Old fears die hard: return of public speaking fear in a virtual reality procedure
Open accessAbstract
Exposure-based therapy is an effective treatment for social anxiety, but some patients relapse. We used a novel virtual reality procedure to examine spontaneous recovery (i.e., a return of fear over time) and fear renewal (i.e., the return of fear after a context switch) in individuals with fear of public speaking. On Day 1, 32 participants received exposure training before a virtual audience. On Day 8, participants completed a spontaneous recovery phase, followed by a fear renewal test, in which they gave a presentation in front of a new (context switch) or the same audience (no context switch). After exposure, participants exhibited a lower heart rate, subjective distress, negative valence, and arousal. One week later, participants showed spontaneous recovery of heart rate, and the context switch group showed renewal of subjective distress, negative valence, and arousal. Future studies can use this procedure to test interventions aimed at improving long-term exposure effects in individuals with public speaking fear.
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In SAD patients, heart rate decreases during VRET alongside subjective measures of stress and arousal.
“By contrast, in SAD patients, heart rate has been observed to decrease during VRET alongside subjective measures of stress and arousal (van Dis et al., 2021).”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as van Dis et al., 2021
Cites
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (2013) · doi:10.1176/appi.books.9780890425596 · Cited by 116,369 · see citing works
Diagnostic and Statistical Manual of Mental Disorders, 5th ed.
Carter, M. J. (2014) · Therapeutic Recreation Journal · Cited by 15,154 · see citing works
<b>mice</b>: Multivariate Imputation by Chained Equations in<i>R</i>
Buuren, S. V., & Groothuis-Oudshoorn, K. (2011) · Journal of Statistical Software · doi:10.18637/jss.v045.i03 · Cited by 13,870 · see citing works
Cohen, J. (1992) · Psychological Bulletin · doi:10.1037//0033-2909.112.1.155 · Cited by 8,771 · see citing works
Jeffreys, H., Moran, P. A. P., & Chatfield, C. (1922) · Nature · doi:10.1038/109132a0 · Cited by 7,837 · see citing works
(2010) · University of Twente Research Information · Cited by 6,037 · see citing works
Anxiety, sensitivity, anxiety frequency, and the prediction of fearfulness
Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986) · Behaviour Research and Therapy · doi:10.1016/0005-7967(86)90143-9 · Cited by 3,169 · see citing works
Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. (2012) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.1359 · Cited by 2,947 · see citing works
Bayesian inference for psychology. Part II: Example applications with JASP
Wagenmakers, E., Love, J., Marsman, M., Jamil, T., Ly, A., Verhagen, J., Selker, R., Gronau, Q. F., Dropmann, D., boutin, B., et al. (2017) · Psychonomic Bulletin & Review · doi:10.3758/s13423-017-1323-7 · Cited by 1,705 · see citing works
Context, ambiguity, and unlearning: sources of relapse after behavioral extinction
Bouton, M. E. (2002) · Biological Psychiatry · doi:10.1016/s0006-3223(02)01546-9 · Cited by 1,662 · see citing works
Parsons, T. D. (2015) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2015.00660 · Cited by 837 · see citing works
Wolff, P., & Barbey, A. K. (2015) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2015.00001 · Cited by 788 · see citing works
Measures of communication‐bound anxiety
McCroskey, J. C. (1970) · Speech Monographs · doi:10.1080/03637757009375677 · Cited by 723 · see citing works
Fear Extinction and Relapse: State of the Art
Vervliet, B., Craske, M. G., & Hermans, D. (2013) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-050212-185542 · Cited by 671 · see citing works
Response rates for CBT for anxiety disorders: need for standardized criteria
Loerinc, A. G., Meuret, A. E., Twohig, M. P., Rosenfield, D., Bluett, E. J., & Craske, M. G. (2015) · Clinical Psychology Review · doi:10.1016/j.cpr.2015.08.004 · Cited by 592 · see citing works
Stability of retrieved memory: Inverse correlation with trace dominance
Eisenberg, M., Kobilo, T., Berman, D. E., & Dudai, Y. (2003) · Science · doi:10.1126/science.1086881 · Cited by 518 · see citing works
Optional stopping: No problem for Bayesians
