A meta-analysis of the efficacy of virtual reality and in vivo exposure therapy as psychological interventions for public speaking anxiety
Open accessAbstract
Public speaking anxiety (PSA) is a prevalent condition with disabling occupational, educational, and social consequences. Exposure therapy is a commonly utilized approach for treating PSA. Traditionally, this intervention has been delivered as in vivo exposure therapy (IVET). Limitations inherent to in vivo as a mode of delivery have been identified and studies have increasingly explored the use of Virtual Reality Exposure Therapy (VRET) as an alternative. Understanding the efficacy of both VRET and IVET as psychological interventions for PSA is important. A systematic search identified 11 studies with 508 participants. Meta-analysis yielded a large significant effect wherein VRET resulted in significant reductions in PSA versus control of −1.39 ( Z = 3.96, p < .001) and a similar large significant effect wherein IVET resulted in significant reductions in PSA versus control of −1.41 ( Z = 7.51, p < .001). Although IVET was marginally superior to VRET, both interventions proved efficacious. Given the advantages of utilizing VRET over IVET future research and clinical practice could explore VRET as a treatment option for PSA.
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VRET demonstrates comparable efficacy to traditional in vivo exposure for SAD and PSA.
“VRET demonstrates comparable efficacy to traditional in vivo exposure.”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Reeves et al., 2022
The Discussion says VRET was “not substantially inferior” to in vivo exposure therapy for public speaking anxiety (PSA), while the Conclusion says in vivo exposure was marginally more efficacious. The Future Directions section says whether treatment targeting PSA reduces broader social anxiety was beyond this meta-analysis’s scope, so the added claim about SAD is not supported. (LLM, conf=0.90)
Experimental — accuracy not yet measuredRecent meta-analyses show that VRET for SAD has significant and enduring effect sizes (Hedges' g ranging from −0.86 to −1.14) over follow-up periods of up to 12 months.
“Recent meta-analyses (Carl et al., 2019; Reeves et al., 2022; Morina et al., 2023; van Loenen et al., 2022; Horigome et al., 2020; Kampmann et al., 2016a) underscore the efficacy of conducting VRET for SAD with significant and enduring effect sizes (Hedges' g ranging from −0.86 to −1.14) over follow-up periods of up to 12 months.”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Reeves et al., 2022
The Results (Analysis 1: VRET versus Control Conditions; page unavailable) report a significant post-treatment reduction in public speaking anxiety, with a pooled effect of −1.39. That does not establish the stated Hedges’ g range for SAD generally. The Limitations explicitly say no follow-up analysis was conducted, so this paper does not support enduring effects over up to 12 months. (LLM, conf=0.92)
Experimental — accuracy not yet measuredMeta-analyses estimate large effect sizes for VRET compared to waitlist control conditions (Hedge's g between 0.86 and 1.46) for SAD and PSA, and moderate to large effect sizes (Hedge's g between 0.49 and 0.78) for anxiety disorders in general.
“Effect sizes for VRET compared to waitlist control conditions are estimated to be large (Hedge's g between 0.86 and 1.46) for SAD (Reeves et al., 2022; Morina et al., 2023; Horigome et al., 2020; Kampmann et al., 2016a) and PSA (Reeves et al., 2022), and moderate to large (Hedge's g between 0.49 and 0.78) for anxiety disorders in general (Carl et al., 2019; van Loenen et al., 2022).”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Reeves et al., 2022
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Experimental — accuracy not yet measuredExposure-based interventions addressing social fears can be resource-intensive and time-consuming.
“Exposure-based interventions addressing social fears can be resource-intensive and time-consuming due to the need to facilitate exposure exercises often outside the safety of a standardized, closely measured and accompanied environment (Reeves et al., 2022; Bouchard et al., 2017).”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Reeves et al., 2022
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“Mode of delivery can impact treatment outcomes in social anxiety, with some reports of VRET being superior to IVET (Bouchard et al., 2017) and dissimilar findings that VRET and IVET are equally efficacious (Klinger et al., 2005).”
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BackgroundThe Role of Risk Avoidance in Anxiety
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“As with other anxiety disorders, individuals with PSA often avoid or escape from situations (Maner & Schmidt, 2006) which involve public speaking.”
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“…speaking to an audience (O’Hair et al., 2011), is recognized as the most prevalent social fear in both clinical (Furmark et al., 2000) and non-clinical samples (Stein et al., 1996); with prevalence rates estimated between 20% (Leary & Kowalski, 1997) and 85% (Motley, 1995) in community samples.”
