Virtual reality exposure in the treatment of fear of flying

Background: Recently, a growing body of research has appeared on different aspects of virtual reality exposure (VRE) therapy applied to the treatment of anxiety disorders. The purpose of this article was to review with a systematic methodology the evidences that support the potential effectiveness of this therapy in the treatment of fear of flying (FOF), a problem that significantly affects patients' social functioning and personal welfare. Methods: Potential studies were identified via computerized search using the PubMed/Medline and Web of Science databases, and additional review of their references. Articles ranged from 1969 to 2007 and the keywords used in the search were: "virtual reality" and "fear of flying"; "virtual reality" and "flying phobia"; or "virtual reality" and "flight phobia." Results: There were 40 studies using VRE in the treatment of FOF identified, mostly on the effectiveness of VRE therapy in group and case studies. Several components of the treatment protocols differed among the studies, which made the results comparison a challenging task. Nevertheless, controlled studies demonstrate that VRE treatment is effective with or without cognitive behavior therapy (CBT) and/or psychoeducation and that it is considered to be an effective component of the treatment of FOF. Conclusions: All studies that used cognitive and relaxation techniques in addition to VRE treatment were effective. More randomized clinical trials are required in which VRE therapy could be compared with standard exposure therapy. Thus, we suggest that CBT, psychoeducation, and VRE could be combined to treat FOF.