Neural effects of a short-term virtual reality self-training program to reduce social anxiety

Abstract

Background Social anxiety disorder (SAD) is characterized by anxiety regarding social situations, avoidance of external social stimuli, and negative self-beliefs. Virtual reality self-training (VRS) at home may be a good interim modality for reducing social fears before formal treatment. This study aimed to find neurobiological evidence for the therapeutic effect of VRS. Methods Fifty-two patients with SAD were randomly assigned to a VRS or waiting list (WL) group. The VRS group received an eight-session VRS program for 2 weeks, whereas the WL group received no intervention. Clinical assessments and functional magnetic resonance imaging scanning with the distress and speech evaluation tasks were repeatedly performed at baseline and after 3 weeks. Results The post-VRS assessment showed significantly decreased anxiety and avoidance scores, distress index, and negative evaluation index for ‘self’, but no change in the negative evaluation index for ‘other’. Patients showed significant responses to the distress task in various regions, including both sides of the prefrontal regions, occipital regions, insula, and thalamus, and to the speech evaluation task in the bilateral anterior cingulate cortex. Among these, significant neuronal changes after VRS were observed only in the right lingual gyrus and left thalamus. Conclusions VRS-induced improvements in the ability to pay attention to social stimuli without avoidance and even positively modulate emotional cues are based on functional changes in the visual cortices and thalamus. Based on these short-term neuronal changes, VRS can be a first intervention option for individuals with SAD who avoid society or are reluctant to receive formal treatment.

The Effects of Virtual Reality in Targeting Transdiagnostic Factors for Mental Health: A Systematic Review of the Literature

“…The number of studies taken into consideration for each transdiagnostic factor varied. Avoidance was the most studied transdiagnostic factor found in 23 articles (63.89%) ( n = 19 experimental studies and n = 4 case studies) [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ], followed by emotion regulation, which was found in eight articles (22.22%; n = 7 experimental studies and n = 1 case study) [ 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 ]; aggression, which was found in three experimental studies (8.33%) [ 70 , 71 , 72 ]; impulsivity, which was found in two studies (5.56%; n =1 experimental study and n = 1 case study) [ 71 , 73 ]; and cognitive reappraisal, which was found in two studies (5.56%; n = 1 experimental study and n = 1 case study) [ 63 , 74 ]. No studies were found for the transdiagnostic factor of disinhibition.…”

“…Among the 36 articles that were selected for the review, different sample sizes were used. Sixteen experimental studies (44.44%) had less than 50 participants [ 40 , 44 , 45 , 47 , 48 , 50 , 51 , 54 , 58 , 60 , 62 , 63 , 66 , 67 , 68 , 72 ], nine (25%) included between 50 and 100 participants [ 39 , 46 , 49 , 53 , 55 , 59 , 64 , 69 , 70 ], and only a few ( n = 4, 11.11%) had a sample size larger than 100 participants [ 43 , 52 , 56 , 71 ]. Finally, seven (19.44%) articles were multiple or single case studies including between one and eight participants [ 41 , 42 , 57 , 61 , 65 , 73 , 74 ].…”

“…In terms of research design, only 23 out of 36 studies (63.89%) were controlled studies, of which 19 were randomized controlled trials (RCTs) (82.61%) [ 39 , 43 , 45 , 46 , 48 , 49 , 50 , 51 , 53 , 54 , 55 , 56 , 59 , 60 , 63 , 64 , 66 , 68 , 71 ] and four (17.39%) were non-randomized controlled studies [ 47 , 67 , 69 , 70 ]. Six studies out of 36 (16.67%) were uncontrolled clinical trials [ 40 , 44 , 52 , 58 , 62 , 72 ], and seven (19.44%) were case studies [ 41 , 42 , 57 , 61 , 65 , 73 , 74 ].…”

“…Six studies out of 36 (16.67%) were uncontrolled clinical trials [ 40 , 44 , 52 , 58 , 62 , 72 ], and seven (19.44%) were case studies [ 41 , 42 , 57 , 61 , 65 , 73 , 74 ]. A total of 21 studies (58.33%) also included a follow-up (ranging from 1 to 12 months) [ 39 , 42 , 43 , 44 , 45 , 46 , 47 , 49 , 51 , 54 , 55 , 56 , 58 , 59 , 60 , 61 , 63 , 64 , 71 , 72 , 73 ].…”

Alteration of resting-state functional connectivity network properties in patients with social anxiety disorder after virtual reality-based self-training

“…More specifically, normalization of resting-state functional connectivity between the amygdala and frontal area is found after exposure-based intervention in SAD patients ( 10 ). In addition, the 2-week VR-based exposure self-training of SAD patients has demonstrated effectiveness on improving performances in social circumstances, which is found to be associated with changes in the functional activity of the visual cortices and thalamus ( 27 ). Nevertheless, few studies have explored the effect of VR-based exposure self-training on resting-state functional connectivity in SAD patients, which has been shown to be different from that of healthy controls ( 16 , 17 ).…”