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“Further advantages associated with the VRET approach include: reduced cost (Miloff et al., 2016), increased scalability (Boeldt et al., 2019) and that the mode of delivery is preferred by patients (Garcia-Palacios et al., 2007).”
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“However, recent studies have indicated that including unpublished literature has a minimal effect on effect sizes in metaanalysis (Hartling et al., 2017; Schmucker et al., 2017).”
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“The negative subscale is a more direct measure of PSA, which is more highly correlated with PSA and shows more sensitivity to change than the positive scale (Hofmann & DiBartolo, 2000).”
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“Her research interests include increasing accessibility of cognitive-behavioural interventions in particular for presentations of anxiety disorders and PTSD. David Curran is a consultant clinical psychologist working in the NHS and clinical director with the Doctorate in Clinical Psychology programme at Queens Univers…”
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“Contrastingly, a meta-analysis demonstrated that there was no significant difference in treatment gains for individuals with SAD who were treated on a group or individual basis (Powers et al., 2008).”
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“Presence, which refers to the level of connection a participant feels with a virtual environment is associated with fear rating and treatment response during VRET for PSA (Price et al., 2011).”
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“As 360° VR equipment is becoming increasingly affordable and accessible (Lindner et al., 2017) future research should utilize this equipment.”
BackgroundThe relation between public speaking anxiety and social anxiety: A review
Blöte, A. W., Kint, M. J. W., Miers, A. C., & Westenberg, P. M. (2008) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2008.11.007 · Cited by 183 · cited 7× · see citing works
“Individuals with PSA have a significantly increased risk of developing Social Anxiety Disorder (SAD) (Blöte et al., 2009) characterized as an enduring fear of at least one social or performance situation in which the individual is exposed to unknown people or to possible scrutiny (American Psychiatric Association, 201…”
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“Of these five utilized VRET (Harris et al., 2002; Heuett & Heuett, 2011; Lindner et al., 2019; North et al., 1998; Wallach et al., 2009), four utilized IVET (Lawm et al.”
BackgroundMethodInfluentialAnxiety Level in Students of Public Speaking: Causes and Remedies
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“This can result in negative consequences for occupational and educational progression wherein public speaking is often a requisite (Raja, 2017) and is recognized as a desirable professional skill (Ulinski & O’Callaghan, 2002).”
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“Treatment adherence, which predicts outcome from CBT in anxiety disorders (Glenn et al., 2013) was only measured in a small number of studies included within this meta-analysis.”
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“When rated as a treatment option, it has low acceptability for client’s (Garcia-Palacios et al., 2007) and therapist’s (Pittig et al., 2019).”
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“It is less time consuming and cumbersome (Emmelkamp, 2005), has lower treatment costs (Miloff et al., 2016) and facilitates easy access to stimuli which can be controlled by the therapist (Hartanto et al., 2014).”
BackgroundInfluentialMeta-analysis of the efficacy of virtual reality exposure therapy for social anxiety
Chesham, R. K., Malouff, J. M., & Schutte, N. S. (2018) · Behaviour Change · doi:10.1017/bec.2018.15 · Cited by 135 · cited 4× · see citing works
“Meta-analyses have demonstrated the comparable efficacy of VRET and IVET for anxiety disorders (Carl et al., 2019), SAD (Chesham et al., 2018; Powers & Emmelkamp, 2008) and Agoraphobia, Specific Phobia and Social Phobia (Wechsler et al., 2019).”
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“The PRCA24 has also been evidenced to correlate significantly with state anxiety, as Reeves et al. 953 measured by the Spielberg State Anxiety measure (McCroskey & Beatty, 1984), suggesting that this measure can be appropriately utilized as a crosssituational predictive instrument.”
MethodKahlon, S., Lindner, P., & Nordgreen, T. (2019) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-019-0307-y · Cited by 130 · cited 1× · see citing works
“For example, Kahlon et al. (2019) reported that VRET reduced PSA in adolescents, however this pilot study did not utilize a control group and was not eligible for inclusion.”
Social phobia subtypes in the general population revealed by cluster analysis
FURMARK, T., TILLFORS, M., STATTIN, H., EKSELIUS, L., & FREDRIKSON, M. (2000) · Psychological Medicine · doi:10.1017/s0033291799002615 · Cited by 128 · cited 2× · see citing works
“, 2011), is recognized as the most prevalent social fear in both clinical (Furmark et al., 2000) and non-clinical samples (Stein et al.”
