Pilot randomized trial of self-guided virtual reality exposure therapy for social anxiety disorder. (December 2021)

• Record Type: Journal Article
• Authors: Zainal, Nur Hani; Chan, William W.; Saxena, Alisha P.; Taylor, Craig Barr; Newman, Michelle G.
• Is Part Of: Behaviour research and therapy. Volume 147(2021)
• Publication Date: 2021-12
• Subjects: Virtual reality -- exposure therapy -- Randomized controlled trial -- Social anxiety disorder -- Presence -- Cybersickness -- Emotional processing theory -- Inhibitory learning; Cognitive therapy -- Periodicals; Psychotherapy -- Periodicals; 616.891
• DOI: 10.1016/j.brat.2021.103984
• Languages: English
• ISSNs: 0005-7967

Abstract

Abstract: 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. Highlights: Self-guided virtual reality exposure therapy (VRE) efficaciously reduced social anxiety and job interview anxiety in SAD. Moderate-to-large pre-post reductions in SAD, job interview anxiety, and worry severity for VRE were larger than waitlist. VRE with 360° video footage was related to increased presence and reduced cybersickness across sessions. No between-treatment effect was observed for depression symptom severity.