A Mobile-Based Virtual Reality Grocery Store for Reducing Social Anxiety in Student Veterans: A Case Study

Background: Virtual Reality Exposure Therapy (VRET) can allow for real-time assessment of anxiety symptoms and enhance treatment outcomes for anxiety disorders, including social anxiety disorder. Student veterans suffering from post-traumatic stress disorder are often plagued by comorbid social anxiety. These diagnoses are associated with avoidance behaviors which, in turn, contribute to difficulty navigating college campuses and negatively impact educational functioning. This study utilized an interdisciplinary research approach based on Emotional Processing Theory to evaluate the usability and feasibility of VRET using a mobile-based virtual reality grocery store. The goals of the intervention were to reduce self-reported social anxiety, stress, and physiological arousal using repeated exposure to a socially stimulating environment.

Methods: This is a case summary of one student veteran (n = 1) from a larger usability and feasibility study on a mobile-based VR grocery store. Screened for inclusion using a structured clinical interview, a male student veteran with one previous deployment met diagnostic criteria for social anxiety disorder. The participant engaged in full immersion of a mobile-based VR grocery store three times per week for four weeks in doses of 12-15 minutes. Data was collected pre-, mid-, and post-intervention, including evaluations of changes in biological signals (i.e., galvanic skin responses (GSR) and electrocardiogram (ECG)) and assessment of social anxiety symptoms using the 28-item Social Anxiety and Distress Scale (SAD). Using real-time monitoring of biophysiological changes, self-report of stress using a SUDs (0-100), and Continuous Decomposition Analysis, researchers evaluated changes in exposure stress levels correlated with biophysiological signals. Usability with assessed with the System Usability Scale, a 10-item scale for assessing ease of use, functioning, and confidence in access and navigation of the mobile application.

Results: Results indicate an increase in heart rate variability (p < .01) and global mean GSR (p < .001) between baseline and VRET exposure. Participant reported a decrease in self-reported stress from baseline (M = 33, SD = 7.49) to post treatment (M = 10.1, SD = 1.75, p <.001) while demonstrating a reduction in GSR from pre (M = 14.67) to post (M = 11.84; p <.01), but not a statistically significant change in heart rate variability. Student veteran social anxiety and distress decreased from 18 to 8 on the SAD, indicating a reduction in anxiety. Participant reported a usability score of 87.5 on the System Usability Scale, indicating that the treatment was positively received.

Conclusions/Implications: Exposure to a virtual reality grocery store positively associated with increased bio signal physiological response during treatment exposure. Repeated exposures reduced stress and anxiety, resulting in lower physiological arousal and social anxiety after treatment. The treatment appeared acceptable to the veteran. Implications of this study include the potential for using mobile-based VRET to reduce symptoms that may impact social and educational functioning for student veterans with social anxiety. A reduction in social anxiety may assist students in increasing learning and accessing key areas on campus that they may otherwise avoid.