BackgroundTherapeutic process during exposure: Habituation model
Benito, K. G., & Walther, M. (2015) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2015.01.006 · Cited by 125 · cited 1× · see citing works
“Subsequently the therapeutic process of habituation results in a decrease in anxiety (Benito & Walther, 2015).”
BackgroundDoes behavioral treatment of social phobia lead to cognitive changes?
Newman, M. G., Hofmann, S. G., Trabert, W., Roth, W. T., & Taylor, C. B. (1994) · Behavior Therapy · doi:10.1016/s0005-7894(05)80160-1 · Cited by 121 · see citing works
Controlling social stress in virtual reality environments
Hartanto, D., Kampmann, I. L., Morina, N., Emmelkamp, P. G. M., Neerincx, M. A., & Brinkman, W.-P. (2014) · PLoS ONE · doi:10.1371/journal.pone.0092804 · Cited by 115 · cited 2× · see citing works
“, 2016) and facilitates easy access to stimuli which can be controlled by the therapist (Hartanto et al., 2014).”
BackgroundHypnotic enhancement of a cognitive behavioral treatment for public speaking anxiety
Schoenberger, N. E., Kirsch, I., Gearan, P., Montgomery, G., & Pastyrnak, S. L. (1997) · Behavior Therapy · doi:10.1016/s0005-7894(97)80038-x · Cited by 100 · cited 4× · see citing works
“, 2009), four utilized IVET (Lawm et al., 1994; Newman et al., 1994; Schoenberger et al., 1997; Trussell, 1978) and two directly compared VRET to IVET (Anderson et al.”
MethodInfluentialPrice, M., & Anderson, P. L. (2012) · Psychotherapy · doi:10.1037/a0024734 · Cited by 99 · cited 6× · see citing works
“In the two studies that compared VRET and IVET (Anderson et al., 2013; Price & Anderson, 2012) the same accompanying intervention was delivered in both conditions.”
BackgroundMethodInfluentialVirtual Reality Therapy: Emerging Topics and Future Challenges
Wiederhold, B. K., & Riva, G. (2019) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2018.29136.bkw · Cited by 78 · cited 1× · see citing works
“Virtual Reality (VR) is a technological intervention currently receiving considerable attention in healthcare research (Wiederhold & Riva, 2019).”
BackgroundCurrent status of knowledge on public-speaking anxiety
Pull, C. B. (2011) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e32834e06dc · Cited by 66 · cited 2× · see citing works
“Of note, is the recent drive to utilize technologically delivered exposure interventions (Pull, 2012).”
BackgroundPsychological Interventions for the Fear of Public Speaking: A Meta-Analysis
Ebrahimi, O. V., Pallesen, S., Kenter, R., & Nordgreen, T. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00488 · Cited by 62 · cited 4× · see citing works
“The majority of PSA interventions are based upon cognitive or behavioral principles (Ebrahimi et al., 2019) which is unsurprising given CBT is the National Institute for Health and Care Excellence (NICE) (2013) recommended intervention for SAD.”
BackgroundInfluentialUlinski, M., & O’Callaghan, S. (2002) · Journal of Education for Business · doi:10.1080/08832320209599070 · Cited by 55 · cited 1× · see citing works
“This can result in negative consequences for occupational and educational progression wherein public speaking is often a requisite (Raja, 2017) and is recognized as a desirable professional skill (Ulinski & O’Callaghan, 2002).”
BackgroundPélissolo, A., Zaoui, M., Aguayo, G., Yao, S. N., Roche, S., Écochard, R., Gueyffier, F., Pull, C., Berthoz, A., Jouvent, R., et al. (2012) · HAL · Cited by 38 · see citing works
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A Speaker's Guidebook: Text and Reference
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Use of graduated behavior rehearsal, feedback, and systematic desensitization for speech anxiety.
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“…et al., 2002; Heuett & Heuett, 2011; Lindner et al., 2019; North et al., 1998; Wallach et al., 2009), four utilized IVET (Lawm et al., 1994; Newman et al., 1994; Schoenberger et al., 1997; Trussell, 1978) and two directly compared VRET to IVET (Anderson et al., 2013; Price & Anderson, 2012).”
