The Effectiveness of Self-Guided Virtual-Reality Exposure Therapy for Public-Speaking Anxiety.

Preethi Premkumar,Rosie Daly,Bethany Huntington,David Joseph Brown,Eva Zysk,Steven Battersby,Alexander Sumich,Nadja Heym

doi:10.3389/fpsyt.2021.694610

Abstract

Objectives: Self-guided virtual-reality exposure therapy (VRET) is a psychological intervention that enables a person to increase their own exposure to perceived threat. Public-speaking anxiety (PSA) is an anxiety-provoking social situation that is characterized by fear of negative evaluation from an audience. This pilot study aimed to determine whether self-guided VRET (1) increases exposure to PSA-specific virtual social threats, and (2) reduces anxiety, arousal, heartrate and PSA over repeated exposure.Methods: Thirty-two University students (27 completers) with high self-reported public-speaking anxiety attended 2 weekly self-guided VRET sessions. Each session involved the participant delivering a 20-min speech in a virtual classroom. Participants were able to increase their exposure to virtual social threat through the audience size, audience reaction, number of speech prompts, and their own salience in the virtual classroom at 4-min intervals. Participants' heartrates and self-reported anxiety and arousal were monitored during these intervals. Participants completed psychometric assessments after each session and 1 month later.Results: Participants increased their exposure to virtual social threat during each VRET session, which coincided with a reduction in heartrate and self-reported anxiety and arousal. Improvement in PSA occurred post-treatment and 1 month later. The in-session improvement in anxiety correlated with reductions in fear of negative evaluation post-treatment and 1 month later.Conclusions: Increased self-exposure to virtual social threat from self-guided VRET relieves anxiety and shows immediate reductions in subjective and physiological arousal during application, but also yields sustained improvement in PSA.

Highlights

Social anxiety is, in part, an exaggerated fear of being negatively evaluated by others, for example being criticized, humiliated or rejected during social interaction, observation, and/or in performance situations [1]
Thirty-two participants were invited to take part in the experiment on the basis of scoring the highest on the Speech Anxiety Thoughts Inventory (SATI) [56] among a large participant pool of 336 students. These 336 students were recruited for potential inclusion in this social anxiety study if they met the inclusion criteria and had completed the SATI in an online survey among other several self-report measures
Improvement in SUDS-anxiety from the first pause of Session 1 to post-Session 2 correlated with [1] improvement in PSAS pretherapy to post-Session 2, r = 0.40, p = 0.023, [2] improvement in BFNE 2 pre-therapy to post-Session 2, r = 0.40, p = 0.022, and [3] improvement in BFNE pre-therapy to follow-up, r = 0.44, p = 0.012. This is the first study to systematically examine the feasibility of self-guided virtual-reality exposure therapy (VRET) for Public-speaking anxiety (PSA). This self-guided VRET aims to encourage individuals with high self-reported PSA to voluntarily pace their gradual exposure to virtual social threat

Summary

Introduction

In part, an exaggerated fear of being negatively evaluated by others, for example being criticized, humiliated or rejected during social interaction, observation, and/or in performance situations [1]. People with social anxiety disorder (SAD) may appear shy and withdrawn in social situations to mask their immense discomfort and may sometimes avoid. SAD has a lifetime prevalence of 4% as per a large multinational epidemiological survey [2]. SAD is said to be the third most common psychiatric disorder [3]. Individuals with SAD may not seek treatment for reasons, such as avoidance of face-to-face contact, lack of confidence in treatment, and financial costs [8, 9]. SAD being both highly prevalent and under-treated makes it a large public health concern with psychological and economic costs to the individual and society

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Conclusion