The role of presence in the level of anxiety experienced in clinical virtual environments

Recent reviews point towards that Virtual Reality Exposure Therapy (VRET) can be an effective medium to provide exposure therapy for anxiety disorders. The concept of presence, usually defined as the sense of being inside the virtual environment, has been considered the principal mechanism that leads to the experience of anxiety in clinical virtual environments. The present study sought to examine the relationship between sense of presence and in-session anxiety in a sample of 210 students showing high and low test anxiety when exposed to both clinical and non-stressful virtual environments. This is the largest study conducted to date with the aim of examining the relationship between presence and anxiety in clinical virtual environments, and the first to explore separately the relationship between presence and state-anxiety in phobic and non-phobic participants. The results suggest that presence was not related to anxiety in a non-stressful environment. It was also found that although presence is related to anxiety in both groups of students when exposed to clinical virtual environments, this relationship was clearly stronger for high test anxiety students. This line of research will broaden our understanding of the mechanisms that lead to the efficacy of VRET.