Rouder, J. N. (2014) · Psychonomic Bulletin & Review · doi:10.3758/s13423-014-0595-4 · Cited by 492 · see citing works
Cognitive processes in social phobia
Stopa, L., & Clark, D. M. (1993) · Behaviour Research and Therapy · doi:10.1016/0005-7967(93)90024-o · Cited by 489 · see citing works
State-of-the-art and future directions for extinction as a translational model for fear and anxiety
Craske, M. G., Hermans, D., & Vervliet, B. (2018) · Philosophical Transactions of the Royal Society B: Biological Sciences · doi:10.1098/rstb.2017.0025 · Cited by 373 · see citing works
van Dis, E. A. M., van Veen, S. C., Hagenaars, M. A., Batelaan, N. M., Bockting, C. L. H., van den Heuvel, R. M., Cuijpers, P., & Engelhard, I. M. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.3986 · Cited by 335 · see citing works
Self-citationSCID-5-CV : structured clinical interview for DSM-5 disorders : clinician version
First, M. B., Williams, J. B. W., Karg, R. S., & Spitzer, R. L. (2016) · Medical Entomology and Zoology · Cited by 308 · see citing works
Updating freeze: Aligning animal and human research
Hagenaars, M. A., Oitzl, M., & Roelofs, K. (2014) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2014.07.021 · Cited by 260 · see citing works
Self-citationCan Wearable Devices Accurately Measure Heart Rate Variability? A Systematic Review
Georgiou, K., Larentzakis, A. V., Khamis, N. N., Alsuhaibani, G. I., Alaska, Y. A., & Giallafos, E. J. (2018) · Folia Medica · doi:10.2478/folmed-2018-0012 · Cited by 244 · see citing works
Social anxiety and fear of negative evaluation: Construct validity of the BFNE-II
Carleton, R. N., Collimore, K. C., & Asmundson, G. J. G. (2006) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2006.03.010 · Cited by 219 · see citing works
How do I appear to others? Social anxiety and processing of the observable self
Mansell, W., & Clark, D. M. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00148-x · Cited by 219 · see citing works
Arntz, A., Rauner, M., & Van den Hout, M. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(95)00032-s · Cited by 208 · see citing works
Extinction, generalization, and return of fear: A critical review of renewal research in humans
Vervliet, B., Baeyens, F., Van den Bergh, O., & Hermans, D. (2013) · Biological Psychology · doi:10.1016/j.biopsycho.2012.01.006 · Cited by 178 · see citing works
Shiban, Y., Schelhorn, I., Pauli, P., & Mühlberger, A. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.05.014 · Cited by 141 · see citing works
Kemppainen, H., Nurmi, H. J., Raivio, N., & Kiianmaa, K. (2015) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2015.00001 · Cited by 140 · see citing works
Scheveneels, S., Boddez, Y., Vervliet, B., & Hermans, D. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2016.08.015 · Cited by 135 · see citing works
Tsao, J. C. I., & Craske, M. G. (2000) · Behavior Therapy · doi:10.1016/s0005-7894(00)80026-x · Cited by 131 · see citing works
Models and methods of emotional concordance
Hollenstein, T., & Lanteigne, D. M. (2014) · Biological Psychology · doi:10.1016/j.biopsycho.2013.12.012 · Cited by 111 · see citing works
Vujanovic (2007) · doi:10.1177/1073191106295053 · Cited by 89 · see citing works
Long-term outcome of social phobia treated by exposure
Fava, G. A., Grandi, S., Rafanelli, C., Ruini, C., Conti, S., & Belluardo, P. (2001) · Psychological Medicine · doi:10.1017/s0033291701004020 · Cited by 84 · see citing works
Clinical relevance of retrieval cues for attenuating context renewal of fear
Culver, N. C., Stoyanova, M., & Craske, M. G. (2010) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.10.002 · Cited by 70 · see citing works
Discussion points for Bayesian inference
Aczél, B., Hoekstra, R., Gelman, A., Wagenmakers, E., Klugkist, I. G., Rouder, J. N., Vandekerckhove, J., Lee, M. D., Morey, R. D., Vanpaemel, W., et al. (2020) · Nature Human Behaviour · doi:10.1038/s41562-019-0807-z · Cited by 67 · see citing works
Engelhard, I. M., Macklin, M. L., McNally, R. J., van den Hout, M., & Arntz, A. R. (2001) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(00)00101-7 · Cited by 64 · see citing works
Predicting Return of Fear Following Exposure Therapy With an Implicit Measure of Attitudes
Vasey, M., Harbaugh, C. N., Buffington, A., Jones, C. R., & Fazio, R. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.08.007 · Cited by 55 · see citing works
Measuring fear: Association among different measures of fear learning.