BackgroundVirtual Empathy : The added value of Virtual Reality in Psychotherapy
Nascivera, N., Alfano, Y. M., Annunziato, T., Messina, M., Iorio, V. S., Cioffi, V., Sperandeo, R., Rosato, M., Longobardi, T., & Maldonato, N. M. (2018) · IEEE International Conference on Cognitive Infocommunications · doi:10.1109/coginfocom.2018.8639906 · Cited by 24 · see citing works
Anxiety sensitivity and speech trait anxiety as predictors of state anxiety during public speaking
Mladenka, J. D., Sawyer, C. R., & Behnke, R. R. (1998) · Communication Quarterly · doi:10.1080/01463379809370112 · Cited by 16 · cited 1× · see citing works
“Numerous studies have demonstrated a significant positive correlation between trait and state public speaking anxiety (Mladenka et al., 1998; Pörhölä, 1997; Roberts et al., 2005).”
BackgroundTrait anxiety, experience, and the public speaking state responses of Finnish university students
Porhölä, M. (1997) · Communication Research Reports · doi:10.1080/08824099709388680 · Cited by 14 · cited 1× · see citing works
“Numerous studies have demonstrated a significant positive correlation between trait and state public speaking anxiety (Mladenka et al., 1998; Pörhölä, 1997; Roberts et al., 2005).”
BackgroundPublic speaking state anxiety as a function of trait anxiety and reactivity mechanisms
Roberts, J. B., Finn, A. N., Harris, K. B., Sawyer, C. R., & Behnke, R. R. (2005) · Southern Communication Journal · doi:10.1080/10417940509373321 · Cited by 12 · cited 1× · see citing works
“Numerous studies have demonstrated a significant positive correlation between trait and state public speaking anxiety (Mladenka et al., 1998; Pörhölä, 1997; Roberts et al., 2005).”
BackgroundA Meta–Analytic Review of Psychological Treatments for Social Anxiety Disorder
Powers, M. B., Sigmarsson, S. R., & Emmelkamp, P. M. G. (2008) · International Journal of Cognitive Therapy · doi:10.1680/ijct.2008.1.2.94 · Cited by 11 · see citing works
Graduated exposure plus feedback in the treatment of speech anxiety
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BackgroundMethodInfluentialUse of graduated behavior rehearsal, feedback, and systematic desensitization for speech anxiety.
Trussell, R. P. (1978) · Journal of Counseling Psychology · doi:10.1037//0022-0167.25.1.14 · Cited by 1 · see citing works
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Schröder, D., Wrona, K. J., Müller, F., Heinemann, S., Fischer, F., & Dockweiler, C. (2023) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2023.101893 · Cited by 85 · see citing works
Tan, Y. L., Chang, V. Y. X., Ang, W. H. D., Ang, W. W., & Lau, Y. (2024) · Anxiety Stress & Coping · doi:10.1080/10615806.2024.2392195 · Cited by 49 · see citing works
“However, some limitations inherent to in vivo delivery are observed, such as patient aversion, difficulty in arranging sessions, difficulty in imagining or visualization of situations, and impractical reconstruction of scenarios (Reeves, Curran, et al., 2022; Scheur-ich et al., 2019).”
Buragohain, 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
“Studies 47,123,124 have consistently shown that VR exposure therapy can reduce fear and anxiety to a similar extent as in-vivo exposure, and these effects are maintained over time.”
Future-Oriented Positive Mental Imagery Reduces Anxiety for Exposure to Public Speaking
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
Seuling, P. D., Czernin, N. S., & Schiele, M. A. (2024) · Neuroscience Applied · doi:10.1016/j.nsa.2024.104074 · Cited by 28 · see citing works
The Symbiosis of Virtual Reality Exposure Therapy and Telemental Health: A Review
Ong, T., Wilczewski, H., Soni, H., Nisbet, Q., Paige, S. R., Barrera, J. F., Welch, B. M., & Bunnell, B. E. (2022) · Frontiers in Virtual Reality · doi:10.3389/frvir.2022.848066 · Cited by 27 · see citing works
“, 2017), which shows promise for self-led VRET (Reeves et al., 2021).”
BackgroundRole of artificial intelligence in behavior management of pediatric dental patients—a mini review
Acharya, S., Godhi, B. S., Saxena, V., Assiry, A. A., Alessa, N. A., Dawasaz, A. A., Alqarni, A., & Karobari, M. I. (2024) · Journal of Clinical Pediatric Dentistry · doi:10.22514/jocpd.2024.055 · Cited by 29 · see citing works
“AR superimposes digital information onto the physical world, whereas VR generates immersive, simulated environments [ 15].”
