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

Abstract

Background Although it has been well demonstrated that the efficacy of virtual reality therapy for social anxiety disorder is comparable to that of traditional cognitive behavioral therapy, little is known about the effect of virtual reality on pathological self-referential processes in individuals with social anxiety disorder. Objective We aimed to determine changes in self-referential processing and their neural mechanisms following virtual reality treatment. Methods We recruited participants with and without a primary diagnosis of social anxiety disorder to undergo clinical assessments (Social Phobia Scale and Post-Event Rumination Scale) and functional magnetic resonance imaging (fMRI) scans. Participants with social anxiety disorder received virtual reality–based exposure treatment for 6 sessions starting immediately after baseline testing. After the sixth session, participants with social anxiety disorder completed follow-up scans during which they were asked to judge whether a series of words (positive, negative, neutral) was relevant to them. Results Of 25 individuals with social anxiety disorder who participated in the study, 21 completed the sessions and follow-up; 22 control individuals also participated. There were no significant differences in age (P=.36), sex (P=.71), or handedness (P=.51) between the groups. Whole-brain analysis revealed that participants in the social anxiety disorder group had increased neural responses during positive self-referential processing in the medial temporal and frontal cortexes compared with those in the control group. Participants in the social anxiety disorder group also showed increased left insular activation and decreased right middle frontal gyrus activation during negative self-referential processing. After undergoing virtual reality–based therapy, overall symptoms of the participants with social anxiety disorder were reduced, and these participants exhibited greater activity in a brain regions responsible for self-referential and autobiographical memory processes while viewing positive words during postintervention fMRI scans. Interestingly, the greater the blood oxygen level dependent changes related to positive self-referential processing, the lower the tendency to ruminate on the negative events and the lower the social anxiety following the virtual reality session. Compared with that at baseline, higher activation was also found within broad somatosensory areas in individuals with social anxiety disorder during negative self-referential processing following virtual reality therapy. Conclusions These fMRI findings might reflect the enhanced physiological and cognitive processing in individuals with social anxiety disorder in response to self-referential information. They also provide neural evidence of the effect of virtual reality exposure therapy on social anxiety and self-derogation.

Prediction of Specific Anxiety Symptoms and Virtual Reality Sickness Using In Situ Autonomic Physiological Signals During Virtual Reality Treatment in Patients With Social Anxiety Disorder: Mixed Methods Study

“…The inclusion criteria for the SAD group were set as follows: (1) men and women aged between 19 and 31 years using the Korean language; (2) condition meeting the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for SAD, as evaluated by the Mini-International Neuropsychiatric Interview [ 17 ]; (3) no psychiatric comorbidity, except for depression and panic disorder, and no experience in psychotropic drug treatment; (4) not currently receiving psychotherapy; (5) not currently diagnosed with medical or neurological disorders; (6) no history of psychotic symptoms that can be triggered by VR interventions; and (7) no susceptibility to visual stimuli. We set the exclusion criteria as follows: (1) any history of organic brain damage or intellectual disability; (2) a history of psychotic symptoms that can be triggered by VR interventions; (3) vulnerability to visual stimuli; and (4) ineligibility for participation in a magnetic resonance imaging assessment (during the study, we performed a functional magnetic resonance imaging evaluation for another project in the same subjects) [ 18 ].…”

Virtual Reality Exposure Therapy for Treating Social Anxiety: A Scoping Review of Treatment Designs and Adaptation to Stuttering

“…Third, several studies investigating VRET for social anxiety were not included in the review as they were outside of the scoping criteria. Some of these expand on innovative techniques such as cloud-based VRET (113), or broaden our understanding of VRET effectiveness by using functional magnetic resonance imaging (114), yet the cumulative effects of such protocols are still unknown due to their recency. Finally, this review focused on adults due to differences in developmental trajectories of social anxiety as well as limited availability of protocols for children and adolescents.…”

Total VREcall

“…Cabeza et al [8] linked the contribution of emotion and vividness of AM to the amygdala, and visual cortex of the brain respectively. Hur et al 's fMRI study reported enhanced cognitive and physiological processing in people with social anxiety order through a VR-based exposure therapy where they were asked to report if the emotional words shown to them were self-relevant [29]. Even though fMRI provides a deeper understanding of AM recall process but due to non-mobile, large and complex setup, it becomes challenging to use it for mobile and interactive VR applications.…”