Can Virtual Reality Effectively Elicit Distress Associated with Social Anxiety Disorder?

Abstract

This study examined the ability of a Virtual Reality (VR) environment to elicit the physiological and subjective arousal typically associated with public speaking. Using 21 adults with Social Anxiety Disorder (SAD) and 24 adults with no disorder, this study had three objectives: (a) to determine whether speaking to a virtual audience elicited significant increases in physiological response (e.g., heart rate, electrodermal activity, and respiratory sinus arrhythmia) and subjective distress over baseline resting conditions (b) to determine if individuals with SAD had a greater increase in physiological arousal and subjective distress when speaking in front of a live audience vs. the virtual environment and (c) to determine whether individuals with SAD had greater changes in physiological and self-reported arousal during each speech task compared to controls. All participants gave an impromptu speech in front of an in vivo and VR audience while measures of physiological arousal and self-reported distress were obtained. Results demonstrated that the VR task elicited significant increases in heart rate, electrodermal activity, and respiratory sinus arrhythmia, and self-reported distress over baseline conditions but was less anxiety-producing than the in vivo speech task. In addition, participants reported a moderate level of presence in the VR task, but significantly less than in the in vivo task. No group differences were found on physiological measures. Clinical implications of these findings and the role of VR in the treatment of SAD are discussed.

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References

  1. Anderson, P., Rothbaum, B. O., & Hodges, L. F. (2003). Virtual reality exposure in the treatment of social anxiety. Cognitive and Behavioral Practice, 10(3), 240–247.

    Article  Google Scholar 

  2. 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(3), 156–158. doi:10.1002/da.20090.

    Article  PubMed  Google Scholar 

  3. Beidel, D. C., Turner, S. M., & Dancu, C. V. (1985). Physiological, cognitive and behavioral aspects of social anxiety. Behaviour Research and Therapy, 23(2), 109–117.

    Article  PubMed  Google Scholar 

  4. Beidel, D. C., Borden, J. W., Turner, S. M., & Jacob, R. G. (1989). The social phobia and anxiety inventory: concurrent validity with a clinic sample. Behaviour Research and Therapy, 27(5), 573–576.

    Article  PubMed  Google Scholar 

  5. Beidel, D. C., Rao, P. A., Scharfstein, L., Wong, N., & Alfano, C. A. (2010). Social skills and social phobia: an investigation of DSM-IV subtypes. Behaviour Research and Therapy, 48(10), 992–1001. doi:10.1016/j.brat.2010.06.005.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Berntson, G. G., Quigley, K. S., & Lozano, D. (2007). Cardiovascular psychophysiology. In J. T. Cacioppo, L. G. Tassinary, & G. G. Berntson (Eds.), Handbook of psychophysiology (3rd ed., pp. 182–210). New York: Cambridge University Press.

    Google Scholar 

  7. Brown, T.A., Di Nardo, P.A., & Barlow, D.H. (1994). Anxiety disorders interview schedule for DSM-IV: Adult version: Oxford University Press.

  8. Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46(1), 5–27.

    Article  PubMed  Google Scholar 

  9. Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: exposure to corrective information. Psychological Bulletin, 99(1), 20–35. doi:10.1037/0033-2909.99.1.20.

    Article  PubMed  Google Scholar 

  10. Garcia-Palacios, A., Botella, C., Hoffman, H., & Fabregat, S. (2007). Comparing acceptance and refusal rates of virtual reality exposure vs. in vivo exposure by patients with specific phobias. CyberPsychology and Behavior, 10(5), 722–724. doi:10.1089/cpb.2007.9962.

    Article  PubMed  Google Scholar 

  11. Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23(1), 56.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Harris, S. R., Kemmerling, R. L., & North, M. M. (2002). Brief virtual reality therapy for public speaking anxiety. Cyber Psychology and Behavior, 5(6), 543–550. doi:10.1089/109493102321018187.

