Look at the audience? A randomized controlled study of shifting attention from self-focus to nonsocial vs. Social external stimuli during virtual reality exposure to public speaking in social anxiety
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Background: Enhanced self-focused attention plays a central role in the maintenance and treatment of Social Anxiety and is targeted in contemporary cognitive behavioral therapy. Actual developments use Virtual Reality (VR) for behavioral training. However, no VR attention training combining exposure to public speaking with shifting attention from self-focus to external focus has been investigated, and no experimental evidence exists on different kinds of external cues as targets of attention. Therefore, we investigated the effects of an attention training during public speaking in VR and examined differential effects of an external focus on nonsocial vs. social stimuli. Methods: In this randomized controlled study, highly socially anxious participants were instructed to focus on either objects or the audience within a virtual speech task. We assessed the pre-post effects on affective reactions, self-perception, and attentional processes during public speaking as well as general Social Anxiety using subjective, physiological, and eye-tracking measures. Repeated-measures analyses of variance (ANOVAs) were calculated to detect changes from pretest to posttest over both groups, and time × group interaction effects. Results: Within the analysis sample ( n = 41), anxiety during public speaking and fear of negative evaluation significantly decreased, with no significant differences between groups. No significant time effect, but a significant time × group effect, was found for the looking time proportion on the audience members' heads. Follow-up tests confirmed a significant increase in the social-focus group and a significant decrease in the nonsocial-focus group. For all other variables, except external focus and fear of public speaking, significant improvements were found over both groups. Further significant time x group effects were found for positive affect during public speaking, with a significant increase in the social focus, and no significant change in the nonsocial-focus group. Conclusion: Our findings suggest that attention training to reduce self-focus can be successfully conducted in VR. Both training versions showed positive short-term effects in the highly socially anxious, with particular advantages of an external social focus concerning eye contact to the audience and positive affect. Further research should investigate whether social focus is even more advantageous long term and if reinterpretations of dysfunctional beliefs could be achieved by not avoiding social cues.
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VRET has been shown to alleviate symptoms of social anxiety in subclinical, but socially anxious probands.
“Besides studies in clinical SAD, VRET has also been shown to alleviate symptoms of social anxiety in subclinical, but socially anxious probands (Morina et al., 2015; Wechsler et al., 2021)”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Wechsler et al., 2021
Heart rate and skin conductance decrease over the course of exposure in high socially anxious participants.
“These measures have furthermore been shown to decrease over the course of the exposure in high socially anxious participants (Wechsler et al., 2021).”
From Virtual Reality exposure therapy in the treatment of public speaking anxiety and social anxiety disorder (2024) · cites this paper as Wechsler et al., 2021
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Kang, H., Rui, Y., Song, R., Yang, C., & Wang, W. (2024) · Sensors · doi:10.3390/s24165363 · Cited by 1 · see citing works
Schmidt-Peter, T., Wechsler, T. F., Kroczek, L. O. H., & Mühlberger, A. (2025) · Frontiers in Virtual Reality · doi:10.3389/frvir.2025.1556898 · Cited by 1 · see citing works
Self-citationEinsatz von Immersion und Virtueller Realität in der Psychotherapie
Wechsler, T. F., & Mühlberger, A. (2024) · DNP – Die Neurologie & Psychiatrie · doi:10.1007/s15202-024-6239-2
Self-citationEmotional 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
Self-Focused and External Attention in Speech Anxiety
Chen, H., Guntermann, M., Qian, M., & Gerlach, A. L. (2026) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443/a000849
Validity of Eye-Tracking Measures in Immersive Virtual Reality: Using Cognitive Theories of Learning
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Designing and evaluating LLM-driven coaching agents for VR public speaking practice
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Dogioiu, D.-I., Morar, A., Moldoveanu, A. D. B., Anghel, A. M., & Berceanu, A. I. (2026) · Information · doi:10.3390/info17080741
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- Authors
- Wechsler, T. F., Pfaller, M., Eickels, R. E. V., Schulz, L. H., & Mühlberger, A.
- Affiliations
- University of Regensburg (DE)
- Corresponding author
- Wechsler, Theresa F.
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2021-12-14
- Volume
- 12
- Pages
- 751272-751272
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC8712494
- OpenAlex
- W4200401307
- Cited by
- 21
- References
- 91
- Citations by year
- 2026: 7 · 2025: 2 · 2024: 7 · 2023: 3 · 2022: 2
- FWCI
- 2.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Regensburg Publication Server (University of Regensburg) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- University of Regensburg Publication Server (University of Regensburg)
- 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 › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- social anxiety, self-focus, external attention, attention training, virtual reality exposure, public speaking, eye contact, audience gaze, fear of negative evaluation, positive affect, cognitive behavioral therapy, eye tracking
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