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Graduate Student Journal of Psychology                                                                             Copyright 2005 by the Department of Counseling & Clinical Psychology
2005, Vol. 7                                                                                                                          Teachers College, Columbia University                          ISSN 1088-4661

The Comparison of Violent Video Games
to a Virtual Reality Exposure Therapy Model

Noreen J. Vail-Gandolfo
Hofstra University

As video games become increasingly realistic and aggressive there is growing concern over the
possible generalization to real-life situations of learned aggressive behavior. To add to this con-
cern, today’s video game technology is very similar to that of virtual reality, which has been
found to effectively change behaviors in clinical settings. Since many similarities exist between
video games and virtual reality, it is possible that video games may elicit a similar change in be-
havior. Three tenets necessary for effective virtual reality exposure therapy, including complete
immersion in the virtual environment, emotional arousal, and the generalization of the learned
behavior to real-life situations, will be discussed and applied to video games (Krijn, Emmelkamp,
Olafsson, & Biemond, 2004). Current literature and future research directions will be discussed.

Although video games have been available for over
thirty years, the violent and realistic content of today’s best
selling games, such as Grand Theft Auto Vice City™ and
Doom 3™, can be traced back to 1992 with the debut of
Mortal Kombat™ (i.e., an interactive game of one-on-one
fighting with human characters and gruesome graphics,
Herz, 1997). Despite the fact that these violent games have
been on the market for over a decade, it was not until the
1999 shooting at Columbine High School in Littleton,
Colorado that concerns of their possible negative effects
were so strongly voiced (Garbarino & Bedard, 2001). This
incident sparked a great deal of debate primarily because
the shooters, Dylan Klebold and Eric Harris, were avid
players of the violent and aggressive game Doom™. It was
reported that they had even gone so far as to make their
own modified version of this particular game that they later
reenacted during the massacre at their school (Hubbard,
1999).

Given that approximately 67% of households with
children own a video game system (Subrahmanyam, Kraut,
Greenfield, & Gross, 2001), it is not surprising that the
video game industry earns more than twenty billion dollars
in worldwide annual sales (Federal Trade Commission,
2000). In 2000, the Federal Trade Commission reported that
of 118 “M” (i.e., mature) rated video games, 70% were
directed at adolescents under the age of 17, and children
between the ages of 13 and 16 were able to purchase these
mature rated games approximately 85% of the time without

Noreen J. Vail-Gandolfo, is a third level doctoral student in the
Combined Ph.D. Program in Clinical and School Psychology at
Hofstra University.

Correspondence concerning this article should be addressed
to Noreen J. Vail-Gandolfo, Department of Psychology, Hofstra
University, 135 Hofstra University, Hauser Hall, Room 222,
Hempstead, NY 11550; e-mail: NVail1@pride.Hofstra.edu.

an adult present. Clearly, these statistics suggest that violent
video games are not only being marketed to and sought
after by children, but they are quite easily obtained. As re-
cent evidence demonstrates that boys and girls spend 13
and 5 hours a week, respectively, playing video games—
almost the equivalent of having a part-time job—(Gentile,
Lynch, Linder, & Walsh, 2004), the question then becomes,
what impact does playing violent video games have on in-
dividuals and their behavior?

Contextual Factors of Video Game Playing

Anderson and Bushman (2001) have applied a General
Affective Aggression Model (GAAM) to violent media
including video games. In this model they suggest that re-
peated exposure to violent video games increases the prob-
ability that an individual will think, feel, and behave more
aggressively. This increase in aggressive responding is me-
diated by several variables, including the characteristics of
the individual person, the situation or game to which they
are exposed, the cognitive and affective excitement of the
person, and the way the person appraises the situation. In
terms of the contextual factors of the game, it has been
found that the most desirable games are those that have the
most realistic graphics and are highly interactive (Wood,
Griffiths, Chappell, & Davies, 2004). It would seem to fol-
low, then, that the more involved in a game the person be-
comes, the greater the possible effect of the game on their
behavior. Moreover, games that require a player to take the
first-person perspective may increase the level of interac-
tion and lead to the possible priming of the player for ag-
gressive thoughts and responses when handling real-life
situations (Anderson & Bushman, 2001).

