A virtual world exists inside a computer. Virtual reality involves the use of additional equipment, such as a headset or goggles, and possibly other items. However, especially in the early days of both technologies, the two terms were used somewhat interchangeably. (See for example Sullivan et al., 2013.)

Both work by giving the user a sense of immersion and embodiment. For some people, virtual reality provides a deeper sense of immersion and more complete sense of embodiment. Various factors in the virtual environment affect the user’s sense of presence as well as their response (Hoffman et al., 2004). Both virtual worlds and virtual reality differ significantly from other forms of computer-aided interactions, including chat rooms and forums.

Behm-Morawitz (2013) found that avatar immersion in a virtual world affects body perception and health. Some argue that the virtual is not separate from the “real,” but is a part of our reality, given the technologies now available.

Ghanbarzadeh et al (2014) created a taxonomy of uses of virtual worlds in healthcare after an extensive literature review. Their taxonomy includes: academic education, professional education, treatment, evaluation, lifestyle, and modeling.

The National Institute on Drug Abuse (NIDA), National Institute of Health (NIH), is actively funding research on virtual reality treatments for pain (Thomas, 2014).

A meta-analysis (Garrett et al., 2014) showed that virtual reality can be a useful distraction for patients undergoing painful procedures. This has been shown for children with cancer (Gershon et al., 2004), children undergoing IV placement (Gold et al., 2006), patients with low back pain (Trost et al., 2015), a patient undergoing thermotherapy (Wright et al., 2005); individuals with phantom limb pain (Ortiz-Catalan et al., 2014), child and adult burn patients (Chan et al., 2007; Das et al., 2005; Hoffman, Doctor, et al., 2000; Hoffman, Patterson, et al., 2000, 2001, 2004, 2008; Maani et al., 2011a, 2011b; Mott et al., 2008; Sharar, 2007; Sil et al., 2013; van Twillert et al., 2007), chronic pain patients (Keefe et al., 2012; Wiederhold et al., 2014), persons with fibromyalgia (Garcia-Palacios et al., 2015; Herrero et al., 2014), and patients undergoing dental procedures (Hoffman, Garcia-Palacios, et al. 2001).

The effects of virtual reality pain control are additive to the effects of opiods (Hoffman et al., 2007). Some evidence exists that virtual reality can be used to enhance pain control (Loreto-Quijada et al., 2014). Virtual pain coaching has also been explored (McDonald et al., 2013). Hypnosis induced while in a virtual world, used as a distraction from pain of burn wound care, has been reported (Patterson et al. 2004, 2006).

Various theories exist about how virtual therapy induces analgesia (Gold et al., 2007; Li et al., 2011).

Interacting with representations (avatars) of fellow humans in a metaphorical environment allows non-speaking people new ways to converse (Alm et al., 1998). The benefits of working in virtual reality for persons on the Autism Spectrum have been documented extensively (Biever, 2007). People with autism spectrum disorders often find virtual world communication more comfortable than in real life.

Communicating in a virtual environment slows social interactions down and gives people with autism better control. Many people with autism, who are unable to interact with others in real life, feel comfortable communicating through their avatar. Observing avatar gestures and experimenting with using them in in-world communication improves the ability of people with autism to interpret facial expressions and body language.

Communication with clinical psychologists could be facilitated in a virtual world setting, and group interaction and cohesiveness could also be positively influenced during therapy (Gorini et al, 2008). Lung cancer patents can be coached to use more assertive communication during virtual clinic visits (Brown-Johnson et al., 2015). Balandin (2011) discusses the use of virtual worlds to support persons with complex communication needs as they participate in communities.

The realistic scenes and personal interactions capture the interest and channel the attention of persons with ADHD (Alm, 1998). Virtual reality can assist people with cognitive impairments (Darrow, 1995). Exercising in a virtual reality environment can lead to significant gains in cognitive function during rehabilitation from traumatic brain injury (Grealy et al., 1999).

