JMIR Publications

ABSTRACT

Background:

Exposure therapy (ET) for anxiety disorders involves introducing the client to the anxiety provoking situation over several treatment sessions. Each time, the client is exposed to a greater anxiety-provoking stimulus – for example, in the case of fear of heights, the client would successively experience being at a greater height. ET is effective, and its counterpart, virtual reality (VR) ET, where VR substitutes real world exposure, equally so. However, ET is expensive in time, requiring several sessions.

Objective:

Here we introduce a paradigm concerned with public speaking anxiety, where the VR exposure occurs in a single session while the client is interacting with a virtual therapist. Over time the therapist transforms into an entire audience with mostly almost imperceptible changes. The objective was to compare the results of this method with traditional VRET and to compare both with a control condition.

Methods:

We carried out a feasibility study comparing three conditions: the single exposure (n=16) as described above, a conventional multiple exposure (n=14) where the same content was delivered in successive segments over 5 sessions, and a control group (n=15) who interacted with a single virtual character to talk about everyday matters. A week later the participants were required to speak on a stage in front of a large audience in VR.

Results:

The results showed that across most of a series of conventional public speaking anxiety measures the single condition was at least as effective in reducing anxiety as the multiple exposure method, and that these were better than the control condition. For example, the ‘Personal Report of Confidence of a Speaker’ (PRCS) is a standard instrument for assessing public speaking anxiety where greater values indicate more anxiety. Using a Bayesian model, the posterior probabilities of improvement compared to a high baseline were 1.7 for both the single and multiple exposures compared to the control group. The ‘State Perceived Index of Competence’ (SPIC) was used as a measure of anticipatory anxiety for speaking on the stage in front of a large audience, where lower values indicate higher anxiety. The probabilities of improvement were just over 4 times greater for the single and multiple conditions compared to the control for a low baseline, and 489 (single) and 53 (multiple) times greater for a middle baseline.

Conclusions:

Overall the results of this feasibility study show that for moderate public speaking anxiety the paradigm of gradual change in a single session is worth following up with further studies – with more severe levels of anxiety, and greater sample size, first with an RCT with non-patients, and subsequently, if the outcomes follow those that we have found with a full clinical trial with patients.