Exposure therapyis a cognitive-behavioral treatment that involves gradually confronting feared stimuli to reduce anxiety. For social anxiety, this may include speaking in front of others or attending social events.
Whileexposure therapy is effective for social anxiety, many individuals may be reluctant to seek in-person treatment due to fear of social situations or stigma.
By providing a safe and accessible way to challenge fears, self-guided exposure and VRET may increase treatment engagement and effectiveness for social anxiety.
Key Points
Rationale
Public speaking anxiety (PSA) is a common variant ofsocial anxiety disorderthat affects up to 77% of the general population (Fumark et al., 1999) and impairs academic and occupational functioning (Beidel & Turner, 2007).
Cognitive-behavioral therapywith exposure is the most evidenced treatment for social anxiety (Kaplan et al., 2018), but many individuals do not seek treatment due to fear of social situations (Chartier-Otis et al., 2010).
While therapist-led VRET has shown efficacy for social anxiety (Carl et al., 2019), self-guided VRET is an emerging advance that could enhance treatment accessibility and engagement (Lindner, 2020).
Method
Procedure
This pilot study involved 32 university students with high self-reported PSA attending two weekly self-guided VRET sessions.
Each session required participants to deliver a 20-minute speech in a virtual classroom, divided into four 5-minute blocks.
During 1-minute intervals between blocks, participants could manipulate their exposure to virtual social threats, including audience size, audience reaction, number of speech prompts, and self-salience.
Sample
Participants (27 completers) were predominantly female (84.4%), Caucasian (84.4%), and undergraduate students (87.5%) with a mean age of 21.4 years. Most (84%) had never been diagnosed with social anxiety disorder.
Measures
Statistical Analysis
Repeated measures ANOVAs examined changes in exposure levels, anxiety, arousal, heart rate, and PSA measures over time.
Correlations assessed relationships between in-session anxiety reduction and PSA outcomes.
Results
As hypothesized, participants gradually increased their exposure to audience size, audience reaction, and self-salience within and across the two VRET sessions (p< .005).
This increased exposure coincided with significant reductions in anxiety (p< .001), arousal (p= .003), and heart rate (p = .002) during the sessions.
PSA measures (SATI, PSAS, PRCS-SF, LSAS, BFNE) showed significant improvements from pre-treatment to post-treatment and 1-month follow-up (p< .005).
Greater in-session anxiety reduction correlated with larger improvements in fear of negative evaluation post-treatment (r = .40) and at follow-up (r = .44).
Insight
This study provides initial evidence that self-guided VRET is a feasible and potentially effective intervention for PSA.
By enabling individuals to gradually expose themselves to fear-provoking virtual social threats, self-guided VRET may help them habituate to anxiety and challenge irrational beliefs in a controlled manner.
Importantly, the correlation between in-session anxiety reduction and improved fear of negative evaluation suggests a potential mechanism of change.
Future research could compare self-guided to therapist-led VRET, examine longer-term outcomes, and explore mediating factors like perceived control and self-efficacy.
Strengths
This study had some many methodological strengths, including:
Limitations
However, this study also had some limitations, including;
Implications
The positive findings support the potential of self-guided VRET as a feasible and efficacious intervention for PSA.
By enabling self-paced exposure to virtual social threats, self-guided VRET may provide an accessible and engaging option for individuals reluctant to seektraditional treatment.
Clinically, self-guided VRET could be a valuable adjunct to therapist-led exposure therapy, allowing patients to practice skills between sessions.
However, the limited follow-up period and subclinical sample underscore the need for further research in clinical populations with long-term follow-up assessments.
Consideration of individual differences like perceived control and self-efficacy may help optimize self-guided VRET protocols.
Overall, this study highlights the promise of self-guided VRET as an innovative approach to treating PSA and lays the groundwork for future clinical applications.
References
Beidel, D. C., & Turner, S. M. (2007). Shy children, phobic adults: Nature and treatment of social anxiety disorder (2nd ed.).American Psychological Association.https://doi.org/10.1037/11533-000
Botella, C., Fernández-Álvarez, J., Guillén, V., García-Palacio, A., & Baños, R. (2017). Recent progress in virtual reality exposure therapy for phobias: a systematic review.Current Psychiatry Reports, 19(7), 42.https://doi.org/10.1007/s11920-017-0788-4
Carl, E., Stein, A. T., Levihn-Coon, A., Pogue, J. R., Rothbaum, B., Emmelkamp, P., Asmundson, G., Carlbring, P., & Powers, M. B. (2019). Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials.Journal of Anxiety Disorders, 61, 27-36.https://doi.org/10.1016/j.janxdis.2018.08.003
Chartier-Otis, M., Perreault, M., & Bélanger, C. (2010). Determinants of barriers to treatment for anxiety disorders.Psychiatric Quarterly, 81(2), 127-138.https://doi.org/10.1007/s11126-010-9123-5
Furmark, T., Tillfors, M., Everz, P. O., Marteinsdottir, I., Gefvert, O., & Fredrikson, M. (1999). Social phobia in the general population: prevalence and sociodemographic profile.Social psychiatry and psychiatric epidemiology,34, 416-424.https://doi.org/10.1007/s001270050163
Kampmann, I. L., Emmelkamp, P. M., Hartanto, D., Brinkman, W. P., Zijlstra, B. J., & Morina, N. (2016). Exposure to virtual social interactions in the treatment of social anxiety disorder: A randomized controlled trial.Behaviour Research and Therapy, 77, 147-156.https://doi.org/10.1016/j.brat.2015.12.016
Kaplan, S. C., Swee, M., & Heimberg, R. G. (2018). Psychological treatments for social anxiety disorder. In G. Conway (Ed.), Oxford Research Encyclopedia of Psychology.Oxford University Press.https://doi.org/10.1093/acrefore/9780190236557.013.98
Lindner, P. (2020). Better, virtually: the past, present, and future of virtual reality cognitive behavior therapy.International Journal of Cognitive Therapy.https://doi.org/10.1007/s41811-020-00090-7
Keep Learning
Here are some reflective questions related to this study that could prompt further discussion:
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
