Appropriate Number of Treatment Sessions in Virtual Reality-Based Individual Cognitive Behavioral Therapy for Social Anxiety Disorder

Abstract

Virtual reality (VR) was introduced to maximize the effect of cognitive behavioral therapy (CBT) by efficiently performing exposure therapy. The purpose of this study was to find out whether VR-based individual CBT with relatively few treatment sessions is effective in improving social anxiety disorder (SAD). This therapy was applied to 115 patients with SAD who were retrospectively classified into 43 patients who completed the nine or 10 sessions normally (normal termination group), 52 patients who finished the sessions early (early termination group), and 20 patients who had extended the sessions (session extension group). The Brief Fear of Negative Evaluation Scale (BFNE) scores tended to decrease in all groups as the session progressed, and the slope of decrease was the steepest in the early termination group and the least steep in the session extension group. Severity of social anxiety in the last session and symptom reduction rate showed no significant group difference. Our findings suggest that short-term VR-based individual CBT of nine to 10 sessions may be effective. When the therapeutic effect is insufficient during this period, the additional benefit may be minimal if the session is simply extended. The improvement in the early termination group suggests that even shorter sessions of five or six can also be effective.

Virtual Reality for Supporting the Treatment of Depression and Anxiety: Scoping Review

“…Articles published in 2018 [ 37 - 43 ] and 2020 [ 15 , 44 - 49 ] were of equal proportions (7/34, 21%), whereas those published in 2017 [ 14 , 50 - 53 ] were the third highest (5/34, 15%). Recent publications from early 2021 [ 54 - 56 ] were also selected (3/34, 9%).…”

“…Multimedia Appendix 5 depicts the distribution of total participants. Most of the articles (13/34, 38%) included <10 participants [ 26 , 31 - 34 , 36 - 38 , 40 - 42 , 45 , 55 ], whereas two studies had >90 participants [ 35 , 54 ].…”

“…Overall, most studies centered around one or the other type of anxiety condition (25/34, 74%) compared with depression (4/34, 12%). SAD was the most studied, with 3% (9/34) of studies focusing on using VR therapy solely for patients with SAD [ 29 , 34 , 37 , 41 , 47 , 50 , 52 - 54 ]. Generalized anxiety disorder (6/34, 18%) [ 27 , 28 , 39 , 42 , 46 , 49 ] was next, followed by public speaking anxiety (4/34, 12%) [ 14 , 31 , 51 , 56 ].…”

“…Interestingly, 6% (2/34) of studies used behavior therapy in addition to VRET, using commercial simulator software in the treatment of SAD [ 41 ] and public speaking anxiety [ 31 ]. It was followed by CBT inside VR (5/34, 15%) [ 26 , 28 , 37 , 50 , 54 ] and VR application (5/34, 15%) [ 30 , 33 , 35 , 43 , 52 ] interventions. Approximately 6% (2/34) of studies demonstrated a unique use of VR applications using music therapy (where participants had to sing a song in a virtual hall) [ 33 ] and art therapy (where participants performed activities using a tilt-brush VR application) [ 35 ].…”

“…A recent study by Jeong et al [ 54 ] aimed to identify the number of sessions that were sufficient for a successful VR intervention in the treatment of SAD, concluding 9-10 sessions or possibly fewer sessions (5-6) of VR-based CBT can be effective in the treatment of SAD. Increasing the number of sessions above this provided minimal additional benefits.…”