Proficiency in interpersonal communication and social skills is fundamental for health sciences students, but public speaking anxiety and communication apprehension frequently compromise academic performance, emotional well-being, and the acquisition of essential competencies. The postpandemic educational environment has exacerbated student stress, highlighting the urgent need for reliable assessment tools for social anxiety in this population. This scoping review protocol aims to map instruments used to assess public speaking anxiety and communication apprehension among health sciences students, analyzing their psychometric properties, cultural adaptations, and application contexts. Following the Joanna Briggs Institute framework and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, a systematic search will be conducted across PubMed, Scopus, Embase, LILACS, Web of Science, the Cochrane Library, and the Biblioteca Virtual em Saúde Portal. Eligible studies will include those evaluating social or performance anxiety in undergraduate or postgraduate health sciences students, using validated or culturally adapted instruments. Two independent reviewers will screen studies, with discrepancies resolved by a third reviewer. Data extraction will be conducted systematically, focusing on structural and content variables. Analysis will use a mixed methods approach, combining descriptive statistics with thematic synthesis and incorporating psychometric expertise. As of May 2026, protocol registration has been completed via the Open Science Framework. Systematic database searches and study selection are scheduled to commence in June 2026, with anticipated completion by December 2026, aligned with a 2-year implementation road map designed to generate comprehensive instrument mapping and secondary analyses for evidence-based health professional training. This protocol establishes a transparent and reproducible methodological plan, ensuring scientific rigor through adherence to Joanna Briggs Institute and PRISMA-ScR standards. It will deepen understanding of social anxiety assessment in oral communication among health sciences students and support the development of more effective interventions. Open Science Framework 10.17605/OSF.IO/YQ4KM; https://osf.io/yq4km. PRR1-10.2196/93700.

ABSTRACT Fear of public speaking (FPS) is the most prevalent Social Anxiety Disorder (SAD), in all professional and educational areas. Existing models investigate FPS from psychological and therapeutic perspectives, being suitable as assessment tools supporting psychotherapeutic interventions. They are not focused on actionable items that can be simulated in a computer environment for treatment or training. This paper introduces a comprehensive and actionable understanding of FPS factors, used to support the user-centric design of VR system for both FPS treatment, and public speech skills training. Our selection and investigation of FPS stressors was based on a literature study and discussions with performing arts experts and mental health professionals experienced in anxiety disorders followed by a questionnaire with 28 items run on 359 individuals. The paper analyses the results of this survey, identifying the primary FPS stressors, and evaluating their significance and correlations with demographic factors. Based on these, a preliminary design of a VR system for FPS treatment and public speech training was performed, and evaluated, from a user-centric perspective, using the same set of respondents. The evaluation showed strong appreciation for all system features, contributing both an actionable quantification of FPS and a user-centered VR training and treatment solution.

Despite the growing importance of English oral communication skills, traditional language learning approaches show limited effectiveness in simultaneously addressing psychological barriers and speaking proficiency among college students. While previous studies have explored anxiety reduction or speaking enhancement separately, a significant gap exists in research examining integrated approaches that tackle Public Speaking Anxiety (PSA), Interview Anxiety, and English-speaking proficiency improvement simultaneously. This study investigated whether an AI-integrated VR oral training application could effectively address these interconnected challenges. A quasi-experimental design was employed with 20 English major students from a mid-central university in Taiwan. Participants completed five training sessions using Meta Quest 2 headsets and an AI-integrated VR oral training application providing tailored feedback on pronunciation, grammar, and fluency based on IELTS standards. Pre- and post-intervention assessments utilized validated instruments including the Personal Report of Public Speaking Anxiety (PRPSA) and Measure of Anxiety in Selection Interviews (MASI), alongside comprehensive speaking proficiency measures. Results demonstrated significant improvements in English speaking proficiency, including increased sentence length and word count, with grammatical errors and incomplete sentences decreasing markedly (p < .001). Concurrently, significant reductions in both PRPSA and MASI scores (p < .05) were observed, though lexical diversity showed slight decline. VR-related motion-sickness symptoms were mildly alleviated, and participants' perceived control increased significantly (p < .05), while interest and attention levels remained stable. These findings suggest that AI-integrated VR oral training applications can effectively enhance English speaking proficiency while simultaneously reducing anxiety levels and improving self-efficacy among English learners. The study addresses a critical research gap by demonstrating the potential of integrated technological approaches to tackle multiple barriers to effective English oral communication, offering promising implications for language education and anxiety management in academic contexts.

