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Therapist-led and self-led one-session virtual reality exposure therapy for public speaking anxiety with consumer hardware and software: A randomized controlled trial
Abstract
Public speaking anxiety (PSA) is a common condition which can be treated effectively with exposure therapy. However, inherent difficulties in stimuli presentation and control limits dissemination and the therapeutic potential. Virtual Reality (VR) technology has the potential to resolve these issues and provide a scalable platform for self-help interventions. No previous study has examined whether this can be achieved using the first generation of consumer VR hardware and software. In the current trial, n = 25 + 25 participants were randomized to either one-session therapist-led VR exposure therapy for PSA followed by a four-week internet-administered VR to in-vivo transition program, or a waiting-list. Linear mixed effects modeling revealed significant, large (within Cohen's d = 1.67) decreases in self-reported PSA. The waiting-list was then given access to an internet-administered, self-led version of the same VR exposure therapy to be conducted at home, followed by the same transition program. Dual-slope mixed effects modeling revealed significant, large (d = 1.35) decreases in self-reported PSA. Results were maintained or improved at six- and twelve-month follow-ups. We show for the first time that low-cost, off-the-shelf consumer VR hardware and software can be used to conduct exposure therapy for PSA, both in the traditional, previously impractical one-session format, and in a novel self-led, at-home format.
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“Comparing both active interventions directly revealed better outcomes at both six- and 12-month follow-up if the intervention was led by a therapist as opposed to the self-guided intervention.”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Lindner et al., 2019
In the citing paper
“Both therapist- and self-led treatments resulted in significant reductions in self-reported PSA symptoms in comparison to the waitlist condition.”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Lindner et al., 2019
In the citing paper
“Notably, performance of in vivo exposure exercises during the post-VR transition period was associated with higher symptom decreases (Lindner et al., 2019).”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Lindner et al., 2019
In the citing paper
“In a similar vein, in a subclinical population with PSA, a therapist-led one-session VRET intervention complemented by a four-week online program including in vivo exposure also resulted in greater symptom improvements than a self-guided intervention complemented by the same online program (Lindner et al., 2019).”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Lindner et al., 2019
In the citing paper
“Different approaches have been explored to address this effect, for instance utilizing video recordings of real audiences within VR instead of computer-rendered virtual humans (cf. Lindner et al., 2019).”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Lindner et al., 2019
In the citing paper
“although the overall number of exposure exercises in this study (21 exercises per patient including the self-management phase) was comparable to other RCTs (Deacon, Kemp, et al., 2013;Lang et al., 2012;Lindner et al., 2019), the condensed treatment format applies fewer exposure exercises than other types of exposure-based CBT (e.g., Clark et al., 2006).”
From Effective—and Tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders (2023) · cites this paper as Lindner et al., 2019
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Metadata
- Authors
- Lindner, P., Miloff, A., Fagernäs, S., Andersen, J., Sigeman, M., Andersson, G., Furmark, T., & Carlbring, P.
- Affiliations
- Stockholm University (SE)
- Uppsala University (SE)
- Linköping University (SE)
- Corresponding author
- Lindner, Philip
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2019-01
- Volume
- 61
- Pages
- 45-54
- ISSN
- 0887-6185 (ISSN-L)
- OpenAlex
- W2884316046
- Cited by
- 175
- References
- 67
- Citations by year
- 2026: 19 · 2025: 25 · 2024: 18 · 2023: 19 · 2022: 17 · 2021: 33 · 2020: 26 · 2019: 17
- FWCI
- 19.17
- Type
- journal article
- Language
- en
- Update notices
- erratum (2019-05-01)
- Open access
- closed
- Locations
- Journal of Anxiety Disorders (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion)
- 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
- public speaking anxiety, virtual reality exposure therapy, low-cost technology, treatment dissemination, maintenance of treatment effects
- MeSH terms
- Adult, Anxiety, Anxiety Disorders, Female, Humans, Implosive Therapy, Male, Self Care, Software, Speech, Virtual Reality Exposure Therapy
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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