The realistic graphics and high level of interaction
sought after in video games calls to mind a similar techno-
logical invention—virtual reality (VR) (Glantz, Rizzo, &



VAIL-GANDOLFO

24

Graap, 2003). Virtual reality allows the individual to be
completely immersed in an alternate environment and expe-
rience situations they may not normally be exposed to
(Krijn et al., 2004). Interestingly, virtual reality has most
recently been demonstrated to elicit changes in patient’s
behaviors in therapeutic settings (Hoffman, 2004) for such
problems as nicotine addiction (Lee et al., 2004) and fear of
flying (Arbona, Osma, Garcia-Palacios, Quero, & Banos,
2004) to name just a few. These findings suggest that be-
havior can be changed with the assistance of a device that is
very similar to video game consoles. While some critics
may argue that violent video games do not increase the
probability of an individual acting in a violent or aggressive
manner (Olson, 2004), if the characteristics of video games
and virtual reality are so similar, from the equipment used
to the presentation of stimuli and virtual reality is found to
facilitate therapeutic change, it seems only logical that
video games may also have the ability to elicit a powerful
change.

Exploring the Influence of Video Games

A meta-analysis of thirty-five research studies con-
ducted by Anderson and Bushman (2001) supported the
position that violent video games increase aggressive be-
havior not only in children, but also in many populations
including male and female adults regardless of the experi-
mental setting. In addition to an increase in aggressive be-
haviors, Anderson and Bushman also found a slight short-
term reduction in pro-social behaviors (i.e., behavior exe-
cuted to help another person) as well as a temporary in-
crease in aggressive thoughts and emotions. Despite the
limited availability of longitudinal data needed to provide
evidence of more lasting effects, this research does support
the position that playing violent video games can negatively
impact an individual’s behavior.

The increasing realism of video games leads one to re-
turn to the literature of virtual reality, specifically virtual
reality exposure therapy (VRET). VRET combines the
technology of virtual reality with the psychological tech-
nique of exposure therapy to provide individuals the op-
portunity to experience various stimuli in a controlled envi-
ronment. It also affords clinicians the opportunity to sub-
merge the patient in a controlled, anxiety-provoking situa-
tion without having to leave the office (Garcia-Palacious,
Hoffman, See, Tsai, & Botella, 2001). Preliminary data on
the use of VRET with such phobias as fear of driving (Wal-
she, Lewis, Kim, O’Sullivan, & Wiederhold, 2003) and fear
of flying (Wiederhold, 2003; Arbona et al., 2004) have been
optimistic in terms of creating a reduction in anxiety. Ac-
cording to Krijn et al. (2004) several conditions must be
met for VRET to be effective, including complete immer-
sion in the virtual environment, emotional arousal, and the
application of the learned behavior to situations occurring
in reality.

Similarities between VRET and
Commercial Video Games

The first condition that must be met is complete im-
mersion of the participant in the virtual reality world which
is accomplished through equipment such as a head mounted
device (HMD), a goggle-like mask that sits on the head and
provides visual stimuli through small video screens and
audio stimuli via headphones. While the stimuli are pre-
sented the individual can become immersed and unaware of
anything occurring externally. Typically, a sensor is con-
nected to the HMD so that all physical movements made by
the client toward the stimuli are carried out in the virtual
environment. Through these and other mechanisms, various
stimuli may be presented visually, aurally, and when possi-
ble tactilely (Krijn et al., 2004).