Constantinou, E., Purves, K. L., McGregor, T., Lester, K. J., Barry, T. J., Treanor, M., Craske, M. G., & Eley, T. C. (2020) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2020.101618 · Cited by 54 · see citing works
van Dis, E. A. M., Hagenaars, M. A., Bockting, C., & Engelhard, I. M. (2019) · Behaviour Research and Therapy · doi:10.1016/j.brat.2019.103416 · Cited by 48 · see citing works
Measuring personality: a comparison of three personality questionnaires in the Netherlands
Barelds, D. P. H., & Luteijn, F. (2002) · Personality and Individual Differences · doi:10.1016/s0191-8869(01)00169-6 · Cited by 38 · see citing works
Kearns, M. L., & Engelhard, I. M. (2015) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2015.00115 · Cited by 36 · see citing works
The Cambridge Handbook of Anxiety and Related Disorders
Olatunji, B. O. (2018) · Cambridge University Press eBooks · doi:10.1017/9781108140416 · Cited by 27 · see citing works
Craske, M. G., Fanselow, M. S., Treanor, M., & Bystritksy, A. (2019) · Biological Psychiatry · doi:10.1016/j.biopsych.2019.04.012 · Cited by 24 · see citing works
Using Retrieval Cues to Attenuate Return of Fear in Individuals With Public Speaking Anxiety
Shin, K. E., & Newman, M. G. (2017) · Behavior Therapy · doi:10.1016/j.beth.2017.07.011 · Cited by 23 · see citing works
Renewal of conditioned fear responses using a film clip as the aversive unconditioned stimulus
Landkroon, E., Mertens, G., Sevenster, D., Dibbets, P., & Engelhard, I. M. (2019) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2019.101493 · Cited by 20 · see citing works
Mertens, G., Braem, S., Kuhn, M., Lonsdorf, T. B., van den Hout, M., & Engelhard, I. M. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.09.003 · Cited by 16 · see citing works
Learning Mechanisms in Fear and Anxiety
Scheveneels, S., Boddez, Y., & Hermans, D. (2018) · The Cambridge Handbook of Anxiety and Related Disorders · doi:10.1017/9781108140416.002 · Cited by 5 · see citing works
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Landkroon, E., van Dis, E. A. M., Meyerbröker, K., Salemink, E., Hagenaars, M. A., & Engelhard, I. M. (2022) · Behavior Therapy · doi:10.1016/j.beth.2021.06.005 · Cited by 28 · see citing works
Self-citationSeuling, P. D., Czernin, N. S., & Schiele, M. A. (2024) · Neuroscience Applied · doi:10.1016/j.nsa.2024.104074 · Cited by 28 · see citing works
“By contrast, in SAD patients, heart rate has been observed to decrease during VRET alongside subjective measures of stress and arousal (van Dis et al., 2021).”
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Leong, J., Perteneder, F., Rajvee, M. R., & Maes, P. (2023) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3544548.3581039 · Cited by 19 · see citing works
Vásquez‐Carbonell, M., & Torres, J. C. (2025) · Computer Animation and Virtual Worlds · doi:10.1002/cav.70012 · Cited by 5 · see citing works
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Majidi, E., & Manshaee, G. (2023) · Current Psychology · doi:10.1007/s12144-023-04485-5 · Cited by 5 · see citing works
“Virtual real - ity (VR) technology is now used extensively in the treat - ment of psychiatric illnesses (El-Qirem et al., 2022; van Dis et al., 2021 ; Qian et al., 2020 ).”
Bouwman, V., Mobach, L., Teachman, B. A., & Salemink, E. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104685 · Cited by 4 · see citing works
Generalization of exposure therapy: Systematic review and recommendations for future research.
Kodzaga, I., Heistermann, J., & Zlomuzica, A. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104751 · Cited by 4 · see citing works
Pratama, D. P., & Putra, P. O. H. (2024) · Sustainability · doi:10.3390/su16146254 · Cited by 2 · see citing works
Artemi, T.-F., Konstantinou, T., Naziri, S., & Panayiotou, G. (2025) · Virtual Worlds · doi:10.3390/virtualworlds4020027 · Cited by 2 · see citing works
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Polastri, M. (2023) · International Journal of Therapy and Rehabilitation · doi:10.12968/ijtr.2023.0063 · Cited by 1 · see citing works
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“Throughout exposure sessions, a decrement of these physiological measures indicates a reduction in public speaking anxiety (Harris, Kemmerling, and North 2002; Hartanto et al. 2016; van Dis et al. 2021; Wechsler et al. 2021).”
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- Authors
- van Dis, E. A. M., Landkroon, E., Hagenaars, M. A., van der Does, F. H. S., & Engelhard, I. M.
- Affiliations
- Utrecht University (NL)
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2021-09
- Volume
- 52
- Issue
- 5
- Pages
- 1188-1197
- ISSN
- 0005-7894 (ISSN-L)
- OpenAlex
- W3128791912
- Cited by
- 20
- References
- 48
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 2 · 2023: 4 · 2022: 2 · 2021: 3
- FWCI
- 2.66
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Behavior Therapy (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Funders
- Leids Universitair Medisch Centrum (453-15-005)
- Nederlandse Organisatie voor Wetenschappelijk Onderzoek
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Keywords
- public speaking anxiety, spontaneous recovery, fear renewal, context switching, virtual reality exposure therapy, exposure therapy, social anxiety, relapse, heart rate, subjective distress, negative valence, arousal
- MeSH terms
- Virtual Reality, Arousal, Fear, Humans, Implosive Therapy, Speech
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