The Effects of Virtual Reality Treatment on Prefrontal Cortex Activity in Patients With Social Anxiety Disorder: Participatory and Interactive Virtual Reality Treatment Study

Abstract

Background Attempts to use virtual reality (VR) as a treatment for various psychiatric disorders have been made recently, and many researchers have identified the effects of VR in psychiatric disorders. Studies have reported that VR therapy is effective in social anxiety disorder (SAD). However, there is no prior study on the neural correlates of VR therapy in patients with SAD. Objective The aim of this study is to find the neural correlates of VR therapy by evaluating the treatment effectiveness of VR in patients with SAD using portable functional near-infrared spectroscopy (fNIRS). Methods Patients with SAD (n=28) were provided with 6 sessions of VR treatment that was developed for exposure to social situations with a recording system of each participant’s self-introduction in VR. After each VR treatment session, the first-person view (video 1) and third-person view (video 2) clips of the participant’s self-introduction were automatically generated. The functional activities of prefrontal regions were measured by fNIRS while watching videos 1 and 2 with a cognitive task, before and after whole VR treatment sessions, and after the first session of VR treatment. We compared the data of fNIRS between patients with SAD and healthy controls (HCs; n=27). Results We found that reduction in activities of the right frontopolar prefrontal cortex (FPPFC) in HCs was greater than in the SAD group at baseline (t=–2.01, P=.049). Comparing the frontal cortex activation before and after VR treatment sessions in the SAD group showed significant differences in activities of the FPPFC (right: t=–2.93, P<.001; left: t=–2.25, P=.03) and the orbitofrontal cortex (OFC) (right: t=–2.10, P=.045; left: t=–2.21, P=.04) while watching video 2. Conclusions Activities of the FPPFC and OFC were associated with symptom reduction after VR treatment for SAD. Our study findings might provide a clue to understanding the mechanisms underlying VR treatment for SAD. Trial Registration Clinical Research Information Service (CRIS) KCT0003854; https://tinyurl.com/559jp2kp

Virtual reality in the diagnostic and therapy for mental disorders: A systematic review

“…Further findings were that outcome expectancy (Price & Anderson, 2012), mindfulness (Burton, Schmertz, Price, Masuda, & Anderson, 2013), and social costs, self-focused attention and self-efficacy (Kampmann, Emmelkamp, & Morina, 2019) influence the effect of exposure therapy regardless of the type of exposure and that the working alliance between therapist and patient similarly increases during treatment in both VRET and exposure group therapy (Ngai, Tully, & Anderson, 2015). Moreover, regarding neural correlates, changes in brain activity in the prefrontal and orbitofrontal cortex (Lee, Choi, Jung, Hur, & Cho, 2021), as well as changes in activation in various brain areas in a selfreferential stimuli processing task (Hur et al, 2021) were found after six sessions of VRET with additional CBT elements. Additionally, fewer dropouts from individualized VRET compared to exposure group therapy were found in an RCT by Johnson, Price, Mehta, and Anderson (2014).…”

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“…There is a dearth of research pertaining to comparative studies on self-reported scores and neural correlates during VRET in treating SAD. A recent VRET study showed that self-rating scores were consistent with neural correlates in SAD ( Lee et al, 2021 ).…”

“…Several studies reveal that the difference between the brain activity of the prefrontal cortex of SAD and control groups at baseline is statistically significant ( Pittig et al, 2018 ; Lee et al, 2021 ; Kredlow et al, 2022 ). There is a dearth of research pertaining to comparative studies on self-reported scores and neural correlates during VRET in treating SAD.…”

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