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ORIGINAL RESEARCH article

Front. Psychiatry
Sec. Psychological Therapy and Psychosomatics
Volume 15 - 2024 | doi: 10.3389/fpsyt.2024.1467141
This article is part of the Research Topic Brain-body Interactions Underlying Comorbid Depression and Other Mood Disorders View all articles

Self-Guided Virtual Reality Exposure Therapy with Biofeedback for Social Anxiety: A

Provisionally accepted
PREETHI PREMKUMAR PREETHI PREMKUMAR 1*Nadja Heym Nadja Heym 2James A. Myers James A. Myers 3Phoebe Formby Phoebe Formby 4Steven Battersby Steven Battersby 4Alexander L. Sumich Alexander L. Sumich 4David J. Brown David J. Brown 4
  • 1 London South Bank University, London, United Kingdom
  • 2 Nottingham Institute of Education, Nottingham Trent University, Nottingham, United Kingdom
  • 3 The University of Sheffield, Sheffield, England, United Kingdom
  • 4 Nottingham Trent University, Nottingham, United Kingdom

The final, formatted version of the article will be published soon.

    We (Premkumar et al., 2021) previously found that self-guided Virtual Reality Exposure Therapy (VRET) improved Public Speaking Anxiety (PSA) and reduced physiological arousal. Biofeedback also reduces physiological arousal from anxiety. If VRET reduces physiological arousal, giving continuous biofeedback could help socially anxious individuals to manage their anxiety. The present study aimed to understand whether biofeedback enhances the responsiveness of VRET. Seventy-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 two consecutive weeks during which 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 during the speech and were asked to lower their arousal accordingly. Participants in both intervention groups completed psychometric assessments of social anxiety after each session and at one-month follow-up. PSA improved by the end of treatment and overall social anxiety improved at one-month follow-up across both groups. The VRET-plus-biofeedback group showed a steadier reduction in FAA than the VRET-alone group at just the first VRET session. The VRET+biofeedback group also produced a greater reduction in self-reported arousal. Thus, biofeedback can steady physiological arousal and lower perceived arousal momentarily. The benefits of self-guided VRET for social anxiety are sustained one month after therapy.

    Keywords: avoidance, Longitudinal, Perceived control, Physiological arousal, presence

    Received: 19 Jul 2024; Accepted: 14 Oct 2024.

    Copyright: © 2024 PREMKUMAR, Heym, Myers, Formby, Battersby, Sumich and Brown. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: PREETHI PREMKUMAR, London South Bank University, London, United Kingdom

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