Accepted for/Published in: JMIR Research Protocols
Date Submitted: Dec 19, 2025
Date Accepted: Jul 6, 2026
One-Session Versus Three-Sessions of Virtual Reality Exposure Therapy for Public Speaking Anxiety: Study Protocol of a Randomized Controlled Trial
ABSTRACT
Background:
A single session of VR exposure for public speaking anxiety has been found to be effective in reducing public speaking anxiety. Previous meta-analysis comparing one session to several sessions of in vivo exposure for specific phobias did not find a difference in effectiveness. However, because of the specificity of VR exposure and public speaking anxiety, it is unclear how dividing the same amount of exposure tasks into three shorter sessions instead of a single long one, would affect the effectiveness of VR exposure for public speaking.
Objective:
The aim of this study is to compare the efficacy of a VR exposure-based intervention for public speaking anxiety and the level of VR presence between a single-session condition and an equal exposure time divided into three sessions, followed by four weeks of online intervention in both groups.
Methods:
This randomized controlled trial will aim to recruit 86 bachelor’s students experiencing high levels of public speaking anxiety, that are randomized into one of two conditions: either one or three sessions of VR exposure therapy with the same total number of exposure exercises. Both conditions will be followed by the same four-week internet program to encourage in vivo exposure tasks for both conditions. The primary outcome will be the Public Speaking Anxiety Scale. Assessments will take place pre-treatment, at the beginning of the face-to-face session and during the face-to-face sessions, one week after the last VR exposure session, at the end of four weeks of the internet program, and at two follow-ups at 3 and 12 months after finishing the online program or equivalent time if the online program was discontinued. Repeated Measures Within-Between ANOVA, the Reliable Change Index (RCI) and effect sizes will be used as statistical analysis and intention-to-treat will be the primary analysis approach, additional per-protocol analysis will be reported.
Results:
Participant recruitment is currently ongoing. The recruitment to the study officially started in January 2024. As of November 2025, a total of 101 participants have completed the initial screening. The final results of the study are expected to be prepared and submitted for publication in March 2026.
Conclusions:
The results of this study could give insight to practitioners and researchers on how to organize VR exposure for public speaking anxiety. Comparing three VR exposure sessions to single session exposure will contribute evidence in choosing one or other modality of intervention for the future research and clinical practice. Clinical Trial: ClinicalTrials.gov NCT06214039; https://clinicaltrials.gov/study/NCT06214039
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