The equipment available in most video game consoles
appears to provide the same type of stimulation as the VR
design. For example, Microsoft’s game system XBOX™,
like all game systems, has handheld controllers to manipu-
late the actions of the characters. Thus, just as in the VR
environment, the actions of the player can be carried out in
the digital world. While audio effects are typically ampli-
fied through television speakers, XBOX™ has capabilities
for both headsets and surround-sound to enhance the inten-
sity of the game. Although these features are available on
most, if not all, of the game consoles currently being sold,
XBOX™ is being highlighted because of its compatibility
with some of the most violent games available including
Doom 3™ and Halo 2™ (Walsh, Gentile, Gieske, Walsh, &
Chasco, 2004). Not only are these games violent, but they
are played from the first-person perspective which means
the player is not seeing and reacting to the stimuli as a char-
acter, but rather as if he or she were in the environment,
much like the VR stimuli. In addition, recent evidence
demonstrates that highly engrossing graphics and game
content are the most desirable characteristics in a video
game (Wood et al., 2004), presumably because they keep
individuals occupied for hours at a time and may prevent
them from engaging in other activities.

Not only is the video game and virtual reality hardware
similar, but both provide a degree of distraction from the
outside world. Interestingly, playing video games has been
found to successfully reduce the level of pain and other side
effects experienced during various medical procedures,
such as nausea associated with chemotherapy in young
children (Redd et al., 1987). In addition, VR has also been
shown to decrease the pulse of pediatric cancer patients, as
well as the level of pain they experience (Gershon, Zimand,
Pickering, Rothbaum, & Hodges, 2004). These findings
indicate that amongst similarly aged children, both video
games and virtual reality have provided a level of immer-
sion that is even able to distract an individual from aversive
stimuli. It is difficult to deny that this is a powerful effect.

The second condition necessary for effective VRET is



THE COMPARISON OF VIOLENT VIDEO GAMES TO A VIRTUAL

25

to elicit an emotional response from the individual so as to
engage him or her on a personal level (Krijn et al., 2004).
To accomplish this, an environment that is salient to the
person is employed. For example, when conducting VRET
with a person who has aviphobia, or fear of flying, VR
would be used to simulate an airplane environment
(Maltby, Kirsch, Mayers, & Allen, 2002). If the stimulus
does not elicit an anxious feeling which the person can
learn to work through, it would seem impossible for the
individual to successfully face his or her fear(s) in real-life
situations. To objectively determine the effect the VR envi-
ronment has on an individual, physiological measures are
often employed. In particular, heart rate has been used as a
way of measuring a person’s reaction to the simulated envi-
ronment and can be indicative of their affective response to
the stimuli (Jang et al., 2002).

As in VRET, violent video games are replete with vis-
ual and audio effects designed to arouse the player. From
rock music to conversations with other characters, these
video games are able to pull the individual into, and sustain
him or her in an alternate world (Wood et al., 2004). In
light of the VRET literature, it appears that the physiologi-
cal arousal achieved through violent video games is similar
to that achieved in VR. One author relates her experience of
playing video games, stating, “During especially difficult
levels of play, my palms would sweat. My heart would
race. I’d have knots in my stomach from anxiety” (Sohn,
2004, ¶2). To further support this author’s experience, An-
derson and Bushman’s (2001) meta-analytic review found a
significant elevation of diastolic (i.e., relaxed heart) and
systolic (i.e., contracted heart) blood pressure, as well as
heart rate when individuals were engaged in playing violent
video games.

Anderson and Bushman (2001) also found a significant
increase in aggressive affect, which they proposed was re-
lated to a heightened sense of anger or hostility in the
player. Additional research by Panee and Ballard (2002)
found this increase in hostile feelings, as well as physio-
logical arousal, after participants played a violent video
game. Thirty-six undergraduate students played a violent
video game after being primed to either high or low aggres-
sive acts. The high aggression condition was referred to as
the “gun-shoot training mode,” in which the participants
were instructed to kill the guards in the video game with a
gun. The low aggression condition was referred to as the
“time attack training mode.” These participants were told
that it was not necessary to kill the guards in the game al-
though they could do so if they chose. After being trained,
all participants then played the video game Metal Gear
Solid™. They found that those individuals in the high ag-
gression group engaged in more violent acts during the
video game than those in the low aggression group. In
terms of physiological and affective arousal, participants in
the high aggression group had a greater increase in heart
rate than the low aggression group, and self-report meas-
ures found that this increase in heart rate was correlated
with greater feelings of hostility. These findings are con-

