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Objective: To identify, critically appraise, and quantitatively synthesize current randomized controlled trials to compare the effects of virtual reality and dose-matched conventional exercises in patients with chronic neck pain., Literature Search: PubMed, Embase, CINAHL, PsycINFO, and Scopus were searched for studies published prior to April 15, 2023. The search strategies combined controlled vocabularies and title/abstract keywords on search themes of virtual reality and neck pain., Methods: A systematic review and meta-analysis of randomized controlled trials was conducted. Two independent reviewers conducted study selection, data extraction, and quality assessment. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Meta-analyses were performed using random-effects models., Synthesis: Six randomized controlled trials including 243 participants with chronic neck pain met the inclusion criteria. Four studies were evaluated as good quality and two as fair. Pooled analysis revealed that virtual reality demonstrated significantly better improvements in the Neck Disability Index in both the short term (mean difference [MD] = -2.16; 95% confidence interval [CI]: -3.50 to -0.82) and long term (MD = -2.95; 95% CI: -4.93 to -0.97), and pain intensity in the short term (MD = -0.94, 95% CI: -1.31 to -0.58). No significant between-group differences were found in pain in the long term and kinesiophobia., Conclusions: Virtual reality is a promising intervention to address disability and pain in patients with chronic neck pain. This review supports the clinical significance of augmenting conventional exercise with virtual reality as part of conservative management of chronic neck pain., (© 2024 The Authors. PM&R published by Wiley Periodicals LLC on behalf of American Academy of Physical Medicine and Rehabilitation.)

At the 39th meeting of the International Society of Traumatic Stress Studies, three leading researchers and clinicians in technology-enabled traumatic stress support were invited to reflect on their careers and contributions to the field. Dr. Brian P. Marx has led the development of large-scale technologies to screen, assess, and treat traumatic stress pathology across diverse etiologies and needs. Dr. Barbara O. Rothbaum, a pioneer in the development of virtual reality for exposure therapy, has demonstrated the efficacy and scalability of digital treatment for traumatic stress. Retired Col. Dr. Eric Vermetten has worked extensively on the intersection of basic mechanisms, novel psychological and biological treatment, and technology for scalable assessment and treatment, primarily in military and mass casualty contexts. The panelists were asked to reflect on their initial ambitions, concerns, unexpected challenges, and the influence of their work on new research trajectories. Their insights provide valuable lessons about the process and content of their work, and their pioneering efforts have significantly advanced the field of technology-enabled traumatic stress support., (© 2024 International Society for Traumatic Stress Studies.)

Background: Hospitalized patients with cancer often experience acute and/or chronic pain. Although virtual reality (VR) has been extensively studied across a wide range of clinical settings, no studies have yet evaluated potential impact on pain management in this patient population., Methods: Prospective randomized controlled trial at an urban academic hospital comparing VR against an active control to mitigate moderate-severe cancer disease and treatment-related pain., Results: A total of 128 adult hospitalized patients with cancer (any tumor type) were randomized to 10 minutes of immersive VR distraction therapy or 10 minutes of two-dimensional guided imagery distraction therapy delivered by handheld tablet. Participants in the two arms were similar in age, sex, race, presence of metastatic disease, concurrent pain specialist consultation, and baseline opioid use. Although both groups experienced improved self-reported pain scores (primary outcome), those randomized to VR experienced significantly greater reduction in pain immediately after intervention compared with active control (p = .03). This difference was sustained for 24 hours as well (p = .004). Within-group analysis showed significant improvement in VR arm of pain bothersomeness (p = .05) and general distress (p = .03) as well., Conclusion: Among hospitalized adult patients with moderate-severe pain related to cancer and cancer therapies, VR provided more nonpharmacologic pain relief than active control and this benefit sustained long after conclusion of the intervention., Plain Language Summary: Virtual reality (VR), a developing technology that immerses the user in new environments, has been shown to improve pain in different patient populations. To test the role of VR in improving pain in hospitalized patients with cancer who report moderate-severe pain, we compared the impact of a 10-minute immersive VR intervention to that of a 10-minute two-dimensional guided imagery experience to improve self-reported pain scores. We found that, although both interventions improved pain, VR did so significantly more. Moreover, participants assigned to VR had sustained improvement in pain 24 hours later., (© 2024 American Cancer Society.)

