Long-term effects of virtual reality exposure therapy for adolescents with public speaking anxiety: a one-year follow-up of a randomised controlled trial

Objective: Public Speaking Anxiety is highly prevalent among adolescents. However, few interventions have been developed specifically for this group. This four-armed randomized trial addressed the following research questions regarding interventions for adolescents with public speaking anxiety (PSA): 1) is Virtual Reality exposure therapy (VRET) more efficacious than online psychoeducation or waitlist, and 2) is VRET followed by online exposure therapy more efficacious than VRET alone or online psychoeducation followed by online exposure therapy?Methods: Adolescents, aged 13–16 with PSA were randomized to four groups: 1) VRET + no additional intervention (n = 20); 2) VRET + online exposure program (n = 20); 3) online psychoeducation program + exposure program (n = 40); or 4) waitlist (n = 20). Self-rated PSA symptoms served as primary outcome measure, with secondary outcomes covering other social anxiety symptoms.Results: Linear mixed models revealed that there was a significant difference in the decrease in PSA symptoms among adolescents receiving VRET compared with waiting list (p = 0.015), but no significant difference to the online psychoeducation program (p = 0.056). However, online psychoeducation program yielded smaller within-group effect sizes compared to VRET, d = 0.33 vs. d = 0.83 respectively. VRET + online exposure program had a significant decrease in PSA symptoms (p = 0.013), but no significant difference from VRET + no additional intervention or online psychoeducation + online exposure program. Symptom reduction remained stable at 3-month follow-up.Conclusion: The study shows the potential of delivering both gamified VRET as well as online psychoeducation and exposure programs as self-guided interventions for adolescents with PSA.Clinical trial registration:clinicaltrials.gov, identifier: NCT04396392

Public Speaking Anxiety (PSA) interventions targeting adolescents exist; however, not all gain improvement. This exploratory study investigated whether PSA interventions resulted in a decrease in perfectionism and whether pre-treatment level and changes in perfectionism moderated the effects on PSA and social anxiety. The sample consisted of 100 adolescents from junior high schools randomized to four groups: 1) VR only (n = 20), 2) VR + online exposure program (n = 20), 3) online psychoeducation and online exposure program (n = 40), 4) waitlist and online psychoeducation program (n = 20). Self-reported symptoms of PSA, social anxiety, and perfectionism were measured at pre, week 3, post, and 3-months follow-up. Level and change in outcome variables were analyzed using latent growth curve modeling. Results revealed that the interventions did not lead to a reduction in perfectionism. Reduction in perfectionism was associated with a larger reduction in all outcome measures from post to follow-up. No interaction was found between pre-treatment perfectionism and PSA symptoms. High pre-treatment levels of perfectionism were associated with poorer outcomes on social anxiety symptoms from post to follow-up for online exposure groups. The results indicate that one should assess and address high pre-treatment levels of perfectionism during PSA interventions.

It is well documented that teachers experience a plethora of emotions in their work including anxiety. While most research has focused on anxiety in regard to curricular areas, teachers may also experience public speaking anxiety. Unlike curricular anxiety, public speaking anxiety permeates all aspects of a teacher’s work, thereby potentially exerting negative consequences for their own well-being and their students’ learning. This multi-method pre-post single-group pilot study aimed to explore sources of pre-service teachers’ public speaking anxiety and to test the utility of a virtual reality (VR) intervention to reduce public speaking and social appearance anxiety. Participants (n = 7) described three sources of public speaking anxiety: communication difficulties, expectations of others, and judgment of others. Participants delivered three lessons over a period of about 5 weeks to a VR classroom simulated by the Virtual Orator © program. There were 22 student avatars representing various genders and ethnicities. Avatars were programmed to be informal in their actions and generally friendly, but they could not interact with the participant. The results of paired-samples t-tests showed that public speaking and social appearance anxiety were significantly reduced following the VR intervention. Participants described the VR as realistic and useful for real life. We discuss the results from the perspective of the control-value theory of emotions with implications for teacher education programs.

