Pilot randomized trial of self-guided virtual reality exposure therapy for social anxiety disorder

Background Virtual reality exposure therapy (VRE) has shown promising efficacy for the treatment of social anxiety disorder (SAD) and related comorbidities. However, most trials conducted to date were therapist-led, and little is known about the efficacy of self-guided VRE. Therefore, this randomized controlled trial (RCT) aimed to determine the efficacy of a self-directed VRE for SAD.

Method Forty-four community-dwelling or undergraduate adults diagnosed with SAD based on the Mini International Neuropsychiatric Interview were randomly assigned to VRE designed to last four sessions or more (n = 26) or waitlist (WL; n = 18). Self-reported SAD severity (Social Phobia Diagnostic Questionnaire and Social Interaction Anxiety Scale), job interview anxiety (Measure of Anxiety in Selection Interviews), trait worry (Penn State Worry Questionnaire), and depression symptoms (Patient Health Questionnaire-9) were administered at baseline, post-treatment, 3-month-follow-up (3MFU), and 6-month-follow-up (6MFU). Piecewise multilevel modeling analyses were conducted to manage clustering in the data.

Results VRE vs. WL resulted in greater reductions in SAD symptom severity, job interview fear, and trait worry, with moderate-to-large effect sizes (Hedge's g = −0.54 to −1.11) from pre-to-post treatment. Although significant between-group differences did not emerge for change in depression, VRE led to change in depression, whereas waitlist did not. These gains were also maintained at 3MFU and 6MFU. Further, facets of presence increased during the course of VRE (g = 0.36–0.45), whereas cybersickness decreased (g = −0.43).

Discussion Brief, self-guided VRE might ameliorate SAD and comorbid worry, for young-to-middle-aged adults with SAD. Other theoretical and practical implications were also discussed.

© This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/

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Work Title Pilot randomized trial of self-guided virtual reality exposure therapy for social anxiety disorder
Access
Open Access
Creators
  1. Nur Hani Zainal
  2. William W. Chan
  3. Alisha P. Saxena
  4. Craig Barr Taylor
  5. Michelle G. Newman
Keyword
  1. Virtual reality
  2. Exposure therapy
  3. Randomized controlled trial
  4. Social anxiety disorder
  5. Presence
  6. Cybersickness
  7. Emotional processing theory
  8. Inhibitory learning
License CC BY-NC-ND 4.0 (Attribution-NonCommercial-NoDerivatives)
Work Type Article
Publisher
  1. Elsevier BV
Publication Date December 2021
Publisher Identifier (DOI)
  1. 10.1016/j.brat.2021.103984
Source
  1. Behaviour Research and Therapy
Deposited June 17, 2022

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Version 1
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  • Created
  • Added Zainal-in p-Pilot randomized trial of self-gui-1.pdf
  • Added Creator Nur Hani Zainal
  • Added Creator William W. Chan
  • Added Creator Alisha P. Saxena
  • Added Creator Craig Barr Taylor
  • Added Creator Michelle G. Newman
  • Published
  • Updated Work Title, Keyword, Description Show Changes
    Work Title
    • Pilot randomized trial of self-guided virtual reality exposure therapy for social anxiety disorder
    • ! Pilot randomized trial of self-guided virtual reality exposure therapy for social anxiety disorder
    Keyword
    • Virtual reality, Exposure therapy, Randomized controlled trial, Social anxiety disorder, Presence, Cybersickness, Emotional processing theory, Inhibitory learning
    Description
    • Background
    • Virtual reality exposure therapy (VRE) has shown promising efficacy for the treatment of social anxiety disorder (SAD) and related comorbidities. However, most trials conducted to date were therapist-led, and little is known about the efficacy of self-guided VRE. Therefore, this randomized controlled trial (RCT) aimed to determine the efficacy of a self-directed VRE for SAD.
    • Method
    • Forty-four community-dwelling or undergraduate adults diagnosed with SAD based on the Mini International Neuropsychiatric Interview were randomly assigned to VRE designed to last four sessions or more (n = 26) or waitlist (WL; n = 18). Self-reported SAD severity (Social Phobia Diagnostic Questionnaire and Social Interaction Anxiety Scale), job interview anxiety (Measure of Anxiety in Selection Interviews), trait worry (Penn State Worry Questionnaire), and depression symptoms (Patient Health Questionnaire-9) were administered at baseline, post-treatment, 3-month-follow-up (3MFU), and 6-month-follow-up (6MFU). Piecewise multilevel modeling analyses were conducted to manage clustering in the data.
    • Results
    • VRE vs. WL resulted in greater reductions in SAD symptom severity, job interview fear, and trait worry, with moderate-to-large effect sizes (Hedge's g = −0.54 to −1.11) from pre-to-post treatment. Although significant between-group differences did not emerge for change in depression, VRE led to change in depression, whereas waitlist did not. These gains were also maintained at 3MFU and 6MFU. Further, facets of presence increased during the course of VRE (g = 0.36–0.45), whereas cybersickness decreased (g = −0.43).
    • Discussion
    • Background
    • Virtual reality exposure therapy (VRE) has shown promising efficacy for the treatment of social anxiety disorder (SAD) and related comorbidities. However, most trials conducted to date were therapist-led, and little is known about the efficacy of self-guided VRE. Therefore, this randomized controlled trial (RCT) aimed to determine the efficacy of a self-directed VRE for SAD.
    • Method
    • Forty-four community-dwelling or undergraduate adults diagnosed with SAD based on the Mini International Neuropsychiatric Interview were randomly assigned to VRE designed to last four sessions or more (n = 26) or waitlist (WL; n = 18). Self-reported SAD severity (Social Phobia Diagnostic Questionnaire and Social Interaction Anxiety Scale), job interview anxiety (Measure of Anxiety in Selection Interviews), trait worry (Penn State Worry Questionnaire), and depression symptoms (Patient Health Questionnaire-9) were administered at baseline, post-treatment, 3-month-follow-up (3MFU), and 6-month-follow-up (6MFU). Piecewise multilevel modeling analyses were conducted to manage clustering in the data.
    • Results
    • VRE vs. WL resulted in greater reductions in SAD symptom severity, job interview fear, and trait worry, with moderate-to-large effect sizes (Hedge's g = −0.54 to −1.11) from pre-to-post treatment. Although significant between-group differences did not emerge for change in depression, VRE led to change in depression, whereas waitlist did not. These gains were also maintained at 3MFU and 6MFU. Further, facets of presence increased during the course of VRE (g = 0.36–0.45), whereas cybersickness decreased (g = −0.43).
    • Discussion
    • Brief, self-guided VRE might ameliorate SAD and comorbid worry, for young-to-middle-aged adults with SAD. Other theoretical and practical implications were also discussed.
  • Updated Work Title Show Changes
    Work Title
    • ! Pilot randomized trial of self-guided virtual reality exposure therapy for social anxiety disorder
    • Pilot randomized trial of self-guided virtual reality exposure therapy for social anxiety disorder
  • Updated