In the forensic field, most studies employing virtual reality (VR) interventions have focused on offenders. The validity and safety of VR applications for victims of crime are still unclear. Following PRISMA guidelines, a systematic review on VR interventions for crime victims was performed to assess the efficacy, acceptability by patients, and cost-effectiveness of these interventions compared to in-person care. We identified 34 potentially eligible studies from 188 records obtained from database searches (Medline/Pubmed, CINAHL, PsycINFO, Web of Science, and Scopus); four additional articles were identified via alternative sources. In total, nine articles were included for the qualitative synthesis. Patient satisfaction with VR interventions was found to be equivalent to face-to-face interventions. Both VR exposure and control groups found relief from posttraumatic symptoms, with differences either statistically insignificant or in favor of VR. Despite the increased costs linked to the technology required, VR appears to be a promising alternative to in vivo exposure, but further research is needed. Limitations of the review include the varied experimental protocols, which did not allow us to conduct a quantitative analysis and comparison of findings across different studies, and the generally poor quality of the studies included. Further research, preferably in larger groups, is needed to shed more light on the effectiveness of VR interventions for traumatized victims of crime., (© 2022 The Authors. Journal of Traumatic Stress published by Wiley Periodicals LLC on behalf of International Society for Traumatic Stress Studies.)

The emotional processing theory of posttraumatic stress disorder (PTSD) posits that avoidance is central to PTSD development and maintenance. Prolonged exposure (PE) therapy, which clinically focuses on avoidance reduction, has strong empirical support as a PTSD treatment. Virtual reality exposure (VRE) has been utilized to accelerate avoidance reduction by increasing multisensory engagement. Although some exposure therapy studies have found associations between avoidance and PTSD symptoms, others have indicated that reexperiencing or hyperarousal symptoms drive symptom trajectories. Using a cross-lagged panel design, the present secondary data analysis examined temporal associations between clinician-assessed PTSD symptom clusters during treatment with PE, VRE, or a waitlist control condition. There were no significant differences between PE and VRE regarding symptom clusters at any assessment. Compared to the waitlist condition, individuals who received VRE or PE exhibited earlier reductions in avoidance/numbing symptoms, β = -.19, 95% CI [-.33, -.05], followed by reductions in hyperarousal symptoms, β = -.21, 95% CI [-.33, -.09]. Hyperarousal symptoms predicted changes in later avoidance/numbing and reexperiencing outcomes across treatment: pretreatment to midtreatment, β = .29, 95% CI [.17, .42]; midtreatment to posttreatment, β = .23, 95% CI [.07, .39]. Reexperiencing symptoms predicted changes in hyperarousal outcomes earlier in treatment, β = .22, 95% CI [.02, .37], whereas avoidance/numbing symptoms predicted changes in hyperarousal outcomes later in treatment, β = .18, 95% CI [.04, .32]. These findings support the efficacy of exposure therapy in addressing avoidance/numbing symptoms and highlight the potential importance of hyperarousal symptoms in relation to other symptom clusters., (© 2020 International Society for Traumatic Stress Studies.)