Biased attention to social threats has been implicated in social anxiety disorder. Modifying visual attention during exposure therapy offers a direct test of this mechanism. We developed and tested a brief virtual reality exposure therapy (VRET) protocol using 360°-video and eye tracking. Participants (N = 21) were randomized to either standard VRET or VRET + attention guidance training (AGT). Multilevel Bayesian models were used to test (1) whether there was an effect of condition over time and (2) whether post-treatment changes in gaze patterns mediated the effect of condition at follow-up. There was a large overall effect of the intervention on symptoms of social anxiety, as well as an effect of the AGT augmentation on changes in visual attention to audience members. There was weak evidence against an effect of condition on fear of public speaking and weak evidence supporting a mediation effect, however these estimates were strongly influenced by model priors. Taken together, our findings suggest that attention can be modified within and during VRET and that modification of visual gaze avoidance may be casually linked to reductions in social anxiety. Replication with a larger sample size is needed.

360° Video virtual reality exposure therapy for public speaking anxiety: A randomized controlled trial

IntroductionWe previously found that self-guided Virtual Reality Exposure Therapy (VRET) improved Public Speaking Anxiety (PSA) and reduced heartrate. Elevated heartrate characterises social anxiety and the self-guided VRET seemed to reduce heartrate. Thus, receiving continuous biofeedback about physiological arousal during the VRET could help socially anxious individuals to manage their anxiety. The present study aimed to determine whether biofeedback enhances the responsiveness of VRET.MethodsSeventy-two individuals with high self-reported social anxiety were randomly allocated to VRET-plus-biofeedback (n=38; 25 completers) or VRET alone (n=35; 25 completers). Three hour-long VRET sessions were delivered over three consecutive weeks. During each session, participants delivered a 20-minute public speech in front of a virtual audience. Participants in the VRET-plus-biofeedback group received biofeedback on heartrate and frontal alpha asymmetry (FAA) within the virtual environment and were asked to lower their arousal accordingly. Participants in both groups completed psychometric assessments of social anxiety after each session and at one-month follow-up.ResultsPSA improved by the end of treatment and overall social anxiety improved one month after the VRET across both groups. The VRET-plus-biofeedback group showed a steadier reduction in FAA in the first VRET session and a greater reduction in self-reported arousal across the three sessions than the VRET-alone group.ConclusionBiofeedback can steady physiological arousal and lower perceived arousal during exposure. The benefits of self-guided VRET for social anxiety are sustained one month after therapy.

Exposure therapy (ET) for anxiety disorders involves introducing the participant to an anxiety-provoking situation over several treatment sessions. Each time, the participant is exposed to a higher anxiety-provoking stimulus; for example, in the case of fear of heights, the participant would successively experience being at a greater height. ET is effective, and its counterpart, virtual reality (VR) exposure therapy (VRET), where VR substitutes real-world exposure, is equally so. However, ET is time-consuming, requiring several sessions. This study aimed to compare the results of single-session exposure with those of traditional VRET with regard to reducing public speaking anxiety. We introduced a paradigm concerned with public speaking anxiety where the VR exposure occurred in a single session while the participant interacted with a virtual therapist. Over time, the therapist transformed into an entire audience with almost imperceptible changes. We carried out a feasibility study with 45 participants, comparing 3 conditions: single-session exposure (n=16, 36%); conventional multiple-session exposure (n=14, 31%), where the same content was delivered in successive segments over 5 sessions; and a control group (n=15, 33%), who interacted with a single virtual character to talk about everyday matters. A week later, the participants were required to speak on a stage in front of a large audience in VR. Across most of the series of conventional public speaking anxiety measures, the single-session exposure was at least as effective in reducing anxiety as the multiple-session exposure, and both these conditions were better than the control condition. The 12-item Personal Report of Confidence as a Speaker was used to measure public speaking anxiety levels, where higher values indicated more anxiety. Using a Bayesian model, the posterior probabilities of improvement compared to a high baseline were at least 1.7 times greater for single- and multiple-session exposures compared to the control group. The State Perceived Index of Competence was used as a measure of anticipatory anxiety for speaking on a stage in front of a large audience, where lower values indicated higher anxiety. The probabilities of improvement were just over 4 times greater for single- and multiple-session exposures compared to the control group for a low baseline and 489 (single) and 53 (multiple) times greater for a middle baseline. Overall, the results of this feasibility study show that for moderate public speaking anxiety, the paradigm of gradual change in a single session is worth following up with further studies with more severe levels of anxiety and a larger sample size, first with a randomized controlled trial with nonpatients and subsequently, if the outcomes follow those that we have found, with a full clinical trial with patients.

