Effectiveness of a Virtual Reality-Based Mutual Gaze Training to Reduce Fear of Public Speaking: A Randomised Controlled Trial

Abstract

Background: Public speaking anxiety (PSA) is the most widespread social fear, with prevalence estimates up to 30%. Anxious individuals typically avoid mutual gaze and report fears of being evaluated by others. We developed a virtual reality (VR) training application (app) aimed at increasing mutual gaze and tested its effectiveness to reduce fear of public speaking. Methods: We used a single-blind, parallel-group, randomised controlled trial design. Between June 18, 2019 and September 19, 2019, 89 participants aged 18–40 years with PSA were randomly assigned to a gaze training (treatment) or a control group. During training, participants were exposed to social situations and instructed to maintain eye contact with people in the VR. Assessments were done at baseline, after a first intervention (acute intervention on a single day: three gaze training sessions of 20 min; control: Google Street View), and after a second intervention phase (repeated intervention over two weeks: nine gaze training sessions of 20 min; control: no further intervention) two months later. The primary outcome measure was subjective fear, rated on the Subjective Units of Distress Scale (SUDS) in a real-life public speaking test (PST). Findings: Repeated, but not acute, gaze training led to a significant reduction of subjective fear as compared to the control group (treatment group, baseline: 48·95 [SD 19·52], post intervention 2: 26·60 [SD 19·23]; control group, baseline: 48·92 [SD 18·43], post intervention 2: 56·34 [SD 28·15]; adjusted mean group difference: −29·82, 95% CI: −41·77 to −17·87; Cohen’s d=−1·07, p<0·0001). Interpretation: Repeated usage of our stand-alone, VR gaze training app reduces the subjectively perceived fear in individuals with PSA in real-life public speaking situations. Trial Registration: The trial has been registered at ClinicalTrials.gov before start of the study with the identifier: NCT03970187 on May 31, 2019. Funding Statement: Transfaculty Research Platform, University of Basel; Swiss National Science Foundation (SNSF). Declaration of Interests: Dominique de Quervain (DQ) and Andreas Papassotiropoulos (AP) are co-founders of GeneGuide AG, a spin off company of the University of Basel. DQ and AP have acquired a license from the University of Basel to use the developed technology for commercial purposes. DQ nor AP have been involved in data acquisition or data analysis. BF reports a grant from the Swiss National Science Foundation during the conduct of the study. All other authors declare no competing interests. Ethics Approval Statement: The study protocol, including the definition of primary and secondary outcomes and statistical analysis plan, has been approved by the Independent Ethics Committee (IEC; Ethics Committee of North-West and Central Switzerland) before the start of the study (i.e. June 18, 2019, first subject in).