Public speaking anxiety (PSA) significantly impairs academic and professional outcomes among university students. While virtual reality exposure therapy (VRET) shows promise for PSA treatment, the specific contribution of social and emotional interviewer reactions remains unclear. This study examines whether VRET with graded interviewer reactions leads to greater reduction in public speaking anxiety than standard automated VR exposure. This two-arm, parallel-group, superiority randomized controlled trial will recruit 92 Korean university students aged ≥18years with elevated PRPSA (Personal Report of Public Speaking Anxiety-18 ≥ 58). Participants will be randomized 1:1 to receive either VR interview training with graded interviewer reactions or control VR training with automated voice prompts only. The intervention consists of three VR sessions, with assessments conducted at baseline, immediately after each session, and at 6- and 12-week follow-ups. The primary outcome is change from baseline in Public Speaking Anxiety Scale (PSAS) total scores at each post-baseline assessment occasion, analyzed using a linear mixed-effects model including fixed effects for group, assessment occasion, and their interaction. Secondary outcomes include Liebowitz Social Anxiety Scale-Self Report and Fear of Negative Evaluation-Brief scores, as well as physiological indicators reflecting anxiety responses during VR exposure, including heart rate variability and electrodermal activity. Exploratory analyses will examine behavioral synchrony using motion energy analysis of video recordings and acoustic features of speech to capture anxiety-related movement and vocal patterns. This trial addresses the limited evidence regarding the added value of graded interviewer reactions in VRET for public speaking anxiety by examining whether they improve outcomes beyond those achieved with standard automated VR exposure. The findings may clarify the role of socially responsive feedback in virtual exposure and inform the development of VR-based anxiety interventions. Clinical Research Information Service (CRiS) KCT0011111. Registered on 06 November 2025.

ABSTRACT Public Speaking Anxiety (PSA) is proven to have an adverse effect on the overall academic performance and future employability of young undergraduate population. With the increasing global interest towards PSA, there is a dearth of pedagogically anchored, culture-specific, and action-oriented research in the Pakistani context. The current study fills this gap by utilizing Pedagogical Action Research (PedAR), an active, cyclical model that integrates reflective teaching with curriculum development. A sample of 42 undergraduate students of Business and Professional Speech course at a private university in Karachi were recruited for this study. The research consisted of three action cycles with interventions that were customized to target the cognitive, behavioral and physiological outcomes of PSA. The ARTICULATE, CAPTIVATE, and CASCADE frameworks were employed and inspired by psychological theory, communication pedagogy, and digital technology (for instance, Yoodli AI). Quantitative data were collected using the Public Speaking Anxiety Scale (PSAS) and qualitative data were based on researcher’s observations, journals, and reflections of the students. Results demonstrated significant PSA decrease in all domains, and improvements in student performance. The research highlights the significance of the PedAR as a PSA-lowering instrument, and as a model of teacher-driven reform that is responsive, reflective, and culturally dynamic. By presenting the teacher as a researcher and the classroom as a site for transformation, this study validates PedAR’s promise as a tool for closing the gaps among theory, policy and practice, while fostering scalable, contextually grounded innovations in Pakistan’s educational context.

The development of a student's personality, particularly during classroom interaction, is heavily influenced by their level of self-confidence. A lack of self-assurance often leads to public speaking anxiety, which subsequently restricts student engagement and diminishes academic performance. This phenomenon is frequently identified among tenth-grade Vocational High School (SMK) students who are navigating a period of environmental transition. This research focuses on enhancing the self-confidence of Grade X SMK students struggling with speech-related anxiety through the implementation of group guidance services utilizing role-playing methods. The study follows a Guidance and Counseling Action Research (GCAR) design conducted over two cycles, consisting of preparatory, executive, monitoring, and evaluative phases. The participants were tenth-grade students with low self-confidence profiles as determined by questionnaires and field observations. Data were analyzed using a descriptive quantitative approach to compare performance levels before and after the intervention. The results demonstrate that group guidance integrated with role-playing is an effective strategy for optimizing student self-confidence, as shown by the consistent upward trend in scores throughout the cycles. These findings suggest that this technique serves as a strategic instrument for school counselors to mitigate social anxiety among students.