Social anxiety disorder (SAD) and major depressive disorder (MDD) are highly comorbid with each other, and comorbidity exacerbates distress and impairment. The prevalence of comorbid depression is higher in women with SAD than in men with SAD, but this is based on global depression scores and cannot speak to heterogeneous individual depression symptoms. The current study bridges this gap by examining gender differences in the relationship between social interaction anxiety and individual depression symptoms. 165 community adults (113 women, 52 men) were included in a series of bootstrapped moderation analyses to examine the main and interaction effects of social interaction anxiety and gender on total depression and individual depressive symptom scores while controlling for age and racial/ethnic background. Social interaction anxiety positively predicted total and individual depression scores. Greater social interaction anxiety predicted greater self-dislike and worthlessness in men than in women. Our findings replicate the finding that social anxiety and depression are highly comorbid with respect to total scores and extend this finding to individual symptoms. Our findings also demonstrate that the relationship between social interaction anxiety and depressive symptoms can be modulated by gender identities. Men with social interaction anxiety may be more prone to distress associated with self/identity. These findings elucidate the specific ways in which social interaction anxiety relates to the constellation of depression symptoms in men and women and highlights the need for more tailored assessment and intervention for socially anxious men and women to target individual dimensions of symptom presentations.

Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder

Public speaking anxiety (PSA) is a prevalent condition with disabling occupational, educational, and social consequences. Exposure therapy is a commonly utilized approach for treating PSA. Traditionally, this intervention has been delivered as in vivo exposure therapy (IVET). Limitations inherent to in vivo as a mode of delivery have been identified and studies have increasingly explored the use of Virtual Reality Exposure Therapy (VRET) as an alternative. Understanding the efficacy of both VRET and IVET as psychological interventions for PSA is important. A systematic search identified 11 studies with 508 participants. Meta-analysis yielded a large significant effect wherein VRET resulted in significant reductions in PSA versus control of −1.39 (Z = 3.96, p < .001) and a similar large significant effect wherein IVET resulted in significant reductions in PSA versus control of −1.41 (Z = 7.51, p < .001). Although IVET was marginally superior to VRET, both interventions proved efficacious. Given the advantages of utilizing VRET over IVET future research and clinical practice could explore VRET as a treatment option for PSA.

Public speaking anxiety is a frequently reported concern among university students, particularly within South Asian contexts such as Pakistan. The present study explored how different psychological factors explain this anxiety by examining the indirect effects of social interaction anxiety and fear of negative evaluation, along with the conditional influence of self-presentation on social media. Data were collected from 711 undergraduate students. Analysis revealed that students who reported stronger prosocial or self-serving reasons for speaking were more likely to experience higher levels of interaction-related anxiety, concerns about negative judgment, and discomfort during public speaking situations. While fear of negative evaluation and social interaction anxiety were found to intensify public speaking anxiety, engagement in self-presentation on social media appeared to lessen it. Furthermore, self-presentation on social media altered the strength of the association between self-serving speaking motives and public speaking anxiety by influencing fear of negative evaluation and social interaction anxiety. Comparative analysis also showed that students enrolled in later semesters experienced greater fear of evaluation and higher public speaking anxiety than those in earlier semesters. These findings provide valuable insights for educators and mental health professionals to design targeted strategies aimed at helping students cope more effectively with public speaking anxiety.

The purpose of this study was to examine the effects of the self-concept and achievement motivation on social anxiety of university students in the K areas. Participants completed questionnaires on self-concept, achievement motivation, speech anxiety, social phobia, and social interaction anxiety test and included total 353. The data were analyzed using correlational analysis and multiple regression analysis. Results of the study were as follows: First, self-concept and achievement motivation showed significant positive correlation. but self-concept, achievement motivation and speech anxiety, social phobia, social interaction anxiety showed significant negative correlation. By looking at these results, university students experience more self-concept as they have high more achievement motivation and more self-concept and achievement motivation as they have low speech anxiety, social phobia, and social interaction anxiety. Second, as a result of regression analysis on relation of speech anxiety, social phobia, and social interaction anxiety, self-concept variable were the main predictor and negative effects. The significance of this study was that specifically examined self-concept corresponding to the cognitive structure from a counseling perspective on social anxiety of university students.

