Abstract
Patients with generalized social anxiety disorder (SAD) avoid various social situations and can be reluctant to engage in in vivo exposure therapy. Highly personalized practising can be required before patients are ready to perform in vivo exposure. Virtual reality-based therapy could be beneficial for this group. To assess the feasibility and potential effect of virtual reality-based cognitive behavioural therapy (VR-CBT) for patients with severe generalized SAD. Fifteen patients with generalized SAD attended up to 16 VR-CBT sessions. Questionnaires on clinical and functional outcomes, and diary assessments on social activity, social anxiety and paranoia were completed at baseline, post-treatment and at 6-months follow-up. Two patients dropped out of treatment. Improvements in social anxiety and quality of life were found at post-treatment. At follow-up, depressive symptoms had decreased, and the effect on social anxiety was maintained. With respect to diary assessments, social anxiety in company and paranoia were significantly reduced by post-treatment. These improvements were maintained at follow-up. No increase was observed in social activity. This uncontrolled pilot study demonstrates the feasibility and treatment potential of VR-CBT in a difficult-to-treat group of patients with generalized SAD. Results suggest that VR-CBT may be effective in reducing anxiety as well as depression, and can increase quality of life.
Highlights
People with generalized social anxiety disorder (SAD) experience extreme anxiety in a broad range of social situations in which they have to interact with other people and are exposed to potential criticism
Two participants stopped after session 7 because of: (1) too high anxiety during exposure and (2) the Virtual reality (VR) equipment was too distracting and the avatars too unrealistic
By follow-up the mean score on ideas of social references had decreased by 25% compared with baseline
Summary
People with generalized social anxiety disorder (SAD) experience extreme anxiety in a broad range of social situations in which they have to interact with other people and are exposed to potential criticism. Generalized SAD is characterized by severe avoidance, the threshold to engage in in vivo exposure can be too high. It can be challenging and time consuming for therapists to find appropriate situations for exposure with the right amount of personalized triggers. Patients with generalized social anxiety disorder (SAD) avoid various social situations and can be reluctant to engage in in vivo exposure therapy. Aims: To assess the feasibility and potential effect of virtual reality-based cognitive behavioural therapy (VR-CBT) for patients with severe generalized SAD. With respect to diary assessments, social anxiety in company and paranoia were significantly reduced by post-treatment. Results suggest that VR-CBT may be effective in reducing anxiety as well as depression, and can increase quality of life
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