sistent with Anderson and Bushman’s evidence that expo-
sure to a high aggressive game increased the participant’s
physiological arousal. The self-reported feelings of in-
creased hostility presents the possibility that violent be-
havior acted out in video games may increase the likelihood
of an individual acting on these hostile feelings, which ac-
cording to the GAAM model mentioned previously, can
influence an individual’s behavior in real-life situations
(Anderson & Bushman, 2001). This leads to the third tenet
of VRET.

The third condition necessary in VRET is that the
learned behaviors generalize to real-life situations. For ex-
ample, in treating someone who has a fear of spiders, the
VRET is considered successful when the patient is able to
control their anxiety in the presence of a spider outside of
the therapeutic environment (Wiederhold & Wiederhold,
2005). In terms of violent video games, there is a great deal
of controversy surrounding this issue of generalization
(Anderson, 2004; Olson, 2004). However, there is research
supporting the hypothesis that playing violent video games
negatively influences the way a person thinks about and
subsequently responds to an ambiguous situation.

For example, Kirsh (1998) compared fifty-two children
in 3rd and 4th grade who played either a violent video game
(Mortal Kombat II™) or a non-violent video game (NBA
Jam™). After playing the video game, the child was read a
story in which a character of the same gender as him or her
caused a negative event to occur, but where the intent was
not clear. Children who had played the violent video game
were more likely to attribute the intent of the character to a
negative, aggressive reason in half of the stories then their
non-violent counterparts. In a sense, being shown the vio-
lent video game may have primed the children to respond in
a negative manner; specifically, the violent content of the
games may have put them in a negative frame of mind that
led them to attribute the actions of the character to behav-
iors that were commensurate with these negative thoughts.

From Video Games to ‘Real-Life’

To further understand how violent video games influ-
ence an individual’s behavior in real-life situations, Ander-
son and Dill (2000) reported their findings from two sepa-
rate studies. In the first they collected self-report data from
227 undergraduate students and correlated it with violent
video game playing. The areas addressed included fre-
quency and type of aggressive behavior, delinquency, and
level of academic achievement as measured by the partici-
pant’s grade point average. In addition, the individual’s
worldview was obtained by asking questions regarding the
likelihood of crime occurring and their feelings of safety in
various situations. The Caprara Irritability Scale (CIS) was
used to assess the individual’s impulsivity in responding to
frustrating stimuli and the Buss-Perry Aggression Ques-
tionnaire was used to assess trait aggression in each partici-
pant. A video game questionnaire was created by the
authors so that participants could identify their favorite



VAIL-GANDOLFO

26

video games and rate the amount of violent content in each
game on a scale of 1 (i.e., little to no violent content) to 7
(i.e., extremely graphic). Participants also reported the
overall frequency with which they played video games.
Results of this study revealed that playing violent video
games was directly related to aggressive behavior as well as
to non-aggressive (i.e., stealing) and aggressive (i.e., hit-
ting) delinquency. It was also found that individuals who
played violent video games had more aggressive personali-
ties as per the CIS and Buss-Perry Aggression Question-
naire. However, there are several limitations to the applica-
tion of these findings to the larger population. First, the
undergraduate sample used poses a threat to the external
validity of this study by making it difficult to generalize
these findings to other groups. In addition the self-report
measure by which data was collected threatens the internal
validity of this study by making it difficult to establish a
true cause and effect relationship. As such, the question
remains: do hostile individuals seek these games out, or are
they hostile because they play these games? The results of
this study do provide valuable insight into the playing hab-
its, personality styles, and aggressive behaviors of young
adults and are an important contribution to the video game
literature.

