Virtually Unexpected: No Role for Expectancy Violation in Virtual Reality Exposure for Public Speaking Anxiety

Abstract

In the current study, we examined the role of expectancy violation and retrospective reasoning about the absence of feared outcomes in virtual reality exposure therapy (VRET). Participants fearful of public speaking were asked to give speeches in virtual reality. We asked each participant individually to report their expectancies about feared outcomes in public speaking situations and which of these could be tested in VRET. Each of the expectancies was categorized as being related to: (1) participants' own reactions, (2) (overt) reactions of the audience, or (3) (covert) negative evaluation. We examined whether the proportion of testable expectancies could predict treatment outcome and which type of expectancies were evaluated as being more testable in VRET. Additionally, we experimentally manipulated retrospective reasoning about whether or not expectancies related to the overt reactions of the audience could be violated by providing verbal information after VRET about whether or not the virtual audience was interactive. A reduction in public speaking anxiety was observed from pre-to post-VRET. Treatment effects were, however, not predicted by the individually reported proportions of testable expectancies. Participants evaluated expectancies about their own reactions as being more testable in VRET compared to expectancies about reactions of the audience or about being negatively evaluated. In addition, we did not find evidence that the experimental manipulation regarding whether or not the audience was interactive influenced treatment effects. In conclusion, the results of the current study suggest that the effects of VRET are not univocally explained by the mechanism of expectancy violation.

Virtual Reality exposure therapy for public speaking anxiety in routine care: a single-subject effectiveness trial

“…The treatment protocol, including exercise design, was explicitly developed with an inhibitory learning rationale and did not emphasize or require habituation. In addition to the wealth of experimental support for this approach over habituation (Craske et al, 2014) -although challenged by recent research (Scheveneels et al, 2019)-this decision was also based on a hypothesis, supported by the physiological findings from the pilot replication study in adolescents (Kahlon et al, 2019), that the VR public speaking paradigm would not evoke a physiological response on par with real-life public speaking, even among users with severe PSA. While previous research has shown that VR public speaking does evoke a significant physiological and subjective fear response, this response is small in terms of absolute numbers (Owens & Beidel, 2015;Takac et al, 2019) and lower than that observed in for example PTSD (Rauch et al, 2018).…”

The use of virtual reality in assessment and treatment of anxiety and related disorders

“…Other studies have investigated potential physiological differences between virtual reality BAT and in vivo BAT (Dechant et al, 2017 ; Kothgassner et al, 2016 ; Owens & Beidel, 2015 ; Scheveneels et al, 2019 ). The findings indicate that asking individuals with and without SAD to give a presentation in front of a virtual audience versus a real audience leads to similar significant increases in physiological outcomes, such as salivary cortisol, cardiovascular or electrodermal activity (Kothgassner et al, 2016 ; Owens & Beidel, 2015 ).…”

“…This applied both to normal participants and individuals with SAD. There is some preliminary evidence that assessing physiological outcomes while being confronted with feared virtual environments may have diagnostic validity (Scheveneels et al, 2019 ).…”

“…However, in recent years the effects of exposure therapy have been explained in terms of the inhibitory learning model (Craske et al, 2014 ). Although underlying mechanisms of VRET are still not well understood (Scheveneels et al, 2019 ), parallels in temporal precedence between VRET and exposure in vivo have been found (Meyerbroeker et al, 2013 ).…”

Better, Virtually: the Past, Present, and Future of Virtual Reality Cognitive Behavior Therapy

“…The focus will be on VR-CBT treatments for anxiety disorders since this application dominates the extant literature, although other clinical applications will also be discussed. In addition to being a treatment tool, VR is also seeing increasing use as an experimental platform for studying psychopathology (Juvrud et al 2018) and treatment mechanisms (Scheveneels et al 2019); coverage of this exciting application is however beyond the scope of this review.…”