Effectiveness of a Participatory and Interactive Virtual Reality Intervention in Patients With Social Anxiety Disorder: Longitudinal Questionnaire Study

Abstract

Background Social anxiety disorder (SAD) is characterized by excessive fear of negative evaluation and humiliation in social interactions and situations. Virtual reality (VR) treatment is a promising intervention option for SAD. Objective The purpose of this study was to create a participatory and interactive VR intervention for SAD. Treatment progress, including the severity of symptoms and the cognitive and emotional aspects of SAD, was analyzed to evaluate the effectiveness of the intervention. Methods In total, 32 individuals with SAD and 34 healthy control participants were enrolled in the study through advertisements for online bulletin boards at universities. A VR intervention was designed consisting of three stages (introduction, core, and finishing) and three difficulty levels (easy, medium, and hard) that could be selected by the participants. The core stage was the exposure intervention in which participants engaged in social situations. The effectiveness of treatment was assessed through Beck Anxiety inventory (BAI), State‐Trait Anxiety Inventory (STAI), Internalized Shame Scale (ISS), Post-Event Rumination Scale (PERS), Social Phobia Scale (SPS), Social Interaction Anxiety Scale (SIAS), Brief-Fear of Negative Evaluation Scale (BFNE), and Liebowitz Social Anxiety Scale (LSAS). Results In the SAD group, scores on the BAI (F=4.616, P=.009), STAI-Trait (F=4.670, P=.004), ISS (F=6.924, P=.001), PERS-negative (F=1.008, P<.001), SPS (F=8.456, P<.001), BFNE (F=6.117, P=.004), KSAD (F=13.259, P<.001), and LSAS (F=4.103, P=.009) significantly improved over the treatment process. Compared with the healthy control group before treatment, the SAD group showed significantly higher scores on all scales (P<.001), and these significant differences persisted even after treatment (P<.001). In the comparison between the VR treatment responder and nonresponder subgroups, there was no significant difference across the course of the VR session. Conclusions These findings indicated that a participatory and interactive VR intervention had a significant effect on alleviation of the clinical symptoms of SAD, confirming the usefulness of VR for the treatment of SAD. VR treatment is expected to be one of various beneficial therapeutic approaches in the future. Trial Registration Clinical Research Information Service (CRIS) KCT0003854; https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=13508

Virtual Reality–Based Psychotherapy in Social Anxiety Disorder: fMRI Study Using a Self-Referential Task

“…Motion capture was conducted using Sensor Suite (Rokoko Electronics) for VR character animation, and voice acting was performed by 4 actors from Korean National University of Arts drama school. In our previous work [ 25 ], we proved that our participatory and interactive VR intervention had significant beneficial effects on depression, anxiety, shame, rumination, and social phobia.…”

“…Individuals diagnosed with social anxiety disorder were asked to participate in the VR therapy program developed and verified by the authors [ 25 ]. Two psychiatrists and two licensed psychologists performed collaborative work to develop a social-anxiety scenario (during a team meeting in class), and the Art & Technology Lab at the Korean National University of Arts designed VR environments using the Unity game engine (Unity Technologies).…”

“…Second, we speculated that neuronal changes in certain brain regions occur during self-referential processing in individuals with social anxiety disorder who have undergone VR therapy. To assess this, we used VR therapy [ 25 ], an alternative to exposure therapy for individuals with social anxiety disorder that provides psychoeducational intervention tailored to social anxiety symptoms. In short, we expected to provide neural evidence of the efficacy and applicability of a VR-based therapeutic approach to alter self-referential processing in individuals with social anxiety disorder.…”

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

“…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 ].…”

“…The most frequent type of VR intervention was VRET (standard VR scene), which was used in 26% (9/34) of studies [ 25 , 31 , 34 , 40 , 41 , 47 , 53 , 55 , 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 ].…”