Augmenting self-guided virtual-reality exposure therapy for social anxiety with biofeedback: a randomised controlled trial

IntroductionWe previously found that self-guided Virtual Reality Exposure Therapy (VRET) improved Public Speaking Anxiety (PSA) and reduced heartrate. Elevated heartrate characterises social anxiety and the self-guided VRET seemed to reduce heartrate. Thus, receiving continuous biofeedback about phy...

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Main Authors: Preethi Premkumar, Nadja Heym, James A. C. Myers, Phoebe Formby, Steven Battersby, Alexander Luke Sumich, David Joseph Brown
Format: Article
Language:English
Published: Frontiers Media S.A. 2024-11-01
Series:Frontiers in Psychiatry
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Online Access:https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1467141/full
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author Preethi Premkumar
Nadja Heym
James A. C. Myers
Phoebe Formby
Steven Battersby
Alexander Luke Sumich
David Joseph Brown
author_facet Preethi Premkumar
Nadja Heym
James A. C. Myers
Phoebe Formby
Steven Battersby
Alexander Luke Sumich
David Joseph Brown
author_sort Preethi Premkumar
collection DOAJ
description IntroductionWe previously found that self-guided Virtual Reality Exposure Therapy (VRET) improved Public Speaking Anxiety (PSA) and reduced heartrate. Elevated heartrate characterises social anxiety and the self-guided VRET seemed to reduce heartrate. Thus, receiving continuous biofeedback about physiological arousal during the VRET could help socially anxious individuals to manage their anxiety. The present study aimed to determine whether biofeedback enhances the responsiveness of VRET.MethodsSeventy-two individuals with high self-reported social anxiety were randomly allocated to VRET-plus-biofeedback (n=38; 25 completers) or VRET alone (n=35; 25 completers). Three hour-long VRET sessions were delivered over three consecutive weeks. During each session, participants delivered a 20-minute public speech in front of a virtual audience. Participants in the VRET-plus-biofeedback group received biofeedback on heartrate and frontal alpha asymmetry (FAA) within the virtual environment and were asked to lower their arousal accordingly. Participants in both groups completed psychometric assessments of social anxiety after each session and at one-month follow-up.ResultsPSA improved by the end of treatment and overall social anxiety improved one month after the VRET across both groups. The VRET-plus-biofeedback group showed a steadier reduction in FAA in the first VRET session and a greater reduction in self-reported arousal across the three sessions than the VRET-alone group.ConclusionBiofeedback can steady physiological arousal and lower perceived arousal during exposure. The benefits of self-guided VRET for social anxiety are sustained one month after therapy.
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spelling doaj-art-b54db22ca7214246ac3ae2cb70bcdd542025-08-20T02:15:36ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402024-11-011510.3389/fpsyt.2024.14671411467141Augmenting self-guided virtual-reality exposure therapy for social anxiety with biofeedback: a randomised controlled trialPreethi Premkumar0Nadja Heym1James A. C. Myers2Phoebe Formby3Steven Battersby4Alexander Luke Sumich5David Joseph Brown6Division of Psychology, London South Bank University, London, United KingdomDepartment of Psychology, Nottingham Trent University, Nottingham, United KingdomDepartment of Psychology, University of Sheffield, Sheffield, United KingdomDepartment of Psychology, Nottingham Trent University, Nottingham, United KingdomIndependent Researcher, Nottingham, United KingdomDepartment of Psychology, Nottingham Trent University, Nottingham, United KingdomDepartment of Computer Science, Nottingham Trent University, Nottingham, United KingdomIntroductionWe previously found that self-guided Virtual Reality Exposure Therapy (VRET) improved Public Speaking Anxiety (PSA) and reduced heartrate. Elevated heartrate characterises social anxiety and the self-guided VRET seemed to reduce heartrate. Thus, receiving continuous biofeedback about physiological arousal during the VRET could help socially anxious individuals to manage their anxiety. The present study aimed to determine whether biofeedback enhances the responsiveness of VRET.MethodsSeventy-two individuals with high self-reported social anxiety were randomly allocated to VRET-plus-biofeedback (n=38; 25 completers) or VRET alone (n=35; 25 completers). Three hour-long VRET sessions were delivered over three consecutive weeks. During each session, participants delivered a 20-minute public speech in front of a virtual audience. Participants in the VRET-plus-biofeedback group received biofeedback on heartrate and frontal alpha asymmetry (FAA) within the virtual environment and were asked to lower their arousal accordingly. Participants in both groups completed psychometric assessments of social anxiety after each session and at one-month follow-up.ResultsPSA improved by the end of treatment and overall social anxiety improved one month after the VRET across both groups. The VRET-plus-biofeedback group showed a steadier reduction in FAA in the first VRET session and a greater reduction in self-reported arousal across the three sessions than the VRET-alone group.ConclusionBiofeedback can steady physiological arousal and lower perceived arousal during exposure. The benefits of self-guided VRET for social anxiety are sustained one month after therapy.https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1467141/fullsocial anxietylongitudinalperceived controlphysiological arousalpresence
spellingShingle Preethi Premkumar
Nadja Heym
James A. C. Myers
Phoebe Formby
Steven Battersby
Alexander Luke Sumich
David Joseph Brown
Augmenting self-guided virtual-reality exposure therapy for social anxiety with biofeedback: a randomised controlled trial
Frontiers in Psychiatry
social anxiety
longitudinal
perceived control
physiological arousal
presence
title Augmenting self-guided virtual-reality exposure therapy for social anxiety with biofeedback: a randomised controlled trial
title_full Augmenting self-guided virtual-reality exposure therapy for social anxiety with biofeedback: a randomised controlled trial
title_fullStr Augmenting self-guided virtual-reality exposure therapy for social anxiety with biofeedback: a randomised controlled trial
title_full_unstemmed Augmenting self-guided virtual-reality exposure therapy for social anxiety with biofeedback: a randomised controlled trial
title_short Augmenting self-guided virtual-reality exposure therapy for social anxiety with biofeedback: a randomised controlled trial
title_sort augmenting self guided virtual reality exposure therapy for social anxiety with biofeedback a randomised controlled trial
topic social anxiety
longitudinal
perceived control
physiological arousal
presence
url https://www.frontiersin.org/articles/10.3389/fpsyt.2024.1467141/full
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