Background: Many people with schizophrenia do not achieve satisfactory improvements in their mental state, particularly the symptom of hearing voices (hallucinations), with medical treatment., Objectives: To examine the effects of Avatar Therapy for people with schizophrenia or related disorders., Search Methods: In December 2016, November 2018 and April 2019, the Cochrane Schizophrenia Group's Study-Based Register of Trials (including registries of clinical trials) was searched, review authors checked references of all identified relevant reports to identify more studies and contacted authors of trials for additional information., Selection Criteria: All randomised clinical trials focusing on Avatar Therapy for people with schizophrenia or related disorders., Data Collection and Analysis: We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and 95% confidence intervals (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and 95% CIs. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. Our main outcomes of interest were clinically important change in; mental state, insight, global state, quality of life and functioning as well as adverse effects and leaving the study early., Main Results: We found 14 potentially relevant references for three studies (participants = 195) comparing Avatar Therapy with two other interventions; treatment as usual or supportive counselling. Both Avatar Therapy and supportive counselling were given in addition (add-on) to the participants' normal care. All of the studies had high risk of bias across one or more domains for methodology and, for other risks of bias, authors from one of the studies were involved in the development of the avatar systems on trial and in another trial, authors had patents on the avatar system pending. 1. Avatar Therapy compared with treatment as usual When Avatar Therapy was compared with treatment as usual average endpoint Positive and Negative Syndrome Scale - Positive (PANSS-P) scores were not different between treatment groups (MD -1.93, 95% CI -5.10 to 1.24; studies = 1, participants = 19; very low-certainty evidence). A measure of insight (Revised Beliefs about Voices Questionnaire; BAVQ-R) showed an effect in favour of Avatar Therapy (MD -5.97, 95% CI -10.98 to -0.96; studies = 1, participants = 19; very low-certainty evidence). No one was rehospitalised in either group in the short term (risk difference (RD) 0.00, 95% CI -0.20 to 0.20; studies = 1, participants = 19; low-certainty evidence). Numbers leaving the study early from each group were not clearly different - although more did leave from the Avatar Therapy group (6/14 versus 0/12; RR 11.27, 95% CI 0.70 to 181.41; studies = 1, participants = 26; low-certainty evidence). There was no clear difference in anxiety between treatment groups (RR 5.54, 95% CI 0.34 to 89.80; studies = 1, participants = 19; low-certainty evidence). For quality of life, average Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (QLESQ-SF) scores favoured Avatar Therapy (MD 9.99, 95% CI 3.89 to 16.09; studies = 1, participants = 19; very low-certainty evidence). No study reported data for functioning. 2. Avatar Therapy compared with supportive counselling When Avatar Therapy was compared with supportive counselling (all short-term), general mental state (Psychotic Symptom Rating Scale (PSYRATS)) scores favoured the Avatar Therapy group (MD -4.74, 95% CI -8.01 to -1.47; studies = 1, participants = 124; low-certainty evidence). For insight (BAVQ-R), there was a small effect in favour of Avatar Therapy (MD -8.39, 95% CI -14.31 to -2.47; studies = 1, participants = 124; low-certainty evidence). Around 20% of each group left the study early (risk ratio (RR) 1.06, 95% CI 0.59 to 1.89; studies = 1, participants = 150; moderate-certainty evidence). Analysis of quality of life scores (Manchester Short Assessment of Quality of Life (MANSA)) showed no clear difference between groups (MD 2.69, 95% CI -1.48 to 6.86; studies = 1, participants = 120; low-certainty evidence). No data were available for rehospitalisation rates, adverse events or functioning., Authors' Conclusions: Our analyses of available data shows few, if any, consistent effects of Avatar Therapy for people living with schizophrenia who experience auditory hallucinations. Where there are effects, or suggestions of effects, we are uncertain because of their risk of bias and their unclear clinical meaning. The theory behind Avatar Therapy is compelling but the practice needs testing in large, long, well-designed, well-reported randomised trials undertaken with help from - but not under the direction of - Avatar Therapy pioneers., (Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Background: The majority of studies comparing active psychological treatments for posttraumatic stress disorder (PTSD) do not find significant differences at posttreatment. This was the case in a recent trial examining prolonged exposure (PE) and virtual reality exposure (VRE) among active-duty soldiers with combat-related PTSD. Matching individual patients to specific treatments provides a potential avenue to improve significantly the public health impact of effective treatments for PTSD. A composite moderator approach was used to identify profiles of patients who would see superior PTSD symptom reduction in VRE or PE to inform future treatment matching., Methods: Active duty U.S. army soldiers (N = 108) were enrolled in a randomized clinical trial comparing VRE and PE in the treatment of PTSD stemming from deployments to Iraq or Afghanistan. Eighteen baseline variables were examined to identify treatment response heterogeneity in two patient groups: those with a superior response to PE and those with a superior response to VRE. The final composite moderator comprised four of 18 baseline variables., Results: Results revealed that patients who were predicted to see greater PTSD symptom reduction in VRE were likely to be younger, not taking antidepressant medication, had greater PTSD hyperarousal symptoms, and were more likely to have greater than minimal suicide risk., Conclusions: Results suggest that treatment matching based on patient profiles could meaningfully improve treatment efficacy for combat-related PTSD. Future research can build on these results to improve our understanding of how to improve treatment matching for PTSD., (© 2018 Wiley Periodicals, Inc.)