BackgroundKahlon, S., Lindner, P., & Nordgreen, T. (2023) · Frontiers in Virtual Reality · doi:10.3389/frvir.2023.1240778 · Cited by 34 · see citing works
Kuleli, D., Tyson, P. J., Davies, N., & Zeng, B. (2025) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2025.100524 · Cited by 20 · see citing works
Effectiveness of telemedicine on common mental disorders: An umbrella review and meta-meta-analysis
Chen, J., Li, C., An, K., Dong, X., Liu, J., & Wu, H. Y. (2024) · Computers in Human Behavior · doi:10.1016/j.chb.2024.108325 · Cited by 16 · see citing works
Scheveneels, S., De Witte, N., & Van Daele, T. (2023) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2023.102695 · Cited by 15 · see citing works
Lévy, A., Nittas, V., & Wray, T. B. (2023) · JMIR Formative Research · doi:10.2196/47443 · Cited by 18 · see citing works
“In psychotherapy, exposure techniques are typically delivered in vivo, meaning that, counselors create tangible experiences surrounding the feared stimuli that patients physically confront in person [10,11].”
BackgroundGualano, R. J., & Campbell, S. W. (2024) · Communication Education · doi:10.1080/03634523.2024.2312873 · Cited by 13 · see citing works
Recent Advances in Psychotherapy with Virtual Reality
Ka-Yee Essoe, J., Patrick, A. K., Reynolds, K., Schmidt, A., Ramsey, K. A., & McGuire, J. F. (2022) · Advances in Psychiatry and Behavioral Health · doi:10.1016/j.ypsc.2022.04.001 · Cited by 10 · see citing works
Brain-Metaverse Interaction for Anxiety Regulation
Jin, N., Wu, Y., Park, J., Qin, Z., & Liang, H. (2023) · International Conference on Virtual Reality · doi:10.1109/icvr57957.2023.10169785 · Cited by 10 · see citing works
“Recent research has shown that Virtual reality (VR) can be a low-cost and time-efficient alternative to physical stimuli [12] [13] [14].”
BackgroundEmbodied strategies for public speaking anxiety: evaluation of the Corp-Oral program
Monge, A. J. G., Guijarro-Romero, S., Santamaría-Vázquez, E., Álvarez, L. M., & Calle, N. J. B. (2023) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2023.1268798 · Cited by 9 · see citing works
Banakou, D., Johnston, T., Beacco, A., Şenel, G., & Slater, M. (2024) · JMIR Formative Research · doi:10.2196/52212 · Cited by 12 · see citing works
“A further recent meta-analysis was reported by Reeves et al [21] with higher effect sizes, although breakdowns across individual studies and measures were not presented.”
BackgroundMethodResultNovel therapeutic and educational approaches: using technology to improve sexuality
Vila, A., Cuadros, J. A., Romero‐Moreno, R., & Nogales‐González, C. (2023) · IntechOpen eBooks · doi:10.5772/intechopen.1001854 · Cited by 7 · see citing works
Macdonald, C. (2024) · Frontiers Virtual Real. · doi:10.3389/frvir.2024.1506938 · Cited by 7 · see citing works
Laine, T. H., Lee, W., Moon, J., & Kim, E. (2025) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2025.103487 · Cited by 8 · see citing works
Improvement of Public Speaking Skills Using Virtual Reality: Development of a Training System
Saufnay, S., Etienne, E., & Schyns, M. (2024) · International Conference on Affective Computing and Intelligent Interaction Workshops and Demos (ACIIW) · doi:10.1109/aciiw63320.2024.00025 · Cited by 5 · see citing works
“By immersing the user in an environment displaying a responsive virtual audience, VR provides speakers with the opportunity to practice their speech in lifelike conditions [1] [5], which consequently fosters skills improvement and stress reduction [8] [10].”
Kahlon, S., Gjestad, R., Lindner, P., & Nordgreen, T. (2023) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2023.2281243 · Cited by 6 · see citing works
“Several meta-analyses have documented the clinical efficacy of internet-delivered interventions (Esfandiari et al., 2021) and VRET (Lim et al., 2022; Reeves et al., 2021) targeting PSA among adults.”