    Article  Google Scholar 

  13. Hartanto, D., Kampmann, I. L., Morina, N., Emmelkamp, P. G., Neerincx, M. A., & Brinkman, W.-P. (2014). Controlling social stress in virtual reality environments. PLoS ONE, 9(3), e92804.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Heimberg, R. G., Horner, K. J., Juster, H. R., Safren, S. A., Brown, E. J., Schneier, F. R., & Liebowitz, M. R. (1999). Psychometric properties of the Liebowitz social anxiety scale. Psychological Medicine, 29, 199–212.

    Article  PubMed  Google Scholar 

  15. Hofmann, S. G., & Dibartolo, P. M. (2000). An instrument to assess self-statements during public speaking: scale development and preliminary psychometric properties. Behaviour Therapy, 31, 499–515.

    Article  Google Scholar 

  16. Klinger, E., Bouchard, S., Légeron, P., Roy, S., Lauer, F., Chemin, I., & Nugues, P. (2005). Virtual reality therapy versus cognitive behavior therapy for social phobia: a preliminary controlled study. Cyber Psychology and Behavior, 8(1), 76–88. doi:10.1089/cpb.2005.8.76.

    Article  Google Scholar 

  17. Kotlyar, M., Donahue, C., Thuras, P., Kushner, M. G., O’Gorman, N., Smith, E. A., & Adson, D. E. (2008). Physiological response to a speech stressor presented in a virtual reality environment. Psychophysiology, 45(6), 1034–1037. doi:10.1111/j.1469-8986.2008.00690.x.

    Article  PubMed  Google Scholar 

  18. Krijn, M., Emmelkamp, P., Olafsson, R. P., & Biemond, R. (2004). Virtual reality exposure therapy of anxiety disorders: a review. Clinical Psychology Review, 24(3), 259–281.

    Article  PubMed  Google Scholar 

  19. Lee, K. M. (2004). Presence, explicated. Communication Theory, 14(1), 27–50.

    Article  Google Scholar 

  20. Liebowitz, M. R. (1987). Social phobia. Modern Problems of Pharmacopsychiatry, 22, 141–173.

    Article  PubMed  Google Scholar 

  21. Liebowitz, M. R., Gorman, J. M., Fyer, A. J., & Klein, D. F. (1985). Social phobia. Review of a neglected anxiety disorder. Archives of General Psychiatry, 42(7), 729–736.

    Article  PubMed  Google Scholar 

  22. Mannuzza, S., Schneier, F. R., Chapman, T. F., Liebowitz, M. R., Klein, D. F., & Fyer, A. J. (1995). Generalized social phobia. Reliability and validity. Archives of General Psychiatry, 52(3), 230–237.

    Article  PubMed  Google Scholar 

  23. North, M. M., North, S. M., & Coble, J. R. (1998). Virtual reality therapy: an effective treatment for phobias. Stud Health Technol Inform, 58, 112–119.

  24. Patel, A., Knapp, M., Henderson, J., & Baldwin, D. (2002). The economic consequences of social phobia. Journal of Affective Disorders, 68(2–3), 221–233. doi:10.1016/S0165-0327(00)00323-2.

    Article  PubMed  Google Scholar 

  25. Pertaub, D.-P., Slater, M., & Barker, C. (2002). An experiment on public speaking anxiety in response to three different types of virtual audience. Presence: Teleoperators and Virtual Environments, 11(1), 68–78.

    Article  Google Scholar 

  26. Podina, I. R., Koster, E. H., Philippot, P., Dethier, V., & David, D. O. (2013). Optimal attentional focus during exposure in specific phobia: a meta-analysis. Clinical Psychology Review, 33(8), 1172–1183. doi:10.1016/j.cpr.2013.10.002.

    Article  PubMed  Google Scholar 

  27. Powers, M. B., Briceno, N. F., Gresham, R., Jouriles, E. N., Emmelkamp, P. M., & Smits, J. A. (2013). Do conversations with virtual avatars increase feelings of social anxiety? Journal of Anxiety Disorders, 27(4), 398–403.

    Article  PubMed  Google Scholar 

  28. Regenbrecht, H. T., Schubert, T. W., & Friedman, F. (1998). Measuring the sense of presence and its relation to fear of heights in virtual environments. International Journal of Human-Computer Interaction, 10, 233–249.