The second study Anderson and Dill (2000) conducted
aimed to obtain a more accurate view of an individual’s
response to a real-life situation after playing a violent video
game. In this study, they compared individuals’ responses
to a perceived opponent in a competitive computer game
after playing either a non-violent or violent video game.
Two hundred ten undergraduate students participated in this
study after being screened for trait irritability. In the first
session, participants played either a violent or non-violent
video game and were then asked to fill out the State Hostil-
ity Scale. They continued playing for another fifteen min-
utes after which they engaged in a cognitive assessment of
aggression that required each participant to read a list of
aggressive and control words as quickly as possible. One
week later the participants returned to the lab and played
the violent or non-violent game from the previous session
for fifteen minutes. They were then told that another par-
ticipant in a separate cubicle would be playing against them
in a competitive reaction task. The person who won would
be able to send the other player a noise blast of different
lengths and volumes, however, the intensity and duration of
the blast was to be determined by the participant prior to
each round. In reality there was no other player and the
noise blasts were set in a pattern so all participants received
an equal number of wins and losses. Results revealed that
exposure to the violent video game was related to more
aggressive behavior in the participant as evidenced by their
delivery of longer lasting noise blasts to their “opponents”
after they had lost the round prior to their winning.

Limitations of Current Research and Future Directions

It is difficult to truly examine the effects of violent
video games on real-life aggression through the use of labo-

ratory experiments and/or retrospective self-report meas-
ures, which are not always the most generalizable sources
of data. It is also important that sweeping generalizations
not be made based on anecdotal evidence, such as blaming
all acts of teen violence on violent video games or other
sources of violent media these individuals may be exposed
to. Ultimately, not every individual exposed to these games
reacts aggressively because individual differences always
exist. Anderson and Bushman (2001) take the individual
into account when applying the General Affective Aggres-
sion Model suggesting that not every one who plays these
games will react aggressively. An example of how individ-
ual differences may affect a person’s response can be found
in the study by Anderson and Dill (2000) described previ-
ously. Some of the participants may have been more hostile
by nature than others causing them to respond more aggres-
sively when they believed they were playing against an-
other person. Therefore, they may have responded aggres-
sively regardless of what game they had been given prior to
competing. However, it is important that we not overlook
the impact these games may have on the cognitions and
behaviors of their players.

With the increasing availability of virtual reality hard-
ware and software and the compatibility of such programs
with desktop personal computers, this area of research may
be more easily studied than in previous years (Riva, 2003).
For those who have access to such technology, future re-
search may take several approaches to explore the similari-
ties and differences of violent video games and virtual real-
ity. Following is an example of one possible study that
could be applied in a laboratory setting and that would con-
sider individual differences in the domain of hostile person-
ality: In the first step, participants would be prescreened
using a measure, such as the Buss-Perry Aggression Ques-
tionnaire, and those individuals who scored in the top and
bottom 25th percentiles would be included in the study in
order to evenly distribute individuals who are high and low
in aggressive personality traits and control for individual
differences. In the second step, participants would be as-
signed to one of six groups based on their scores on the
Buss-Perry Aggression Questionnaire including: high or
low aggression and violent video games, high or low ag-
gression and virtual reality, and high or low aggression and
a neutral task, such as putting together a puzzle. Next, each
participant would engage in the assigned activity for fifteen
minutes after which time self-report data of aggressive
feelings would be collected using a measure such as the
State Hostility Scale. Physiological arousal data would be
obtained before, during, and after each participant engaged
in the assigned activity via heart rate and blood pressure.
Finally, after participants completed the self-report ques-
tionnaire they would engage in a laboratory activity that
would mimic a real-life situation, such as helping a confed-
erate or another participant try to solve a posed problem, to
determine whether or not there is an effect on their level of
frustration and frequency of verbal and non-verbal aggres-
sive behaviors. Frustration would be measured by the num-



THE COMPARISON OF VIOLENT VIDEO GAMES TO A VIRTUAL

27

ber of attempts made at completing the task, verbal aggres-
sion would be measured by the frequency of negative utter-
ances, and non-verbal aggression would be measured by the
frequency of negative actions, such as slamming hands on a
table. This data would be collected by a blind observer to
reduce the probability of expectancy effects.