Purpose: Virtual reality (VR) technology is an effective tool in treatment of acute pain. Numerous studies show the effectiveness of this method both in a clinical context and in the laboratory. However, research results on the effectiveness of VR in pediatric venipuncture pain is not conclusive-not all studies report the analgesic effect of VR. In addition to testing effectiveness of VR, we also assess the usability of a novel hands-free interface., Design and Methods: Patients of paediatric nephrology clinic (N = 38; mean age 11 years, range 7-17) participated in a posttest only between group quasi-experimental study. Participants in the treatment group received the venipuncture procedure with VR distraction. They were wearing a head-mounted Oculus DK2 HMD, and playing a game designed by the authors of the study. The game was based on Multiple Object Tracking (MOT) task, where players have to remember and simultaneously track several moving targets. MOT has been used in many studies on attention and working memory. Participants rated their pain and stress intensity on visual analogue scales (VAS) on a scale of 0 to 100 and answered a short questionnaire., Results: The VR group reported significantly lower pain intensity than the controls (mean = 15.16 ± 20.51 vs. 37.05 ± 30.66; t = 2.59, df = 36, p < .02, d = 0.863). Similar results were obtained for stress level (11.16 ±18.58 vs 41.89 ± 40.89; t = 2.98, df = 36, p < .01, d = 0.993). There were no correlations with age., Practice Implications: VR can be as an effective tool to minimize pediatric pain and stress due to venipuncture. The MOT-based VR game was suitable for children at the studied age range. This solution can be easily applied by nurses in their clinical practice., (© 2017 Wiley Periodicals, Inc.)

Background: When a memory is recalled, it may again exist in a labile state and stored information becomes amenable to change, a psychobiological process known as reconsolidation. Exposure therapy for anxiety disorders involves accessing a fear memory and modifying it with less fearful information. A preclinical study reported that providing a reminder of a fear memory 10 min prior to extinction training in humans decreased fear up to 1 year later (Schiller et al., 2010)., Methods: For this pilot clinical study, we used virtual reality exposure therapy (VRE) for fear of flying (FoF) to determine if using a cue to reactivate the memory of the feared stimulus 10 min prior to exposure sessions leads to fewer anxiety-related behaviors and a more durable response compared to a neutral cue. FoF participants (N = 89) received four sessions of anxiety management training followed by four sessions of VRE. Participants were randomly assigned to receive an FoF cue (reactivation group) or a neutral cue (control group) prior to the VRE sessions. Heart rate (HR) and skin conductance levels (SCLs) were collected during posttreatment and 3-month follow-up assessments as objective markers of fear responding., Results: Treatment was effective and all clinical measures improved equally between groups at posttreatment with maintained gains through follow-ups. Significant differences were identified with regard to HR and SCL indices., Conclusions: These results suggest that memory reactivation prior to exposure therapy did not have an impact on clinical measures but may enhance the effect of exposure therapy at the physiological level., (© 2017 Wiley Periodicals, Inc.)

Objective To define relationships between the frontal sinus opening, ostia of other frontal recess cells, and endoscopic landmarks and to develop a clinically useful framework to guide frontal sinus surgery. Study Design Retrospective review. Setting Tertiary care academic referral center. Methods Adult patients with computed tomography (CT) without sinonasal pathology were included. Virtual endoscopy (using OsiriX) and corresponding CT reconstructions were used to identify all visible ostia in the frontal recess and characterize their positions in spaces between the uncinate/agger nasi (U), bulla ethmoidalis (EB), and middle turbinate (MT). Results Two hundred sides in 100 patients (median age 51 years, 62% female) were analyzed. The "center" of each map was defined as the intersection of spaces between U, EB, and MT. The frontal sinus opening was in the "center" in 53% of frontal recesses, lateral to this position in 29%, and anterior in 11%. When the frontal sinus opening was at the "center," anterior ostia drained frontal Kuhn T cells in 51% and intersinus septal cells in 23%. The skull base attachment of the apical strut of the uncinate process demarcated medial and lateral within the space between U and EB, with the opening to the frontal sinus medial in 68% and lateral in 31%. Left-right asymmetry in frontal sinus openings was noted in 46% of patients. Conclusion Combining preoperative imaging and knowledge of these anatomic relationships may facilitate more efficient frontal outflow tract identification and instrumentation. This represents the first and largest description of ostial configurations relative to endoscopic structural landmarks., Level of Evidence: 4.

