Can You Feel It?: Effectiveness of Anxiety Cues for the Design of Virtual Reality Exposure Therapy

Virtual reality exposure therapy (VRET) has been widely acknowledged as an effective alternative for in vivo exposure therapy (iVET). So far, previous research focused on long- and short-term effectiveness and comparisons to iVET, whereas the impact of design choices is understudied. Hence, the present study focuses on the effectiveness of several types of anxiety cues for the manipulation of anxiety. More specifically, five interoceptive cues (i.e., “fake” bodily sensations for tunnel vision, light flickering, heartbeat audio, blurred vision, and dizziness) and a physical cue (i.e., heat stimulation) are implemented in the VRET design of a within-subjects experiment with people who have claustrophobic and panic tendencies (N = 24). Results show that adding interoceptive cues significantly increased reported levels of anxiety, independent of the type of interoceptive cue. However, introducing a physical cue in VRET can also be effective but has no real added value when combined. Studies focusing on the design of anxiety cues can be valuable in understanding the effectiveness of VRET.