Introduction Public Speaking Anxiety (PSA) is a highly prevalent disorder and may lead to adverse consequences. Virtual Reality Exposure Therapy (VRET) is an effective treatment for PSA in adults and adolescents, yet little is known about the long-term effects of VRET for PSA. Method The current study assessed the clinical effects of a two-phased, four-armed RCT study at 12-month follow-up. In the original trial, a total of 100 adolescents were randomly assigned to one of four conditions: 1). VRET-only, 2) VRET + online exposure program, 3) Online psychoeducation program + online exposure program, or 4) Waitlist + online psychoeducation program. Participants were assessed on public speaking anxiety-, social interaction anxiety- and social phobia symptoms. Results At group level, online psychoeducation and online exposure had a statistically significant reduction in PSAS scores from post-treatment to 12-month follow-up, whereas the other groups maintained their treatment gains. Social interaction anxiety symptoms remained unchanged following the intervention, while the improvement in social phobia symptoms was maintained at 12-month follow-up. Discussion This study provides an early indication that both VRET, and online psychoeducation + online exposure, could be effective methods of reducing PSA in adolescents over a 12-month period. However, as the findings have several limitations, including small sample size, this needs to be explored further. The study was pre-registered at Clinicaltrials.gov (NCT04396392) on the 11th of February 2020.

This study aimed to reveal the views of social studies teachers and prospective social studies teachers in Turkey regarding their speaking anxiety. The research utilized a phenomenological design, a qualitative research method. The study group consisted of 10 social studies teachers and 20 prospective social studies teachers from Turkey. Criterion sampling, a type of purposeful sampling, was used to select the study group, and participants were chosen from among social studies teachers and prospective teachers who reported experiencing speaking anxiety based on their own statements. A semi-structured interview form consisting of open-ended questions was used as the data collection tool. The data obtained from the semi- structured interview form were subjected to content analysis. The results showed that social studies teachers focused on difficulty in self-expression and fear of not being able to express themselves, while prospective social studies teachers experienced anxiety in terms of stress, tension, and feelings of inadequacy. Furthermore, both teachers and prospective teachers exhibited behavioral and affective responses such as speech impairment, tension, worry, and feeling under pressure when experiencing anxiety. The study revealed that anxiety leads to difficulties in self-expression, and preparation for the topic emerged as an effective coping mechanism. Based on the findings, it is recommended that practical courses on communication and oral expression skills be included in teacher training programs; that psycho-educational interventions be implemented to address the affective dimension of speech anxiety; and that practices be developed to strengthen prospective teachers' self-efficacy, and systematically impart planned speaking and topic preparation skills. Future research should examine speech anxiety using mixed-methods, including variables such as gender, length of professional experience, class level, and personality traits.

This study investigates the pairwise correlation between public speaking self-efficacy beliefs and public speaking anxiety among Omani students in their English as a Foreign Language (EFL) classes. The study employed a quantitative approach to assess the correlation between students' confidence in public speaking and their anxiety levels. The results showed a weak negative correlation (r = -0.03) between public speaking self-efficacy beliefs and public speaking anxiety, with a p-value of 0.696, which means that there is no statistically significant relationship. These findings emphasize that students who perceive themselves as skilled in public speaking do not necessarily demonstrate diminished anxiety. This contradicts the assumption that heightened self-efficacy directly mitigates anxiety and highlights the complexity of psychological factors influencing public speaking performance. The results differ from previous studies in Western contexts that found a negative relationship between self-efficacy and anxiety. Cultural or contextual factors may clarify this discrepancy, suggesting that confidence alone may not alleviate anxiety in all educational settings. The research study underscores the necessity for targeted interventions beyond the mere enhancement of public speaking self-efficacy beliefs to alleviate public speaking anxiety in EFL classes. Subsequent research ought to utilize longitudinal study methodologies and more extensive populations to investigate this complex relationship further.