Virtual reality has shown promising results in the treatment of posttraumatic stress disorder (PTSD) for some traumatic experiences, but sexual assault has been understudied. One important question to address is the relevance and safety of a virtual environment (VE) allowing patients to be progressively exposed to a sexual assault scenario. The aim of this study was to validate such a VE. Thirty women (victims and nonvictims of sexual assault) were randomly assigned in a counter-balanced order to 2 immersions in a virtual bar: a control scenario where the encounter with the aggressor does not lead to sexual assault and an experimental scenario where the participant is assaulted. Immersions were conducted in a fully immersive 6-wall system. Questionnaires were administered and psychophysiological measures were recorded. No adverse events were reported during or after the immersions. Repeated-measures analyses of covariance revealed a significant time effect and significantly more anxiety (Cohen's f = 0.41, large effect size) and negative affect (Cohen's f = 0.35, medium effect size) in the experimental scenario than in the control condition. Given the safety of the scenario and its potential to induce emotions, it can be further tested to document its usefulness with sexual assault victims who suffer from PTSD., (Copyright © 2017 International Society for Traumatic Stress Studies.)

Background: Parkinson's disease (PD) is a neurodegenerative disorder that is best managed by a combination of medication and regular physiotherapy. In this context, virtual reality (VR) technology is proposed as a new rehabilitation tool with a possible added value over traditional physiotherapy approaches. It potentially optimises motor learning in a safe environment, and by replicating real-life scenarios could help improve functional activities of daily living., Objectives: The objective of this review was to summarise the current best evidence for the effectiveness of VR interventions for the rehabilitation of people with PD in comparison with 1) active interventions, and 2) passive interventions. Our primary goal was to determine the effect of VR training on gait and balance. Secondary goals included examining the effects of VR on global motor function, activities of daily living, quality of life, cognitive function, exercise adherence, and the occurrence of adverse events., Search Methods: We identified relevant articles through electronic searches of the Cochrane Movement Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, Embase, CINAHL, the Physiotherapy Evidence Database (PEDro), online trials registers, and by handsearching reference lists. We carried out all searches up until 26 November 2016., Selection Criteria: We searched for randomised and quasi-randomised controlled trials of VR exercise interventions in people with PD. We included only trials where motor rehabilitation was the primary goal., Data Collection and Analysis: Two review authors independently searched for trials that corresponded to the predefined inclusion criteria. We independently extracted and assessed all data for methodological quality. A third review author was responsible for conflict resolution when required., Main Results: We included 8 trials involving 263 people with PD in the review. Risk of bias was unclear or high for all but one of the included studies. Study sample sizes were small, and there was a large amount of heterogeneity between trials with regard to study design and the outcome measures used. As a result, we graded the quality of the evidence as low or very low. Most of the studies intended to improve motor function using commercially available devices, which were compared with physiotherapy. The interventions lasted for between 4 and 12 weeks.In comparison to physiotherapy, VR may lead to a moderate improvement in step and stride length (standardised mean difference (SMD) 0.69, 95% confidence interval (CI) 0.30 to 1.08; 3 studies; 106 participants; low-quality evidence). VR and physiotherapy interventions may have similar effects on gait (SMD 0.20, 95% CI -0.14 to 0.55; 4 studies; 129 participants; low-quality evidence), balance (SMD 0.34, 95% CI -0.04 to 0.71; 5 studies; 155 participants; low-quality evidence), and quality of life (mean difference 3.73 units, 95% CI -2.16 to 9.61; 4 studies; 106 participants). VR interventions did not lead to any reported adverse events, and exercise adherence did not differ between VR and other intervention arms.The evidence available comparing VR exercise with a passive control was more limited. The evidence for the main outcomes of interest was of very low quality due to the very small sample sizes of the two studies available for this comparison., Authors' Conclusions: We found low-quality evidence of a positive effect of short-term VR exercise on step and stride length. VR and physiotherapy may have similar effects on gait, balance, and quality of life. The evidence available comparing VR with passive control interventions was more limited. Additional high-quality, large-scale studies are needed to confirm these findings.

