Speaking AnxietySocial Communication

PROSPERO-registered systematic review + meta-analysis (22 studies, n=703) in Psychological Medicine: VRET for social anxiety disorder is efficacious with durable effects, and treatment-discontinuation rates are comparable to in-vivo exposure

Horigome T et al. · 2020 · Psychological Medicine · Systematic Review · n = 703 · 22 RCTs of VRET for social anxiety and related phobias (pooled) · DOI
Evidence certainty: High certainty
How this was rated

PROSPERO-registered systematic review and meta-analysis (CRD42019121097) - pre-registration is the methodological gold standard for review work. Peer-reviewed in Psychological Medicine (Cambridge - one of the highest-impact psychiatry journals globally, IF ~10). Inclusion criteria are clinically meaningful: SAD diagnosis, at least three sessions (rules out single-session feasibility designs), at least 10 participants (rules out very-small case series). 22 studies (n=703) is a substantial pool. Hedges' g + dropout-risk-ratio analyzes are the appropriate primary + secondary outcomes. Limitations are inherent to any meta-analysis: heterogeneity of VR hardware, variation in treatment dose and CBT integration.

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A PROSPERO-registered (CRD42019121097) systematic review and meta-analysis of VRET for social anxiety disorder, published in Psychological Medicine. Inclusion criteria: SAD or related phobias; at least three VRET sessions; minimum 10 participants. 22 studies met criteria (total n=703). Primary outcome: social anxiety evaluation score change synthesized with Hedges' g random-effects modeling. Secondary outcome: risk ratio for treatment discontinuation. The review evaluates VRET's magnitude of efficacy, duration of efficacy, and dropout rates against in-vivo exposure and against passive controls.

Clinical bottom line

The most rigorously designed VRET-for-SAD meta-analysis published to date - PROSPERO-registered, published in Psychological Medicine (one of the highest-impact psychiatry venues globally), with explicit dropout analysis alongside efficacy synthesis. The 22 included studies (n=703) confirm VRET as efficacious for SAD with durable effects and dropout rates comparable to in-vivo exposure. For clinicians and procurement teams citing the single most authoritative SAD-VRET meta-analysis, this is now the reference of choice. Complements Carl 2019 (broader anxiety) and Wechsler 2019 (matched-dose phobias) with SAD-specific depth.

Key findings

  • PROSPERO-registered (CRD42019121097) systematic review + meta-analysis of VRET for SAD
  • Published in Psychological Medicine (Cambridge) - one of the highest-impact psychiatry journals globally
  • Inclusion criteria: (1) SAD or related phobias patient samples; (2) VRET conducted for at least THREE sessions; (3) at least 10 participants per study
  • 22 studies met criteria, with total pooled sample of n=703 participants
  • PRIMARY outcome: social anxiety evaluation score change synthesized with Hedges' g random-effects model
  • SECONDARY outcome: risk ratio for treatment discontinuation (dropout) - addresses the clinical concern that some VRET protocols may have higher dropout than in-vivo exposure
  • Coverage of LONG-TERM efficacy (one of three key questions the review addresses) - addresses whether VRET gains persist beyond post-treatment
  • Japanese-led authorship (Keio University School of Medicine, Tokyo, Japan + Hofstra/Northwell, NY, USA) - extends VRET evidence beyond the predominantly North-American + European literature
  • Author Kishimoto is corresponding - established psychiatrist with international reputation in clinical psychiatry research

Background

By 2019-2020, the VRET-for-SAD evidence base had grown to multiple RCTs (Anderson 2013, Bouchard 2017, Kampmann 2016, Wallach 2009, Klinger 2005, and others) and several earlier reviews (Powers 2008, Opris 2012, Chesham 2018, Kampmann 2016 Meta). What the field lacked was a methodologically tight, pre-registered, high-impact-venue meta-analysis that specifically addressed VRET’s MAGNITUDE of efficacy, DURATION of efficacy, AND dropout rates in SAD.

What they did and found

PROSPERO-registered (CRD42019121097) systematic review + meta-analysis. Inclusion: SAD/related phobia samples, at least 3 VRET sessions, minimum 10 participants. 22 studies met criteria, total n=703. Primary outcome: SAD score change (Hedges’ g, random-effects). Secondary outcome: dropout risk ratio.

The review confirms VRET as efficacious for SAD with durable effects and dropout rates comparable to in-vivo exposure. (Specific Hedges’ g and confidence intervals reported in published article.)

Why this matters + Limitations

For citing the single most authoritative SAD-VRET meta-analysis, this is now the reference of choice. The PROSPERO registration + Psychological Medicine venue + explicit dropout analysis give it standing beyond earlier reviews. Limitations: heterogeneity of VR hardware across pooled studies, variation in treatment dose and CBT integration, no PWS-specific subgroup.

Implications for practice

For clinicians and procurement teams citing the single most authoritative SAD-VRET meta-analysis, this is now the reference of choice. The PROSPERO registration + Psychological Medicine venue + explicit dropout analysis give it standing that earlier SAD-VRET reviews (Chesham 2018, Kampmann 2016 Meta) cannot match. For grant applications and procurement documents, citing Horigome 2020 alongside Carl 2019 (broader anxiety) and Wechsler 2019 (matched-dose phobias) gives the meta-analytic backbone for VRET-in-SAD evidence. For PWS with SAD comorbidity, this paper's effect-size estimates and dropout findings are the cleanest available citation for arguing VRET should be considered alongside standard talk therapy.

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Cite this study

If you reference this study in your work, the canonical citation formats are:

APA 7th
Horigome, T., Kurokawa, S., Sawada, K., Kudo, S., Shiga, K., Mimura, M., & Kishimoto, T. (2020). Virtual reality exposure therapy for social anxiety disorder: a systematic review and meta-analysis. Psychological Medicine. https://doi.org/10.1017/S0033291720003785.
AMA 11th
Horigome T, Kurokawa S, Sawada K, Kudo S, Shiga K, Mimura M, Kishimoto T. Virtual reality exposure therapy for social anxiety disorder: a systematic review and meta-analysis. Psychological Medicine. 2020. doi:10.1017/S0033291720003785.
BibTeX
@article{horigome2020,
  author = {Horigome, T. and Kurokawa, S. and Sawada, K. and Kudo, S. and Shiga, K. and Mimura, M. and Kishimoto, T.},
  title = {Virtual reality exposure therapy for social anxiety disorder: a systematic review and meta-analysis},
  journal = {Psychological Medicine},
  year = {2020},
  doi = {10.1017/S0033291720003785},
  url = {https://withvr.app/evidence/studies/horigome-2020}
}
RIS
TY  - JOUR
AU  - Horigome, T.
AU  - Kurokawa, S.
AU  - Sawada, K.
AU  - Kudo, S.
AU  - Shiga, K.
AU  - Mimura, M.
AU  - Kishimoto, T.
TI  - Virtual reality exposure therapy for social anxiety disorder: a systematic review and meta-analysis
JO  - Psychological Medicine
PY  - 2020
DO  - 10.1017/S0033291720003785
UR  - https://withvr.app/evidence/studies/horigome-2020
ER  -

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Funding & independence

Affiliations: Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Asaka Hospital, Fukushima; Japanese Red Cross Ashikaga Hospital, Tochigi; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York. Specific funding sources reported in published article. Peer-reviewed in Psychological Medicine (Cambridge). PROSPERO-registered (CRD42019121097). No withVR BV involvement. Summary prepared independently by withVR.

Last reviewed: 2026-05-17 Next review due: 2027-05-17 Reviewed by: Gareth Walkom