This study addresses the critical need for soft skills development among orphaned and underprivileged youth, focusing on the persistent challenge of public speaking anxiety and low self-confidence. The objective was to design, implement, and evaluate a targeted training program to enhance self-efficacy and foundational public speaking abilities for students at the Griya Yatim &amp; Dhuafa (GYD) BSD 3 orphanage. The methodology involved a one-day experiential workshop titled "Speak Up! I Can!", integrating interactive theoretical instruction on communication principles with practical simulation exercises. A direct observational approach was used to assess changes in key behavioral indicators of confidence before and after the intervention. Results demonstrated significant positive shifts: participant willingness to speak publicly increased dramatically to approximately 80%, accompanied by marked improvements in non-verbal communication cues such as eye contact, posture, and facial expression. The overall estimated confidence score for the group rose from a low to a moderate range. The program concluded that a structured, practice-oriented workshop grounded in self-efficacy theory is an effective intervention for initiating confidence and skill development in vulnerable youth populations. This initiative contributes to the field by demonstrating the practical application of communication science in community empowerment and offers a replicable model for similar interventions aimed at enhancing the psychosocial readiness of at-risk children.

ABSTRACT Senior university academics are regularly required to speak publicly as part of their roles. They are often selected to present for their discipline expertise and may not receive any formal public speaking training prior to commencing in their academic positions. Little is known about the stress that senior academics experience during public speaking. Glossophobia, the fear of public speaking, can be manifested in observable physical symptoms and internal mental discomfort. This study used mixed methods to combine data on self-perceptions and observed stress responses of senior academics presenting at a hybrid research conference. The study identified that there was a significant discrepancy between observed and self-reported stress, as well as the challenges associated with observations taken virtually. It was also identified that general tools for stress measurement may need to be reconsidered5 for senior cohorts as all senior academics utilized filler words during their presentations, which may reflect more on a lack of training than glossophobia or public speaking discomfort.

Public Speaking Anxiety (PSA) is a form of social anxiety spread among university students, negatively affecting both academic performance and overall psychological well-being. Virtual Reality (VR)–based interventions combined with Cognitive Behavioral Therapy (CBT) represent a promising approach for treating PSA, as they enable gradual and controlled exposure to feared social situations by simulating realistic audiences and environments. The primary aim of this study is to evaluate whether the use of VR as a support to standard psychotherapy is effective in managing anxiety and PSA in university students who access the University Psychological Counseling Service (UPCS). This article outlines the study protocol for a randomized controlled trial (RCT). Participants will be divided into two groups: (1) a control group receiving psychological counseling, and (2) an experimental group that receives psychological counseling integrated with VR interventions based on 360° video scenarios. The intervention will include two VR-based modules: a VR–Exposure and Response Prevention (ERP) module, designed to provide graded immersive exposure to anxiety-provoking scenarios, and a VR–Acceptance and Commitment Training (ACT) module, aimed at enhancing mindfulness and psychological flexibility through guided experiential practice. Psychological and physiological data collected during the sessions will be analyzed to compare the effectiveness of VR-integrated psychotherapy with traditional counseling alone. This study will introduce a novel VR-based ERP and ACT training protocol designed to reduce public speaking anxiety in university students by integrating innovative, immersive VR scenarios within a psychological counseling context. The proposed approach may be particularly relevant for university settings, as it offers a scalable, standardized, and controllable VR-supported counseling protocol aimed at reducing PSA, enhancing students’ academic functioning (e.g., oral exams and presentations), and strengthening the overall effectiveness of university psychological counseling services. This protocol was registered at the Clinical Trials.gov (Identifier: NCT07351409) on January 16, 2026.

