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Cited by 84Virtual Reality Applications and ImpactsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesDigital Mental Health Interventions

Pilot randomized trial of self-guided virtual reality exposure therapy for social anxiety disorder

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Zainal, Nur Hani, Chan, William W., Saxena, Alisha P., Taylor, Craig Barr, Newman, Michelle G.·2021·Behaviour Research and Therapy
DOI 10.1016/j.brat.2021.103984PMC PMC8759454
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Abstract

Background Virtual reality exposure therapy (VRE) has shown promising efficacy for the treatment of social anxiety disorder (SAD) and related comorbidities. However, most trials conducted to date were therapist-led, and little is known about the efficacy of self-guided VRE. Therefore, this randomized controlled trial (RCT) aimed to determine the efficacy of a self-directed VRE for SAD.Method Forty-four community-dwelling or undergraduate adults diagnosed with SAD based on the Mini International Neuropsychiatric Interview were randomly assigned to VRE designed to last four sessions or more (n = 26) or waitlist (WL; n = 18). Self-reported SAD severity (Social Phobia Diagnostic Questionnaire and Social Interaction Anxiety Scale), job interview anxiety (Measure of Anxiety in Selection Interviews), trait worry (Penn State Worry Questionnaire), and depression symptoms (Patient Health Questionnaire-9) were administered at baseline, post-treatment, 3-month-follow-up (3MFU), and 6-month-follow-up (6MFU). Piecewise multilevel modeling analyses were conducted to manage clustering in the data.Results VRE vs. WL resulted in greater reductions in SAD symptom severity, job interview fear, and trait worry, with moderate-to-large effect sizes (Hedge's g = -0.54 to -1.11) from pre-to-post treatment. Although significant between-group differences did not emerge for change in depression, VRE led to change in depression, whereas waitlist did not. These gains were also maintained at 3MFU and 6MFU. Further, facets of presence increased during the course of VRE (g = 0.36-0.45), whereas cybersickness decreased (g = -0.43).Discussion Brief, self-guided VRE might ameliorate SAD and comorbid worry, for young-to-middle-aged adults with SAD. Other theoretical and practical implications were also discussed.

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  • In 12 of the studies the VR intervention was done in 4 to 24 sessions.

    “In 12 of the studies the VR intervention was done in 4 to 24 sessions (7–10, 12, 13, 20, 24, 32, 41, 42, 44).”

    From A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression (2023) · cites this paper as [12]

    The Method’s Session protocol reports that participants in this trial completed 1–8 VR exposure sessions, not a minimum of four. The paper therefore contradicts the stated range as applied to this cited study; it does not establish the aggregate count of 12 studies. (LLM, conf=0.84)

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  • In SAD patients who underwent four or more self-guided sessions of VRET comprising either a job interview or a dinner party scenario, SAD symptom reductions were reported post-treatment and maintained after six months.

    “In a study in SAD patients who underwent four or more self-guided sessions of VRET comprising either a job interview or a dinner party scenario, SAD symptom reductions were reported post-treatment and maintained after six months (Zainal et al., 2021).”

    From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Zainal et al., 2021

    The Method describes a choice between job-interview and dinner-party VRE, and the Primary outcomes report reduced SAD severity after treatment with gains maintained at six months. However, the Session protocol says participants completed 1–8 sessions (mean 3.55), so the claim that the patients underwent four or more sessions overstates what they received. (LLM, conf=0.90)

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  • The majority of the studies have implemented gamification and persuasive technology features in VR interventions specifically targeting anxiety and depression.

    “The majority of the studies have implemented gamification and persuasive technology features in VR interventions specifically targeting anxiety and depression (7, 8, 10–13, 20, 32, 41, 42, 44).”

    From A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression (2023) · cites this paper as [12]

    The Method section (page unavailable) describes a VR intervention for social anxiety with interactive prompts, a virtual therapist, and distress-rating features. It does not identify gamification features or establish that a majority of VR studies use these features; this trial also targets anxiety, not depression. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Recorded videos have shown promising results for treating social or public speaking anxiety.

    “Although these two types of scenarios are similarly immersive (Nason et al., 2020), recorded videos are more accessible and have shown promising results for treating social or public speaking anxiety (Reeves et al., 2021; Zainal et al., 2021).”

    From Virtual reality acceptance and commitment therapy intervention for social and public speaking anxiety: A randomized controlled trial (2023) · cites this paper as Zainal et al., 2021

  • The findings indicate the presence of four distinct types of scenes across the included studies: exposure to feared conditions, relaxation/mindfulness, teaching coping skills, and games to reinforce learned skills.

    “The findings indicate the presence of four distinct types of scenes across the included studies. These include scenarios designed to expose participants to feared conditions (10–12, 21, 32, 42, 44), visually appealing scenery intended for relaxation and mindfulness (9, 13, 43), scenes created for teaching coping skills specific to diagnosed conditions (7, 8, 41), and games developed to reinforce”

    From A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression (2023) · cites this paper as [12]

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3 of the 114 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Bouchard S, Robillard G, & Renaud P (2007). Revising the factor structure of the simulator sickness questionnaire. Annual Review of CyberTherapy and Telemedicine, 5, 128– 137.
  2. Bouchard S, St-Jacques J, Renaud P, & Wiederhold BK (2009). Side effects of immersions in virtual reality for people suffering from anxiety disorders. Journal of CyberTherapy and Rehabilitation, 2, 127– 137.
  3. Hope DA, Heimberg RG, & Turk CL (2019). Managing social anxiety: A cognitive- behavioral therapy approach (3rd ed.). New York, NY: Oxford University Press.
  4. Lister HA, Piercey CD, & Joordens C (2010). The effectiveness of 3-D video virtual reality for the treatment of fear of public speaking. Journal of CyberTherapy and Rehabilitation, 3, 375– 381.

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Authors
Zainal, N. H., Chan, W. W., Saxena, A. P., Taylor, C. B., & Newman, M. G.
Affiliations
  • Pennsylvania State University (US)
  • Palo Alto University (US)
Corresponding author
Zainal, Nur Hani
ORCID
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2021-12
Volume
147
Pages
103984
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2021.103984
PMC
PMC8759454
OpenAlex
W3201863710
Cited by
84
References
114
Citations by year
2026: 20 · 2025: 18 · 2024: 20 · 2023: 17 · 2022: 9
FWCI
7.05
Type
journal article
Language
en
Open access
Licence
Locations
  • Behaviour Research and Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • ScholarSphere (Penn State Libraries) (submittedVersion, cc-by-nc-nd)
Funders
National Institute of Mental Health (R01MH115128)
Topics
  • Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
virtual reality exposure therapy, social anxiety disorder, self-guided treatment, trait worry, depression, presence, cybersickness, treatment efficacy, maintenance of treatment effects
MeSH terms
Phobia, Social, Adult, Anxiety, Humans, Middle Aged, Pilot Projects, Psychiatric Status Rating Scales, Treatment Outcome, Virtual Reality Exposure Therapy

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