BackgroundPeople with social anxiety disorder (SAD) fear social interactions and may be reluctant to seek treatments involving exposure to social situations. Social exposure conducted in virtual reality (VR), embedded in individual cognitive–behavioural therapy (CBT), could be an answer.AimsTo show that conducting VR exposure in CBT for SAD is effective and is more practical for therapists than conducting exposurein vivo.MethodParticipants were randomly assigned to either VR exposure (n= 17),in vivoexposure (n= 22) or waiting list (n= 20). Participants in the active arms received individual CBT for 14 weekly sessions and outcome was assessed with questionnaires and a behaviour avoidance test. (Trial registration number ISRCTN99747069.)ResultsImprovements were found on the primary (Liebowitz Social Anxiety Scale) and all five secondary outcome measures in both CBT groups compared with the waiting list. Conducting exposure in VR was more effective at post-treatment thanin vivoon the primary outcome measure and on one secondary measure. Improvements were maintained at the 6-month follow-up. VR was significantly more practical for therapists thanin vivoexposure.ConclusionsUsing VR can be advantageous over standard CBT as a potential solution for treatment avoidance and as an efficient, cost-effective and practical medium of exposure.

Background: In the context of the COVID-19 pandemic, legislations are being modified around the world to allow patients to receive mental health services through telehealth. Unfortunately, there are no large clinical trial available to reliably document the efficacy of delivering videoconferencing psychotherapy (VCP) for people with panic disorder and agoraphobia (PDA) and whether basic psychotherapeutic processes are altered. Methods: This 2-arm intent-to-treat non-inferiority study reports on a clinical trial on VCP and documents how therapeutic working alliance and motivation toward psychotherapy are associated to treatment outcome. We hypothesized that VCP would not be inferior to standard face-to-face (FF) cognitive behavior therapy for PDA. No specific hypothesis was stated to address working alliance and treatment mechanisms. VCP was compared to a gold-standard psychotherapy treatment for PDA, which was delivered either in person or in videoconference, with a strict tolerance criterion of about 2 points on the primary outcome measure. Seventy one adult patients were recruited. Measures of working alliance were collected after the first, fifth, and last session. Motivation toward therapy at pre-treatment and working alliance after the fifth therapy session were used as predictors of treatment outcome and compared with change in dysfunctional beliefs toward bodily sensations. Results: Panic disorder, agoraphobia, fear of sensations and depressed mood all showed significant improvements and large effect-sizes from pre to post-treatment. Gains were maintained at follow-up. No significant differences were found between VCP and FF, and effect sizes were trivial for three of the four outcome measures. Noninferiority tests confirmed that VCP was no less effective than FF therapy on the primary outcome measure and two of the three secondary outcome measures. Working alliance was very strong in VCP and did not statistically differ from FF. Working alliance and motivation did not predict treatment outcome, which was significantly predicted by the

The cognitive behavioral treatment of generalized anxiety disorder (GAD) often involves exposing patients to a catastrophic scenario depicting their most feared worry. The aim of this study was to examine whether a standardized scenario recreated in virtual reality (VR) would elicit anxiety and negative affect and how it compared to the traditional method of imagining a personalized catastrophic scenario. A sample of 28 participants were first exposed to a neutral non-catastrophic scenario and then to a personalized scenario in imagination or a standardized virtual scenario presented in a counterbalanced order. The participants completed questionnaires before and after each immersion. The results suggest that the standardized virtual scenario induced significant anxiety. No difference was found when comparing exposure to the standardized scenario in VR and exposure to the personalized scenario in imagination. These findings were specific to anxiety and not to the broader measure of negative affect. Individual differences in susceptibility to feel present in VR was a significant predictor of increase in anxiety and negative affect. Future research could use these scenarios to conduct a randomized control trial to test the efficacy and cost/benefits of using VR in the treatment of GAD.

This study is about pain expressed by virtual humans and empathy in users immersed in virtual reality. It focuses on whether people feel more empathy toward the pain of a virtual human when the virtual human is a realistic representation of a known individual, as opposed to an unknown person, and if social presence is related to users' empathy toward a virtual human's pain. The 42 participants were immersed in virtual reality using a large immersive cube with images retro projected on all six faces (CAVE-Like system) where they can interact in real time with virtual characters. The first immersion (baseline/control) was with a virtual animal, followed by immersions involving discussions with a known virtual human (i.e., the avatar of a person they were familiar with) or an unknown virtual human. During the verbal exchanges in virtual reality, the virtual humans expressed acute and very strong pain. The pain reactions were identical in terms of facial expressions, and verbal and nonverbal behaviors. The Conditions by Time interactions in the repeated measures analyses of variance revealed that participants were empathic toward both virtual humans, yet more empathic toward the known virtual human. Multivariate regression analyses revealed that participants' feeling of social presence--impression that the known virtual character is really there, with them--was a significant predictor of empathy.