavior therapy for post-traumatic stress disorder in terrorist-affected people in Thailand

Although cognitive behaviour therapy (CBT) is the treatment of choice for post-traumatic stress disorder (PTSD), there is no evidence of its success with PTSD patients still under direct threat of terrorist attacks. This study reports the first randomized controlled trial of CBT for PTSD terrorist-affected people. Twenty-eight survivors of terrorist attacks in southern Thailand were randomized to 8 sessions of either CBT or treatment as usual (TAU). CBT was modified to accommodate the realistic threats facing patients. There were independent assessments conducted before, immediately after, and 3 months following treatment. Main outcome measures included symptoms of PTSD (PTSD Symptom Scale Interview), depression (Beck Depression Inventory) and complicated grief (Inventory of Complicated Grief). CBT resulted in significantly greater reduction in symptoms, including PTSD, depression, and complicated grief, at follow-up than TAU. Relative to TAU, CBT had stronger effect sizes at follow-up for PTSD, depression, and complicated grief. More patients in the CBT condition (75%) achieved high end-state functioning than participants in the TAU (33%). This preliminary evidence suggests that PTSD, depression, and complicated grief can be effectively treated despite ongoing threats of terrorism. Further, it demonstrates that non-specialist mental health workers in a non-western setting can be efficiently trained in using CBT, and this training can translate into successful treatment gains in trauma-affected individuals.     

Systematic Review of the Efficacy of Cognitive-Behavior Therapy Related Treatments for Victims of Natural Disasters: A Worldwide Problem

Natural disasters can have devastating consequences. Each year, about 225 million people are victims of natural disasters worldwide, and up to 13,5 million of these people can develop post-traumatic stress disorder (PTSD) in the first or second year following the disaster. Cognitive-behavior therapy (CBT) is the first-choice treatment for this disorder. In order to evaluate the efficacy of psychotherapeutic treatment based on cognitive-behavior therapy for people who developed post traumatic stress disorder after natural disasters we conducted a systematic search of published studies. We used the terms reported below in the electronic databases ISI Web of Science, PsycINFO, PubMed, PILOTS and Scopus with no restrictions of language or publication date. Articles that described randomized controlled, non-randomized controlled and non controlled studies on the efficacy of cognitive-behavior therapy for individuals diagnosed with post-traumatic stress disorder after exposure to a natural disaster were eligible for inclusion. The studies were required to use a standardized measure of effectiveness before and after the intervention and have a group of patients who had used cognitive-behavior therapy as the only intervention. Our search identified 820 studies, and 11 were selected for this review. These 11 studies involved 742 subjects, 10 related to earthquakes and 1 to a hurricane. The cognitive-behavior therapy techniques used were various: 7 studies used exposure therapy, 2 studies used problem solving, and the only 2 studies with adolescents used techniques including reconstructions and reprocessing of the traumatic experience. As limitations, the search involved only five electronic databases, no experts in the field were consulted, and the heterogeneity of the findings made it impossible to perform a meta-analysis. The results suggest the efficacy of cognitive-behavior therapy, particularly exposure techniques, for the treatment of post-traumatic stress disorder after earthquakes. However, further studies with stronger methodologies, i.e. randomized-control trials and non-randomized controlled trials, are needed.     

Mechanisms of Virtual Reality Exposure Therapy: The Role of the Behavioral Activation and Behavioral Inhibition Systems

J. A. Gray’s (1975) theory distinguishes between two motivational systems, which he refers to as the behavioral activation system (BAS) and the behavioral inhibition system (BIS). D. C. Fowles (1980) has shown that heart rate responses reflect activity of the BAS, and electrodermal responses reflect activity of the BIS. Both BAS and BIS are reliably activated during in-vivo exposure to fearful situations (F. H. Wilhelm & W. T. Roth, 1998). However, due to the constraints imposed by virtual reality (VR), we hypothesized that VR exposure to fearful situations would activate the BIS alone. To test this hypothesis, a VR free-standing elevator simulation was presented to participants selected for high and low fear of heights. As predicted, the high-anxious group strongly responded electrodermally (effect size d = 1.53), but showed only minimal HR elevations during exposure (d = 0.12), and little other cardiovascular or respiratory changes. The low-anxious control group showed little electrodermal and HR reactivity (d = 0.28 and 0.12). A comparison with data from a previous study demonstrated that this pattern was in stark contrast to the large electrodermal and cardiovascular response observed during situational in-vivo exposure outside the laboratory. We conclude that the BIS, but not BAS, is selectively activated during VR exposure, causing discordance between self-report and commonly used physiological measures of anxiety. Results are discussed within the framework of E. B. Foa & M. J. Kozak’s (1986) emotional processing theory of fear modification, suggesting different mechanisms underlying VR and in-vivo exposure treatments.