Patients with public speaking anxiety show improvement after VR exposure therapy, study finds

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A new study suggests that exposure therapy using virtual reality (VR) technology may be an effective way for patients with public speaking anxiety to overcome their fears. These findings were published in Cognitive Behavior Therapy.

VR technology continues to improve and evolve, becoming more affordable and accessible for potential use in therapy. VR offers unique advantages for mental health interventions, and one example of this has to do with exposure therapy — a technique for treating anxiety that involves exposing the patient to a feared event in order to reduce the associated fears. Using VR, specific experiences can be created that are either not possible or not feasible to recreate in real life. These experiences can be manipulated for each individual and allow for an alarmingly realistic, yet safe exposure to a feared event.

Faced with limited existing data, Philip Lindner and his team aimed to test the effects of VR-assisted therapy in treating a common type of anxiety — public speaking anxiety (PSA).

The researchers recruited a group of 20 patients from psychological clinics. All patients had public speaking anxiety in addition to social anxiety disorder. The subjects participated in a three-hour VR-assisted therapy session alongside a clinical psychologist.

The therapy sessions addressed public speaking anxiety through cognitive-behavioral principles, which involved targeting catastrophic beliefs through exposure exercises. The patients were coached through a series of speech tasks which they then performed in front of a virtual audience using VR technology. The VR experience was highly customizable and could be adjusted for each patient according to environment, mood of the audience, and audience behaviors. Following their speech, the patients were able to play back their performance, witnessing it as if they were a member of the virtual audience.

The results of the therapy intervention were encouraging. The patients’ self-reports showed a robust decrease in public speaking anxiety following VR-assisted therapy. The findings further suggested that the exposure therapy exerted these benefits by reducing patients’ fear of negative evaluation and catastrophic beliefs.

Lindner and colleagues also found that patients rated the quality of their speech performances higher after watching the avatar perform a playback of their speech. “The significant but weak decrease in fear of negative evaluation found in the current study supports the hypothesis that virtual reality exposure therapy for PSA works primarily by disproving catastrophic beliefs about one’s own performance and display of physiological symptoms, rather than how one is perceived by others,” the researchers say.

Lindner and team point out that their findings are meaningful in that they suggest that ordinary clinicians with minimal training can effectively lead VR-assisted therapy that can benefit patients with public speaking anxiety.

The researchers call for future studies to attempt to replicate these results among a larger sample and with the addition of a comparison group.

The study, “Virtual Reality exposure therapy for public speaking anxiety in routine care: a single-subject effectiveness trial”, was authored by Philip Lindner, Jesper Dagöö, William Hamilton, Alexander Miloff, Gerhard Andersson, Andreas Schill, and Per Carlbring.