The realistic graphical interface allows mobility through the landscape with minimal physical effort. Navigating a three-dimensional Virtual Reality landscape improves spatial awareness. Warner’s research (1995) showed that eye/hand coordination and fine motor skills can be developed with the patient using very little strength.

Mao et al. (2014) report improved balance in patients given virtual reality training. Participation in a virtual reality balance exercise program improved balance confidence and function by adults with moderate or severe traumatic brain injury (Thornton et al., 2005). These adults and their caregivers also showed substantially greater enthusiasm and knowledge compared to a control group participating in an activity-based program.

Virtual reality therapy with monitoring of hand movements has been used with stroke patients (Burdea, 2002). Gatica-Rojas and Mendez-Rebolledo (2014) envision virtual reality devices used in physical rehabilitation therapy for patients with neurological disorders who need motor training.

A pilot mind-body therapeutic intervention for stress control is described by Hoch et al. (2012). Yuen et al. (2013) report an effective virtual world treatment for social anxiety disorder. A case study of a psychotherapy intervention is provided by Quackenbush and Krasner (2014). Brahnam and Brooks (2014) developed a virtual world expressive therapy psychotherapy treatment. Phobia-inducing virtual environments have been prescribed for patients with cognitive deficits (Burdea, 2003).

Some adults with intellectual disabilities can be trained to use virtual worlds (Balandin & Molka-Danielsen, 2015; Hall et al., 2011). People with developmental disabilities can learn life skills, such as grocery shopping, through the use of virtual reality (Standen & Cromby, 1995). Persons recovering from traumatic brain injury can learn meal preparation skills in virtual reality settings (Christiansen et al., 1998).

for people on the Autism Spectrum (Parsons & Mitchell, 2002). Participants can practice behaviors through role-play situations, in a safe environment for rule learning and task repetition. Practicing behaviors, both within and across contexts, may encourage people with autism to have a more flexible approach to social problem solving.

Knapfel et al (2014) used a virtual world to promote the use of Personal Health Records. Individuals with severe disabilities, who might not be able to participate in focus group research on healthcare topics, can offer their thoughts in a virtual world setting (Krueger, 2014).

Generally, providing online resources and patient support has been seen as beneficial (Stevens, 2004; Williams & Nicolas, 2005). Managing chronic illness in isolated rural environments is challenging due to limited sources of social support and health information. Research on an Internet intervention targeting this population (Hill & Weinert, 2004) showed that highly interactive features of the project were rated as most important by the participants. Overall, the program was beneficial in assisting participants to better manage their chronic illness.

Self-management for diabetes has been facilitated through the use of virtual world communities (Johnson et al., 2013; Mitchell et al., 2014; Rosal et al., 2014; Ruggiero et al. 2015; Vorderstrasse et al., 2014; Watson, 2008).

Peer support delivered through a virtual world environment can benefit caregivers as well (O’Connor et al., 2014).

Additionally, virtual reality may be used in diagnosis of neurologic conditions (Llobera et al., 2013). Elderly patients can be monitored remotely through a combination of sensors and virtual world avatars (Pouke & Hakkila, 2013).

Virtual therapy fosters motivation to work at improving health and physical and mental functioning during rehabilitation because the person is having fun (Warner, 1995). Warner notes that a physiological reason is not the deterrent from improvement, “it’s the psychological capacity that blocks them. They don’t want to do it. They are depressed. They’ve lost function.”

Virtual therapeutic interventions have been shown to improve cognitive function and concentration for individuals who have suffered a traumatic brain injury through interaction with a pleasant activity. Researchers (Sveistrup et al., 2004) have shown that for this disability group, working in virtual therapy increases both self esteem and empowerment.

Individuals with a variety of disabling conditions showed improvements on six psychosocial measures after interacting in a virtual world without specific treatment (Gilbert et al., 2013). Individuals in the study showed lower trait anxiety, loneliness and depressive symptoms, and improved positive affect, self-esteem, and life satisfaction.