Virtual reality (VR) technology has been successfully used to study the influence of specific and contextual food-related cues on emotional, cognitive and behavioural responses in patients with eating disorders (ED) and healthy controls. Following this research line, the present study assesses the effect on reported food craving of the type of food (low calorie versus high calorie) and the presence or absence of other people (private versus social context) in VR environments. Relationships between craving and body mass index (BMI) and ED symptoms are also explored. Eighty-seven female students were exposed to four VR scenarios presented in random order: a low-calorie kitchen, a high-calorie kitchen, a low-calorie restaurant and a high-calorie restaurant. After 2 minutes of exposure to each virtual scenario, food craving was assessed. Repeated measures analyses of covariance were conducted to assess changes in food craving following exposure to the different VR environments. Time elapsed since the last meal was introduced as a covariate to control for responses produced by food deprivation. Correlation and hierarchical multiple regression analyses were also conducted to assess the relationship between reported food craving and BMI and ED symptoms. Participants experienced higher levels of food craving after exposure to high-calorie foods (in both the kitchen and restaurant environments) than after exposure to low-calorie foods. Being alone in the kitchen or with friends in the restaurant had no effect on reported craving. Overall, neither BMI nor ED symptoms were related with reported food craving; only in the restaurant with low-calorie food was a significant negative correlation found between BMI and food craving. The results suggest that cue exposure in virtual environments is an effective procedure for inducing food craving in healthy controls and may be useful as a research and therapeutic tool in clinical populations., (Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.)

Metachromatic leukodystrophy (MLD) is a lysosomal storage disease characterized by demyelination of the peripheral and central nerves. Patients with MLD can present with gait disturbances, progressive spastic quadriparesis, diffuse muscle atrophy, and areflexia attributable to central or peripheral nerve involvements. The rehabilitation of patients with MLD generally focuses on gait disturbances, balance impairments, and muscle weaknesses. Here, we present a case of MLD in which virtual reality (VR) training was used as an adjunctive therapy. We also discuss the complementary role of VR therapy, which was successfully integrated with a conventional rehabilitation program for a young patient with MLD who had impaired balance and gait. After completion of the integrated rehabilitation program, the patient demonstrated improvements in functional independency, mobility, walking speed, and balance. His total Functional Independence Measure score increased from 97 to 109, 6-minute walk test increased from 342 to 396 m, 10-minute walk test decreased from 11 to 7 seconds, and Berg Balance Scale score increased from 38 to 42 points. Moreover, 6 weeks after completion of the therapy, these improvements were sustained for the most part. Adding VR to a conventional rehabilitation program is an emerging trend in neurologic rehabilitation. Our patient with MLD demonstrated considerable improvements with a high level of enjoyment and satisfaction., (Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

Context: Virtual reality exposure therapy (VRET) is an extension of traditional exposure therapy and has been used to treat a variety of anxiety disorders. VRET utilizes a computer-generated virtual environment to present fear-relevant stimuli. Recent studies have evaluated the use of VRET for treatment of PTSD; however, a systematic evaluation of the methodological quality of these studies has yet to be conducted., Objectives: This review aims to (a) identify treatment outcome studies examining the use of VRET for the treatment of PTSD and (b) appraise the methodological quality of each study using the 2010 Consolidating Standards of Reporting Trials (CONSORT) Statement and its 2008 extension for nonpharmacologic interventions., Methods: Two independent assessors conducted a database search (PsycINFO, Medline, CINAHL, Google Scholar) of studies published between January 1990 and June 2013 that reported outcome data comparing VRET with another type of treatment or a control condition. Next, a CONSORT quality appraisal of each study was completed., Results: The search yielded nine unique studies. The CONSORT appraisal revealed that the methodological quality of studies examining VRET as a treatment for PTSD was variable., Conclusion: Although preliminary findings suggest some positive results for VRET as a form of exposure treatment for PTSD, additional research using well-specified randomization procedures, assessor blinding, and monitoring of treatment adherence is warranted. Movement toward greater standardization of treatment manuals, virtual environments, and equipment would further facilitate interpretation and consolidation of this literature., (© 2013 Wiley Periodicals, Inc.)