BackgroundChan, V. W. M. (2025) · SN Computer Science · doi:10.1007/s42979-025-04320-7 · Cited by 4 · see citing works
Allen, S., Batista, B. F., Zhang, L., & Haynal, K. (2024) · Communication education · doi:10.1080/03634523.2024.2430778 · Cited by 6 · see citing works
“VR has been associated with addressing anxiety from speaking in public through VR exposure therapy (Kahlon et al., 2019; Mechling, 2019; Premakumar et al., 2021; Reeves et al., 2022; Takac et al., 2019) and through the opportunity for imagined interactions (Honeycutt, 2008; LeFebvre et al., 2021).”
Effectiveness of XR‐Based Exposure Therapy for Phobic Disorders
Lamb, R. L., Perry, J., Sutherland, E. C., Hoston, D., Garris, A., & DeRiggs, A. (2025) · Journal of Counseling & Development · doi:10.1002/jcad.12557 · Cited by 4 · see citing works
Parcha, J. M. (2023) · Communication Teacher · doi:10.1080/17404622.2023.2254363 · Cited by 4 · see citing works
Gomes, P. V., Sá, V. J., Donga, J., Marques, A., Gomes, B., de Almeida, R. S., & Pereira, J. (2023) · XoveTIC Conference (XoveTIC) · doi:10.17979/spudc.000024.42 · Cited by 4 · see citing works
Identifying demographic and personality correlates of public speaking anxiety among adult workers
Dewaele, J., & Furnham, A. F. (2026) · Acta Psychologica · doi:10.1016/j.actpsy.2026.106247 · Cited by 3 · see citing works
Bettahi, L., Remacle, A., Schyns, M., Etienne, E., Etienne, A.-M., & Leclercq, A. (2026) · Frontiers in Virtual Reality · doi:10.3389/frvir.2026.1755571 · Cited by 3 · see citing works
Artificial intelligence (AI) for virtual reality exposure therapy (VRET): A systematic review
Bergsnev, K., & Laws, A. L. S. (2026) · Translational Psychiatry · doi:10.1038/s41398-026-03936-4 · Cited by 3 · see citing works
Lewis-Fung, S. E., Tchao, D., Gray, H. G., Nguyen, E., Pardini, S., Harris, L. R., Calabia, D., & Appel, L. (2023) · Frontiers in Virtual Reality · doi:10.3389/frvir.2023.1209535 · Cited by 3 · see citing works
Derks, L. M., Becker, E. S., Rinck, M., Holtmann, M., Legenbauer, T., & Lange, W. (2024) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-024-00831-y · Cited by 3 · see citing works
“VR-paradigms are thought to have high ecological validity and studies show comparability between virtual-and real-world IPD-behaviours (e.g., [47]) not only in assessments but also with regard to therapeutic interventions (e.g., [48]).”
Review and Analysis of Successful PSA Interventions: An Applied Perspective
McWilliam, A. M., Beattie, S., & Callow, N. (2025) · The Journal of psychology · doi:10.1080/00223980.2025.2459662 · Cited by 5 · see citing works
“Finally, Reeves et al. (2022) conducted a meta-analysis to investigate the efficacy of VRET and in vivo exposure therapies for PSA.”
InfluentialA Systematic Literature Review:Virtual Reality's in Decreasing Public Speaking Anxiety (PSA)
SalsabilaHadi, S. A., Putri, M. S., Ismiarti, F., Gunawan, A. A. S., & Pramudya, F. S. (2023) · International Conference on Information Technology and Computing (ICITCOM) · doi:10.1109/icitcom60176.2023.10442335 · Cited by 3 · see citing works
“…the same purpose, although with less physical interaction, with the conventional in vivo exposure therapy as psychological interventions for public speaking anxiety reduction effort [31] RQ3: What is the difference between the public speaking anxiety percentage levels before and after treatment?”