Virtual environments offer disabled users more and better control over their surroundings and their interactions with other individuals. This may be the main benefit of their being in this type of setting (Alm et al, 1998). Virtual environments do this by offering experiences that are both engaging and rewarding, that shift the user’s focus from completing a therapeutic task to interacting with the virtual environment.

Beside improved motivation among users with various conditions, advantages to their participation in virtual reality settings include adaptability and variability based on baseline functioning, transparent data storage, online remote data access by caregivers, economy of scale, and reduced medical costs (Burdea, 2003). Because virtual worlds are internet-based, they can be used by people in different geographic areas synchronously (Gorini, 2008). Ethical and legal issues for therapy delivered in virtual environments are no different from those for therapy delivered in person (Yellowlees et al., 2012).

McClintock, H. F., Kurichi, J. E., Barg, F. K., Krueger, A., Colletti, P. M., Wearing, K. A., et al. (2017). Health care access and quality for persons with disabilities: Patient and provider recommendations. Disability and Health Journal. (in press) View the abstract here.
(https://www.sciencedirect.com/science/article/pii/S1936657417302340)

Winkler, S. L., Cooper, R., Kraiger, K., Ludwig, A., Krueger, A., et al. (2017). Self-management intervention for amputees in a virtual world environment. Journal of Alternative Medicine Research, suppl. Special Issue: Virtual reality technologies for rehabilitation, 9(2), 141-145.

Alm, N., Arnott, J. L., Murray, I. R., & Buchanan, I. (1998, Oct). Virtual reality for putting people with disabilities in control. Systems, Man, and Cybernetics, 2, 1174-1179.

Balandin, S. (2011, June). Participation by adults with lifelong disability: more than a trip to the bowling alley. International Journal of Speech-language Pathology, 13(3), 207-217.

Balandin, S. & Molka-Danielsen, J. (2015). Teachers’ perceptions of virtual worlds as a medium for social inclusion for adults with intellectual disability. Disability and Rehabilitation, 37(17), 1543-1550.

Behm-Morawitz, E.  (2013, Feb). Self-Presence and the Effects of the Avatar on Health and Appearance. Games for health journal, 2(1), 50-52.

Biever, C. (2007, June). Let’s meet tomorrow in Second Life. NewScientist, 2610, 26-27.

Brahnam, S., & Brooks, A. L. (2014). Two innovative healthcare technologies at the intersection of serious games, alternative realities, and play therapy. Studies in health technology and informatics, (207), 153-162.

Brewer, L. C., Kaihoi, B., Zarling, K. K., Squires, R. W., Thomas, R., & Kopecky, S. (2015, April). The use of virtual world-based cardiac rehabilitation to encourage healthy lifestyle choices among cardiac patients: intervention development and pilot study protocol. JMIR research protocols, 4(2), e39.

Brown-Johnson, C. G; Berrean, B., & Cataldo, J. K. (2015, Apr). Development and usability evaluation of the mHealth Tool for Lung Cancer (mHealth TLC): A virtual world health game for lung cancer patients.  Patient education and counseling, 98(4):506-511.

Burdea, G. C. (2002, Jan). Virtual Reality-based Post-Stroke Rehabilitation. Paper presented at the 10th annual Medicine Meets Virtual Reality conference, Newport Beach, CA.

Burdea, G. C. (2003). Virtual rehabilitation–benefits and challenges. Methods of Information in Medicine, 42(5), 519-523.

Chan, E.A., Chung, J.W., Wong, T.K., Lien, A.S., & Yang, J.Y. (2007). Application of a virtual reality prototype for pain relief of pediatric burn in Taiwan. Journal of Clinical Nursing, 16(4), 786–793.

Christiansen, C., Abreu, B., Ottenbacher, K., Huffman, K., Masel, B., & Culpepper, R. (1998, August). Task performance in virtual environments used for cognitive rehabilitation after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 79(8), 888-892.