Abstract This systematic scoping review mapped the empirical literature on Virtual Reality Exposure-Based Therapy (VRET) delivered via commercially available head-mounted displays for adult anxiety-related disorders, to characterize study targets, methods, and gaps. A comprehensive database search yielded 1097 records. Publications were excluded if anxiety was not a measured outcome; if exposure was paired with other techniques (e.g., relaxation or additional therapies) in a way that prevented evaluation of exposure as a stand-alone component; or if virtual reality was delivered via methods other than head-mounted displays. Thirty studies met inclusion criteria and were charted for synthesis. The 30 included studies examined phobias (n = 11), Obsessive-Compulsive Disorder (n = 4), public speaking anxiety and social anxiety (n = 13), and other anxiety presentations (n = 2; social physique anxiety; MRI anxiety). Most studies reported pre- to post-intervention reductions in anxiety symptoms, but study designs and outcome measures varied substantially. Acceptability and engagement were generally favorable when assessed, but measurement approaches were inconsistent and adverse effects were not uniformly reported. Methodological heterogeneity and limited replication constrained cross-study comparability. The current evidence base indicates growing application of HMD-based VRET across multiple anxiety-related targets and suggests potential clinical benefit in many studies; however, heterogeneity and small samples limit the strength of inferences regarding comparative outcomes. Future research would benefit from standardized reporting of intervention parameters and equipment, consistent measurement of acceptability, and adequately powered comparative designs with longer follow-up to clarify where HMD-based VRET is most feasible and beneficial.

Public speaking anxiety (PSA) is a prevalent concern among senior high school students and may be influenced by individual learning preferences and the nature of teacher feedback. This study examined the relationship between language learning styles, teacher feedback, and public speaking anxiety among Grade 11 HUMSS students at a private university in Cagayan de Oro City in the school year 2024-2025. Using a predictive–correlational design, data were collected from randomly selected students through survey questionnaires. Descriptive statistics, Pearson correlation, and multiple regression analysis were employed to analyze the data. Results revealed that auditory and visual learning styles were the most preferred among students, while teacher feedback was consistently rated high across formative, summative, and reflective dimensions. Despite this, students reported a high level of public speaking anxiety. Significant relationships were found between public speaking anxiety, language learning styles, and teacher feedback, with the visual learning style emerging as the strongest predictor of anxiety. These findings suggest that mismatches between instructional approaches and students’ preferred learning styles may heighten anxiety during oral communication tasks. The study highlights the importance of implementing differentiated and multimodal instructional strategies to support learners better and reduce public speaking anxiety among senior high school students.

ABSTRACT Audience characteristics are often manipulated in virtual exposure or training programmes for public speaking anxiety. However, it is unclear how specific components influence stress-related emotional responses and whether public speaking anxiety levels moderate their relationships. In this study, 102 participants with varied public speaking anxiety levels gave a speech to a virtual audience consisting of either 2 or 6 members and with either an encouraging or a critical attitude. Physiological signals, speech characteristics, subjective stress levels, and audience evaluation were measured during the experiment. Results show that participants overall evaluated the encouraging audience more positively and felt more nervous in the critical audience condition. In people with higher public speaking anxiety levels, the nervousness was stronger in the critical condition, but their heart rate was higher in the encouraging condition. Speech characteristics were not influenced by the attitude conditions. Furthermore, virtual audience size was not related to any emotional responses, but we found that the higher participants’ public speaking anxiety, the more they trusted the small audience. We discuss these results in relation to previous findings for each emotional response and the factors that may have contributed to the emotional discordance.

This paper examines demographic, self-esteem and personality correlates of Public Speaking Anxiety. In all 1049 working adults indicated how anxious they were in giving speeches in public and they also filled out the High Potential Trait Indicator (HPTI). We used correlations and regressions to explore the relationship between the independent variables and Public Speaking Anxiety. Our multiple regression indicated five significant factors that accounted for 15% of the variance: younger more than older; female more than male, and those who scored lower on self-esteem, courage and competitiveness rated their Public Speaking Anxiety higher. Results are discussed in terms of the previous literature and implications for helping people struggling with Public Speaking Anxiety.

