Clinical context and treatment target
Historical Canadian guidance distinguishes clinically impairing fear and avoidance from ordinary dislikes or caution. Its specific-phobia approach emphasizes exposure-based treatment, while recognizing differences between phobia types (Katzman et al., 2014). The clinical distinction matters: being nervous about an animal or procedure is not itself a diagnosis, and a reassuring description of a feared situation is not the same intervention as a structured exposure treatment. The guideline is older contextual material, so newer trials and reviews should guide contemporary delivery questions.
Sources: Katzman et al., 2014
Brief versus repeated sessions
Odgers et al. (2022) synthesized single- and multiple-session in-vivo exposure studies involving 1,758 participants. Both formats showed substantial pre/post improvement, with no significant pooled differences between formats. The review supports studying efficient treatment delivery, but its pre/post comparisons do not establish randomized equivalence. The number of session categories also exceeds the number of unique studies; it would be incorrect to add those counts or describe every study as an adult randomized trial. Its abstract does not provide enough information for a full independent appraisal of age-specific effects or adverse events.
Sources: Odgers et al., 2022
Virtual reality compared with real-world exposure
Wechsler et al. (2019) directly compared virtual-reality and in-vivo exposure in randomized trials. The specific-phobia subset contained only 4 trials and 153 participants, with g−0.15 (95% CI −0.47 to 0.16), in the direction favouring in-vivo exposure. The interval and small sample do not establish equivalence; they leave room for differences. The subset also combines different fears, so findings should not be generalized without qualification to every phobia, especially where the practical risks and procedures differ.
Sources: Wechsler et al., 2019
A recent development
Bunnell et al. (2026) tested a shared telehealth VR clinic against standard telemental-health exposure in 54 adults with fears of dogs, snakes, or spiders. Feasibility benchmarks were encouraging, but the study was not designed to establish clinical superiority and found no significant clinical between-group differences. One site, one therapist, selected eligibility, and commercial affiliations limit generalization. This is a useful example of a promising service model that still needs a larger confirmatory trial, rather than a discovery that replaces established treatment.
Sources: Bunnell et al., 2026
Durability and open questions
Follow-up syntheses suggest maintained benefits can occur, but do not justify promising permanent absence of fear (van Dis et al., 2020). Exposure is a treatment process whose planning and context matter; this review does not provide instructions for hazardous or medically sensitive situations. Future digital research could examine preparation, reflection, or tracking as an adjunct to clinician-led care. Relevant outcomes include approach behaviour and real-world participation. Remaining questions concern phobia subtypes, comparable treatment doses, people who avoid sessions, and adverse effects.
Sources: van Dis et al., 2020; Odgers et al., 2022; Wechsler et al., 2019; Bunnell et al., 2026
References
Links open the original papers or official sources. Access labels describe the material assessed for this review.
Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., Van Ameringen, M., & the Canadian Anxiety Guidelines Initiative Group (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry, 14(Suppl. 1), S1. 10.1186/1471-244X-14-S1-S1
Access assessed: full text, PMC; initial challenge resolved on final recheck
Odgers, K., Kershaw, K. A., Li, S. H., & Graham, B. M. (2022). The relative efficacy and efficiency of single- and multi-session exposure therapies for specific phobia: A meta-analysis. Behaviour Research and Therapy, 159, 104203. 10.1016/j.brat.2022.104203
Access assessed: PubMed abstract and metadata; indexed publisher excerpt
Wechsler, T. F., Kümpers, F., & Mühlberger, A. (2019). Inferiority or even superiority of virtual reality exposure therapy in phobias? A systematic review and quantitative meta-analysis on randomized controlled trials specifically comparing the efficacy of virtual reality exposure to gold standard in vivo exposure in agoraphobia, specific phobia, and social phobia. Frontiers in Psychology, 10, 1758. 10.3389/fpsyg.2019.01758
Access assessed: full text, publisher
Bunnell, B. E., Schuler, K. R., Craggs, J. G., Welch, B. M., & Ong, T. (2026). Examining the efficacy of a telehealth-based virtual reality clinic in treating adults with specific phobia: Feasibility randomized controlled trial. JMIR Formative Research, 10, e84670. 10.2196/84670
Access assessed: full text, PMC
van Dis, E. A. M., van Veen, S. C., Hagenaars, M. A., Batelaan, N. M., Bockting, C. L. H., van den Heuvel, R. M., Cuijpers, P., & Engelhard, I. M. (2020). Long-term outcomes of cognitive behavioral therapy for anxiety-related disorders: A systematic review and meta-analysis. JAMA Psychiatry, 77(3), 265–273. 10.1001/jamapsychiatry.2019.3986
Access assessed: primary abstract and indexed full-text excerpts; PMC challenge/repository403
This evidence review is educational. It does not provide an individual diagnosis or treatment plan. Read the review methods, access limits, and clinical-review status.