    Article  Google Scholar 

  29. Rothbaum, B. O., & Hodges, L. F. (1999). The use of virtual reality exposure in the treatment of anxiety disorders. Behavior Modification, 23(4), 507.

    Article  PubMed  Google Scholar 

  30. Schubert, T., Friedmann, F., & Regenbrecht, H. (2001). The experience of presence:factor analytic insights. Presence: Teleoperators and Virtual Environments, 10, 266–281.

    Article  Google Scholar 

  31. Schuemie, M. J., Bruynzeel, M., Drost, L., Brinckman, M., de Haan, G., Emmelkamp, P. M. G., & van der Mast, C. A. P. G. (2000). Treatment of acrophobia in virtual reality: A pilot study. Paper presented at the euromedia. Belgium: Antwerp.

    Google Scholar 

  32. Slater, M., Pertaub, D., & Steed, A. (1999). Public speaking in virtual reality: facing an audience of avatars. IEEE Computer Graphics and Applications, 19, 6–9.

    Article  Google Scholar 

  33. Slater, M., Pertaub, D.-P., Baker, C., & Clark, D. M. (2006). An experimental study on fear of public speaking using a virtual environment. Cyber Psychology and Behavior, 9(5), 627–633. doi:10.1089/cpb.2006.9.627.

    Article  Google Scholar 

  34. Stein, M. B., Walker, J. R., & Forde, D. R. (1996). Public-speaking fears in a community sample. Prevalence, impact on functioning, and diagnostic classification. Archives of General Psychiatry, 53(2), 169–174.

    Article  PubMed  Google Scholar 

  35. Tardy, C. H., Thompson, W. R., & Allen, M. T. (1989). Cardiovascular responses during speech: does social support mediate the effects of talking on blood pressure? Journal of Language and Social Psychology, 8(3–4), 271–285. doi:10.1177/0261927X8983007.

    Article  Google Scholar 

  36. Turner, S. M., Beidel, D. C., Dancu, C. V., & Keys, D. J. (1986). Psychopathology of social phobia and comparison to avoidant personality disorder. Journal of Abnormal Psychology, 95(4), 389–394.

    Article  PubMed  Google Scholar 

  37. Turner, S. M., Beidel, D. C., Dancu, C. V., & Stanley, M. A. (1989). An empirically derived inventory to measure social fears and anxiety: the social phobia and anxiety inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1, 35–40.

    Article  Google Scholar 

  38. Wiederhold, B. K., & Wiederhold, M. D. (1998). A review of virtual reality as a psychotherapeutic tool. Cyber Psychology and Behavior, 1(1), 45–52. doi:10.1089/cpb.1998.1.45.

    Article  Google Scholar 

  39. Wittchen, H. U., & Beloch, E. (1996). The impact of social phobia on quality of life. International Clinical Psychopharmacology, 11(Suppl 3), 15–23.

    Article  PubMed  Google Scholar 

  40. Zhang, W., Ross, J., & Davidson, J. R. (2004). Social anxiety disorder in callers to the anxiety disorders association of America. Depression and Anxiety, 20(3), 101–106. doi:10.1002/da.20020.

    Article  PubMed  Google Scholar 

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Conflict of Interest

Maryann E. Owens decalres that there is no conflict of interest; Deborah C. Beidel declares that there is no conflict of interest.

Experiment Participants

All procedures were approved by the University of Central Florida's Institutional Review Board. All patients provided informed consentprior to participation.

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Correspondence to Maryann E. Owens.

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Owens, M.E., Beidel, D.C. Can Virtual Reality Effectively Elicit Distress Associated with Social Anxiety Disorder?. J Psychopathol Behav Assess 37, 296–305 (2015). https://doi.org/10.1007/s10862-014-9454-x

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Keywords

  • Social anxiety disorder
  • Public speaking
  • Virtual reality
  • Exposure therapy
  • Physiological arousal
  • Subjective distress