Alteration of resting-state functional connectivity network properties in patients with social anxiety disorder after virtual reality-based self-training

Abstract

Social anxiety disorder (SAD) is a mental disorder characterized by excessive anxiety in social situations. This study aimed to examine the alteration of resting-state functional connectivity in SAD patients related to the virtual reality-based self-training (VRS) which enables exposure to social situations in a controlled environment. Fifty-two SAD patients were randomly assigned to the experimental group who received the VRS, or the control group who did not. Self-report questionnaires and resting-state functional magnetic resonance imaging (fMRI) were performed to assess clinical symptoms and analyze the resting-state network properties, respectively. Significant decrease in social anxiety and an increase in self-esteem was found in the experimental group. From the resting-state fMRI analysis, alteration of local network properties in the left dorsolateral prefrontal gyrus (-10.0%, p = 0.025), left inferior frontal gyrus (-32.3%, p = 0.044), left insula (-17.2%, p = 0.046), left Heschl's gyrus (-21.2%, p = 0.011), bilateral inferior temporal gyrus (right: +122.6%, p = 0.045; left:−46.7%, p = 0.015), and right calcarine sulcus (+17.0%, p = 0.010) were found in the experimental group. Average shortest path length (+8.3%, p = 0.008) and network efficiency (-7.6%, p = 0.011) are found to be altered from the global network property analysis. In addition, the experimental group displayed more positive and more negative changes in the correlation trend of average shortest path length (p = 0.004) and global network efficiency (p = 0.014) with the severity of social anxiety, respectively. These results suggest potential effectiveness of the VRS, which is possibly related to the change of aberrant processing and control of visual and auditory linguistic stimuli and the adaptive change in rumination pattern.

A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression

“…In terms of VR displays, eleven studies implemented the use of HMD (7-13, 21, 41, 42, 44). The results indicate that the most commonly utilized VR headsets are Samsung Gear VR (7,8,10) and Oculus Rift (9, 11, 21). Other VR display platforms employed include the Pico VR headset (12), HTC Vive Pro (13,41), and nVisor SX (44).…”

“…The study also examined whether the VR interventions were performed individually or in a group setting. The results showed that 11 studies utilised an individual setting (7-13, 21, 24, 32, 42, 44), while four used a group setting (7,8,20,41,43).…”

“…In seven studies, the control group received treatment as usual, such as CBT or PCT (9,11,20,24,42,44). Seven studies had a waitlist or no intervention or a control group (7,8,10,12,32,41,44), and one study offered health controls to the control group (21).…”

“…Three studies had less than 4 sessions (11,21,43). The duration per session was reported in 13 studies, with 3 studies offering 10 min or less (9, 10, 32), 4 studies between 15 and 30 min (7,8,12,41,43), 4 studies between 45 and 60 min ( (11,20,24,44)), and 2 studies did 90 min or more per session (21, 42).…”

“…Some ongoing or planned studies explore the potential of administering mental health treatment remotely through VR (22,23). However, a notable gap in current research pertains to the inconclusive evidence of its efficacy, given that certain studies have involved researchers directly during interventions or not yet finished (7,8,22). By exploring the multifaceted nature of VR and integrating gamification, this review establishes the foundation for comprehending how VR, with its diverse modalities, can be leveraged to optimize remote work settings.…”