BackgroundJeon, M., Kim, M., Lee, Y., Lee, S., Kim, H., & Jung, D. (2025) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/3706599.3720233 · Cited by 3 · see citing works
“Existing studies have primarily focused on evaluating the clinical efficacy of VRET and its applicability from a patient-centered perspective [18, 32] However, these studies have not sufficiently addressed the perspectives of therapists, who are the key agents in the actual adoption of this…”
Changes in feared outcome expectancy and relief during exposure for public speaking anxiety
Barnes‐Horowitz, N. M., Zbozinek, T. D., & Craske, M. G. (2025) · Behaviour Research and Therapy · doi:10.1016/j.brat.2025.104817 · Cited by 3 · see citing works
Virtual Reality as a Tool in Gender-Affirming Voice Training: A Pilot Study
Leyns, C., Bosschem, L., Papeleu, T., Sabbe, L., Walkom, G., & D’haeseleer, E. (2025) · Journal of Voice · doi:10.1016/j.jvoice.2025.06.034 · Cited by 2 · see citing works
Aslan, A., & Kayhan, S. (2025) · Ana Dili Eğitimi Dergisi · doi:10.16916/aded.1721429 · Cited by 2 · see citing works
Wang, Y., & Wang, L. (2024) · SID Symposium Digest of Technical Papers · doi:10.1002/sdtp.17197 · 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
Montesinos, F., Calderón-Pozo, C., Flujas-Contreras, J. M., Diéguez, S., & Lobato, D. (2025) · Current Psychology · doi:10.1007/s12144-025-08341-6 · Cited by 3 · see citing works
Advancing virtual reality interventions for sexuality and related emotions: a systematic review
Vila, A., Sansoni, M., & Riva, G. (2025) · Virtual Reality · doi:10.1007/s10055-025-01112-5 · Cited by 1 · see citing works
“These studies, among others, reveal how this technology provides therapeutic advantages such as higher stimulative control, confidentiality (Reeves et al. 2022; Botella et al.2006; Massetti et al. 2018), and the possibility to face stimuli otherwise difficult to experience in real life (Sansoni et…”
Espinoza, S. A. N., Salazar, C., Valdés, G. A. N., Silva, M. F. N., Varas, F. I., Ayala, G. N., Munro, G., Laborda, M. A., Míguez, G., & Quezada-Scholz, V. E. (2025) · Behavioral Psychology/Psicología Conductual · doi:10.31083/bp49436 · Cited by 1 · see citing works
LLM-based Embodied Conversational Agent for Reducing Foreign Language Speaking Anxiety in Social VR
Pan, M., Liu, P., Zhang, J., Cao, R., Ariyawansa, V., Li, Y., Yao, B., Wang, D., Pasquier, P., Kitson, A., et al. (2026) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3772318.3791068 · Cited by 1 · see citing works
USING VIRTUAL REALITY SIMULATION TO REDUCE STAGE FRIGHT DURING PUBLIC APPEARANCES
Coviello, R. S. A. R. (2022) · doi:10.33965/el2022_202203l006 · Cited by 1 · see citing works
Landkroon, E. (2021) · doi:10.33540/651
فعالية العلاج بالتعريض في تخفيف اضطراب قلق الكلام لدى طلاب الجامعة
الطنطاوي, ح. ش. م. (2023) · مجلة کلية التربية · doi:10.21608/jfe.2023.311807
VR as a Tool for Enhancing Public Speaking Skills
Ciupe, A., Maraciuc, C., & Orza, B. (2024) · Lecture notes in networks and systems · doi:10.1007/978-3-031-54327-2_5
Social Anxiety Disorder, Public Speaking Anxiety and Virtual Reality Exposure Therapy
Konstantinou, T., & Panayiotou, G. (2024) · Springer eBooks · doi:10.1007/978-3-031-56798-8_6
Strategy for increasing Public Speaking skills through the News Anchor method
Sari, E. A., & Salsabela, K. (2024) · COMMICAST · doi:10.12928/commicast.v5i1.10100
“There should be many scientific studies discussing public speaking methods from multiple points of view, starting from the audience's point of view, context point of view, verbal and nonverbal communication point of view, psychological point of view, and cultural point of view (Reeves, 2022).”
BackgroundAlgorithm of Behaviour of Virtual Avatars During Public Speaking Training in a VR Environment
Jędrasiak, K., Wolański, R. R., & Bereska, D. (2024) · Bezpieczeństwo i Technika Pożarnicza · doi:10.12845/sft.64.2.2024.3
“Shifting focus to the academic sector, numerous studies and projects have investigated the use of virtual avatars in public speaking training [13].”
The Power of Self-Talk for Speaking Anxiety Reduction Among EFL Learners
Alnaeem, L. A. (2025) · Theory and Practice in Language Studies · doi:10.17507/tpls.1501.12
Treating Anxiety Disorders with Virtual Reality
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Research on the Knowledge Map and Application Prospect of Virtual Environment in Teaching
Zhong, X. (2025) · International Conference on Education and Training Technologies (ICETT) · doi:10.1109/icett66247.2025.11136872
“Many educational researchers and technical experts have explored the application of virtual environment in teaching from the interdisciplinary perspectives of pedagogy[3], computer science[4], psychology[5] and so on.”