If the proposed study were carried out it would be ex-
pected that significant differences would arise between the
hostile and non-hostile groups in all three conditions in
their scores on the State Hostility Scale. Significant differ-
ences would also be expected between the low and high
aggression neutral task group and the high aggression VR
and high aggression video game groups in terms of
physiological arousal, level of frustration, and verbal and
non-verbal aggression. By prescreening individuals it
would be possible to determine the differences that exist
between the groups when given the various activities.
Based on the theoretical assumptions presented above, it is
hypothesized that no significant differences would exist
between the video game and virtual reality groups.

Although the proposed study is just an example of how
future research might explore this area, it is important, from
a clinical perspective, to further understand the mechanisms
of change in behavior that playing video games may have
on individuals. In considering the characteristics of VRET
and violent video games, it is interesting to note the simi-
larities of the environment created and the effects of the
stimuli on the participant. Although there is a relatively
small amount of literature available on both virtual reality
and violent video games, it is possible to make the theoreti-
cal hypothesis that because VRET can elicit changes in
people’s behaviors and there are strong similarities between
video games and virtual reality, violent video games may
also elicit the same types of change in behavior.

References

Anderson, C. A. (2004). An update of the effects of playing
violent video games. Journal of Adolescence, 27(1), 113-
122.

Anderson, C. A., & Bushman, B. J. (2001). Effects of vio-
lent video games on aggressive behavior, aggressive cog-
nition, aggressive affect, physiological arousal and proso-
cial behavior: A meta-analytic review of the scientific lit-
erature. Psychological Review, 12(5), 353-359.

Anderson, C. A., & Dill, K. E. (2000). Video games and
aggressive thoughts, feelings, and behavior in the labo-
ratory and in life. Journal of Personality and Social Psy-
chology, 78(4), 772-790.

Arbona, C. B., Osma, J., Garcia-Palacious, A., Quero, S., &
Banos, R. M. (2004). Treatment of flying phobia using
virtual reality: Data from a 1 year follow-up using multi-
ple baseline design. Clinical Psychology & Psychother-
apy, 11(5), 311-323.

Federal Trade Commission. (2000). Marketing violent en-
tertainment to children: A review of self-regulation and
industry practices in the motion picture, music recording,

and electronic game industries. Washington, D.C.: Fed-
eral Trade Commission.

Garbarino, J., & Bedard, C. (2001). Parents under siege:
Why you are the solution, not the problem, in your child’s
life. New York, NY: Simon and Schuster Adult Publish-
ing.

Garcia-Palacious, A., Hoffman, H. G., See, S. K., Tsai, A.,
& Botella, C. (2001). Redefining therapeutic success with
virtual reality exposure therapy. CyberPsychology & Be-
havior, 4(3), 341-348.

Gentile, D. A., Lynch, P. J., Linder, J. R., & Walsh, D. A.
(2004). The effects of violent video game habits on ado-
lescent hostility, aggressive behaviors, and school per-
formance. Journal of Adolescence, 27(1), 5-22.

Gershon, J., Zimand, E., Pickering, M., Rothbaum, B. O., &
Hodges, L. (2004). A pilot and feasibility study of virtual
reality as a distraction for children with cancer. Journal
of the American Academy of Child & Adolescent Psy-
chiatry, 43(10), 1243-1249.

Glantz, K., Rizzo, A., & Graap, K. (2003). Virtual reality
for psychotherapy: Current reality and future possibili-
ties. Psychotherapy: Theory, Research, Practice, Train-
ing, 40(1-2), 55-67.

Herz, J. C. (1997). Joystick Nation. Toronto, Canada: Little
Brown & Co. Ltd.

Hubbard, B. (1999, June 18). Researchers say Harris recon-
figured video game. Rocky Mountain News. Retrieved on
March 14, 2005 from http://denver/rockymountain.com/
shooting/0502doom8.shtml

Hoffman, H. G. (2004). Virtual-reality therapy. Scientific
American, 291(2), 58-65.

