The clinical use of virtual reality (VR) has proven its efficacy, especially when used as an exposure technique. A prominent property of VR's utility is its equivalence with the reality it represents. In this study, we explored this equivalence in a clinical context using neuroimaging. A sample of 32 adults with specific phobias (i.e., to cockroaches, spiders, or lizards) was divided into two groups: One was exposed to phobic stimuli using VR and the other was exposed to real phobic images (RI). We used brain activations as a dependent measure, focusing specifically on brain areas usually associated with fear processing. Whole-brain analysis detected higher activations for RI in the hippocampus, occipital, and calcarine areas. A specific analysis of the amygdala and insula also detected higher activations and extensions in response to RI, but VR stimuli also activated those areas in a significant manner. These results suggest that even in those cases where RI stimuli activate all of the brain's fear-processing circuits, VR stimuli do so as well. This implies that VR can be useful as an exposure technique similar to RI and applied as more than a mere training mechanism.
Keywords: anxiety disorders; fMRI; neuroimaging; real phobic images; specific phobia; virtual reality.