Gegieckaitė, G., Zamalijeva, O., Petraškaitė, K., Nagevice, E., Lindner, P., Carlbring, P., Daele, T. V., Andersson, G., & Eimontas, J. (2025) · doi:10.2196/preprints.89612
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Emotional responses to a public speaking task: effects of virtual audience size and attitude
Fasya, E. L., van den Bos, E., Heylen, D. K. J., & Kret, M. (2026) · Behaviour & Information Technology · doi:10.1080/0144929x.2026.2633772
“Virtual reality exposure therapy is an emerging intervention that effectively reduces public speaking anxiety (Ebrahimi et al. 2019; Reeves et al. 2022).”
Colella, G. M., Silvestro, E., Cosentino, V., Capparelli, V., Gravina, A., Barbieri, L., Costabile, A., Bruno, F., & Craig, F. (2026) · BMC Psychology · doi:10.1186/s40359-026-04418-4
“Recent epidemiological studies have shown that university students often report high levels of stress, generalized anxiety [2], and social anxiety [3].”
Mohr, S. V., Kirchner, A., & Teichmann, M. R. (2026) · SSRN Electronic Journal · doi:10.2139/ssrn.6531528
Hauge, P. R., Gjestad, R., Lindner, P., Nordgreen, T., & Kahlon, S. (2026) · Frontiers in Virtual Reality · doi:10.3389/frvir.2026.1792043
Kim, M., Jeon, M., Lee, Y., Lee, Y., 유소은, Lee, S., Kim, H., Cho, C., Cho, C.-Y., Hur, J., et al. (2026) · Trials · doi:10.1186/s13063-026-09779-0
Introduction to virtual reality technology
Brizzi, G., Pupillo, C., & Riva, G. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-36741-0.00009-7
Amin, S. M., & Jamilah (2026) · Language, Technology, and Social Media. · doi:10.70211/ltsm.3026-7196.481
“Studies on technology-supported exposure and presentation practice also show that repeated exposure, simulation, and controlled practice environments can reduce anxiety and improve public performance readiness [38], [39], [40].”
Gegieckaitė, G., Zamalijeva, O., Petraškaitė, K., Nagevice, E., Lindner, P., Carlbring, P., Daele, T. V., Andersson, G., & Eimontas, J. (2025) · JMIR Research Protocols · doi:10.2196/89612 · Cited by 1 · see citing works
“The use of VR is becoming more prevalent in research, as well as in clinical practice [16].”
InfluentialSocial anxiety and preferred interpersonal distance: The role of estimation bias
Bucur, S., Prasad, D., & Lange, W. (2026) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2026.07.007
Pedagogy of Practice: Toward Better Understanding of the Development of Leadership Skills
Detert, J. R., & McKee, S. E. (2026) · Academy of Management Learning and Education · doi:10.5465/amle.2025.0286
Roccaforte, G., Meduri, A., Failla, C., Franco, D., Vitolo, M., Maiorana, M. V., Musotto, R., Rabarbari, E., Natale, A. F. D., Antichi, L., et al. (2026) · Lecture notes in computer science · doi:10.1007/978-3-032-33500-5_32
- Authors
- Reeves, R., Curran, D., Gleeson, A., & Hanna, D.
- Affiliations
- Queen's University Belfast (GB)
- Corresponding author
- Hanna, Donncha
- Venue
- Behavior Modification
- Publisher
- SAGE Publications
- Published
- 2021-02-03
- Volume
- 46
- Issue
- 4
- Pages
- 937-965
- ISSN
- 0145-4455 (ISSN-L)
- 1552-4167
- PMC
- PMC9158252
- OpenAlex
- W3128823880
- Cited by
- 69
- References
- 82
- Citations by year
- 2026: 16 · 2025: 19 · 2024: 15 · 2023: 12 · 2022: 4 · 2021: 3
- FWCI
- 1.39
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Behavior Modification (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Portal (Queen's University Belfast) (submittedVersion, cc-by-nc)
- 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 › Social Psychology › Communication in Education and Healthcare
- Keywords
- public speaking anxiety, virtual reality exposure therapy, in vivo exposure therapy, psychological intervention, speaking anxiety, treatment comparison
- MeSH terms
- Virtual Reality, Psychosocial Intervention, Anxiety, Humans, Implosive Therapy, Speech, Virtual Reality Exposure Therapy
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