Investigating the feasibility & design of virtual reality exposure therapy for subclinical anxiety
File(s)
Author(s)
Caltabiano, Anna
Type
Thesis or dissertation
Abstract
This thesis explores the feasibility, acceptability, and design considerations for Virtual Reality Exposure-Based Therapy (VRET) for adults with subclinical anxiety. Although subclinical populations are at increased risk for developing full-threshold disorders, they remain underrepresented in both research and treatment. VRET is a promising intervention for anxiety-related conditions, but its use for subclinical cases, and specifically for subclinical contamination Obsessive-Compulsive Disorder (OCD) and fear of needles, has not been sufficiently investigated.
Contamination OCD and fear of needles were selected as use cases due to their significant public health implications, including functional impairment and healthcare avoidance. These conditions also reflect distinct yet complementary anxiety profiles: contamination OCD involves obsessional thoughts and compulsive behaviors, while fear of needles is characterized by specific phobic avoidance. Both are well-established targets for exposure-based therapy and involve visual/situational triggers that are particularly well-suited to simulation in virtual environments. Studying both conditions offered early insight into the applicability of VRET across differing forms of anxiety symptomatology.
The thesis includes five studies. A systematic review highlights gaps in existing anxiety VRET literature. A survey study characterizes the associated symptom profiles and life interference. Two case studies conduct early-phase feasibility evaluation of VRET for these two conditions. A final study analyzes physiological data to identify markers of anxiety and explore whether machine learning models can distinguish between different anxiety profiles during virtual exposures.
Together, these studies demonstrate that VRET can evoke anxiety responses suitable for exposure-based interventions in these two subclinical anxiety cases. The findings suggest that VRET is an acceptable and promising option for individuals who may not access traditional therapy. By focusing on subclinical anxiety and leveraging scalable digital tools, this research supports the development of more accessible, preventative mental health interventions and advances efforts to democratize care for populations traditionally underserved by conventional therapeutic models.
Contamination OCD and fear of needles were selected as use cases due to their significant public health implications, including functional impairment and healthcare avoidance. These conditions also reflect distinct yet complementary anxiety profiles: contamination OCD involves obsessional thoughts and compulsive behaviors, while fear of needles is characterized by specific phobic avoidance. Both are well-established targets for exposure-based therapy and involve visual/situational triggers that are particularly well-suited to simulation in virtual environments. Studying both conditions offered early insight into the applicability of VRET across differing forms of anxiety symptomatology.
The thesis includes five studies. A systematic review highlights gaps in existing anxiety VRET literature. A survey study characterizes the associated symptom profiles and life interference. Two case studies conduct early-phase feasibility evaluation of VRET for these two conditions. A final study analyzes physiological data to identify markers of anxiety and explore whether machine learning models can distinguish between different anxiety profiles during virtual exposures.
Together, these studies demonstrate that VRET can evoke anxiety responses suitable for exposure-based interventions in these two subclinical anxiety cases. The findings suggest that VRET is an acceptable and promising option for individuals who may not access traditional therapy. By focusing on subclinical anxiety and leveraging scalable digital tools, this research supports the development of more accessible, preventative mental health interventions and advances efforts to democratize care for populations traditionally underserved by conventional therapeutic models.
Version
Open Access
Date Issued
2025-09-04
Date Awarded
2026-07-01
Copyright Statement
Attribution-NonCommercial 4.0 International Licence (CC BY-NC)
License URL
Advisor
van Zalk, Nejra
Di Simplicio, Martina
Sponsor
London Interdisciplinary Social Science Doctoral Training Partnership
Publisher Department
Dyson School of Design Engineering
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)