Darrow, M. (1995, August). Virtual reality’s increasing potential for meeting the needs of persons with disabilities: What about cognitive impairments? Paper presented at the Virtual Reality and Persons with Disabilities Conference, San Francisco, CA.

Das, D.A., Grimmer, K.A., Sparnon, A.L., McRae, S.E., Thomas, B.H. (2005). The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: a randomized controlled trial. BMC Pediatrics, 5(1), 1.

Hall, V., Conboy-Hill, S., & Taylor, D. (2011, Nov). Using virtual reality to provide health care information to people with intellectual disabilities: acceptability, usability, and potential utility. Journal of medical Internet research, 13(4), e91.

Garcia-Palacios, A.,  Herrero, R., Vizcaino, Y., Belmonte, M. A., Castilla, D., Molinari, G., et al. (2015, June). Integrating virtual reality with activity management for the treatment of fibromyalgia: acceptability and preliminary efficacy. The Clinical Journal of Pain, 31(6), 564-72.

Garrett, B., Taverner, T., Masinde, W., Gromala, D., Shaw, C., & Negraeff, M. (2014, Dec). A rapid evidence assessment of immersive virtual reality as an adjunct therapy in acute pain management in clinical practice. The Clinical Journal of Pain, 30(12), 1089-1098.

Gatica-Rojas, V. & Mendez-Rebolledo, G. (2014, April). Virtual reality interface devices in the reorganization of neural networks in the brain of patients with neurological diseases. Neural regeneration research, 9(8), 888-896.

Gershon, J., Zimand, E., Pickering, M., Rothbaum, B. O., & Hodges, L. A pilot and feasibility study of virtual reality as a distraction for children with cancer. Journal of the American Academy of Child and Adolescent Psychiatry, 43(10), 1243–1249.

Ghanbarzadeh, R., Ghapanchi, A. H., Blumenstein, M., & Talaei-Khoei, A. (2014, Feb). A decade of research on the use of three-dimensional virtual worlds in healthcare: A systematic literature review. Journal of medical Internet research, 16(2), e47.

Gilbert, R., Murphy, N., Krueger, A., Ludwig, A., & Effron, T. (2013). Psychological Benefits of Participating in 3D Virtual Worlds for Individuals with Real World Disabilities. International Journal of Disability, Development and Education, 60(3), 208-224.

Gold, J. I., Kim,S. H., Kant, A. J., Joseph, M. HJ., & Rizzo, A. S. (2006, April). Effectiveness of virtual reality for pediatric pain distraction during i.v. placement. Cyberpsychology and Behavior, 9(2), 207-212.

Gold, J. I., Belmont, K.A., & Thomas, D. A. (2007). The neurobiology of virtual reality pain attenuation. Cyberpsychology and Behavior, 10(4), 536–544.

Gorini, A., Gaggioli, A., Vigna, C., & Riva, G. (2008, Aug). A second life for eHealth: Prospects for the us of 3-D virtual worlds in clinical psychology. Journal of medical Internet research, 10(3), e21

Grealy, M. A., Johnson, D. A., & Rushton, S. K. (1999, June). Improving cognitive function after brain injury: The use of exercise and virtual reality. Archives of Physical Medicine and Rehabilitation, 80(6), 661-667.

Herrero, R., Garcia-Palacios, A., Castilla, D., Molinari, G., & Botella, C. (2014, June). Virtual reality for the induction of positive emotions in the treatment of fibromyalgia: a pilot study over acceptability, satisfaction, and the effect of virtual reality on mood. Cyberpsychology, Behavior and Social networking, 17(6), 379-84.

Hill, W. G., & Weinert, C. (2004). An evaluation of an online intervention to provide social support and health education. Computers, Informatics, Nursing, 22(5), 282-288.

Hoch, D. B., Watson, A. J., Linton, D. A., Bello, H. E., Senelly, M., Milik, M. T., et al. (2012). The feasibility and impact of delivering a mind-body intervention in a virtual world. PLoS One, 7(3), e33843.