Jang, D. P., Kim, I. Y., Nam, S. W., Wiederhold, B. K.,
Wiederhold, M. D., & Kim, S. I.(2002). Analysis of
physiological response to two virtual environments:
Driving and flying simulations. CyberPsychology and
Behavior, 5(1), 11-18.

Kirsh, S. J. (1998). Seeing the world through Mortal Kom-
bat-colored glasses: Violent video games and the devel-
opment of short-term attribution bias. Childhood: A
Global Journal of Child Research, 5(2), 177-184.

Krijn, M., Emmelkamp, P. M. G., Olafsson, R. P., &
Biemond, R. (2004). Virtual reality exposure therapy of
anxiety disorders: A review. Clinical Psychology Review,
24, 259-281.

Lee, J., Lim, Y., Graham, S. J., Kim, G., Wiederhold, B. K.,
Wiederhold, M. D., Kim, I. Y., & Kim, S. I. (2004).
Nicotine craving and cue exposure therapy by usingvir-
tual environments. CyberPsychology & Behavior, 7(6),
705-713.

Maltby, N., Kirsch, I., Mayers, M., & Allen, G. J. (2002).
Virtual reality exposure therapy for the treatment of fear
of flying: A controlled investigation. Journal of Con-
sulting and Clinical Psychology, 70(5), 1112-1118.

Olson, C. K. (2004). Media violence research and youth
violence data: Why do they conflict? Academic Psychia-
try, 28(2), 144-150.



VAIL-GANDOLFO

28

Panee, C. D., & Ballard, M. E. (2002). High versus low
aggressive priming during video-game training: Effects
on violent action during game play, hostility, heart rate,
and blood pressure. Journal of Applied Social Psychol-
ogy, 32(12), 2458-2474.

Redd, W. H., Jacobsen, P. B., Die-Trill, M., Dermatis, H.,
McEvoy, M., & Holland, J. C. (1987). Cognitive atten-
tional distraction in the control of conditioned nausea in
pediatric cancer patients receiving chemotherapy. Journal
of Consulting and Clinical Psychology, 55(3), 391-395.

Riva, G. (2003). Applications of virtual environments in
medicine. Methods of Information in Medicine, 42(5),
524-534.

Sohn, E. (2004, January 14). The violent side of video
games. Science News for Kids. Retrieved on December 12,
2004, from http://www.sciencenewsforkids.org/articles/
20040114 /Feature1.asp

Subrahmanyam, K., Kraut, R., Greenfield, P., & Gross, E.
(2001). New forms of electronic media. In D. G. Singer
and J. L. Singer (Eds.), Handbook of children and the
media (pp. 395-414). Thousand Oaks, CA: Sage Publica-
tions Inc.

Walsh, D., Gentile, D., Gieske, J., Walsh, M., & Chasco, E.
(2004). Ninth annual Mediawise video game report card.
Minneapolis, MN: National Institute on Media and the
Family.

Walshe, D. G., Lewis, E. J., Kim, S. I., O’Sullivan, K., &
Wiederhold, B. K. (2003). Exploring the use of computer
games and virtual reality in exposure therapy for fear of
driving following a motor vehicle accident. CyberPsy-
chology and Behavior, 63(3), 329-334.

Wiederhold, B. K. (2003). Three-year follow-up for virtual
reality exposure for fear of flying. CyberPsychology and
Behavior, 6(4), 441-445.

Wiederhold, B. K. & Wiederhold, M. D. (2005). Arachno-
phobia. In B. K. Wiederhold & M. D. Wiederhold (Eds.),
Virtual reality therapy for anxiety disorders: Advances in
evaluation and treatment (pp. 173-179). Washington,
DC: American Psychological Association.

Wood, R. T. A., Griffiths, M. D., Chappell, D., & Davies,
M. N. O. (2004). The structural characteristics of video
games: A psycho-structural analysis. CyberPsychology &
Behavior, 7(1), 1-10.


