Virtual Reality and Exposure Group Therapy for Social Anxiety Disorder: Results from a 4–6 Year Follow-Up

Abstract

This is the first long-term follow-up study of virtual reality exposure therapy and exposure group therapy for social anxiety disorder—completed 6 years, on average, after treatment completion. Participants (N = 28) had a clinical diagnosis of social anxiety disorder that included public speaking fears and had previously completed 8 sessions of either virtual reality exposure therapy or exposure group therapy delivered according to a treatment manual. The final sample was ethnically diverse, middle-aged (mean age = 42 years) and mostly female (71%). Participants completed standardized self-report measures of public speaking anxiety and fear of negative evaluation, a behavioral speech task, a diagnostic interview, and ratings of global improvement. Participants showed statistically significant improvement on all self-report measures from pre-treatment to follow-up. All participants completed the speech task, with two exceptions: one participant declined to do the speech task and one person completed the follow-up assessment by phone. The majority of participants no longer met diagnostic criteria for the disorder (54%) and reported themselves “very much” or “much” improved (68%). With one exception, there were no differences between treatments at follow-up across self-report, clinician-rated, and behavioral data. Virtual reality exposure therapy and exposure group therapy for social anxiety disorder produce long-lasting benefits, consistent with research on a variety of forms of short-term cognitive behavioral therapy for social anxiety disorder.

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References

  1. Acarturk, C., Cuipers, P., van Straten, A., & de Graaf, R. (2009). Psychological treatment of social anxiety disorder: A meta-analysis. Psychological Medicine, 29, 241–254. doi:10.1017/S0033291708003590.

    Article  Google Scholar 

  2. Anderson, P., Jacobs, C. H., Lindner, G. K., Edwards, S., Zimand, E., Hodges, L., et al. (2006). Cognitive behavior therapy for fear of flying: Sustainability of treatment gains after September 11. Behavior Therapy, 37, 91–97. doi:10.1016/j.beth.2005.05.001.

    Article  PubMed  Google Scholar 

  3. Anderson, P. L., Price, M., Edwards, S. M., Obasaju, M. A., Schmertz, S. K., Zimand, E., et al. (2013). Virtual reality exposure therapy for social anxiety disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 81, 751. doi:10.1037/a0033559.

    Article  PubMed  Google Scholar 

  4. Anderson, P. L., Zimand, E., Hodges, L. F., & Rothbaum, B. O. (2005). Cognitive behavioral therapy for public-speaking anxiety using virtual reality for exposure. Depression and Anxiety, 22, 156–158. doi:10.1002/da.20090.

    Article  PubMed  Google Scholar 

  5. Beidel, D. C., Turner, S. M., Jacob, R. G., & Cooley, M. R. (1989). Assessment of social phobia: Reliability of an impromptu speech task. Journal of Anxiety Disorders, 3, 149–158. doi:10.1016/0887-6185(89)90009-1.

    Article  Google Scholar 

  6. First, M. B., Gibbon, M., Spitzer, R. L., & Williams, J. B. W. (2002). Structured clinical interview for the DSM-IV-TR axis 1 disorders. New York: Biometrics Research Department.

    Google Scholar 

  7. Grant, B., Hasin, D., Huang, B., et al. (2005). The epidemiology of social anxiety disorder in the United States: Results from the national epidemiologic survey on alcohol and related conditions. The Journal of Clinical Psychiatry, 66, 1351–1361.

    Article  PubMed  Google Scholar 

  8. Guy, W. (1976). ECDEU assessment manual for psychotherapy—revised (DHEW Publication No ADM 76-338). Bethesda, MD: National Institute of Mental Health.

    Google Scholar 

  9. Hedman, E., Furmark, T., Carlbring, P., Ljotsson, B., Ruck, C., Lindefors, N., et al. (2011). A 5-year follow-up of internet-based cognitive behavior therapy for social anxiety disorder. Journal of Medical Internet Research, 13, e39. doi:10.2196/jmir.1776.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Heimberg, R. G., Salzman, D. G., Holt, C. S., & Blendell, K. A. (1993). Cognitive—behavioral group treatment for social phobia: Effectiveness at five-year followup. Cognitive therapy and Research, 17, 325–339. doi:10.1007/BF01177658.

    Article  Google Scholar 

  11. Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: A comprehensive model and its treatment implications. Cognitive Behaviour Therapy, 36, 195–209. doi:10.1080/16506070701421313.

    Article  Google Scholar 

  12. Leary, M. R. (1983). A brief version of the fear of negative evaluation scale. Personality and Social Psychology Bulletin, 9, 371–375. doi:10.1177/0146167283093007.

    Article  Google Scholar 

  13. Mörtberg, E., Clark, D. M., & Bejerot, S. (2011). Intensive group cognitive therapy and individual cognitive therapy for social phobia: Sustained improvement at 5-year follow-up. Journal of Anxiety Disorders, 25, 994–1000. doi:10.1016/j.janxdis.2011.06.007.

    Article  PubMed  Google Scholar 

  14. Paul, G. (1966). Insight versus desensitization in psychotherapy: An experiment in anxiety reduction. Redwood City: Stanford University Press.

    Google Scholar 

  15. Safir, M. P., Wallach, H. S., & Bar-Zvi, M. (2012). Virtual reality cognitive-behavior therapy for public speaking anxiety one-year follow-up. Behavior Modification, 36, 235–246. doi:10.1177/0145445511429999.

    Article  PubMed  Google Scholar 

  16. Wallach, H. S., Safir, M. P., & Bar-Zvi, M. (2009). Virtual reality cognitive behavior therapy for public speaking anxiety. Behavior Modification, 33, 314–338. doi:10.1177/0145445509331926.

    Article  PubMed  Google Scholar 

  17. Whaley, A. L., & Davis, K. E. (2007). Cultural competence and evidence-based practice in mental health services: A complementary perspective. American Psychologist, 62, 563–574. doi:10.1037/0003-066X.62.6.563.

    Article  PubMed  Google Scholar 

  18. Willutzki, U., Teismann, T., & Schulte, D. (2012). Psychotherapy for social anxiety disorder: Long-term effectiveness of resource-oriented cognitive-behavioral therapy and cognitive therapy in social anxiety disorder. Journal of Clinical Psychology, 68, 581–591. doi:10.1002/jclp.21842.

    Article  PubMed  Google Scholar 

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Acknowledgements

The parent study was supported by a grant to the first author from the National Institute of Mental Health, R42 MH 60506-02. The collection of follow-up data was supported by money from the department of the first author. The sponsors had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

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Correspondence to Page L. Anderson.

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Conflict of Interest

Page L. Anderson has received research grants from the Andrew Kukes Foundation for Social Anxiety, the National Institutes of Health, and Pfizer Pharmaceuticals. Shannan M. Edwards, Jessica R. Goodnight declare that they have no conflict of interest.

Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (national and institutional). Informed consent was obtained from all individual subjects participating in the study. If any identifying information is contained in the paper the following statement is also necessary—additional informed consent was obtained from any subjects for whom identifying information appears in this paper.

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No animal studies were carried out by the authors for this article.

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This work was based in part on the dissertation of Shannan M. Edwards.

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Anderson, P.L., Edwards, S.M. & Goodnight, J.R. Virtual Reality and Exposure Group Therapy for Social Anxiety Disorder: Results from a 4–6 Year Follow-Up. Cogn Ther Res 41, 230–236 (2017). https://doi.org/10.1007/s10608-016-9820-y

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Keywords

  • Cognitive behavior therapy
  • Anxiety
  • Follow-up studies
  • Virtual reality exposure therapy
  • Exposure group therapy