Hoffman, H.G., Doctor, J.N., Patterson, D.R., Carrougher, G.J., Furness, T.A., 3rd. (2000). Virtual reality as an adjunctive pain control during burn wound care in adolescent patients. Pain, 85(1–2), 305–309.

Hoffman, H.G., Patterson, D.R., & Carrougher, G.J. (2000). Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study. The Clinical Journal of Pain, 16(3), 244–250

Hoffman, H.G., Garcia-Palacios, A., Patterson, D.R., et al. (2001). The effectiveness of virtual reality for dental pain control: a case study. Cyberpsychology and Behavior, 4(4), 527–535.

Hoffman, H.G., Patterson, D.R., Carrougher, G.J., & Sharar, S.R. (2001). Effectiveness of virtual reality-based pain control with multiple treatments. The Clinical Journal of Pain, 17(3), 229–235.

Hoffman, H.G., Patterson, D.R., Magula, J., et al. (2004). Water-friendly virtual reality pain control during wound care. Journal of Clinical Psychology, 60(2), 189–195.

Hoffman, H.G., Sharar, S.R., Coda, B., et al. (2004). Manipulating presence influences the magnitude of virtual reality analgesia. Pain, 111(1–2), 162–168.

Hoffman, H.G., Richards, T.L., Van Oostrom, T,. et al. (2007). The analgesic effects of opioids and immersive virtual reality distraction: evidence from subjective and functional brain imaging assessments. Anesthesia & analgesia, 105(6), 1776–1783.

Hoffman, H.G., Patterson, D.R., Seibel, E., et al. (2008). Virtual reality pain control during burn wound debridement in the hydrotank. The Clinical Journal of Pain, 24(4), 299–304.

Johnson, V., Feenan, K., Setliff, G., Pereira, K., Hassell, N., Beresford, H. F., et al. (2013). Building a virtual environment for diabetes self-management education and support.  International journal of virtual communities and social networking. 2013;5(3).

Keefe, F. J., Huling, D. A., Coggins, M. J., Keefe, D. F., Rosenthal, M .Z., Herr, N. R., et al. (2012, Nov). Virtual Reality for Persistent Pain: A New Direction for Behavioral Pain Management. Pain, 153(11), 2163-2166.

Knapfel, S., Plattner, B., Santo, T., & Tyndall, S. (2014). Promotion of meaningful use of a personal health record in second life. Studies in health technology and informatics, 201, 413-417.

Krueger, A.,  Colletti, P., Bogner, H., Barg, F.,  & Stineman, M. (2014). Conducting focus groups in Second Life on health-related topics. in Sharkey, P. M., Pareto, L., Broeren, J., & Rydmark, M. (Eds.) Proceedings of the 10th international conference on disability, virtual reality and associated technologies (ICDVRAT 2014). Downloaded September 27, 2015, from http://www.researchgate.net/publication/275330439_Proceedings_of_the_10th_international_conference_on_disability_virtual_reality_and_associated_technologies_%28ICDVRAT_2014%29

Li, A., Montano, Z., Chen, V. J., & Gold, J. I. (2011 March). Virtual reality and pain management: current trends and future directions. Pain Management, 1(2), 147-157.

Llobera, J., Gonzalez-Franco, M., Perez-Marcos, D., Valls-Sole, J., Slater, M., Sanchez-Vives, M. V. (2013, Mar). Virtual reality for assessment of patients suffering chronic pain: a case study. Experimental brain research, 225(1), 105-117.

Loreto-Quijada, D., Gutierrez-Maldonado, J., Nieto, R., Gutierrez-Martinez, O., Ferrer-Garcia, M., Saldana, C.,  et al. (2014, June). Differential effects of two virtual reality interventions: distraction versus pain control. Cyberpsychology, behavior and social networking, 17(6), 353-358.

