Virtual Reality Cognitive Behavior Therapy for Public Speaking Anxiety

Abstract

Public speaking anxiety (PSA) is a common phobia. Although cognitive behavior therapy (CBT) is preferred, difficulties arise with the exposure component (lack of therapist control, patient's inability to imagine, self-flooding, loss of confidentiality resulting from public exposure). Virtual reality CBT (VRCBT) enables a high degree of therapist control, thus overcoming these difficulties. This study examined whether VRCBT is an alternative to CBT. Participants with PSA were randomly assigned to VRCBT (28 participants), CBT (30 participants), and wait list control (WLC; 30 participants). VRCBT and CBT were significantly more effective than WLC in anxiety reduction on four of five anxiety measures, and on subject's self-rating of anxiety during a behavioral task. No significant differences were found on observer ratings of the behavioral task. However, twice as many participants dropped out from CBT than from VRCBT. Our results demonstrated that VRCBT is an effective and brief treatment regimen, equal to CBT.

Virtual reality exposure using three-dimensional images for the treatment of social phobia

“…Wallack et al also found a low dropout rate in the group receiving a virtual reality intervention as compared to patients receiving CBT alone. 10 The therapeutic outcomes obtained persisted throughout the 6-month study period. This is consistent with other studies, which have shown a persistence of therapeutic effects for as long as 1 year.…”

“…[8][9][10][11][12][13]22 However, many of these studies [8][9][10]12,13,22 employed virtual reality systems with immersive headsets, while the virtual reality system used in this study is easier for clinicians to obtain and use in their offices. One study used computer-generated 3D scenes, but the sample was composed only by individuals with public-speaking anxiety, 11 which limits the generalizability of its results.…”

“…20,21 VRE has advantages over imagined or in vivo exposures. [9][10][11]13,22 It can provide standardized and controlled environments, and scenes can be repeated to achieve therapeutic goals. 23,24 Moreover, exposure to virtual environments bridges the gap between an imagined situation and a real one; it allows the patient to be exposed to anxiety-generating stimuli as if he or she were in a real situation.…”

“…27 VRE also has the advantages of costing less than in vivo exposure, because it shortens the treatment time, and being associated with fewer dropouts than live exposure. 10,28 Numerous studies have tried to create and evaluate the use of virtual environments that reproduce anxietygenerating situations. [8][9][10][11][12][13] However, few controlled studies have demonstrated efficacy in the treatment of social phobias.…”

“…[8][9][10][11][12][13] However, few controlled studies have demonstrated efficacy in the treatment of social phobias. All relevant studies have shown improvements, but with limitations such as the use of participants with circumscribed social phobia 8,[10][11][12][13] ; the use of more complex VRE systems, such as virtual reality headsets [9][10][11][12][13] ; the use of patients on a waiting list for therapy as a control group 11 ; and collection of limited measurements of the phobic experience. 8,10,12 DSM-5 did not modify the diagnostic criteria for social phobia.…”