Public speaking anxiety (PSA) is present in most individuals with social anxiety disorder (SAD). As for SAD, exposure therapy is considered the gold-standard treatment for PSA. However, it is known that not all patients benefit from it. Recent research (Hauck Behav Res Ther: 104553, 2024) suggests that glucose facilitates fear extinction and consolidation, processes crucial for psychotherapeutic success, demonstrating its potential as an adjuvant to improve the efficacy of exposure therapy. The present study aims to translate previous findings into a clinical context, by studying the effects of glucose on fear exposure for participants with PSA. Participants with PSA will complete a spaced multi-day public speaking exposure procedure (Cheng J Behav Ther Exp Psychiatry: 54;101-107, 2017), an established and successful method of investigating treatment for PSA (Culver J Behav Ther Exp Psychiatry: 43:787-93, 2012; Niles Behav Res Ther: 68:27-36, 2015). The effectiveness of the exposure treatment will be measured through self-report assessment and the physiological measures skin conductance (SC), and heart rate (HR). Participants will be randomly assigned to receive either glucose or a placebo prior to exposure in a randomized controlled trial. This study is the first to investigate glucose administration as cognitive enhancer in a subclinical population, emphasizing the transition from bench to bedside. We provide a detailed study protocol to increase transparency in open science as well as enabling researchers to use the detailed protocol to implement with other manipulations, to improve exposure therapy in the long run.

Debating in L1 is strenuous but more onerous in L2, causing public speaking anxiety (PSA). Immersive Virtual Reality (iVR) offers a potential environment for practicing English debate. Innocuous iVR environment contributes a personalized treatment for PSA; however, the number of relevant studies in EFL context remains limited. In this study, iVR was adapted in Indonesia. The study measured how iVR-based debate impacted PSA, the extent to which PSA and English debating performance differed between face-to-face and iVR-based debates, and the perceptions of two debate modes. An explanatory sequential design of mixed methods was employed, recruiting sophomores (N = 59) majoring in English. Both Class A (N = 29) and B (N = 30) received the same treatments, iVR-based debates, but with the switched sequences. Data were collected through Personal Report of Communication Apprehension (PRCA), English debate scoring rubric, reflection papers, and interviews. The simple linear regression affirmed the strong relationship between the students’ PSA and their English debating performance (p-values = .001 and .006). The β-values were negative (−.164 and −.080), indicating an inverse correlation between the variables. The paired-sample t-test confirmed the statistically-significant decrease in the PSA and statistically-significant increase in the English debating performance (p = .001). The thematic analysis revealed core categories: (1) the challenges of face-to-face debate, (2) the benefits of iVR, (3) the challenges of iVR-based debate, and (4) the commitments for further utilizing iVR. iVR provides an alternative learning environment to reduce students’ PSA and improve their English debating performance. This study recommends that educators adapt iVR-based debate activities in their English classrooms and mitigate potential drawbacks during implementation.

English public speaking anxiety, self-efficacy, and strategies during the competitions among English majors in China

This study examines speech anxiety among sixth-semester English Education students at Tadulako University, highlighting the ongoing challenges that hinder students' ability to communicate confidently despite having taken various speaking courses. This study aims to identify the main factors contributing to speaking anxiety and analyze the coping strategies used by students to overcome these psychological barriers in the classroom context. Using a mixed-methods design that sequentially combined qualitative and quantitative methods, this study first collected quantitative data through a questionnaire administered to sixth-semester students to measure anxiety levels and identify contributing factors, followed by semi-structured interviews with selected participants to gain deeper insights into their personal experiences and management strategies. Findings indicate that speaking anxiety primarily stems from two interrelated domains: psychological factors, including fear of negative evaluation, lack of confidence, and perfectionism; and linguistic factors, such as limited vocabulary, grammatical uncertainty, and pronunciation difficulties. Students reported using various coping mechanisms, ranging from thorough preparation and collaboration with peers to relaxation techniques and talking. This study emphasizes that speaking anxiety is not merely temporary nervousness, but rather a complex phenomenon that affects student participation in class, learning motivation, and their perception of themselves as future English language educators. This highlights the need for a more supportive learning environment and targeted interventions to address the emotional and linguistic dimensions of this challenge.