Maani, C. V., Hoffman, H. G., Fowler, M., Maiers, A. J., Gaylord, K. M., & Desocio, P. A. (2011a, April). Combining ketamine and virtual reality pain control during severe burn wound care: One military and one civilian patient. Pain Management, 12(4), 673-678.

Maani, C. V., Hoffman, H. G., Morrow, M., Maiers, A., Gaylord, K., McGhee, L. L., et al. (2011b, July). Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles. The Journal of Trauma, 71(1 Suppl), S125-30.

Mao, Y., Chen, P., Li, L., & Huang, D. (2014, Sept). Virtual reality training improves balance function. Neural regeneration research, 9(17), 1628-1634.

McDonald, D. D., Walsh, S., Vergara, C., & Gifford, T. (2013, Dec). Effect of a virtual pain coach on pain management discussions: a pilot study. Pain management nursing, 14(4), 200-209.

Mitchell, S. E., Mako, M., Sadikova,E., Barnes, L., Stone, A., Rosal, M. C., et al. (2014, Nov). The comparative experiences of women in control: diabetes self-management education in a virtual world. Journal of diabetes science and technology, 8(6), 1185-1192.

Mott J, Bucolo S, Cuttle L, et al. (2008) The efficacy of an augmented virtual reality system to alleviate pain in children undergoing burns dressing changes: a randomized controlled trial. Burns, 34, 803–808.

O’Connor, M. F., Arizmendi, B. J., & Kaszniak, A. W. (2014, Aug). Virtually supportive: a feasibility pilot study of an online support group for dementia caregivers in a 3D virtual environment. Journal of aging studies, 30, 87-93.

Ortiz-Catalan, M., Sander, N., Kristoffersen, M. B., Hakansson, B., & Branemark, R. (2014, Feb). Treatment of phantom limb pain (PLP) based on augmented reality and gaming controlled by myoelectric pattern recognition: a case study of a chronic PLP patient. Frontiers Neuroscience, 8, 24.

Parsons, S., & Mitchell, P. (2002, June). The potential of virtual reality in social skills training for people with autistic spectrum disorders. Journal of Intellectual Disability Research, 46(Pt. 5), 430-443.

Patterson, D.R., Tininenko, J.R., Schmidt, A.E., & Sharar, S.R. (2004). Virtual reality hypnosis: a case report. International Journal of Clinical and Experimental Hypnosis, 52, 27–38.

Patterson, D.R., Wiechman, S.A., Jensen, M., & Sharar, S.R. (2006). Hypnosis delivered through immersive virtual reality for burn pain: a clinical case series. International Journal of Clinical and Experimental Hypnosis, 54(2), 130–142.

Pouke, M. & Hakkila, J. (2013, Dec). Elderly healthcare monitoring using an avatar-based 3D virtual environment. International journal of environmental health research, 17;10(12):7283-7298.

Quackenbush, D. M., & Krasner, A. (2012, Nov). Avatar therapy: Where technology, symbols, culture and connection collide. Journal of psychiatric practice, 18(6), 451-459.

Rosal, M. C., Heyden, R., Mejilla, R., Capelson, R., Chalmers, K. A., Rizzo DePaoli, M., et al. (2014, Oct). A virtual world versus face-to-face intervention format to promote diabetes self-management among African American women: A pilot randomized clinical trial. JMIR research protocols, 3(4), e54.

Ruggiero, L., Moadsiri, A., Quinn, L. T., Riley, B. B., Danielson, K. K., Monahan, C., et al. (2014). Diabetes island: preliminary impact of a virtual world self-care educational intervention for African Americans with type 2 diabetes. JMIR Serious Games, 2014;2(2). pii: e10.

Sharar, S.R., Carrougher, G.J., Nakamura, D., et al. (2007). Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies. Archives of physical medicine and rehabilitation, 88(12 Suppl 2):S43–S49.

