JMIR Publications

ABSTRACT

Background:

Although it has been well demonstrated that the efficacy of VR therapies for social anxiety disorder (SAD) is comparable to traditional cognitive-behavioral therapy, little is known about the effect of VR on the pathological self-referential processes in SAD.

Objective:

This study aims to determine the changes in self-referential processing and their neural mechanisms following VR treatment.

Methods:

We obtained scans from 25 participants with a primary diagnosis of SAD. Then, the subjects received VR-based exposure treatment starting immediately after the baseline MRI scan and clinical assessments and continuing for six sessions. Eventually, 21 SAD subjects completed follow-up scans after the sixth session of VR therapy in which the subjects were asked to judge whether a series of words (positive, negative, neutral) was relevant to themselves. Twenty-two age-, sex-, and handedness-matched controls also underwent baseline clinical assessments and fMRI scans.

Results:

The whole-brain analysis revealed that compared with the controls, the SAD group had increased neural responses during positive self-referential processing in the medial temporal and frontal cortexes. This group also showed increased left insular activation and decreased right middle frontal gyrus activation during negative self-referential processing. After undergoing VR-based therapy, the subjects with SAD rated negative words as less relevant (P = .066) and positive words as more relevant (P = .064) to themselves at the postintervention session than at baseline. Their overall symptoms, as measured with the Social Phobia Scale (SPS) and Post-Event Rumination Scale (PERS), were reduced accordingly. We also found that these subjects displayed greater activity in a group of brain regions responsible for self-referential and autobiographical memory processes while viewing positive words at the postintervention fMRI scan. Compared with that at baseline, higher activation was found within broad somatosensory areas of the subjects with SAD during negative self-referential processing following VR therapy.

Conclusions:

The current fMRI findings reflect the enhanced physiological and cognitive processing of individuals with SAD in response to self-referential information. They also provide neural evidence of the effect of VR exposure therapy on social anxiety and self-derogation. Clinical Trial: CRIS Registration Number-KCT0003854