Therapeutic processes in virtual reality exposure therapy: The role of cognitions and the therapeutic alliance

Little is known about the processes involved in Virtual Reality Exposure Therapy (VRET), including the role of the therapeutic alliance and the patients' cognitions. This study was designed to investigate VRET processes in patients with specific phobias. We analyzed the influence of VRET on self-efficacy and negative self-statements without addressing these cognitions directly through treatment. In addition, we examined whether the quality of the therapeutic alliance as assessed with the Working Alliance Inventory (WAI) predicted successful outcome in VRET in terms of anxiety reduction. As expected, results showed that anxiety was reduced through treatment and an increase in self-efficacy, and a decrease in negative self-statements was observed. The quality of the therapeutic alliance was only positively related to outcome in fear of flying patients, but not in patients with acrophobia.