Sil, S., Dahlqist, L. M., Burns, A. J. (2013, April). Case study: videogame distraction reduces behavioral distress in a preschool-aged child undergoing repeated burn dressing changes: a single-subject design. Journal of pediatric psychology, 38(3), 330-341.

Standen, P.J., & Cromby, P.J., (1995). Can students with developmental disabilities use Virtual Reality to learn skills which will transfer to the real world? Paper presented at the Virtual Reality and Persons with Disabilities Conference, San Francisco, CA.

Stevens ,L. (2004). Online patient support: Mostly a boon, but challenges remain. Medicine on the Net, 10(3), 1-6.

Sullivan, D. K., Goeta, J. R., Gibson, C. A., Washburn, R. A., Smith, B. K., Lee,J., et al. (2013, May-June). Improving weight maintenance using virtual reality (Second Life). Journal of nutrition education and behavior, 45(3), 264-268.

Sveistrup. H., Thornton, M., Bryanton, C., McComas, J., Marshall, S., Finestone, H., McCormick, A., McLean, J., Brien, M., Lajoie, Y., & Bisson, E. (2004). Outcomes of intervention programs using flatscreen virtual reality. Conference proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 7, 4856-4858.

Thomas, D. A. (2014, June). Virtual Reality Research Continues to Progress at the National Institutes of Health. Cyberpsychology, behavior and social networking, 17(6), 334.

Thornton, M., Marshall, S., McComas, J., Finestone, H., McCormick, A., & Sveistrup, H. (2005, November). Benefits of activity and virtual reality based balance exercise programmes for adults with traumatic brain injury: perceptions of participants and their caregivers. Brain Injuries, 19(12):989-1000.

Trost Z., Zielke, M., Guck, A., Nowlin, L., Zakhidov, D., France, C. R., et al. (2015). The promise and challenge of virtual gaming technologies for chronic pain: the case of graded exposure for low back pain. Pain Management, 5(3), 197-206.

van Twillert B, Bremer M, Faber AW. Computer-generated virtual reality to control pain and anxiety in pediatric and adult burn patients during wound dressing changes. J Burn Care Res. 2007;28(5):694–702.

Vorderstrasse, A., Shaw, R. J., Blascovich, J., & Johnson, C. M. (2014, Oct). A theoretical framework for a virtual diabetes self-management community intervention. Western Journal of Nursing Research, 36(9), 1222-1237.

Warner, D. (1995). Virtual reality: Focuses on the quality of life. Paper presented at the Virtual Reality and Persons with Disabilities Conference, San Francisco, CA.

Watson, A. J., Grant, R. W., Bello, H., & Hoch, D. B. (2008, July). Brave new worlds: How virtual environments can augment traditional care in the management of diabetes. Journal of diabetes science and technology, 2(4), 697-702.

Weikle, B. (1995). Riding the perfect wave: Putting virtual reality to work with disabilities. Retrieved July 17, 2007, from http://www.connsensebulletin.com/weikle.html.

Wiederhold, B. K., Gao, K., Sulea, C., & Wiederhold, M. D. (2014, June). Virtual reality as a distraction technique in chronic pain patients. Cyberpsychology, behavior and social networking,17(6), 346-352.

Williams, P., & Nicholas, D. (2005). Creating online resources for the vulnerable. Library & Information Update, 4(4), 30-31.

Wright, J. L., Hoffman, H. G., & Sweet, R. M. (2005, Dec). Virtual reality as an adjunctive pain control during transurethral microwave thermotherapy. Urology, 66(6), 1320.

Yellowlees, P. M., Holloway, K. M, & Parish, M. B. (2012, Sept). Therapy in virtual environments–clinical and ethical issues. Telemedicine journal and e-health, 18(7), 558-564.

Yuen, E. K.,  Herbert, J. D., Forman, E. M., Goetter, E. M., Comer, R., & Bradley, J. C.  (2013, Mar). Treatment of social anxiety disorder using online virtual environments in second life. Behavior Therapy, 44(1), 51-61.