Feasibility of Virtual Reality Exposure As a Treatment for Adolescent Social Anxiety

Background: Social anxiety disorder (SAD) is a mental health condition characterized by a fear of negative evaluation, excessive self-consciousness, and avoidance of social contacts. SAD ranks among the top ten chronic disorders affecting health-related quality of life. Typical onset is 15.5 years. While SAD interventions for children and adolescents exist, they are long and time consuming. Virtual reality (VR) technology offers a potentially more efficient approach for treating adolescents by offering convenient exposure treatment and coaching opportunities in an office setting. VR exposure therapy has been efficacious in treating adult anxiety disorders, but has not been developed for adolescents.

VR may be appealing to adolescents as it provides a safe place to confront social fears and develop social skills with low social risk. There is a need to test whether youth respond to the VR social scenarios as intended prior to its testing as an intervention. This study had three primary aims: 1) Test the feasibility of a VR Social Anxiety Exposure System (VRSAES) for differentiating between adolescents with SAD and without SAD; 2) Test the feasibility of VRSAES for differentiating between socially reactive VR environments and neutral VR environments; and 3) Test whether adolescents with SAD react differently to a public speaking VR scenario when compared to a social party VR scenario.

Methods: Forty-one adolescents aged 13-17 were recruited from a community sample. A quasi-experimental design compared adolescents with and without SAD. Group assignment was determined using the cut-off score for the LSAS-CA scale. Youth were immersed in exposures including introductory and concluding neutral underwater scenes, social interaction during a party scene, and a participant-led presentation scene in a classroom. To prevent order effects, participants were randomly assigned to the party or classroom scene as the first social environment. Anxiety during VR immersion was assessed using each individual’s average Subjective Units of Distress Scale (SUDS) score across four total scores per scenario. A two (with and without anxiety) by four (VR context) ANOVA with repeated measures was used to compare the differences in SUDS ratings across VR scenes.

Results: Results indicated that the two groups (with and without social anxiety) differed on the average of the SUDS ratings (F(1, 39) = 12.84; p = .0009) and there was a significant difference between the VR contexts when group was ignored (F(3, 117) = 60.42; p < .0001).  More importantly, there was a significant interaction between group and context, F(3, 117) = 8.36; p = .0012.  Simple main effects comparing the group at each context indicated that while the group did not differ after the first or second neutral contexts, they did differ in the presentation context, F(1, 39) = 12.97; p = .0009 and party context, F(1, 39) = 7.95; p = .0075, with the socially anxious group having higher scores on the SUDS at both of these time points.

Conclusions: This study suggests VR is a feasible exposure treatment modality for adolescents with SAD, and that future research should focus on developing efficient VR exposure interventions for this population.