The major goal of this research was to investigate the efficacy of virtual reality therapy (VRT) in the treatment of the fear of public speaking. After an extensive two-stage screening process, sixteen subjects were selected from the pool. They were assigned to two treatment conditions: VRT (N=8) and comparison group (N=8). Fourteen subjects completed the study. The VRT group was exposed to the virtual reality public speaking scene while the comparison group was exposed to a trivial virtual reality scene and guided by the experimenters to manage their phobia either by using visualization techniques or selfexposure to the situation they feared. The VRT and comparison group sessions were conducted on an individual basis over a five week period. Two assessment measures were used in this study. The first measure used was the Attitude Towards Public Speaking (ATPS) Questionnaire. The second measure used was the eleven-point Subjective Units of Disturbance (SUD) scale. These measurements assessed the anxiety, avoidance, attitudes and disturbance associated with their fear of public speaking before and after treatments. In addition, objective measures such as heart rate was collected in each stage of the treatment. Significant differences between the six subjects who completed the VRT sessions and comparison group were found on all measures. The VRT group showed significant improvement after five weeks of treatment. The comparison group did not show any meaningful changes. The authors concluded that VRT was successful in reducing the fear of the public speaking.

Virtual reality (VR) offers new and flexible ways to provide psychological interventions. The aim of this study was to develop and investigate the effectiveness of a VR intervention based on acceptance and commitment therapy (ACT) for social and public speaking anxiety. ACT is a process-based approach that aims to (a) increase individuals’ abilities to handle difficult emotional and cognitive experiences and (b) develop the motivation required for change to occur. In this study, a sample of university students with social interaction or communication anxiety (N = 76; age M = 24.95, SD = 6.50, 69.7% females) was blindly randomized into a total of 2 h of VR ACT training (VRACT; n = 37) or a waiting list control (WLC; n = 39) group. The VRACT group was gradually exposed to social situations using a VR head-mounted display (HMD) and received audio-recorded ACT-based instructions aimed at increasing psychological flexibility. The outcome measurements included self-reported social and communication anxiety, well-being, psychological processes, and behavioral measures. At the final feedback meeting held one week after attending three VR sessions, we observed a significant decrease in social and communication anxiety (d = 0.55–0.61) and a significant improvement in psychological flexibility (d = 0.61), with moderate effect sizes. These findings contribute to advancing knowledge of how ACT can be efficaciously delivered using VR to improve mental health outcomes for university students with social anxiety.

BackgroundNomophobia and social anxiety have significant negative implications for the physical and mental health of students, as well as their academic performance. Considering the variability in findings across studies on the prevalence of nomophobia and social anxiety, this study aimed to investigate the prevalence of nomophobia, its associated factors, and its relationship with social interaction anxiety among nursing students.MethodsThis cross-sectional descriptive-analytical study was conducted between August 22nd and September 23rd, 2023, at the School of Nursing and Midwifery in Kermanshah, located in western Iran. A convenience sampling method was employed, resulting in the recruitment of 258 participants. Data were collected using a three-part questionnaire, including a demographic information form, the Nomophobia Questionnaire (NMP-Q) to assess the severity of nomophobia, and the Social Interaction Anxiety Scale (SIAS) to measure social anxiety levels. Data were analyzed using STATA, version 14. Descriptive statistics were used to summarize demographic and clinical characteristics. The Chi-square test, one-way analysis of variance, the Pearson correlation coefficient, and linear regression modeling were employed for inferential analysis.ResultsAll participating nursing students (n = 258) exhibited some degree of nomophobia. The prevalence of mild, moderate, and severe nomophobia was 40.7%, 40.3%, and 19%, respectively. Furthermore, 25.6% of the students experienced social anxiety. A significant positive correlation was found between nomophobia scores and social interaction anxiety (r =.37, P <.001). Social interaction anxiety emerged as the only significant independent predictor of nomophobia (P <.001), explaining 21% of the variance in nomophobia scores.ConclusionsThe results indicate both the prevalence of nomophobia and social anxiety, as well as the correlation between these two factors among students. Considering the numerous risks associated with nomophobia and social interaction anxiety, it is essential to optimize technology use and improve social interactions among students. Identifying students at risk of nomophobia and social interaction anxiety and providing psychological counseling services to them should be prioritized.