Virtual Reality Exposure in Cognitive Behavioral Group Therapy for Social Anxiety Disorder: A Qualitative Evaluation Based on Patients’ and Therapists’ Experiences
Abstract
Social anxiety disorder (SAD) is a highly prevalent and impairing disorder. Current best practice is cognitive behavioral therapy (CBT), but there are several challenges associated with performing exposure therapy. Virtual reality exposure (VRE) may improve treatment efficacy of SAD in a group therapy context, because it allows for greater control, flexibility, and individualization of the exposure stimuli. However, to date no study has investigated the use of VRE for SAD in a group context. In the present study, nine patients who had undergone group CBT with VRE for SAD and three therapists responsible for the treatment were interviewed about their experiences. The objective of the study was to investigate the practical and therapeutic challenges of using VRE in a group therapy context. Thematic analysis was used to analyze the data. The results showed that it was difficult for the patients to engage with the VRE in a group therapy context and that there were several practical challenges. However, all participants found the VRE exercises to be meaningful, because it gave them a medium to practice and understand typically avoided social situations. The latter has not previously been described as a treatment mechanism for anxiety through virtual reality. However, the appropriateness of VRE in group therapy remains unclear. Implications are discussed.
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VRET's potential resides in its ability to create personalized exposure sanctuaries for PTSD or training grounds for fundamental research models.
“VRET’s potential resides in its ability to create personalized exposure sanctuaries for PTSD [31,32], or training grounds for fundamental research models [33,34,35].”
From SAFEvR MentalVeRse.app: Development of a Free Immersive Virtual Reality Exposure Therapy for Acrophobia and Claustrophobia (2024) · cites this paper as [34]
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Effectiveness and User Experience of Virtual Reality for Social Anxiety Disorder: Systematic Review
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“Positive qualitative responses suggest that VR allowed patients to gain more insights into their anxiety and a better understanding of the social situations that they would normally avoid or be too emotionally activated to observe [50].”
BackgroundMethodInfluentialBuragohain, D., Khichar, S., Deng, C., Meng, Y., & Chaudhary, S. (2025) · Scientific Reports · doi:10.1038/s41598-025-00916-4 · Cited by 44 · see citing works
“Moreover, cognitive behavioral therapy (CBT) sessions in VR environments can help patients identify and challenge their negative thoughts and behaviors in an interactive manner 52 .”
Ørskov, P. T., Lichtenstein, M. B., Ernst, M. T., Fasterholdt, I., Matthiesen, A. F., Scirea, M., Bouchard, S., & Andersen, T. E. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.991755 · Cited by 18 · see citing works
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Best, P., Kupeli-Holt, S., D’Arcy, J., Elliott, A., Duffy, M., & Daele, T. V. (2023) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2023.03.003 · Cited by 19 · see citing works
Lo, B., Durocher, K., Charow, R., Kimball, S., Phạm, Q., Sockalingam, S., Wiljer, D., & Strudwick, G. (2025) · Journal of Medical Internet Research · doi:10.2196/67820 · Cited by 10 · see citing works
“Human-computer interface [53,55,57,60,62,71,75,82,90,92,96,105,108,132,138,140,141,144,146,155,184,187] Availability and alignment of content delivery to end-user preferences (eg, audiobook or video) Preferred modality of content delivery [64,75,90,108,110,115,118,119,121,150,162,167,168,170,182]…”
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Gaina, M.-A., Sbarcea, S.-V., Popa, B.-S., Stefanescu, B.-V., Gaina, A.-M., Szalontay, A.-S., Bolos, A., & Stefanescu, C. (2024) · Brain Sciences · doi:10.3390/brainsci14070651 · Cited by 8 · see citing works
“Participants should have the autonomy to make informed choices about their treatment, including options for customization and control [34,95].”
BackgroundErnst, M. T., Bouchard, S., Andersen, T. E., Ørskov, P. T., Tarp, K., & Lichtenstein, M. B. (2024) · JMIR Formative Research · doi:10.2196/55679 · Cited by 6 · see citing works
“While studies have been made on the efficacy of VR exposure in the treatment of SAD, few studies have applied 360° environments [28,30-32].”
BackgroundUduwa-vidanalage, E. S., Lee, J. D., Hermans, D., Engelhard, I. M., Scheveneels, S., & Meyerbröker, K. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06756-w · Cited by 5 · see citing works
“It has been argued that it may be more difficult to reproduce social situations in VR environments, compared to other phobic stimuli (e.g., heights, flying), due to the complexity of human interactions [4].”
Kjærstad, H. L., Jespersen, A. E., Bech, J. L., Weidemann, S., Bjertrup, A. J., Hestbæk, E., Simonsen, S., Glenthøj, L. B., Nordentoft, M., Reveles, K., et al. (2024) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2024.11.006 · Cited by 5 · see citing works
Skierś, K., Peng, D., Kundu, A., et al. (2025) · IEEE Transactions on Visualization and Computer Graphics · doi:10.1109/tvcg.2025.3616754 · Cited by 3 · see citing works
“…Exposure Therapy (VRET), designed to gradually expose patients to anxiety-provoking stimuli within a controlled and safe virtual environment [3]; VR-based Cognitive Behavioral Therapy (VR-CBT), which utilizes immersive VR scenarios to facilitate cognitive restructuring and behavioural…”
Dhunnoo, P., Wetzlmair-Kephart, L.-C., & O’Carroll, V. (2022) · Research Square · doi:10.21203/rs.3.rs-2330671/v1 · Cited by 3 · see citing works
Arnfred, B. T., Zeka, F., Hjorthøj, C. R., Winding, C., Moeller, K. S., Pedersen, M. Ø., Rosenberg, N., Clemmensen, L., Glenthøj, L. B., & Nordentoft, M. (2025) · JMIR Mental Health · doi:10.2196/73815 · Cited by 2 · see citing works
“These concerns are consistent with prior findings [61] and align with the notion that therapeutic context, patient characteristics, and VR characteristics can influence the experience of VR environments [62].”
Self-citationLindeberg, T., Patmisari, E., & McLaren, H. (2026) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2026.101001
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- Authors
- Arnfred, B. T., Bang, P., Winther Davy, J., Larsen, L. Q., Hjorthøj, C., & Christensen, A. B.
- Affiliations
- University of Copenhagen (DK)
- Venue
- Translational Issues in Psychological Science
- Published
- 2021-09
- Volume
- 7
- Issue
- 3
- Pages
- 229-247
- ISSN
- 2332-2136 (ISSN-L)
- 2332-2179
- OpenAlex
- W4206047394
- Cited by
- 16
- References
- 0
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 4 · 2023: 3 · 2022: 2
- FWCI
- 2.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Translational Issues in Psychological Science (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- 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
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- virtual reality exposure therapy, social anxiety disorder, group cognitive behavioral therapy, exposure therapy, patient experience, therapist experience, treatment engagement, social avoidance, therapeutic mechanisms
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